2651
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Sarfo FS, Mobula LM, Sarfo-Kantanka O, Adamu S, Plange-Rhule J, Ansong D, Gyamfi RA, Duah J, Abraham B, Ofori-Adjei D. Estimated glomerular filtration rate predicts incident stroke among Ghanaians with diabetes and hypertension. J Neurol Sci 2018; 396:140-147. [PMID: 30471633 PMCID: PMC6330840 DOI: 10.1016/j.jns.2018.11.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/10/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023]
Abstract
Background Sub-Saharan Africa is currently experiencing a high burden of both chronic kidney disease (CKD) and stroke as a result of a rapid rise in shared common vascular risk factors such as hypertension and diabetes mellitus. However, no previous study has prospectively explored independent associations between CKD and incident stroke occurrence among indigenous Africans. This study sought to fill this knowledge gap. Methods A prospective cohort study involving Ghanaians adults with hypertension or type II diabetes mellitus from 5 public hospitals. Patients were followed every 2 months in clinic for 18 months and assessed clinically for first ever stroke by physicians. Serum creatinine derived estimated glomerular filtration rates (eGFR) were determined at baseline for 2631 (81.7%) out of 3296 participants. We assessed associations between eGFR and incident stroke using a multivariate Cox Proportional Hazards regression model. Results Stroke incidence rates (95% CI) increased with decreasing eGFR categories of 89, 60–88, 30–59 and <29 ml/min corresponding to incidence rates of 7.58 (3.58–13.51), 14.45 (9.07–21.92), 29.43 (15.95–50.04) and 66.23 (16.85–180.20)/1000 person-years respectively. Adjusted hazard ratios (95%CI) for stroke occurrence according to eGFR were 1.42 (0.63–3.21) for eGFR of 60-89 ml/min, 1.88 (1.17–3.02) for 30-59 ml/min and 1.52 (0.93–2.43) for <30 ml/min compared with eGFR of >89 ml/min. Adjusted HR for stroke occurrence among patients with hypertension with eGFR<60 ml/min was 3.69 (1.49–9.13), p = .0047 and among those with diabetes was 1.50 (0.56–3.98), p = .42. Conclusion CKD is dose-dependently associated with occurrence of incident strokes among Ghanaians with hypertension and diabetes mellitus. Further studies are warranted to explore interventions that could attenuate the risk of stroke attributable to renal disease among patients with hypertension in SSA. We assessed association between incident stroke and estimated glomerular filtration rate. 2631 participants stroke-free Ghanaian adults with hypertension or diabetes were followed for 14 months. There were 45 incident strokes. Incident stroke risk independently increased with declining eGFR.
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Affiliation(s)
- Fred Stephen Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda Meta Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Osei Sarfo-Kantanka
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Sheila Adamu
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Daniel Ansong
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana, School of Medicine and Dentistry, Accra, Ghana
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2652
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Kang SY, Battle KE, Gibson HS, Cooper LV, Maxwell K, Kamya M, Lindsay SW, Dorsey G, Greenhouse B, Rodriguez-Barraquer I, Reiner RCJ, Smith DL, Bisanzio D. Heterogeneous exposure and hotspots for malaria vectors at three study sites in Uganda. Gates Open Res 2018; 2:32. [PMID: 30706054 PMCID: PMC6350504 DOI: 10.12688/gatesopenres.12838.2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Heterogeneity in malaria transmission has household, temporal, and spatial components. These factors are relevant for improving the efficiency of malaria control by targeting heterogeneity. To quantify variation, we analyzed mosquito counts from entomological surveillance conducted at three study sites in Uganda that varied in malaria transmission intensity. Mosquito biting or exposure is a risk factor for malaria transmission. Methods: Using a Bayesian zero-inflated negative binomial model, validated via a comprehensive simulation study, we quantified household differences in malaria vector density and examined its spatial distribution. We introduced a novel approach for identifying changes in vector abundance hotspots over time by computing the Getis-Ord statistic on ratios of household biting propensities for different scenarios. We also explored the association of household biting propensities with housing and environmental covariates. Results: In each site, there was evidence for hot and cold spots of vector abundance, and spatial patterns associated with urbanicity, elevation, or other environmental covariates. We found some differences in the hotspots in rainy vs. dry seasons or before vs. after the application of control interventions. Housing quality explained a portion of the variation among households in mosquito counts. Conclusion: This work provided an improved understanding of heterogeneity in malaria vector density at the three study sites in Uganda and offered a valuable opportunity for assessing whether interventions could be spatially targeted to be aimed at abundance hotspots which may increase malaria risk. Indoor residual spraying was shown to be a successful measure of vector control interventions in Tororo, Uganda. Cement walls, brick floors, closed eaves, screened airbricks, and tiled roofs were features of a house that had shown reduction of household biting propensity. Improvements in house quality should be recommended as a supplementary measure for malaria control reducing risk of infection.
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Affiliation(s)
- Su Yun Kang
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Katherine E Battle
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Harry S Gibson
- Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Laura V Cooper
- Department of Veterinary Medicine, Cambridge University, Cambridge, UK
| | - Kilama Maxwell
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Moses Kamya
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Bryan Greenhouse
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Robert C Jr Reiner
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, USA
| | - David L Smith
- Institute for Health Metrics & Evaluation, University of Washington, Seattle, WA, USA
| | - Donal Bisanzio
- RTI International, Washington DC, USA.,Centre for Tropical Diseases, Sacro Cuore-Don Calabria Hospital, Negrar, Italy
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2653
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Rodrigues H, Cobucci R, Oliveira A, Cabral JV, Medeiros L, Gurgel K, Souza T, Gonçalves AK. Burnout syndrome among medical residents: A systematic review and meta-analysis. PLoS One 2018; 13:e0206840. [PMID: 30418984 PMCID: PMC6231624 DOI: 10.1371/journal.pone.0206840] [Citation(s) in RCA: 229] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Burnout is a psychological syndrome that is very common among medical residents. It consists of emotional exhaustion (EE), depersonalization (DP) and reduced personal accomplishment (PA). OBJECTIVE To estimate burnout among different medical residency specialties. METHODS A systematic review with meta-analysis was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of bibliographic databases and grey literature was conducted, from inception to March 2018. The following databases were accessed: Embase, PubMed, Web of Science, Google Scholar and Scopus, and 3,575 studies were found. Methodological quality was evaluated by Agency for Healthcare Research and Quality Methodology Checklist for Cross-Sectional/Prevalence Study. In the final analysis, 26 papers were included. Their references were checked for additional studies, but none were included. RESULTS 4,664 medical residents were included. High DP, EE and low PA proportions were compared. Specialties were distributed into three groups of different levels of burnout prevalence: general surgery, anesthesiology, obstetrics/gynecology and orthopedics (40.8%); internal medicine, plastic surgery and pediatrics (30.0%); and otolaryngology and neurology (15.4%). Overall burnout prevalence found for all specialties was 35.7%. CONCLUSION The prevalence of burnout syndrome was significantly higher among surgical/urgency residencies than in clinical specialties. PROSPERO REGISTRATION CRD42018090270.
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Affiliation(s)
- Hugo Rodrigues
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ricardo Cobucci
- Department of Obstetrics and Gynecology, Potiguar University, Natal, Brazil
| | - Antônio Oliveira
- Department of Pharmacy, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - João Victor Cabral
- Medical student, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Leany Medeiros
- Medical resident at Family Medicine Program, Hospital Santa Marcelina, São Paulo, Brazil
| | - Karen Gurgel
- Medical resident at Obstetrics and Gynecology Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Tházio Souza
- Medical resident at Obstetrics and Gynecology Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ana Katherine Gonçalves
- Health Science Postgraduate Program, Universidade Federal do Rio Grande do Norte, Natal, Brazil
- Department of Obstetrics and Gynecology, Universidade Federal do Rio Grande do Norte, Natal, Brazil
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2654
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Munar W, Snilstveit B, Stevenson J, Biswas N, Eyers J, Butera G, Baffour T, Aranda LE. Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries - Study protocol. Gates Open Res 2018; 2:27. [PMID: 29984360 PMCID: PMC6030397 DOI: 10.12688/gatesopenres.12826.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background . For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion . Implications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.
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Affiliation(s)
- Wolfgang Munar
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Birte Snilstveit
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Jennifer Stevenson
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Nilakshi Biswas
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - John Eyers
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Gisela Butera
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Theresa Baffour
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Ligia E Aranda
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
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2655
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Hernández-Aguilar MT, Bartick M, Schreck P, Harrel C, Noble L, Calhoun S, Dodd S, Elliott-Rudder M, Lappin S, Larson I, Lawrence RA, Marinelli KA, Marshall N, Mitchell K, Reece-Stremtan S, Rosen-Carole C, Rothenberg S, Seo T, Wonodi A. ABM Clinical Protocol #7: Model Maternity Policy Supportive of Breastfeeding. Breastfeed Med 2018; 13:559-574. [PMID: 30457366 DOI: 10.1089/bfm.2018.29110.mha] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Maria-Teresa Hernández-Aguilar
- 1 Breastfeeding Clinical Unit Dr. Peset, University Hospital Dr. Peset, National Health Service, Valencia, Spain .,2 National Coordinator of Spain Baby-Friendly Initiative (IHAN-España Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia), Madrid, Spain
| | - Melissa Bartick
- 3 Department of Medicine, Cambridge Health Alliance , Cambridge, Massachusetts.,4 Harvard Medical School, Boston, Massachusetts
| | - Paula Schreck
- 5 Department of Pediatrics, Ascension St. John , Detroit, Michigan
| | - Cadey Harrel
- 6 Department of Family Medicine, University of Arizona , Tucson, Arizona
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2656
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Davies N, Heffron R. Global and national guidance for the use of pre-exposure prophylaxis during peri-conception, pregnancy and breastfeeding. Sex Health 2018; 15:501-512. [PMID: 30447703 PMCID: PMC6790372 DOI: 10.1071/sh18067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 09/15/2018] [Indexed: 12/30/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a well-established biomedical HIV prevention strategy and recommended to reduce HIV risk during peri-conception, pregnancy and breastfeeding. Efforts are needed to translate global recommendations into national guidelines and implementation strategies. This article presents the current status of policy guidance for the use of PrEP during peri-conception, pregnancy and breastfeeding, with a particular focus on high prevalence countries, including those in sub-Saharan Africa. PrEP clinical guidelines released by ministries of health or other national-level health bodies, with a particular focus on recommendations for PrEP use during peri-conception, pregnancy and breastfeeding, were reviewed and summarised. Among countries with PrEP guidelines and/or policy, pregnancy is recognised as a period with increased HIV vulnerability, and some recommend PrEP use specifically during pregnancy. Only one country notes that PrEP is contraindicated during pregnancy, recognising a gap in complete safety data from women using PrEP throughout pregnancy. PrEP is not contraindicated as a peri-conception HIV prevention strategy in any country, but only three countries have specific guidance for peri-conception HIV prevention. Multiple barriers to the implementation of PrEP during pregnancy and breastfeeding are discussed, including barriers at the policy, health systems, social and personal levels. Although pregnancy is a period of heightened risk and fertility rates are high in many settings with high HIV burden, few PrEP policies have included guidance for PrEP use specific to peri-conception, pregnancy and breastfeeding periods. This gap can be overcome by the development or adoption of national clinical guidelines and implementation strategies from exemplary countries.
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2657
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Munar W, Wahid SS, Mookherji S, Innocenti C, Curry L. Team- and individual-level motivation in complex primary care system change: A realist evaluation of the Salud Mesoamerica Initiative in El Salvador. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12878.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background:We study the role of individual and team-level motivation in explaining large-scale primary care performance improvements in El Salvador, one of the top-performing countries in the Salud Mesoamerica Initiative.Methods:Case study with outlier sampling of high-performing, community health teams in El Salvador. Design includes scoping review of literature, document review, non-participant observation, and qualitative analysis of in-depth interviews following a realist case study protocol.Results:The interplay between program interventions and organizational, community and policy contexts trigger multi-level motivational mechanisms that operate in complex, dynamic fashion. Interventions like performance measurement and team-based, in-kind incentives foster motivation among individual members of high-performing teams, which may be moderated by working conditions, supervision practices, and by the stress exerted by the interventions themselves. Individuals report a strong sense of public service motivation and an overarching sense of commitment to the community they serve. At the interpersonal level, the linkage between performance measurement and in-kind incentives triggers a sense of collective efficacy and increases team motivation and improvement behaviors. The convening of learning forums and performance dialogue increases the stakes for high-performing teams, helps them make sense of performance data, and leads to performance information utilization for healthcare improvements. Closeness to communities creates strong emotional linkages among team members that further increases collective efficacy and social identity. Such changes in individuals, team, and organizational behaviors can contribute to improved delivery of primary care services and explain the gains in performance demonstrated by the program.Conclusions:This case suggests that primary care systems that rely on multi-disciplinary teams for the provision of care can benefit from performance measurement and management interventions that leverage individual and team-level motivation. Realist evaluation can help prioritize policy-relevant research and enhance the design and evaluation of large-scale performance reforms in primary care systems in low- and middle-income settings.
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2658
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Acuña-Villaorduña C, Schmidt-Castellani LG, Marques-Rodrigues P, White LF, Hadad DJ, Gaeddert M, Ellner JJ, Fennelly KP, Palaci M, Dietze R, Jones-López EC. Cough-aerosol cultures of Mycobacterium tuberculosis in the prediction of outcomes after exposure. A household contact study in Brazil. PLoS One 2018; 13:e0206384. [PMID: 30372480 PMCID: PMC6205616 DOI: 10.1371/journal.pone.0206384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background Mycobacterium tuberculosis cultures of cough-generated aerosols from patients with pulmonary tuberculosis (TB) are a quantitative method to measure infectiousness and to predict secondary outcomes in exposed contacts. However, their reproducibility has not been established. Objective To evaluate the predictive value of colony-forming units (CFU) of M. tuberculosis in cough aerosols on secondary infection and disease in household contacts in Brazil. Methods Adult sputum smear+ and culture+ pulmonary TB cases underwent a standard evaluation and were categorized according to aerosol CFU. We evaluated household contacts for infection at baseline and at 8 weeks with TST and IGRA, and secondary disease. Results We enrolled 48 index TB cases; 40% had negative aerosols, 27% low aerosols (<10 CFU) and 33% high aerosols (≥10 CFU). Of their 230 contacts, the proportion with a TST ≥10 mm at 8 weeks was 59%, 65% and 75%, respectively (p = 0.34). Contacts of high aerosol cases had greater IGRA readouts (median 4.6 IU/mL, IQR 0.02–10) when compared to those with low (0.8, 0.2–10) or no aerosol (0.1, 0–3.7; p = 0.08). IGRA readouts in TST converters of high aerosol cases (median 20 IU/mL, IQR 10–24) were larger than those from aerosol-negative (0.13, 0.04–3; p = o.o2). 8/9 (89%) culture+ secondary TB cases occurred in contacts of aerosol+ cases. Conclusion Aerosol CFU predicts quantitatively IGRA readouts among household contacts of smear positive TB cases. Our results strengthen the argument of using cough aerosols to guide targeted preventive treatment strategies, a necessary component of current TB elimination projections.
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Affiliation(s)
- Carlos Acuña-Villaorduña
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | | | | | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - David Jamil Hadad
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Mary Gaeddert
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jerrold J. Ellner
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Kevin P. Fennelly
- Pulmonary Clinical Medicine Section, Cardiovascular and Pulmonary Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Moises Palaci
- Mycobacteriology Laboratory, Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Universidade Federal do Espírito Santo, Vitória, Brazil
- Global Health & Tropical Medicine - Instituto de Higiene e Medicina Tropical - Universidade Nova de Lisboa, Lisbon, Portugal
| | - Edward C. Jones-López
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
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2659
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Ssekubugu R, Renju J, Zaba B, Seeley J, Bukenya D, Ddaaki W, Moshabela M, Wamoyi J, McLean E, Ondenge K, Skovdal M, Wringe A. "He was no longer listening to me": A qualitative study in six Sub-Saharan African countries exploring next-of-kin perspectives on caring following the death of a relative from AIDS. AIDS Care 2018; 31:754-760. [PMID: 30360642 PMCID: PMC6446248 DOI: 10.1080/09540121.2018.1537467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In the era of widespread antiretroviral therapy, few studies have explored the perspectives of the relatives involved in caring for people living with HIV (PLHIV) during periods of ill-health leading up to their demise. In this analysis, we explore the process of care for PLHIV as their death approached, from their relatives’ perspective. We apply Tronto’s care ethics framework that distinguishes between care-receiving among PLHIV on the one hand, and caring about, caring for and care-giving by their relatives on the other. We draw on 44 in-depth interviews conducted with caregivers following the death of their relatives, in seven rural settings in Eastern and Southern Africa. Relatives suggested that prior to the onset of poor health, few of the deceased had disclosed their HIV status and fewer still were relying on anyone for help. This lack of disclosure meant that some caregivers spoke of enduring a long period of worry, and feelings of helplessness as they were unable to translate their concern and “caring about” into “caring for”. This transition often occurred when the deceased became in need of physical, emotional or financial care. The responsibility was often culturally prescribed, rarely questioned and usually fell to women. The move to “care-giving” was characterised by physical acts of providing care for their relative, which lasted until death. Tronto’s conceptualisation of caring relationships highlights how the burden of caring often intensifies as family members’ caring evolves from “caring about”, to “caring for”, and eventually to “giving care” to their relatives. This progression can lead to caregivers experiencing frustration, provoking tensions with their relatives and highlighting the need for interventions to support family members caring for PLHIV. Interventions should also encourage PLHIV to disclose their HIV status and seek early access to HIV care and treatment services.
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Affiliation(s)
| | - Jenny Renju
- b Population Studies Group, Faculty of Epidemiology and Public Health , London School of Hygiene and Tropical Medicine, London, UK.,c Malawi Epidemiology and Intervention Research Unit , Karonga , Malawi
| | - Basia Zaba
- b Population Studies Group, Faculty of Epidemiology and Public Health , London School of Hygiene and Tropical Medicine, London, UK
| | - Janet Seeley
- d Faculty of Public Health and Policy , London School of Hygiene and Tropical Medicine, London, UK.,e MRC/UVRI and LSHTM Uganda Research Unit , Entebbe , Uganda.,f Africa Health Research Institute , South Africa
| | - Dominic Bukenya
- e MRC/UVRI and LSHTM Uganda Research Unit , Entebbe , Uganda
| | | | - Mosa Moshabela
- f Africa Health Research Institute , South Africa.,g University of KwaZulu-Natal , Durban , South Africa
| | - Joyce Wamoyi
- h National Institute for Medical Research, Mwanza Centre, Mwanza, Tanzania
| | - Estelle McLean
- c Malawi Epidemiology and Intervention Research Unit , Karonga , Malawi
| | - Kenneth Ondenge
- i Kenya Medical Research Institute Center for Global Health Research Kisumu , Kenya
| | - Morten Skovdal
- j Department of Public Health , University of Copenhagen , Copenhagen , Denmark.,k Biomedical Research and Training Institute , Harare , Zimbabwe
| | - Alison Wringe
- b Population Studies Group, Faculty of Epidemiology and Public Health , London School of Hygiene and Tropical Medicine, London, UK
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2660
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Rentsch CT, Wringe A, Machemba R, Michael D, Urassa M, Todd J, Reniers G, Zaba B. Linkage to care and antiretroviral therapy initiation by testing modality among individuals newly diagnosed with HIV in Tanzania, 2014-2017. Trop Med Int Health 2018; 23:1384-1393. [PMID: 30282113 PMCID: PMC6334504 DOI: 10.1111/tmi.13153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To measure linkage to care and antiretroviral therapy (ART) initiation among newly diagnosed individuals with HIV in a rural Tanzanian community. METHODS We included all new HIV diagnoses of adults made between 2014 and 2017 during community- or facility-based HIV testing and counselling (HTC) in a rural ward in northwest Tanzania. Community-based HTC included population-level HIV serological testing (sero-survey), and facility-based HTC included a stationary, voluntary HTC clinic (VCT) and an antenatal clinic (ANC) offering provider-initiated HTC (ANC-PITC). Cox regression models were used to compare linkage to care rates by testing modality and identify associated factors. Among those in care, we compared initial CD4 cell counts and ART initiation rates by testing modality. RESULTS A total of 411 adults were newly diagnosed, of whom 10% (27/265 sero-survey), 18% (3/14 facility-based ANC-PITC) and 53% (68/129 facility-based VCT) linked to care within 90 days. Individuals diagnosed using facility-based VCT were seven times (95% CI: 4.5-11.0) more likely to link to care than those diagnosed in the sero-survey. We found no difference in linkage rates between those diagnosed using facility-based ANC-PITC and sero-survey (P = 0.26). Among individuals in care, 63% of those in the sero-survey had an initial CD4 count >350 cells/mm3 vs. 29% of those using facility-based VCT (P = 0.02). The proportion who initiated ART within 1 year of linkage to care was similar for both groups (94% sero-survey vs. 85% facility-based VCT; P = 0.16). CONCLUSIONS Community-based sero-surveys are important for earlier diagnosis of HIV-positive individuals; however, interventions are essential to facilitate linkage to care.
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Affiliation(s)
- Christopher T Rentsch
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Alison Wringe
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard Machemba
- The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Denna Michael
- The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Mark Urassa
- The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Jim Todd
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.,The Tazama Project, National Institute for Medical Research, Mwanza, Tanzania
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Basia Zaba
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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2661
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Watkins DA, Yamey G, Schäferhoff M, Adeyi O, Alleyne G, Alwan A, Berkley S, Feachem R, Frenk J, Ghosh G, Goldie SJ, Guo Y, Gupta S, Knaul F, Kruk M, Nugent R, Ogbuoji O, Qi J, Reddy S, Saxenian H, Soucat A, Jamison DT, Summers LH. Alma-Ata at 40 years: reflections from the Lancet Commission on Investing in Health. Lancet 2018; 392:1434-1460. [PMID: 30343859 DOI: 10.1016/s0140-6736(18)32389-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/09/2018] [Accepted: 08/15/2018] [Indexed: 12/16/2022]
Affiliation(s)
- David A Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA.
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke University, Durham, NC, USA
| | | | - Olusoji Adeyi
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | | | - Ala Alwan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Richard Feachem
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Julio Frenk
- Office of the President, University of Miami, Miami, FL, USA
| | - Gargee Ghosh
- Development Policy and Finance, Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Sue J Goldie
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Yan Guo
- School of Public Health, Peking University Health Science Center, Beijing, China
| | | | - Felicia Knaul
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Margaret Kruk
- Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Osondu Ogbuoji
- Center for Policy Impact in Global Health, Duke University, Durham, NC, USA
| | - Jinyuan Qi
- Office of Population Research, Princeton University, Princeton, NJ, USA
| | | | | | - Agnés Soucat
- Department of Health Systems Finance and Governance, World Health Organization, Geneva, Switzerland
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
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2662
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Rubashkin N, Warnock R, Diamond-Smith N. A systematic review of person-centered care interventions to improve quality of facility-based delivery. Reprod Health 2018; 15:169. [PMID: 30305129 PMCID: PMC6180507 DOI: 10.1186/s12978-018-0588-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes. METHODS We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature. We used systematic review methodology that enabled us to extract and synthesize quantitative and qualitative data. We categorized interventions according to their primary and secondary PCC objectives. We categorized outcomes into person-centered and clinical (labor and delivery, perinatal, maternal mental health). RESULTS Our initial search strategy yielded 9378 abstracts; we conducted full-text reviews of 32 quantitative, 6 qualitative, 2 mixed-methods studies, and 7 systematic reviews (N = 47). Past interventions pursued these primary PCC objectives: autonomy, supportive care, social support, the health facility environment, and dignity. An intervention's primary and secondary PCC objectives frequently did not align with the measured person-centered outcomes. Generally, PCC interventions either improved or made no difference to person-centered outcomes. There was no clear relationship between PCC objectives and clinical outcomes. CONCLUSIONS This systematic review presents a comprehensive analysis of facility-based delivery interventions using a current definition of person-centered care. Current definitions of PCC propose new domains of inquiry but may leave out previous domains.
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Affiliation(s)
- Nicholas Rubashkin
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Ruby Warnock
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General, University of California, San Francisco, 1001 Potrero Avenue, 6D, San Francisco, CA 94110 USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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2663
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Barani V, Hegarty-Craver M, Rosario P, Madhavan P, Perumal P, Sasidaran S, Basil M, Raj A, Berg AB, Stowell A, Heaton C, Grego S. Characterization of fecal sludge as biomass feedstock in the southern Indian state of Tamil Nadu. Gates Open Res 2018; 2:52. [PMID: 32803126 PMCID: PMC7383100 DOI: 10.12688/gatesopenres.12870.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Transformative sanitation technologies aim to treat fecal sludge (FS) by thermal processes and recover resources from it. There is a paucity of data describing the relevant properties of FS as viable feedstock for thermal treatment in major geographical target areas, such as India. Methods: This study characterized FS collected from septic tanks in two cities located in the Indian southern state of Tamil Nadu. FS samples were obtained at the point of discharge from trucks in Tiruppur (n=85 samples) and Coimbatore (n=50 samples). Additionally, biosolids obtained from sewage treatment plants (STP) in the cities of Coimbatore and Madurai were characterized. Proximate and ultimate analysis as conducted by the fuel industry was carried out. Results: The average higher heating value (HHV) across all FS samples in Tiruppur (13.4 MJ/kg) was much higher than the value for FS in Coimbatore (5.4 MJ/kg), which was partially attributed to the high ash content of 69% in the latter samples. The HHV in the biosolids samples ranged between 10 and 12.2 MJ/Kg. The average total solids (TS) content for FS was 3.3% and 2.0% for Tiruppur and Coimbatore respectively, while the median TS content for the two cities was 2.3% and 1.2%. The heavy metal content of the ash was found to be below the thresholds for land disposal. Conclusions: This is one of the first studies that has systematically characterized fecal sludge in cities in India and determined its calorific content. We expect these data to serve as input data in the design of thermal processes for fecal sludge treatment.
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Affiliation(s)
- Viswa Barani
- PSG Institute for Medical Sciences and Research, Coimbatore, TN, 641004, India
| | | | | | | | | | | | - Milan Basil
- RTI International - India, New Delhi, 100037, India
| | - Antony Raj
- RTI International - India, New Delhi, 100037, India
| | - Adrian B. Berg
- RTI International, Research Triangle Park, NC, 27709, USA
| | - Andrea Stowell
- RTI International, Research Triangle Park, NC, 27709, USA
| | - Camille Heaton
- RTI International, Research Triangle Park, NC, 27709, USA
| | - Sonia Grego
- Center for WaSH-AID, Duke University, Durham, NC, 27701, USA
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2664
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Munar W, Wahid SS, Curry L. Characterizing performance improvement in primary care systems in Mesoamerica: A realist evaluation protocol. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12782.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Evaluations of performance measurement and management interventions in public, primary care delivery systems of low- and middle-income countries are scarce. In such contexts, few studies to date have focused on characterizing how, why and under what contextual conditions do such complex, multifaceted arrangements lead to intended and unintended consequences for the healthcare workforce, the healthcare organizations involved, and the communities that are served. Methods. Case-study design with purposeful outlier sampling of high-performing primary care delivery systems in El Salvador and Honduras, as part of the Salud Mesoamerica Initiative. Case study design is suitable for characterizing individual, interpersonal and collective mechanisms of change in complex adaptive systems. The protocol design includes literature review, document review, non-participant observation, and qualitative analysis of in-depth interviews. Data analysis will use inductive and deductive approaches to identify causal patterns organized as ‘context-mechanism-outcome’ configurations. Findings will be triangulated with existing secondary data sources collected including country-specific performance measurement data, impact, and process evaluations conducted by the Salud Mesoamerica Initiative. Discussion. This realist evaluation protocol aims to characterize how, why and under what conditions do performance measurement and management arrangements contribute to the improvement of primary care system performance in two low-income countries.
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2665
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Laux TS. A Strange Calculus. Am J Trop Med Hyg 2018; 99:817-818. [PMID: 30292245 PMCID: PMC6159579 DOI: 10.4269/ajtmh.18-0246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Timothy S. Laux
- Jan Swasthya Sahyog/People’s Health Support Group, Bilaspur, India; Columbia University Medical Center, New York, New York
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2666
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Bitton A, Veillard JH, Basu L, Ratcliffe HL, Schwarz D, Hirschhorn LR. The 5S-5M-5C schematic: transforming primary care inputs to outcomes in low-income and middle-income countries. BMJ Glob Health 2018; 3:e001020. [PMID: 30305941 PMCID: PMC6169658 DOI: 10.1136/bmjgh-2018-001020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/10/2018] [Accepted: 08/26/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Asaf Bitton
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jeremy H Veillard
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Lopa Basu
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hannah L Ratcliffe
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dan Schwarz
- Ariadne Labs, Brigham & Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Lisa R Hirschhorn
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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2667
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Strande L, Schoebitz L, Bischoff F, Ddiba D, Okello F, Englund M, Ward BJ, Niwagaba CB. Methods to reliably estimate faecal sludge quantities and qualities for the design of treatment technologies and management solutions. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2018; 223:898-907. [PMID: 30005415 DOI: 10.1016/j.jenvman.2018.06.100] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 06/08/2018] [Accepted: 06/30/2018] [Indexed: 05/28/2023]
Abstract
Sanitation access in urban areas of low-income countries is provided through unstandardized onsite technologies containing accumulated faecal sludge. The demand for infrastructure to manage faecal sludge is increasing, however, no reliable method exists to estimate total accumulated quantities and qualities (Q&Q) This proposed approach averages out complexities to estimate conditions at a centralized to semi-centralized scale required for management and treatment technology solutions, as opposed to previous approaches evaluating what happens in individual containments. Empirical data, demographic data, and questionnaires were used in Kampala, Uganda to estimate total faecal sludge accumulation in the city, resulting in 270 L/cap∙year for pit latrines and 280 L/cap∙year for septic tanks. Septic tank sludge was more dilute than pit latrine sludge, however, public toilet was not a distinguishing factor. Non-household sources of sludge represent a significant fraction of the total and have different characteristics than household-level sludge. Income level, water connection, black water only, solid waste, number of users, containment volume, emptying frequency, and truck size were predictors of sludge quality. Empirical relationships such as a COD:TS of 1.09 ± 0.56 could be used for more resource efficient sampling campaigns. Based on this approach, spatially available demographic, technical and environmental (SPA-DET) data and statistical relationships between parameters could be used to predict Q&Q of faecal sludge.
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Affiliation(s)
- Linda Strande
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Department of Sanitation, Water and Solid Waste for Development (Sandec), Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Lars Schoebitz
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Department of Sanitation, Water and Solid Waste for Development (Sandec), Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Fabian Bischoff
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Department of Sanitation, Water and Solid Waste for Development (Sandec), Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Daniel Ddiba
- Department of Civil and Environmental Engineering, College of Engineering, Design, Art and Technology (CEDAT), Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Francis Okello
- Department of Civil and Environmental Engineering, College of Engineering, Design, Art and Technology (CEDAT), Makerere University, P.O. Box 7062, Kampala, Uganda.
| | - Miriam Englund
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Department of Sanitation, Water and Solid Waste for Development (Sandec), Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Barbara J Ward
- Eawag: Swiss Federal Institute of Aquatic Science and Technology, Department of Sanitation, Water and Solid Waste for Development (Sandec), Überlandstrasse 133, 8600, Dübendorf, Switzerland.
| | - Charles B Niwagaba
- Department of Civil and Environmental Engineering, College of Engineering, Design, Art and Technology (CEDAT), Makerere University, P.O. Box 7062, Kampala, Uganda.
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2668
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Macfadyen S, Paull C, Boykin L, De Barro P, Maruthi M, Otim M, Kalyebi A, Vassão D, Sseruwagi P, Tay W, Delatte H, Seguni Z, Colvin J, Omongo C. Cassava whitefly, Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) in East African farming landscapes: a review of the factors determining abundance. BULLETIN OF ENTOMOLOGICAL RESEARCH 2018; 108:565-582. [PMID: 29433589 PMCID: PMC7672366 DOI: 10.1017/s0007485318000032] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a pest species complex that causes widespread damage to cassava, a staple food crop for millions of households in East Africa. Species in the complex cause direct feeding damage to cassava and are the vectors of multiple plant viruses. Whilst significant work has gone into developing virus-resistant cassava cultivars, there has been little research effort aimed at understanding the ecology of these insect vectors. Here we assess critically the knowledge base relating to factors that may lead to high population densities of sub-Saharan African (SSA) B. tabaci species in cassava production landscapes of East Africa. We focus first on empirical studies that have examined biotic or abiotic factors that may lead to high populations. We then identify knowledge gaps that need to be filled to deliver sustainable management solutions. We found that whilst many hypotheses have been put forward to explain the increases in abundance witnessed since the early 1990s, there are little published data and these tend to have been collected in a piecemeal manner. The most critical knowledge gaps identified were: (i) understanding how cassava cultivars and alternative host plants impact population dynamics and natural enemies; (ii) the impact of natural enemies in terms of reducing the frequency of outbreaks and (iii) the use and management of insecticides to delay the development of resistance. In addition, there are several fundamental methodologies that need to be developed and deployed in East Africa to address some of the more challenging knowledge gaps.
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Affiliation(s)
- S. Macfadyen
- CSIRO, Clunies Ross St. Acton, ACT, 2601, Australia
- Author for correspondence Phone: +61 (02) 62464432 Fax: +61 (02) 62464094
| | - C. Paull
- CSIRO, Boggo Rd. Dutton Park, QLD, 4001, Australia
| | - L.M. Boykin
- University of Western Australia, School of Molecular Sciences, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - P. De Barro
- CSIRO, Boggo Rd. Dutton Park, QLD, 4001, Australia
| | - M.N. Maruthi
- Natural Resources Institute, University of Greenwich, Chatham Maritime, Kent, ME4 4TB, UK
| | - M. Otim
- National Crops Resources Research Institute, Kampala, Uganda
| | - A. Kalyebi
- National Crops Resources Research Institute, Kampala, Uganda
- Mikocheni Agricultural Research Institute, P.O. Box 6226 Dar es Salaam, Tanzania
| | - D.G. Vassão
- Max Planck Institute for Chemical Ecology, Hans-Knoell Str. 8 D-07745 Jena, Germany
| | - P. Sseruwagi
- Mikocheni Agricultural Research Institute, P.O. Box 6226 Dar es Salaam, Tanzania
| | - W.T. Tay
- CSIRO, Boggo Rd. Dutton Park, QLD, 4001, Australia
| | - H. Delatte
- CIRAD, UMR PVBMT, Saint Pierre, La Réunion 97410-F, France
| | - Z. Seguni
- Mikocheni Agricultural Research Institute, P.O. Box 6226 Dar es Salaam, Tanzania
| | - J. Colvin
- Natural Resources Institute, University of Greenwich, Chatham Maritime, Kent, ME4 4TB, UK
| | - C.A. Omongo
- National Crops Resources Research Institute, Kampala, Uganda
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2669
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Baron D, Essien T, Pato S, Magongo M, Mbandazayo N, Scorgie F, Rees H, Delany‐Moretlwe S. Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub-Saharan Africa. J Int AIDS Soc 2018; 21 Suppl 7:e25175. [PMID: 30334610 PMCID: PMC6193316 DOI: 10.1002/jia2.25175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large-scale national and regional clinical trials. This article examines Wits RHI's lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond. DISCUSSION For the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi-party regional research consortia as well as overseeing GPP for smaller investigator-driven trials. Through this iterative roll-out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi-disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization-wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines. CONCLUSIONS Thanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect - 'collateral benefits' will require the collective buy-in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.
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Affiliation(s)
- Deborah Baron
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Health Behavior at the UNC Gillings School of Global Public HealthJohannesburgSouth Africa
| | | | - Sinazo Pato
- International Partnership for MicrobicidesJohannesburgSouth Africa
| | - Miliswa Magongo
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Fiona Scorgie
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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2670
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Vail B, Morgan MC, Dyer J, Christmas A, Cohen SR, Joshi M, Gore A, Mahapatra T, Walker DM. Logistical, cultural, and structural barriers to immediate neonatal care and neonatal resuscitation in Bihar, India. BMC Pregnancy Childbirth 2018; 18:385. [PMID: 30268110 PMCID: PMC6162900 DOI: 10.1186/s12884-018-2017-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 09/18/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In India, the neonatal mortality rate is nearly double the Sustainable Development Goal target with more than half of neonatal deaths occurring in only four states, one of which is Bihar. Evaluations of immediate neonatal care and neonatal resuscitation skills in Bihar have demonstrated a need for significant improvement. However, barriers to evidence based practices in clinical care remain incompletely characterized. METHODS To better understand such barriers, semi-structured interviews were conducted with 18 nurses who participated as mentors in the AMANAT maternal and child health quality improvement project, implemented by CARE India and the Government of Bihar. Nurse-mentors worked in primary health centers throughout Bihar facilitating PRONTO International emergency obstetric and neonatal simulations for nurse-mentees in addition to providing direct supervision of clinical care. Interviews focused on mentors' perceptions of barriers to evidence based practices in immediate neonatal care and neonatal resuscitation faced by mentees employed at Bihar's rural primary health centers. Data was analyzed using the thematic content approach. RESULTS Mentors identified numerous interacting logistical, cultural, and structural barriers to care. Logistical barriers included poor facility layout, supply issues, human resource shortages, and problems with the local referral system. Cultural barriers included norms such as male infant preference, traditional clinical practices, hierarchy in the labor room, and interpersonal relations amongst staff as well as with patients' relatives. Poverty was described as an overarching structural barrier. CONCLUSION Interacting logistical, cultural and structural barriers affect all aspects of immediate neonatal care and resuscitation in Bihar. These barriers must be addressed in any intervention focused on improving providers' clinical skills. Strategic local partnerships are vital to addressing such barriers and to contextualizing skills-based trainings developed in Western contexts to achieve the desired impact of reducing neonatal mortality.
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Affiliation(s)
- Brennan Vail
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94143 USA
| | - Melissa C. Morgan
- Department of Pediatrics, University of California San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA 94143 USA
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, Box 1224, San Francisco, CA 94158 USA
- Maternal, Adolescent, Reproductive, and Child Health Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jessica Dyer
- PRONTO International, 1820 E. Thomas Street APT 16, Seattle, WA USA
| | - Amelia Christmas
- PRONTO International, State RMNCH+A Unit, C-16 Krishi Nagar, A.G. Colony, Patna, Bihar 80002 India
| | - Susanna R. Cohen
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112 USA
| | - Megha Joshi
- CARE India Solutions for Sustainable Development, Bihar Technical Support Unit, House No.14, Patliputra Colony, Patna, Bihar 800013 India
| | - Aboli Gore
- CARE India Solutions for Sustainable Development, Bihar Technical Support Unit, House No.14, Patliputra Colony, Patna, Bihar 800013 India
| | - Tanmay Mahapatra
- CARE India Solutions for Sustainable Development, Bihar Technical Support Unit, House No.14, Patliputra Colony, Patna, Bihar 800013 India
| | - Dilys M. Walker
- Institute for Global Health Sciences, University of California San Francisco, 550 16th Street, 3rd Floor, Box 1224, San Francisco, CA 94158 USA
- PRONTO International, 1820 E. Thomas Street APT 16, Seattle, WA USA
- Department of Obstetrics and Gynecology and Reproductive Services, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA 94110 USA
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2671
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Caulley L, Hunink MG, Kilty S, Metha V, Scangas G, Rodin D, Randolph G, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes. Otolaryngol Head Neck Surg 2018; 160:11-21. [PMID: 30252610 DOI: 10.1177/0194599818800477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.
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Affiliation(s)
- Lisa Caulley
- 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G Hunink
- 4 Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.,5 Center for Health Decision Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shaun Kilty
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vikas Metha
- 6 Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, USA
| | - George Scangas
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Rodin
- 8 Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,9 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Randolph
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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2672
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Comparison of short messaging service self-reported adherence with other adherence measures in a demonstration project of HIV preexposure prophylaxis in Kenya and Uganda. AIDS 2018; 32:2237-2245. [PMID: 30005025 PMCID: PMC6755137 DOI: 10.1097/qad.0000000000001955] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Short messaging service (SMS) can collect adherence data on a frequent basis and is relatively anonymous, and therefore could potentially reduce recall and social desirability biases prevalent in other self-reported measures. METHODS We compared SMS self-reported adherence with three self-reported adherence questions (rating of ability to adhere, frequency of doses taken, percentage of doses taken) and two objective adherence measures [electronic adherence monitoring (EAM) and plasma tenofovir levels] using data from HIV-uninfected members of serodiscordant couples enrolled in a preexposure prophylaxis demonstration project in Kenya and Uganda. RESULTS Of 373 enrolled participants, 256 (69%) were male and median age at enrolment was 29 years (26, 35). Fifty-two percent were from Kenya and median education at enrolment was 10 years (7,12). Overall, median adherence was 90, 75, 85, 94 and 79%, respectively, for self-report by SMS, rating, frequency, percentage and EAM adherence. Spearman's correlation coefficient between SMS and interviewer-administered self-reported measures was 0.18 for rating and frequency, 0.22 for percentage and 0.14 for EAM (all P < 0.001). The estimated difference in average adherence between SMS and self-reported rating, frequency, percentage adherence and EAM was 8.1 (P < 0.001), 0.3 (P = 0.81), -5.2 (P < 0.001) and 9.5 (P < 0.001), respectively. Area under the receiver-operating curve assessing the ability of SMS self-report to discriminate between detectable and undetectable tenofovir was 0.51. CONCLUSION Our study found low correlation between SMS self-report and other self-reported and objective adherence measures and did not discriminate between detectable and undetectable plasma tenofovir levels. Future use of SMS self-report should explore alternative means for reducing potential biases.
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2673
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Sarfo FS, Mobula LM, Plange-Rhule J, Ansong D, Ofori-Adjei D. Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study. J Neurol Sci 2018; 395:17-24. [PMID: 30268724 PMCID: PMC6227375 DOI: 10.1016/j.jns.2018.09.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 09/06/2018] [Accepted: 09/12/2018] [Indexed: 11/25/2022]
Abstract
Background The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. Methods A prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. Results Of 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77–18.38], with rates among diabetics with hypertension being 16.64 [10.58–25.00], hypertension of 13.77 [9.33–19.64] and diabetes was 9.81 [3.59–21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18–5.67) and physical inactivity, 1.81 (1.06–3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00–9.27), p = .05 for stroke occurrence. Conclusion Incident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes. The first prospective cohort study to assess factors associated with incident strokes among Ghanaians 3220 participants stroke free adults with hypertension or diabetes were followed for an average of 14 months There were 54 strokes with incidence rate of 14.19 events per 1000 person-years Patients with both diabetes with hypertension had highest stroke rates Previous cigarette smoking and physical inactivity were independently associated with incident strokes
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Affiliation(s)
- Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
| | - Linda M Mobula
- Johns Hopkins University School of Medicine, Baltimore, MD, USA; Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Daniel Ansong
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Kumasi, Ghana; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - David Ofori-Adjei
- Department of Medicine & Therapeutics, University of Ghana School of Medicine and Dentistry, Accra, Ghana
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2674
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Hooyman A, Kayekjian D, Xiao R, Jiang C, Vanderbilt DL, Smith BA. Relationships between variance in electroencephalography relative power and developmental status in infants with typical development and at risk for developmental disability: An observational study. Gates Open Res 2018. [DOI: 10.12688/gatesopenres.12868.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Electroencephalography (EEG) is a non-invasive tool that has the potential to identify and quantify atypical brain development. We introduce a new measure here, variance of relative power of resting-state EEG. We sought to assess whether variance of relative power of resting-state EEG could predict i) classification of infants as typical development (TD) or at risk (AR) for developmental disability, and ii) Bayley developmental scores at the same visit or future visits. Methods: A total of 22 infants with TD participated, aged between 38 and 203 days. In addition, 11 infants broadly at risk participated (6 high-risk pre-term, 4 low-risk pre-term, 1 high-risk full-term), aged between 40 and 225 days of age (adjusted for prematurity). We used EEG to measure resting-state brain function across months. We calculated variance of relative power as the standard deviation of the relative power across each of the 32 EEG electrodes. The Bayley Scales of Infant Development (3rd edition) was used to measure developmental level. Infants were measured 1-6 times each, with 1 month between measurements. Results: Our main findings were: i) variance of relative power of resting state EEG can predict classification of infants as TD or AR, and ii) variance of relative power of resting state EEG can predict Bayley developmental scores at the same visit (Bayley raw fine motor, Bayley raw cognitive, Bayley total raw score, Bayley motor composite score) and at a future visit (Bayley raw fine motor). Conclusions: This was a preliminary, exploratory, small study. Our results support variance of relative power of resting state EEG as an area of interest for future study as a biomarker of neurodevelopmental status and as a potential outcome measure for early intervention.
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2675
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Bertozzi E, Bertozzi-Villa A, Kulkarni P, Sridhar A. Collecting family planning intentions and providing reproductive health information using a tablet-based video game in India. Gates Open Res 2018; 2:20. [PMID: 29984358 PMCID: PMC6030399 DOI: 10.12688/gatesopenres.12818.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2018] [Indexed: 11/20/2022] Open
Abstract
Background: In response to a Grand Challenges in Global Health call for action to collect data about family planning intentions and increase the uptake of family planning methods in India, our team designed, developed, and piloted the
My Future Family video game in Karnataka Province. The game educates adolescents about human sexuality and reproduction while asking players when they would like to achieve five important family planning milestones. Participants were also asked to report who influences them the most when making family planning decisions. Methods: Focus groups were conducted and the resulting data used to design the game which was iteratively tested and then piloted in 11 schools in rural and urban areas of southern India. Data was collected throughout gameplay and cross-checked with paper questionnaires. Results: In August 2017, we successfully piloted the game with 382 adolescents and validated its efficacy both as an educational tool and as an innovative means of accurate data collection. Conclusion: It has historically been problematic to gather accurate data about adolescents in India on this culturally sensitive topic for a variety of reasons. These include difficulties obtaining consent, developing appropriate survey methods, and framing questions in language that young people can understand. Our game met these challenges by working within a single school system with approval from senior administration, delivering information via a game environment which freed players from societal constraints, and communicating information via images and audio in addition to text in both English and Kannada (the local language).
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Affiliation(s)
- Elena Bertozzi
- Department of Game Design & Development, Quinnipiac University, Hamden, CT, USA
| | | | - Praveen Kulkarni
- Department of Community Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India
| | - Aparna Sridhar
- Department of Obstetrics and Gynecology, David Greffen School of Medicine, Los Angeles, CA, USA
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2676
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WITHDRAWN: Estimated glomerular filtration rate predicts incident stroke among ghanaians with diabetes and hypertension. J Neurol Sci 2018. [DOI: 10.1016/j.jns.2018.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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2677
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Sarfo FS. Dyslipidaemia among African adults. LANCET GLOBAL HEALTH 2018; 6:e940-e941. [DOI: 10.1016/s2214-109x(18)30305-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 06/12/2018] [Indexed: 11/26/2022]
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2678
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Wall KM, Ingabire R, Allen S, Karita E. Cost per insertion and couple year of protection for post-partum intrauterine devices and implants provided during service scale-up in Kigali, Rwanda. Gates Open Res 2018; 2:39. [PMID: 32328566 PMCID: PMC7163922 DOI: 10.12688/gatesopenres.12858.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 01/08/2023] Open
Abstract
Introduction: In two high-volume government hospitals, their two affiliated health facilities, and two additional health facilities, we developed and implemented post-partum intrauterine device (PPIUD) and post-partum (PP) implant promotions and service delivery procedures between May and July 2017 in Kigali, Rwanda. Between August 2017 and July 2018, 9,073 pregnant women received PPIUD/PP implant promotions who later delivered in one of our selected facilities. Of those, 2,633 had PPIUDs inserted, and 955 had PP implants inserted. Methods: Here, we detail the expenditures during the implementation from the payer perspective (including both the implementation costs and the cost of contraceptive methods) and estimate the cost per PPIUD insertion, PP implant insertion, and couple years of protection (CYP) for PPIUD and PP implant users. Research costs for formative work were excluded. Results: A total of $74,147 USD was spent on the implementation between August 2017 and July 2018. The largest expense (34% of total expenses) went toward personnel, including doctoral-level, administrative, data management and nurse counseling staff. Training for PPIUD and implant providers and promoters comprised 8% of total expenses. Recruitment and reimbursements comprised 6% of expenses. Costs of implants to the government comprised 12% of the expenses, much higher than the cost of IUDs (1%). Costs per insertion were $25/PPIUDs and $77/PP implant. Costs per CYP were $5/PPIUDs and $20/PP implant. Conclusion: The PPIUD/PP implant service implementation provided services at a low cost per insertion and CYP. Understanding the cost per PPIUD/PP implant inserted and CYP can help to inform the cost of scaling up PPIUD/PP implant service implementation activities and resource allocation decision-making by the Rwandan Ministry of Health.
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Affiliation(s)
- Kristin M. Wall
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Rosine Ingabire
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
| | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Etienne Karita
- Projet San Francisco, Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine, Rollins School of Public Health, Emory University, Kigali, Rwanda
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2679
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Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M. Validation of the person-centered maternity care scale in India. Reprod Health 2018; 15:147. [PMID: 30157877 PMCID: PMC6114501 DOI: 10.1186/s12978-018-0591-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/15/2018] [Indexed: 11/25/2022] Open
Abstract
Background Person-centered care during childbirth is recognized as a critical component of quality of maternity care. But there are few validated tools to measure person-centered maternity care (PCMC). This paper aims to fill this measurement gap. We present the results of the psychometric analysis of the PCMC tool that was previously validated in Kenya using data from India. We aim to assess the validity and reliability of the PCMC scale in India, and to compare the results to those found in the Kenya validation. Methods We use data from a cross-sectional survey conducted from August to October 2017 with recently delivered women at 40 government facilities in Uttar Pradesh, India (N = 2018). The PCMC measure used is a previously validated scale with subscales for dignity and respect, communication and autonomy, and supportive care. We performed psychometric analyses, including iterative exploratory and confirmatory factor analysis, to assess construct and criterion validity and reliability. Results The results provide support for a 27-item PCMC scale in India with a possible score range from 0 to 81, compared to the 30-item PCMC scale in Kenya with a 0 to 90 possible score range. The overall PCMC scale has good reliability (Cronbach alpha = 0.85). Similar to Kenya, we are able to group the items in to three conceptual domains representing subscales for “Dignity and Respect,” “Communication and Autonomy,” and “Supportive Care.” The sub-scales also have relatively good reliability (Cronbach alphas range from 0.67 to 0.73). In addition, increasing scores on the scale is associated with future intentions to deliver in the same facility, suggesting good criterion validity. Conclusions This research extends the PCMC literature by presenting results of validating the PCMC scale in a new context. The psychometric analysis using data from Uttar Pradesh, India corroborates the Kenya analysis showing the scale had good content, construct, and criterion validity, as well as high reliability. The overlap in items suggests that this scale can be used across different contexts to compare women’s experiences of care, and to inform and evaluate quality improvement efforts to promote comprehensive PCMC.
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Affiliation(s)
- Patience A Afulani
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA.
| | - Nadia Diamond-Smith
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA
| | - Beth Phillips
- School of Medicine, Institute for Global Health Sciences, University of California, San Francisco, USA
| | | | - May Sudhinaraset
- Jonathan and Karin Fielding School of Public Health, University of California, Los Angeles, USA
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2680
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Tang XT, Cai L, Shen Y, Du YZ. Diversity and evolution of the endosymbionts of Bemisia tabaci in China. PeerJ 2018; 6:e5516. [PMID: 30186690 PMCID: PMC6119459 DOI: 10.7717/peerj.5516] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/05/2018] [Indexed: 12/02/2022] Open
Abstract
The whitefly Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a cryptic species complex, including members that are pests of global importance. This study presents a screening of B. tabaci species in China for infection by the primary endosymbiont, Portiera aleyrodidarum, and two secondary endosymbionts, Arsenophonus and Cardinium. The results showed that P. aleyrodidarum was detected in all B. tabaci individuals, while Arsenophonus was abundant in indigenous species of B. tabaci Asia II 1, Asia II 3, and China 1 but absent in the invasive species, Middle East-Asia Minor 1 (MEAM1); Cardinium presented in the Mediterranean (MED), Asia II 1 and Asia II 3 species but was rarely detected in the MEAM1 and China 1 species. Moreover, phylogenetic analyses revealed that the P. aleyrodidarum and mitochondrial cytochrome oxidase 1 (mtCO1) phylograms were similar and corresponding with the five distinct cryptic species clades to some extent, probably indicating an ancient infection followed by vertical transmission and subsequent co-evolutionary diversification. In contrast, the phylogenetic trees of Arsenophonus and Cardinium were incongruent with the mtCO1 phylogram, potentially indicating horizontal transmission in B. tabaci cryptic species complex. Taken together, our study showed the distinct infection status of endosymbionts in invasive and indigenous whiteflies; we also most likely indicated the co-evolution of primary endosymbiont and its host as well as the potential horizontal transfer of secondary endosymbionts.
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Affiliation(s)
- Xiao-Tian Tang
- School of Horticulture and Plant Protection & Institute of Applied Entomology, Yangzhou University, Yangzhou, Jiangsu, China.,Department of Entomology, Texas A&M University, College Station, TX, USA
| | - Li Cai
- School of Horticulture and Plant Protection & Institute of Applied Entomology, Yangzhou University, Yangzhou, Jiangsu, China
| | - Yuan Shen
- Agriculture and Forestry Bureau of Binhu District, Wuxi, China
| | - Yu-Zhou Du
- School of Horticulture and Plant Protection & Institute of Applied Entomology, Yangzhou University, Yangzhou, Jiangsu, China.,Joint International Research Laboratory of Agriculture and Agri-Product Safety, the Ministry of Education, Yangzhou University, Yangzhou, Jiangsu, China
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2681
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Diamond-Smith N, Warnock R, Sudhinaraset M. Interventions to improve the person-centered quality of family planning services: a narrative review. Reprod Health 2018; 15:144. [PMID: 30153846 PMCID: PMC6114885 DOI: 10.1186/s12978-018-0592-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 08/17/2018] [Indexed: 11/10/2022] Open
Abstract
Person-centered care, a key component of quality of care, is receiving increased attention for maternal and reproductive health. While many interventions have aimed to improve person-centered care for family planning, there is no known narrative review of person-centered-focused interventions in family planning and the outcomes of these interventions. This narrative review fills this gap by conducting a rigorous analysis of interventions that address person-centered care and measure family planning related outcomes, including quality, knowledge and use/continuation. The search of the published and grey literature, from 1990 to 2015 identified 5530 papers, of which 25 were ultimately included in the analysis (after exclusion criteria was applied). We grouped these interventions under seven domains of person-centered care: dignity, autonomy, privacy/confidentiality, communication, social support, supportive care, and trust. We find that person-centered interventions had high success in improving perceptions of quality and knowledge of family planning among clients; however, results were less consistent in improving family planning uptake and continuation. These findings will help program and policy makers develop interventions that incorporate person-centered components to have the highest likelihood for success in improving clients' experiences and family planning use.
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Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - Ruby Warnock
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA
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2682
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Young R, Bekele T, Gunn A, Chapman N, Chowdhary V, Corrigan K, Dahora L, Martinez S, Permar S, Persson J, Rodriguez B, Schäferhoff M, Schulman K, Singh T, Terry RF, Yamey G. Developing new health technologies for neglected diseases: a pipeline portfolio review and cost model. Gates Open Res 2018; 2:23. [PMID: 30234193 DOI: 10.12688/gatesopenres.12817.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Funding for neglected disease product development fell from 2009-2015, other than a brief injection of Ebola funding. One impediment to mobilizing resources is a lack of information on product candidates, the estimated costs to move them through the pipeline, and the likelihood of specific launches. This study aimed to help fill these information gaps. Methods: We conducted a pipeline portfolio review to identify current candidates for 35 neglected diseases. Using an adapted version of the Portfolio to Impact financial modelling tool, we estimated the costs to move these candidates through the pipeline over the next decade and the likely launches. Since the current pipeline is unlikely to yield several critical products, we estimated the costs to develop a set of priority "missing" products. Results: We found 685 neglected disease product candidates as of August 31, 2017; 538 candidates met inclusion criteria for input into the model. It would cost about $16.3 billion (range $13.4-19.8B) to move these candidates through the pipeline, with three-quarters of the costs incurred in the first 5 years, resulting in about 128 (89-160) expected product launches. Based on the current pipeline, there would be few launches of complex new chemical entities; launches of highly efficacious HIV, tuberculosis, or malaria vaccines would be unlikely. Estimated additional costs to launch one of each of 18 key missing products are $13.6B assuming lowest product complexity or $21.8B assuming highest complexity ($8.1B-36.6B). Over the next 5 years, total estimated costs to move current candidates through the pipeline and develop these 18 missing products would be around $4.5B (low complexity missing products) or $5.8B/year (high complexity missing products). Conclusions: Since current annual global spending on product development is about $3B, this study suggests the annual funding gap over the next 5 years is at least $1.5-2.8B.
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Affiliation(s)
- Ruth Young
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Tewodros Bekele
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Alexander Gunn
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Nick Chapman
- Policy Cures Research, Sydney, NSW, 2010, Australia
| | | | | | - Lindsay Dahora
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Department of Immunology, Duke University, Durham, NC, 27710, USA
| | | | - Sallie Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Children's Health and Discovery Institute; Department of Pediatrics, Duke University, Durham, NC, 27710, USA
| | | | - Bill Rodriguez
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | - Kevin Schulman
- Duke Clinical Research Institute, Duke University, Durham, NC, 27715, USA
| | - Tulika Singh
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27710, USA
| | - Robert F Terry
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, CH-1211, Switzerland
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
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2683
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Young R, Bekele T, Gunn A, Chapman N, Chowdhary V, Corrigan K, Dahora L, Martinez S, Permar S, Persson J, Rodriguez B, Schäferhoff M, Schulman K, Singh T, Terry RF, Yamey G. Developing new health technologies for neglected diseases: a pipeline portfolio review and cost model. Gates Open Res 2018. [PMID: 30234193 DOI: 10.12688/gatesopenres.12817.1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background: Funding for neglected disease product development fell from 2009-2015, other than a brief injection of Ebola funding. One impediment to mobilizing resources is a lack of information on product candidates, the estimated costs to move them through the pipeline, and the likelihood of specific launches. This study aimed to help fill these information gaps. Methods: We conducted a pipeline portfolio review to identify current candidates for 35 neglected diseases. Using an adapted version of the Portfolio to Impact financial modelling tool, we estimated the costs to move these candidates through the pipeline over the next decade and the likely launches. Since the current pipeline is unlikely to yield several critical products, we estimated the costs to develop a set of priority "missing" products. Results: We found 685 neglected disease product candidates as of August 31, 2017; 538 candidates met inclusion criteria for input into the model. It would cost about $16.3 billion (range $13.4-19.8B) to move these candidates through the pipeline, with three-quarters of the costs incurred in the first 5 years, resulting in about 128 (89-160) expected product launches. Based on the current pipeline, there would be few launches of complex new chemical entities; launches of highly efficacious HIV, tuberculosis, or malaria vaccines would be unlikely. Estimated additional costs to launch one of each of 18 key missing products are $13.6B assuming lowest product complexity or $21.8B assuming highest complexity ($8.1B-36.6B). Over the next 5 years, total estimated costs to move current candidates through the pipeline and develop these 18 missing products would be around $4.5B (low complexity missing products) or $5.8B/year (high complexity missing products). Conclusions: Since current annual global spending on product development is about $3B, this study suggests the annual funding gap over the next 5 years is at least $1.5-2.8B.
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Affiliation(s)
- Ruth Young
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Tewodros Bekele
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Alexander Gunn
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Nick Chapman
- Policy Cures Research, Sydney, NSW, 2010, Australia
| | | | | | - Lindsay Dahora
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Department of Immunology, Duke University, Durham, NC, 27710, USA
| | | | - Sallie Permar
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Children's Health and Discovery Institute; Department of Pediatrics, Duke University, Durham, NC, 27710, USA
| | | | - Bill Rodriguez
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | | | - Kevin Schulman
- Duke Clinical Research Institute, Duke University, Durham, NC, 27715, USA
| | - Tulika Singh
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC, 27710, USA.,Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, 27710, USA
| | - Robert F Terry
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, CH-1211, Switzerland
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
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2684
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Occurrence of Schistosoma bovis on Pemba Island, Zanzibar: implications for urogenital schistosomiasis transmission monitoring. Parasitology 2018; 145:1727-1731. [PMID: 30086805 PMCID: PMC7116046 DOI: 10.1017/s0031182018001154] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The causative agent of urogenital schistosomiasis, Schistosoma haematobium, was thought to be the only schistosome species transmitted through Bulinus snails on Unguja and Pemba Island (Zanzibar, United Republic of Tanzania). For insights into the environmental risk of S. haematobium transmission on Pemba Island, malacological surveys collecting Bulinus globosus and B. nasutus, two closely related potential intermediate hosts of S. haematobium were conducted across the island in November 2016. Of 1317 B. globosus/B. nasutus collected, seven B. globosus, identified through sequencing a DNA region of the mitochondrial cytochrome oxidase subunit 1 (cox1), were observed with patent infections assumed to be S. haematobium. However, when the collected cercariae were identified through sequencing a region of the cox1 and the nuclear internal transcribed spacer (ITS1 + 2), schistosomes from five of these B. globosus collected from a single locality were in fact S. bovis. The identified presence of S. bovis raises concerns for animal health on Pemba, and complicates future transmission monitoring of S. haematobium. These results show the pertinence for not only sensitive, but also species-specific markers to be used when identifying cercariae during transmission monitoring, and also provide the first molecular confirmation for B. globosus transmitting S. bovis in East Africa.
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2685
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2686
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Bondo A, Nambiar B, Lufesi N, Deula R, King C, Masache G, Makwenda C, Costello A, Rhoda D, McCollum ED, Colbourn T. An assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey in Malawi. Gates Open Res 2018; 2:37. [PMID: 30569035 PMCID: PMC6266718 DOI: 10.12688/gatesopenres.12837.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in Malawi from November 2011 using a three dose primary series at 6, 10, and 14 weeks of age to reduce Streptococcus pneumoniae-related diseases. To date, PCV13 paediatric coverage in Malawi has not been rigorously assessed. We used household surveys to longitudinally track paediatric PCV13 coverage in rural Malawi. Methods: Samples of 60 randomly selected children (30 infants aged 6 weeks to 4 months and 30 aged 4-16 months) were sought in each of 20 village clinic catchment 'basins' of Kabudula health area, Lilongwe, Malawi between March 2012 and June 2014. Child health information was reviewed and mothers interviewed to determine each child's PCV13 dose status and vaccine timing. The survey was completed six times in 4-8 month intervals. Survey inference was used to assess PCV13 dose coverage in each basin for each age group. All 20 basins were pooled to assess area-wide vaccination coverage over time, by age in months, and adherence to the vaccination schedule. Results: We surveyed a total of 8,562 children in six surveys; 82% were in the older age group. Overall, in age-eligible children, two-dose and three-dose coverage increased from 30% to 85% and 10% to 86%, respectively, between March 2012 and June 2014. PCV13 coverage was higher in the older age group in all surveys. Although it varied by basin, PCV13 coverage was consistently delayed: median ages at first, second and third doses were 9, 15 and 21 weeks, respectively. Conclusion: In our rural study area, PCV13 introduction did not meet the Malawi Ministry of Health one-year three-dose 90% coverage target, but after 2 years reached levels likely to reduce the prevalence of both invasive and non-invasive paediatric pneumococcal diseases. Better adherence to the PCV13 schedule may reduce pneumococcal disease in younger Malawian children.
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Affiliation(s)
- Austin Bondo
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - Bejoy Nambiar
- UCL Institute for Global Health, London, WC1N 1EH, UK
| | - Norman Lufesi
- Acute Respiratory Infections Unit, Ministry of Health, Lilongwe, Malawi
| | - Rashid Deula
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - Carina King
- UCL Institute for Global Health, London, WC1N 1EH, UK
| | - Gibson Masache
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | - Charles Makwenda
- Parent and Child Health Initiative (PACHI) Trust, Lilongwe, Malawi
| | | | - Dale Rhoda
- Biostat Global Consulting, Worthington, OH, 43085, USA
| | - Eric D McCollum
- UCL Institute for Global Health, London, WC1N 1EH, UK.,Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, USA.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Tim Colbourn
- UCL Institute for Global Health, London, WC1N 1EH, UK
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2687
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Sudhinaraset M, Afulani PA, Diamond-Smith N, Golub G, Srivastava A. Development of a Person-Centered Family Planning Scale in India and Kenya. Stud Fam Plann 2018; 49:237-258. [PMID: 30069983 DOI: 10.1111/sifp.12069] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite recognition that person-centered care is a critical component to providing high quality family planning services, there lacks consensus on how to operationalize and measure it. This paper describes the development and validation of a person-centered family planning (PCFP) scale in India and Kenya. Cross-sectional data were collected from 522 women in Kenya and 225 women in India who visited a health facility providing family planning services. Psychometric analyses, including exploratory factor analysis, were employed to assess the validity and reliability of the PCFP scale. Separate scales were developed for India and Kenya due to context-specific items. We assessed criterion validity by examining the association between PCFP and global measures of quality and satisfaction with family planning care. The analysis resulted in a multidimensional PCFP scale, including 20 items in Kenya and 22 items in India. Through iterative factor analysis, two subscales were identified for both countries: "autonomy, respectful care, and communication" and "health facility environment." This scale may be used to evaluate quality improvement interventions and experiences of women globally to support women in achieving their reproductive health goals.
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2688
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Ramírez AL, Hall-Mendelin S, Doggett SL, Hewitson GR, McMahon JL, Ritchie SA, van den Hurk AF. Mosquito excreta: A sample type with many potential applications for the investigation of Ross River virus and West Nile virus ecology. PLoS Negl Trop Dis 2018; 12:e0006771. [PMID: 30169512 PMCID: PMC6136815 DOI: 10.1371/journal.pntd.0006771] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 09/13/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Emerging and re-emerging arthropod-borne viruses (arboviruses) cause human and animal disease globally. Field and laboratory investigation of mosquito-borne arboviruses requires analysis of mosquito samples, either individually, in pools, or a body component, or secretion such as saliva. We assessed the applicability of mosquito excreta as a sample type that could be utilized during studies of Ross River and West Nile viruses, which could be applied to the study of other arboviruses. METHODOLOGY/PRINCIPAL FINDINGS Mosquitoes were fed separate blood meals spiked with Ross River virus and West Nile virus. Excreta was collected daily by swabbing the bottom of containers containing batches and individual mosquitoes at different time points. The samples were analyzed by real-time RT-PCR or cell culture enzyme immunoassay. Viral RNA in excreta from batches of mosquitoes was detected continuously from day 2 to day 15 post feeding. Viral RNA was detected in excreta from at least one individual mosquito at all timepoints, with 64% and 27% of samples positive for RRV and WNV, respectively. Excretion of viral RNA was correlated with viral dissemination in the mosquito. The proportion of positive excreta samples was higher than the proportion of positive saliva samples, suggesting that excreta offers an attractive sample for analysis and could be used as an indicator of potential transmission. Importantly, only low levels of infectious virus were detected by cell culture, suggesting a relatively low risk to personnel handling mosquito excreta. CONCLUSIONS/SIGNIFICANCE Mosquito excreta is easily collected and provides a simple and efficient method for assessing viral dissemination, with applications ranging from vector competence experiments to complementing sugar-based arbovirus surveillance in the field, or potentially as a sample system for virus discovery.
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Affiliation(s)
- Ana L. Ramírez
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Sonja Hall-Mendelin
- Public Health Virology, Forensic and Scientific Services, Department of Health, Queensland, Australia
| | - Stephen L. Doggett
- Department of Medical Entomology, NSW Health Pathology-ICPMR, Westmead Hospital, Westmead, New South Wales, Australia
| | - Glen R. Hewitson
- Public Health Virology, Forensic and Scientific Services, Department of Health, Queensland, Australia
| | - Jamie L. McMahon
- Public Health Virology, Forensic and Scientific Services, Department of Health, Queensland, Australia
| | - Scott A. Ritchie
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
- Australian Institute of Tropical Health and Medicine, James Cook University, Cairns, Queensland, Australia
| | - Andrew F. van den Hurk
- Public Health Virology, Forensic and Scientific Services, Department of Health, Queensland, Australia
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2689
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Rossitto De Marchi B, Kinene T, Mbora Wainaina J, Krause-Sakate R, Boykin L. Comparative transcriptome analysis reveals genetic diversity in the endosymbiont Hamiltonella between native and exotic populations of Bemisia tabaci from Brazil. PLoS One 2018; 13:e0201411. [PMID: 30052670 PMCID: PMC6063447 DOI: 10.1371/journal.pone.0201411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/14/2018] [Indexed: 12/22/2022] Open
Abstract
The whitefly, Bemisia tabaci, is a species complex of more than 40 cryptic species and a major agricultural pest. It causes extensive damage to plants mainly by transmitting plant viruses. There is still a lack of genomic data available for the different whitefly species found in Brazil and their bacterial endosymbionts. Understanding the genetic and transcriptomic composition of these insect pests, the viruses they transmit and the microbiota is crucial to sustainable solutions for farmers to control whiteflies. Illumina RNA-Seq was used to obtain the transcriptome of individual whiteflies from 10 different populations from Brazil including Middle East-Asia Minor 1 (MEAM1), Mediterranean (MED) and New World 2 (NW2). Raw reads were assembled using CLC Genomics Workbench and subsequently mapped to reference genomes. We obtained whitefly complete mitochondrial genomes and draft genomes from the facultative bacterial endosymbiont Hamiltonella for further phylogenetic analyses. In addition, nucleotide sequences of the GroEL chaperonin gene from Hamiltonella from different populations were obtained and analysed. There was concordance in the species clustering using the whitefly complete mitogenome and the mtCOI gene tree. On the other hand, the phylogenetic analysis using the 12 ORF's of Hamiltonella clustered the native species NW2 apart from the exotics MEAM1 and MED. In addition, the amino acid analysis of GroEL chaperonin revealed a deletion only in Hamiltonella infecting NW2 among whiteflies populations analysed which was further confirmed by PCR and Sanger sequencing. The genomic data obtained in this study will aid understanding the functions that Hamiltonella may have in whitefly biology and serve as a reference for further studies regarding whiteflies in Brazil.
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Affiliation(s)
| | - Tonny Kinene
- School of Molecular Sciences and Australian Research Council Centre of Excellence in Plant Energy Biology, University of Western Australia, Crawley, Perth, WA, Australia
| | - James Mbora Wainaina
- School of Molecular Sciences and Australian Research Council Centre of Excellence in Plant Energy Biology, University of Western Australia, Crawley, Perth, WA, Australia
| | - Renate Krause-Sakate
- UNESP–Universidade Estadual Paulista, Faculdade de Ciências Agronomicas, Botucatu-SP, Brazil
| | - Laura Boykin
- School of Molecular Sciences and Australian Research Council Centre of Excellence in Plant Energy Biology, University of Western Australia, Crawley, Perth, WA, Australia
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2690
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Reasons for non-vaccination and incomplete vaccinations among children in Pakistan. Vaccine 2018; 36:5288-5293. [PMID: 30054162 DOI: 10.1016/j.vaccine.2018.07.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Global immunization efforts have received a boost through the introduction of several new vaccines. These efforts however, are threatened by sub-optimal vaccine coverage, particularly in countries with large birth cohorts. Pakistan has one of the largest birth cohorts in the world, where coverage of routine vaccination remains persistently inadequate. We undertook this study to ascertain reasons for non-vaccination or incomplete vaccination of children less than two years in 8 districts of southern Pakistan. METHODS A cross-sectional survey using WHO recommended rapid coverage assessment technique was conducted in 2014. Using probability proportional to size method, we sampled 8400 households with eligible children (aged 4-12 months). Using a structured questionnaire, mothers or other primary caregivers were interviewed to determine vaccination status of an index child. In case of non-vaccination or incomplete vaccination, respondents were asked for reasons leading to low/no vaccine uptake. RESULTS Based on both vaccination record and recall, only 30.8% of children were fully vaccinated, 46% had an incomplete vaccination status while 23%were non-vaccinated. The most frequently reported reasons for non-vaccination included: mothers/caregivers being unaware of the need for vaccination (35.3%), a fear of side effects (23%), mother/caregiver being too busy (16.6%), distance from vaccination centers (13.8%), and non-availability of either vaccinators or vaccines at vaccination centers (10.7%). Reasons identified for incomplete vaccination were similar, with caregivers being unaware of the need for subsequent doses (27.3%), non-availability of vaccinators or vaccines (17.7%), mother/caregiver being too busy (14.8%), fear of side effects (11.2%), and postponement for another time (8.7%). CONCLUSION Various factors result in non-compliance with vaccination schedules and vaccine refusal within the surveyed communities, ranging from lack of knowledge to non-availability of supplies at vaccination centers. These barriers are best addressed through multi-pronged strategies addressing supply gaps, increasing community awareness and enhancing demand for routine vaccination services.
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2691
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Terry RF, Yamey G, Miyazaki-Krause R, Gunn A, Reeder JC. Funding global health product R&D: the Portfolio-To-Impact Model (P2I), a new tool for modelling the impact of different research portfolios. Gates Open Res 2018; 2:24. [PMID: 30234194 PMCID: PMC6139376 DOI: 10.12688/gatesopenres.12816.2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2018] [Indexed: 12/04/2022] Open
Abstract
Background: The Portfolio-To-Impact (P2I) Model is a novel tool, developed to estimate minimum funding needs to accelerate health product development from late stage preclinical study to phase III clinical trials, and to visualize potential product launches over time. Methods: A mixed methods approach was used. Assumptions on development costs at each phase were based on clinical trial costs from Parexel's R&D cost sourcebook. These were further refined and validated by interviews, with a wide variety of stakeholders from Product Development Partnerships, biopharmaceutical and diagnostic companies, and major funders of global health R&D. Results: the tool was used to create scenarios describing the impact, in terms of products developed, of different product portfolios with funding ranging from $1 million per annum through to $500 million per annum. These scenarios for a new global financing mechanism have been previously presented in a report setting out the potential for a new fund for research and development which would assist in accelerating product development for the diseases of poverty. Conclusion: The P2I tool does enable a user to model different scenarios in terms of cost and number of health products launched when applied to a portfolio of health products. The model is published as open access accompanied with a user guide. The design allows it to be adapted and used for other health R&D portfolio analysis as described in an accompanying publication focussing on the pipeline for neglected diseases in 2017. We aim to continually refine and improve the model and we ask users to provide us with their own inputs that can help us update key parameters and assumptions. We hope to catalyse users to adapt the model in ways that can increase its value, accuracy, and applications.
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Affiliation(s)
- Robert F Terry
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, 1211, Switzerland
| | - Gavin Yamey
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - Ryoko Miyazaki-Krause
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, 1211, Switzerland
| | - Alexander Gunn
- Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, NC, 27710, USA
| | - John C. Reeder
- The Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, 1211, Switzerland
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2692
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Malherbe ST, Dupont P, Kant I, Ahlers P, Kriel M, Loxton AG, Chen RY, Via LE, Thienemann F, Wilkinson RJ, Barry CE, Griffith-Richards S, Ellman A, Ronacher K, Winter J, Walzl G, Warwick JM. A semi-automatic technique to quantify complex tuberculous lung lesions on 18F-fluorodeoxyglucose positron emission tomography/computerised tomography images. EJNMMI Res 2018; 8:55. [PMID: 29943161 PMCID: PMC6020088 DOI: 10.1186/s13550-018-0411-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 06/08/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There is a growing interest in the use of 18F-FDG PET-CT to monitor tuberculosis (TB) treatment response. However, TB causes complex and widespread pathology, which is challenging to segment and quantify in a reproducible manner. To address this, we developed a technique to standardise uptake (Z-score), segment and quantify tuberculous lung lesions on PET and CT concurrently, in order to track changes over time. We used open source tools and created a MATLAB script. The technique was optimised on a training set of five pulmonary tuberculosis (PTB) cases after standard TB therapy and 15 control patients with lesion-free lungs. RESULTS We compared the proposed method to a fixed threshold (SUV > 1) and manual segmentation by two readers and piloted the technique successfully on scans of five control patients and five PTB cases (four cured and one failed treatment case), at diagnosis and after 1 and 6 months of treatment. There was a better correlation between the Z-score-based segmentation and manual segmentation than SUV > 1 and manual segmentation in terms of overall spatial overlap (measured in Dice similarity coefficient) and specificity (1 minus false positive volume fraction). However, SUV > 1 segmentation appeared more sensitive. Both the Z-score and SUV > 1 showed very low variability when measuring change over time. In addition, total glycolytic activity, calculated using segmentation by Z-score and lesion-to-background ratio, correlated well with traditional total glycolytic activity calculations. The technique quantified various PET and CT parameters, including the total glycolytic activity index, metabolic lesion volume, lesion volumes at different CT densities and combined PET and CT parameters. The quantified metrics showed a marked decrease in the cured cases, with changes already apparent at month one, but remained largely unchanged in the failed treatment case. CONCLUSIONS Our technique is promising to segment and quantify the lung scans of pulmonary tuberculosis patients in a semi-automatic manner, appropriate for measuring treatment response. Further validation is required in larger cohorts.
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Affiliation(s)
- Stephanus T. Malherbe
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patrick Dupont
- Department of Neurosciences, Laboratory for Cognitive Neurology, KU Leuven, Belgium
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ilse Kant
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Petri Ahlers
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Magdalena Kriel
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - André G. Loxton
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ray Y. Chen
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
| | - Friedrich Thienemann
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
- Department of Medicine, Faculty of Health Science, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Robert J. Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
- Department of Medicine, Faculty of Health Science, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- The Francis Crick Institute, Midland Road, London, NW1 2AT UK
- Department of Medicine, Imperial College London, London, W2 1PG UK
| | - Clifton E. Barry
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Tuberculosis Research Section, Laboratory of Clinical Infectious Diseases, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD USA
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Science, University of Cape Town, Observatory, 7925 Republic of South Africa
| | - Stephanie Griffith-Richards
- Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annare Ellman
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Katharina Ronacher
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Translational Research Institute, Mater Research Institute – The University of Queensland, Brisbane, QLD Australia
| | - Jill Winter
- Catalysis Foundation for Health, Emeryville, CA USA
| | - Gerhard Walzl
- DDST-NRF Centre of Excellence for Biomedical Tuberculosis Research and South African Medical Research Council Centre for Tuberculosis Research, Cape Town, South Africa
- Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James M. Warwick
- Division of Nuclear Medicine, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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2693
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018; 2:4. [PMID: 29984356 PMCID: PMC6030396 DOI: 10.12688/gatesopenres.12779.3] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- University of Toronto, Toronto, Canada
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, USA
- Department of Health Care Policy, Harvard Medical School, Boston, USA
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2694
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Dugani S, Afari H, Hirschhorn LR, Ratcliffe H, Veillard J, Martin G, Lagomarsino G, Basu L, Bitton A. Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review. Gates Open Res 2018. [PMID: 29984356 DOI: 10.12688/gatesopenres.12779.1] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.
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Affiliation(s)
- Sagar Dugani
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,University of Toronto, Toronto, Canada.,Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Henrietta Afari
- Department of Medicine , Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA
| | - Jeremy Veillard
- The World Bank Group, Washington, D.C., USA.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | | | | | - Lopa Basu
- Armstrong Institute for Patient Safety & Quality, Johns Hopkins University, Baltimore, USA
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, USA.,Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, USA.,Department of Health Care Policy, Harvard Medical School, Boston, USA
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2695
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Musa BM, Ibekwe E, Mwale S, Eurien D, Oldenburg C, Chung G, Heller RF. HIV treatment and monitoring patterns in routine practice: a multi-country retrospective chart review of patient care. F1000Res 2018; 7:713. [PMID: 30647906 PMCID: PMC6317496 DOI: 10.12688/f1000research.15169.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/02/2019] [Indexed: 01/25/2023] Open
Abstract
Background: A study of patient records in four HIV clinics in three sub-Saharan African countries examined routine clinical care patterns and variations. Methods: Clinic characteristics were described, and patient data extracted from a sample of medical records. Data on treatment, CD4 count and viral load (VL) were obtained for the last visit in the records, dates mainly between 2015 and 2017, patient demographic data were obtained from the first clinic visit. Results: Four clinics, two in Nigeria, one in Zambia and one in Uganda, all public facilities, using national HIV treatment guidelines were included. Numbers of patients and health professionals varied, with some variation in stated frequency of testing for CD4 count and VL. Clinical guidelines were available in each clinic, and most drugs were available free to patients. The proportion of patients with a CD4 count in the records varied from 84 to 100 percent, the latest median count varied from 269 to 593 between clinics. 35% had a record of a VL test, varying from 1% to 63% of patients. Lamivudine (3TC) was recorded for more than 90% of patients in each clinic, and although there was variation between clinics in the choice of antiretroviral therapy (ART), the majority were on first line drugs consistent with guidelines. Only about 2% of the patients were on second-line ARTs. In two clinics, 100% and 99% of patients were prescribed co-trimoxazole, compared with 7% and no patients in the two other clinics. Conclusions: The wide variation in available clinic health work force, levels and frequency of CD4 counts, and VL assessment and treatment indicate sub-optimal adherence to current guidelines in routine clinical care. There is room for further work to understand the reasons for this variation, and to standardise record keeping and routine care of HIV positive patients.
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Affiliation(s)
- Baba M Musa
- Department of Medicine, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
| | - Everistus Ibekwe
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, M15 6GX, UK
| | - Stanley Mwale
- Centre for Infectious Disease Research in Zambia, Lusaka, 10101, Zambia
| | - Daniel Eurien
- Advanced Field Epidemiology Training Program , Kampala, Uganda
| | - Catherine Oldenburg
- The Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco, San Francisco, CA, 94143, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, 94143, USA
| | - Gary Chung
- Johnson & Johnson, New Brunswick, NJ, 08901, USA
| | - Richard F Heller
- People's Open Access Education Initiative, Manchester, M30 9ED, UK
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2696
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Ndwandwe D, Uthman OA, Adamu AA, Sambala EZ, Wiyeh AB, Olukade T, Bishwajit G, Yaya S, Okwo-Bele JM, Wiysonge CS. Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa: A Multicountry Analyses. Hum Vaccin Immunother 2018; 14:2358-2364. [PMID: 29688133 PMCID: PMC6284496 DOI: 10.1080/21645515.2018.1467685] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Understanding the gaps in missed opportunities for vaccination (MOV) in sub-Saharan Africa would inform interventions for improving immunisation coverage to achieving universal childhood immunisation. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, 5 showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in DR Congo to 20.1% in Kenya. Important factors responsible for the inequality varied across countries. In Madagascar, the largest contributors to inequality in MOV were media access, number of under-five children, and maternal education. However, in Liberia media access narrowed inequality in MOV between poor and non-poor households. The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. The findings suggest the need for addressing social determinants of health.
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Affiliation(s)
- Duduzile Ndwandwe
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Olalekan A Uthman
- b Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School , Coventry , United Kingdom.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Abdu A Adamu
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Evanson Z Sambala
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Alison B Wiyeh
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Tawa Olukade
- d Department of Research and Development , Center for Evidence Based Global Health , Minna , Nigeria
| | - Ghose Bishwajit
- e School of International Development and Global Studies, University of Ottawa , Ontario , Canada
| | - Sanni Yaya
- e School of International Development and Global Studies, University of Ottawa , Ontario , Canada
| | | | - Charles S Wiysonge
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,g Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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2697
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Proaño A, Bui DP, López JW, Vu NM, Bravard MA, Lee GO, Tracey BH, Xu Z, Comina G, Ticona E, Mollura DJ, Friedland JS, Moore DAJ, Evans CA, Caligiuri P, Gilman RH. Cough Frequency During Treatment Associated With Baseline Cavitary Volume and Proximity to the Airway in Pulmonary TB. Chest 2018; 153:1358-1367. [PMID: 29559307 PMCID: PMC6026292 DOI: 10.1016/j.chest.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/14/2018] [Accepted: 03/01/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cough frequency, and its duration, is a biomarker that can be used in low-resource settings without the need of laboratory culture and has been associated with transmission and treatment response. Radiologic characteristics associated with increased cough frequency may be important in understanding transmission. The relationship between cough frequency and cavitary lung disease has not been studied. METHODS We analyzed data in 41 adults who were HIV negative and had culture-confirmed, drug-susceptible pulmonary TB throughout treatment. Cough recordings were based on the Cayetano Cough Monitor, and sputum samples were evaluated using microscopic observation drug susceptibility broth culture; among culture-positive samples, bacillary burden was assessed by means of time to positivity. CT scans were analyzed by a US-board-certified radiologist and a computer-automated algorithm. The algorithm evaluated cavity volume and cavitary proximity to the airway. CT scans were obtained within 1 month of treatment initiation. We compared small cavities (≤ 7 mL) and large cavities (> 7 mL) and cavities located closer to (≤ 10 mm) and farther from (> 10 mm) the airway to cough frequency and cough cessation until treatment day 60. RESULTS Cough frequency during treatment was twofold higher in participants with large cavity volumes (rate ratio [RR], 1.98; P = .01) and cavities located closer to the airway (RR, 2.44; P = .001). Comparably, cough ceased three times faster in participants with smaller cavities (adjusted hazard ratio [HR], 2.89; P = .06) and those farther from the airway (adjusted HR, 3.61;, P = .02). Similar results were found for bacillary burden and culture conversion during treatment. CONCLUSIONS Cough frequency during treatment is greater and lasts longer in patients with larger cavities, especially those closer to the airway.
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Affiliation(s)
- Alvaro Proaño
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru.
| | - David P Bui
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - José W López
- Laboratorio de Bioinformática y Biología Molecular, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Nancy M Vu
- Department of Internal Medicine, Cleveland Clinic, Cleveland, OH
| | - Marjory A Bravard
- Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Department of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Gwenyth O Lee
- Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
| | - Brian H Tracey
- Department of Electrical and Computer Engineering, Tufts University, Medford, MA
| | - Ziyue Xu
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Germán Comina
- Escuela Profesional de Ingeniería Física, Facultad de Ciencias, Universidad Nacional de Ingeniería, Lima, Peru; Department of Global Community Health and Behavioral Sciences, Tulane University, New Orleans, LA
| | - Eduardo Ticona
- Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Peru; Servicio de Enfermedades Infecciosas y Tropicales, Hospital Nacional Dos de Mayo, Lima, Peru
| | - Daniel J Mollura
- Center for Infectious Disease Imaging, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD
| | - Jon S Friedland
- Section of Infectious Diseases & Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London, England
| | - David A J Moore
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; TB Centre, London School of Hygiene and Tropical Medicine, London, England
| | - Carlton A Evans
- Innovation for Health and Development, Laboratory of Research and Development, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Section of Infectious Diseases & Immunity and Wellcome Trust Imperial College Centre for Global Health Research, Imperial College London, London, England
| | - Philip Caligiuri
- Department of Radiology & Imaging Sciences, University of Utah School of Medicine, Salt Lake City, UT
| | - Robert H Gilman
- Laboratorio de Investigación en Enfermedades Infecciosas, Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru; Asociación Benéfica PRISMA, Lima, Peru; Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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2698
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James S, Collins FH, Welkhoff PA, Emerson C, Godfray HCJ, Gottlieb M, Greenwood B, Lindsay SW, Mbogo CM, Okumu FO, Quemada H, Savadogo M, Singh JA, Tountas KH, Touré YT. Pathway to Deployment of Gene Drive Mosquitoes as a Potential Biocontrol Tool for Elimination of Malaria in Sub-Saharan Africa: Recommendations of a Scientific Working Group †. Am J Trop Med Hyg 2018; 98:1-49. [PMID: 29882508 PMCID: PMC5993454 DOI: 10.4269/ajtmh.18-0083] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/04/2018] [Indexed: 12/22/2022] Open
Abstract
Gene drive technology offers the promise for a high-impact, cost-effective, and durable method to control malaria transmission that would make a significant contribution to elimination. Gene drive systems, such as those based on clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR associated protein, have the potential to spread beneficial traits through interbreeding populations of malaria mosquitoes. However, the characteristics of this technology have raised concerns that necessitate careful consideration of the product development pathway. A multidisciplinary working group considered the implications of low-threshold gene drive systems on the development pathway described in the World Health Organization Guidance Framework for testing genetically modified (GM) mosquitoes, focusing on reduction of malaria transmission by Anopheles gambiae s.l. mosquitoes in Africa as a case study. The group developed recommendations for the safe and ethical testing of gene drive mosquitoes, drawing on prior experience with other vector control tools, GM organisms, and biocontrol agents. These recommendations are organized according to a testing plan that seeks to maximize safety by incrementally increasing the degree of human and environmental exposure to the investigational product. As with biocontrol agents, emphasis is placed on safety evaluation at the end of physically confined laboratory testing as a major decision point for whether to enter field testing. Progression through the testing pathway is based on fulfillment of safety and efficacy criteria, and is subject to regulatory and ethical approvals, as well as social acceptance. The working group identified several resources that were considered important to support responsible field testing of gene drive mosquitoes.
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Affiliation(s)
- Stephanie James
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | | | | | | | | | - Michael Gottlieb
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Brian Greenwood
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Fredros O. Okumu
- Ifakara Health Institute, Ifakara, Tanzania
- University of Glasgow, Glasgow, Scotland
- University of the Witwatersrand, Johannesburg, South Africa
| | - Hector Quemada
- Donald Danforth Plant Science Center, Saint Louis, Missouri
| | - Moussa Savadogo
- New Partnership for Africa’s Development, Ouagadougou, Burkina Faso
| | - Jerome A. Singh
- Centre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South Africa
| | - Karen H. Tountas
- Foundation for the National Institutes of Health, Bethesda, Maryland
| | - Yeya T. Touré
- University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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2699
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Munar W, Snilstveit B, Stevenson J, Biswas N, Eyers J, Butera G, Baffour T, Aranda LE. Evidence gap map of performance measurement and management in primary care delivery systems in low- and middle-income countries - Study protocol. Gates Open Res 2018; 2:27. [PMID: 29984360 PMCID: PMC6030397 DOI: 10.12688/gatesopenres.12826.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 10/12/2023] Open
Abstract
Background. For the last two decades there has been growing interest in governmental and global health stakeholders about the role that performance measurement and management systems can play for the production of high-quality and safely delivered primary care services. Despite recognition and interest, the gaps in evidence in this field of research and practice in low- and middle-income countries remain poorly characterized. This study will develop an evidence gap map in the area of performance management in primary care delivery systems in low- and middle-income countries. Methods. The evidence gap map will follow the methodology developed by 3Ie, the International Initiative for Impact Evaluation, to systematically map evidence and research gaps. The process starts with the development of the scope by creating an evidence-informed framework that helps identify the interventions and outcomes of relevance as well as help define inclusion and exclusion criteria. A search strategy is then developed to guide the systematic search of the literature, covering the following databases: Medline (Ovid), Embase (Ovid), CAB Global Health (Ovid), CINAHL (Ebsco), Cochrane Library, Scopus (Elsevier), and Econlit (Ovid). Sources of grey literature are also searched. Studies that meet the inclusion criteria are systematically coded, extracting data on intervention, outcome, measures, context, geography, equity, and study design. Systematic reviews are also critically appraised using an existing standard checklist. Impact evaluations are not appraised but will be coded according to study design. The process of map-building ends with the creation of an evidence gap map graphic that displays the available evidence according to the intervention and outcome framework of interest. Discussion. Applications arising from the evidence map will be discussed in a separate paper that will summarize findings and make recommendations for the development of a prioritized research agenda.
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Affiliation(s)
- Wolfgang Munar
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Birte Snilstveit
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Jennifer Stevenson
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Nilakshi Biswas
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - John Eyers
- International Initiative for Impact Evaluation (3Ie), London International Development Centre, London, WC1H 0PD, UK
| | - Gisela Butera
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Theresa Baffour
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
| | - Ligia E. Aranda
- Milken Institute School of Public Health, Department of Global Health, George Washington University, Washington, DC, 20052, USA
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2700
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Nugent R, Bertram MY, Jan S, Niessen LW, Sassi F, Jamison DT, Pier EG, Beaglehole R. Investing in non-communicable disease prevention and management to advance the Sustainable Development Goals. Lancet 2018; 391:2029-2035. [PMID: 29627167 DOI: 10.1016/s0140-6736(18)30667-6] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/20/2018] [Accepted: 03/09/2018] [Indexed: 01/05/2023]
Abstract
Reduction of the non-communicable disease (NCD) burden is a global development imperative. Sustainable Development Goal (SDG) 3 includes target 3·4 to reduce premature NCD mortality by a third by 2030. Progress on SDG target 3·4 will have a central role in determining the success of at least nine SDGs. A strengthened effort across multiple sectors with effective economic tools, such as price policies and insurance, is necessary. NCDs are heavily clustered in people with low socioeconomic status and are an important cause of medical impoverishment. They thereby exacerbate economic inequities within societies. As such, NCDs are a barrier to achieving SDG 1, SDG 2, SDG 4, SDG 5, and SDG 10. Productivity gains from preventing and managing NCDs will contribute to SDG 8. SDG 11 and SDG 12 offer clear opportunities to reduce the NCD burden and to create sustainable and healthy cities.
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Affiliation(s)
- Rachel Nugent
- Research Triangle Institute International, Seattle, WA, USA.
| | | | - Stephen Jan
- The George Institute for Global Health, University of NSW, Sydney, NSW, Australia
| | - Louis W Niessen
- Department of International Public Health and Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Franco Sassi
- Centre for Health Economics and Policy Innovation, Imperial College Business School, London, UK
| | - Dean T Jamison
- Institute for Global Health Sciences, University of California, San Francisco, CA, USA
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