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Chaneliere M, Buchet-Poyau K, Keriel-Gascou M, Rabilloud M, Colin C, Langlois-Jacques C, Touzet S. A multifaceted risk management program to improve the reporting rate of patient safety incidents in primary care: a cluster-randomised controlled trial. BMC PRIMARY CARE 2024; 25:244. [PMID: 38971743 PMCID: PMC11227140 DOI: 10.1186/s12875-024-02476-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/11/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND While patient safety incident reporting is of key importance for patient safety in primary care, the reporting rate by healthcare professionals remains low. This study aimed to assess the effectiveness of a risk management program in increasing the reporting rate within multiprofessional primary care facilities. METHODS A nation-wide cluster-randomised controlled trial was performed in France, with each cluster defined as a primary care facility. The intervention included professional e-learning training, identification of a risk management advisor, and multidisciplinary meetings to address incident analysis. In the first observational period, a patient safety incident reporting system for professionals was implemented in all facilities. Then, facilities were randomised, and the program was implemented. Incidents were reported over the 15-month study period. Quasi-Poisson models were used to compare reporting rates. RESULTS Thirty-five facilities (intervention, n = 17; control, n = 18) were included, with 169 and 232 healthcare professionals, respectively, involved. Overall, 7 out of 17 facilities carried out the entire program (41.2%), while 6 did not hold meetings (35.3%); 48.5% of professionals logged on to the e-learning website. The relative rate of incidents reported was 2.7 (95% CI = [0.84-11.0]; p = 0.12). However, a statistically significant decrease in the incident rate between the pre-intervention and post-intervention periods was observed for the control arm (HR = 0.2; 95% CI = [0.05-0.54]; p = 0.02), but not for the intervention arm (HR = 0.54; 95% CI = [0.2-1.54]; p = 0.23). CONCLUSION This program didn't lead to a significant improvement in the patient safety incident reporting rate by professionals but seemed to sustain reporting over time. Considering that the program was fully implemented in only 41% of facilities, this highlights the difficulty of implementing such multidisciplinary programs in primary care despite its adaptation to the setting. A better understanding of how risk management is currently organized in these multiprofessional facilities is of key importance to improve patient safety in primary care. TRIAL REGISTRATIONS The study has been registered at clinicaltrials.gov (NCT02403388) on 30 March 2015.
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Affiliation(s)
- Marc Chaneliere
- Family Medicine Department, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Lyon, 69008, France.
- Service Recherche Et Épidémiologie Clinique, Hospices Civils de Lyon, Pole de Santé Publique, 162 Avenue Lacassagne, Lyon, 69003, France.
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France.
| | - Karine Buchet-Poyau
- Service Recherche Et Épidémiologie Clinique, Hospices Civils de Lyon, Pole de Santé Publique, 162 Avenue Lacassagne, Lyon, 69003, France
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Maud Keriel-Gascou
- Family Medicine Department, Université Claude Bernard Lyon 1, 8 Avenue Rockefeller, Lyon, 69008, France
- Service Recherche Et Épidémiologie Clinique, Hospices Civils de Lyon, Pole de Santé Publique, 162 Avenue Lacassagne, Lyon, 69003, France
| | - Muriel Rabilloud
- Service de Biostatistique Et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, 69003, France
- UMR 5558, Laboratoire de Biométrie Et Biologie Évolutive, CNRS, Équipe Biostatistique-Santé, Villeurbanne, 69100, France
| | - Cyrille Colin
- Service Recherche Et Épidémiologie Clinique, Hospices Civils de Lyon, Pole de Santé Publique, 162 Avenue Lacassagne, Lyon, 69003, France
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
| | - Carole Langlois-Jacques
- Service de Biostatistique Et Bioinformatique, Hospices Civils de Lyon, Pôle Santé Publique, Lyon, 69003, France
- UMR 5558, Laboratoire de Biométrie Et Biologie Évolutive, CNRS, Équipe Biostatistique-Santé, Villeurbanne, 69100, France
| | - Sandrine Touzet
- Service Recherche Et Épidémiologie Clinique, Hospices Civils de Lyon, Pole de Santé Publique, 162 Avenue Lacassagne, Lyon, 69003, France
- Research On Healthcare Performance (RESHAPE), Université Claude Bernard Lyon 1, INSERM U1290, Lyon, France
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Zeleke GT, Avan BI, Dubale MA, Schellenberg J. Effect of the data-informed platform for health intervention on the culture of data use for decision-making among district health office staff in North Shewa Zone, Ethiopia: a cluster-randomised controlled trial. BMC Med Inform Decis Mak 2024; 24:190. [PMID: 38970070 PMCID: PMC11225382 DOI: 10.1186/s12911-024-02597-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 07/01/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Similar to other low and middle-income countries, Ethiopia faces limitations in using local health data for decision-making.We aimed to assess the effect of an intervention, namely the data-informed platform for health, on the culture of data-based decision making as perceived by district health office staff in Ethiopia's North Shewa Zone. METHODS By designating district health offices as 'clusters', a cluster-randomised controlled trial was implemented. Out of a total of 24 districts in the zone, 12 districts were allocated to intervention arm and the other 12 in the control group arms. In the intervention arm district health office teams were supported in four-monthly cycles of data-driven decision-making over 20 months. This support included: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritizing; and (e) a consultative process to develop, commit to, and follow up on action plans. To measure the culture of data use for decision-making in both intervention and control arms, we interviewed 120 health management staff (5 per district office). Using a Likert scale based standard Performance of Routine Information System Management tool, the information is categorized into six domains:- evidence-based decision making, emphasis on data quality, use of information, problem solving, responsibility and motivation. After converting the Likert scale responses into percentiles, difference-in-difference methods were applied to estimate the net effect of the intervention. In intervention districts, analysis of variance was used to summarize variation by staff designation. RESULTS The overall decision-making culture in health management staff showed a net improvement of 13% points (95% C.I:9, 18) in intervention districts. The net effect of each of the six domains in turn was an 11% point increase (95% C.I:7, 15) on culture of evidence based decision making, a 16% point increase (95% C.I:8, 24) on emphasis on data quality, a 20% point increase (95% C.I:12, 28) on use of information, a 21% point increase (95% C.I:13, 29) on problem solving, and a 10% point increase (95% C.I:4, 16) on responsibility and motivation. In terms of variation by staff designation within intervention districts, statistically significant differences were observed only for problem solving and responsibility. CONCLUSION The data-informed platform for health strategy resulted in a measurable improvement in data use and structured decision-making culture by using existing systems, namely the Performance Monitoring Team meetings. The intervention supported district health offices in identifying and solving problems through a structured process. After further research, DIPH intervention could also be applied to other health administration and facility levels. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05310682, Dated 25/03/ 2022.
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Affiliation(s)
- Girum Taye Zeleke
- Health System and reproductive health research directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
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Cha S, Jung S, Abera T, Beyene ET, Schmidt WP, Ross I, Jin Y, Bizuneh DB. Performance of Pit Latrines and Their Herd Protection Against Diarrhea: A Longitudinal Cohort Study in Rural Ethiopia. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2200541. [PMID: 38834532 PMCID: PMC11216697 DOI: 10.9745/ghsp-d-22-00541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/30/2024] [Indexed: 06/06/2024]
Abstract
In sanitation policies, "improved sanitation" is often broadly described as a goal with little rationale for the minimum standard required. We conducted a secondary analysis of data collected as part of a cluster randomized controlled trial in rural Ethiopia. We compared the performance of well-constructed and poorly constructed pit latrines in reducing child diarrhea. In addition, we explored whether having a well-constructed household latrine provides indirect protection to neighbors if cluster-level coverage reaches a certain threshold. We followed up children aged younger than 5 years (U5C) of 906 households in rural areas of the Gurage zone, Ethiopia, for 10 months after community-led total sanitation interventions. A study-improved latrine was defined as having all the following: pit of ≥2 m depth, slab of any material, drop-hole cover, wall, roof, door, and handwashing facilities (water and soap observed). U5C in households with a study-improved latrine had 54% lower odds of contracting diarrhea than those living in households with a latrine missing 1 or more of the characteristics (adjusted odds ratio [aOR]=0.46; 95% confidence interval [CI]=0.27, 0.81; P=.006). Analyses were adjusted for child age and sex, presence of improved water for drinking, and self-reported handwashing at 4 critical times. The odds of having diarrhea among those with an improved latrine based on the World Health Organization/UNICEF Joint Monitoring Program (JMP) definition (i.e., pit latrines with slabs) were not substantially different from those with a JMP-unimproved latrine (aOR=0.99; 95% CI=0.56, 1.79; P=.99). Of U5C living in households without a latrine or with a study-unimproved latrine, those in the high-coverage villages were less likely to contract diarrhea than those in low-coverage villages (aOR=0.55; 95% CI=0.35, 0.86; P=.008). We recommend that academic studies and routine program monitoring and evaluation should measure more latrine characteristics and evaluate multiple latrine categories instead of making binary comparisons only.
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Affiliation(s)
- Seungman Cha
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom.
- Department of Global Development and Entrepreneurship, Graduate School of Global Development and Entrepreneurship, Handong Global University, Pohang, South Korea
| | - Sunghoon Jung
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Ermias Tadesse Beyene
- Department of Human Ecology and Technology, Graduate School of Advanced Convergence, Handong Global University, Pohang, South Korea
| | - Wolf-Peter Schmidt
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ian Ross
- Department of Disease Control, Faculty of Infectious and Tropical Disease, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yan Jin
- Department of Microbiology, Dongguk University College of Medicine, Gyeongju, Korea
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Hasker E, Assoumani Y, Randrianantoandro A, Ramboarina S, Braet SM, Cauchoix B, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Attoumani N, Grillone SH, Ronse M, Peeters Grietens K, Rakoto-Andrianarivelo M, Harinjatovo H, Supply P, Snijders R, Hoof C, Tsoumanis A, Suffys P, Rasamoelina T, Corstjens P, Ortuno-Gutierrez N, Geluk A, Cambau E, de Jong BC. Post-exposure prophylaxis in leprosy (PEOPLE): a cluster randomised trial. Lancet Glob Health 2024; 12:e1017-e1026. [PMID: 38762282 DOI: 10.1016/s2214-109x(24)00062-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 02/03/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Post-exposure prophylaxis (PEP) using single-dose rifampicin reduces progression from infection with Mycobacterium leprae to leprosy disease. We compared effectiveness of different administration modalities, using a higher (20 mg/kg) dose of rifampicin-single double-dose rifampicin (SDDR)-PEP. METHODS We did a cluster randomised study in 16 villages in Madagascar and 48 villages in Comoros. Villages were randomly assigned to four study arms and inhabitants were screened once a year for leprosy, for 4 consecutive years. All permanent residents (no age restriction) were eligible to participate and all identified patients with leprosy were treated with multidrug therapy (SDDR-PEP was provided to asymptomatic contacts aged ≥2 years). Arm 1 was the comparator arm, in which no PEP was provided. In arm 2, SDDR-PEP was provided to household contacts of patients with leprosy, whereas arm 3 extended SDDR-PEP to anyone living within 100 m. In arm 4, SDDR-PEP was offered to household contacts and to anyone living within 100 m and testing positive to anti-phenolic glycolipid-I. The main outcome was the incidence rate ratio (IRR) of leprosy between the comparator arm and each of the intervention arms. We also assessed the individual protective effect of SDDR-PEP and explored spatial associations. This trial is registered with ClinicalTrials.gov, NCT03662022, and is completed. FINDINGS Between Jan 11, 2019, and Jan 16, 2023, we enrolled 109 436 individuals, of whom 95 762 had evaluable follow-up data. Our primary analysis showed a non-significant reduction in leprosy incidence in arm 2 (IRR 0·95), arm 3 (IRR 0·80), and arm 4 (IRR 0·58). After controlling for baseline prevalence, the reduction in arm 3 became stronger and significant (IRR 0·56, p=0·0030). At an individual level SDDR-PEP was also protective with an IRR of 0·55 (p=0·0050). Risk of leprosy was two to four times higher for those living within 75 m of an index patient at baseline. INTERPRETATION SDDR-PEP appears to protect against leprosy but less than anticipated. Strong spatial associations were observed within 75 m of index patients. Targeted door-to-door screening around index patients complemented by a blanket SDDR-PEP approach will probably have a substantial effect on transmission. FUNDING European and Developing Countries Clinical Trials Partnership. TRANSLATION For the French translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium.
| | | | | | | | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Zahara Salim
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Mohammed Amidy
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | - Nissad Attoumani
- National Tuberculosis and Leprosy Control Program, Moroni, Comoros
| | | | - Maya Ronse
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | - Philip Supply
- University Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, U1019-UMR 9017, Center for Infection and Immunity of Lille, Lille, France
| | | | | | | | - Philip Suffys
- Oswaldo Cruz Institute, Fiocruz, Laboratory of Molecular Biology Applied to Mycobacteria, Rio de Janeiro, Brazil
| | | | | | | | | | - Emmanuelle Cambau
- Inserm, IAME, Université Paris Cité, UMR 1137, Paris, France; AP-HP, Hôpital Bichat, Service de Mycobacteriologie Specialisee et de Reference, Paris, France
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Wu Z, Deng W, Ye Y, Xu J, Han D, Zheng Y, Zheng Q. Liraglutide, a glucagon-like peptide-1 receptor agonist, inhibits bone loss in an animal model of osteoporosis with or without diabetes. Front Endocrinol (Lausanne) 2024; 15:1378291. [PMID: 38868747 PMCID: PMC11167098 DOI: 10.3389/fendo.2024.1378291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 05/07/2024] [Indexed: 06/14/2024] Open
Abstract
Introduction Liraglutide (Lrg), a novel anti-diabetic drug that mimics the endogenous glucagon-like peptide-1 to potentiate insulin secretion, is observed to be capable of partially reversing osteopenia. The aim of the present study is to further investigate the efficacy and potential anti-osteoporosis mechanisms of Lrg for improving bone pathology, bone- related parameters under imageology, and serum bone metabolism indexes in an animal model of osteoporosis with or without diabetes. Methods Eight databases were searched from their inception dates to April 27, 2024. The risk of bias and data on outcome measures were analyzed by the CAMARADES 10-item checklist and Rev-Man 5.3 software separately. Results Seventeen eligible studies were ultimately included in this review. The number of criteria met in each study varied from 4/10 to 8/10 with an average of 5.47. The aspects of blinded induction of the model, blinding assessment of outcome and sample size calculation need to be strengthened with emphasis. The pre-clinical evidence reveals that Lrg is capable of partially improving bone related parameters under imageology, bone pathology, and bone maximum load, increasing serum osteocalcin, N-terminal propeptide of type I procollagen, and reducing serum c-terminal cross-linked telopeptide of type I collagen (P<0.05). Lrg reverses osteopenia likely by activating osteoblast proliferation through promoting the Wnt signal pathway, p-AMPK/PGC1α signal pathway, and inhibiting the activation of osteoclasts by inhibiting the OPG/RANKL/RANK signal pathway through anti-inflammatory, antioxidant and anti-autophagic pathways. Furthermore, the present study recommends that more reasonable usage methods of streptozotocin, including dosage and injection methods, as well as other types of osteoporosis models, be attempted in future studies. Discussion Based on the results, this finding may help to improve the priority of Lrg in the treatment of diabetes patients with osteoporosis.
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Affiliation(s)
- Zongyi Wu
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Deng
- Department of Rheumatology Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yiming Ye
- Department of Rheumatology Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Xu
- Department of Rheumatology Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Deyu Han
- Department of Rheumatology Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Zheng
- Department of Nephrology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qun Zheng
- Department of Rheumatology Immunology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
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Sandi F, Mercer G, Geneau R, Bassett K, Bintabara D, Kalolo A. Alternative community-led intervention to improve uptake of cataract surgery services in rural Tanzania-The Dodoma Community Cataract Acceptance Trial (DoCCAT): a protocol for intervention co-designing and implementation in a cluster-randomized controlled trial. Biol Methods Protoc 2024; 9:bpae016. [PMID: 38566775 PMCID: PMC10987207 DOI: 10.1093/biomethods/bpae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 02/26/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
Age-related lens opacification (cataract) remains the leading cause of visual impairment and blindness worldwide. In low- and middle-income countries, utilization of cataract surgical services is often limited despite community-based outreach programmes. Community-led research, whereby researchers and community members collaboratively co-design intervention is an approach that ensures the interventions are locally relevant and that their implementation is feasible and socially accepted in the targeted contexts. Community-led interventions have the potential to increase cataract surgery uptake if done appropriately. In this study, once the intervention is co-designed it will be implemented through a cluster-randomized controlled trial (cRCT) with ward as a unit of randomization. This study will utilise both the qualitative methods for co-designing the intervention and the quantitative methods for effective assessment of the developed community-led intervention through a cRCT in 80 rural wards of Dodoma region, Tanzania (40 Intervention). The 'intervention package' will be developed through participatory community meetings and ongoing evaluation and modification of the intervention based on its impact on service utilization. Leask's four stages of intervention co-creation will guide the development within Rifkin's CHOICE framework. The primary outcomes are two: the number of patients attending eye disease screening camps, and the number of patients accepting cataract surgery. NVivo version 12 will be used for qualitative data analysis and Stata version 12 for quantitative data. Independent and paired t-tests will be performed to make comparisons between and within groups. P-values less than 0.05 will be considered statistically significant.
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Affiliation(s)
- Frank Sandi
- Department of Ophthalmology, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Gareth Mercer
- Department of Ophthalmology & Visual Sciences, University of Toronto, Toronto, Canada
| | - Robert Geneau
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Kenneth Bassett
- Department of Ophthalmology, The University of British Columbia, Vancouver, Canada
| | - Deogratius Bintabara
- Department of Community Medicine, The University of Dodoma Medical School, Dodoma, Tanzania
| | - Albino Kalolo
- Department of Public Health, St Francis University College of Health and Allied Sciences, Morogoro, Tanzania
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Avan BI, Dubale M, Taye G, Marchant T, Persson LÅ, Schellenberg J. Data-driven decision-making for district health management: a cluster-randomised study in 24 districts of Ethiopia. BMJ Glob Health 2024; 9:e014140. [PMID: 38423549 PMCID: PMC10910485 DOI: 10.1136/bmjgh-2023-014140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Use of local data for health system planning and decision-making in maternal, newborn and child health services is limited in low-income and middle-income countries, despite decentralisation and advances in data gathering. An improved culture of data-sharing and collaborative planning is needed. The Data-Informed Platform for Health is a system-strengthening strategy which promotes structured decision-making by district health officials using local data. Here, we describe implementation including process evaluation at district level in Ethiopia, and evaluation through a cluster-randomised trial. METHODS We supported district health teams in 4-month cycles of data-driven decision-making by: (a) defining problems using a health system framework; (b) reviewing data; (c) considering possible solutions; (d) value-based prioritising; and (e) a consultative process to develop, commit to and follow up on action plans. 12 districts were randomly selected from 24 in the North Shewa zone of Ethiopia between October 2020 and June 2022. The remaining districts formed the trial's comparison arm. Outcomes included health information system performance and governance of data-driven decision-making. Analysis was conducted using difference-in-differences. RESULTS 58 4-month cycles were implemented, four or five in each district. Each focused on a health service delivery challenge at district level. Administrators' practice of, and competence in, data-driven decision-making showed a net increase of 77% (95% CI: 40%, 114%) in the regularity of monthly reviews of service performance, and 48% (95% CI: 9%, 87%) in data-based feedback to health facilities. Statistically significant improvement was also found in administrators' use of information to appraise services. Qualitative findings also suggested that district health staff reported enhanced data use and collaborative decision-making. CONCLUSIONS This study generated robust evidence that 20 months' implementation of the Data-Informed Platform for Health strengthened health management through better data use and appraisal practices, systemised problem analysis to follow up on action points and improved stakeholder engagement. TRIAL REGISTRATION NUMBER NCT05310682.
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Affiliation(s)
- Bilal Iqbal Avan
- Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Mehret Dubale
- London School of Hygiene & Tropical Medicine, London, UK
| | - Girum Taye
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Tanya Marchant
- Disease Control, London School of Hygiene & Tropical Medicine, London, UK
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Sih C, Protopopoff N, Koffi AA, Ahoua Alou LP, Dangbenon E, Messenger LA, Kulkarni MA, Zoh MG, Camara S, Assi SB, N'Guessan R, Cook J. Efficacy of chlorfenapyr-pyrethroid and piperonyl butoxide-pyrethroid long-lasting insecticidal nets (LLINs) compared to pyrethroid-only LLINs for malaria control in Côte d'Ivoire: a three group, cluster randomised trial. Trials 2024; 25:151. [PMID: 38419075 PMCID: PMC10900640 DOI: 10.1186/s13063-024-07969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 02/05/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The massive scale-up of long-lasting insecticidal nets (LLIN) has led to a major reduction in malaria burden in many sub-Saharan African (SSA) countries. The World Health Organization (WHO) has recently issued a strong recommendation for the use of chlorfenapyr-pyrethroid LLINs compared to standard pyrethroid-only LLINs in areas of high insecticide resistance intensity. However, there is still a lack of conclusive evidence on the efficacy of piperonyl butoxide-pyrethroid (PBO-py) LLINs, especially in West Africa, where vector composition and resistance mechanisms may be different from vectors in East Africa. METHODS This is a three-arm, superiority, triple-blinded, cluster randomised trial, with village as the unit of randomisation. This study conducted in Côte d'Ivoire will evaluate the efficacy on epidemiological and entomological outcomes of (1) the control arm: MAGNet® LN, which contains the pyrethroid, alpha-cypermethrin, (2) VEERALIN® LN, a net combining the synergist PBO and alpha-cypermethrin, and (3) Interceptor® G2 LN, which incorporates chlorfenapyr and alpha-cypermethrin, two adulticides with different mechanisms of action. A total of 33 villages with an average of 200 households per village will be identified, mapped, and randomised in a ratio of 1:1:1. Nets will be distributed at a central point following national guidelines with 1 net for every 2 people. The primary outcome of the trial will be incidence of malaria cases (confirmed by rapid diagnostic test (RDT)) in a cohort of 50 children aged 6 months to 10 years in each cluster, followed for 12 months (active case detection). Secondary outcomes are cross-sectional community prevalence of malaria infection (confirmed by RDT) in the study population at 6 and 12 months post-intervention (50 randomly selected persons per cluster), vector density, entomological inoculation rate (EIR), and phenotypic and genotypic insecticide resistance at baseline and 12 months post-intervention in 3 sentinel villages in each treatment arm. DISCUSSION In addition to generating further evidence for next-generation LLINs, this study will also provide the first evidence for pyrethroid-PBO nets in a West African setting. This could further inform WHO recommendations on the pragmatic use of pyrethroid-PBO nets. TRIAL REGISTRATION ClinicalTrials.gov NCT05796193. Registered on April 3, 2023.
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Affiliation(s)
- Colette Sih
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK.
| | - Natacha Protopopoff
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Alphonsine A Koffi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Ludovic P Ahoua Alou
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Edouard Dangbenon
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Louisa A Messenger
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV, 89154, USA
| | - Manisha A Kulkarni
- School of Epidemiology & Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marius G Zoh
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Soromane Camara
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Serge B Assi
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Raphael N'Guessan
- Faculty of Infectious and Tropical Diseases, Disease Control Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Institut Pierre Richet (IPR)/Institut National de Santé Publique (INSP), Bouaké, Côte d'Ivoire
| | - Jackie Cook
- Faculty of Epidemiology and Population Health, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Medical Research Council (MRC) International Statistics and Epidemiology Group, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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López-Ejeda N, Charle-Cuéllar P, Samake S, Dougnon AO, Sánchez-Martínez LJ, Samake MN, Bagayoko A, Bunkembo M, Touré F, Vargas A, Guerrero S. Effectiveness of decentralizing outpatient acute malnutrition treatment with community health workers and a simplified combined protocol: a cluster randomized controlled trial in emergency settings of Mali. Front Public Health 2024; 12:1283148. [PMID: 38450139 PMCID: PMC10915236 DOI: 10.3389/fpubh.2024.1283148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024] Open
Abstract
Background Outpatient treatment of acute malnutrition is usually centralized in health centers and separated into different programs according to case severity. This complicates case detection, care delivery, and supply chain management, making it difficult for families to access treatment. This study assessed the impact of treating severe and moderate cases in the same program using a simplified protocol and decentralizing treatment outside health centers through community health workers (CHWs). Methods A three-armed cluster randomized controlled trial under a non-inferiority hypothesis was conducted in the Gao region of Mali involving 2,038 children between 6 and 59 months of age with non-complicated acute malnutrition. The control arm consisted of 549 children receiving standard treatment in health centers from nursing staff. The first intervention arm consisted of 800 children treated using the standard protocol with CHWs added as treatment providers. The second intervention arm consisted of 689 children treated by nurses and CHWs under the ComPAS simplified protocol, considering mid-upper arm circumference as the sole anthropometric criterion for admission and discharge and providing a fixed dose of therapeutic food for severe and moderate cases. Coverage was assessed through cross-sectional surveys using the sampling evaluation of access and coverage (SLEAC) methodology for a wide area involving several service delivery units. Results The recovery rates were 76.3% in the control group, 81.8% in the group that included CHWs with the standard protocol, and 92.9% in the group that applied the simplified protocol, confirming non-inferiority and revealing a significant risk difference among the groups. No significant differences were found in the time to recovery (6 weeks) or in anthropometric gain, whereas the therapeutic food expenditure was significantly lower with the simplified combined program in severe cases (43 sachets fewer than the control). In moderate cases, an average of 35 sachets of therapeutic food were used. With the simplified protocol, the CHWs had 6% discharge errors compared with 19% with the standard protocol. The treatment coverage increased significantly with the simplified combined program (SAM +42.5%, MAM +13.8%). Implications Implementing a simplified combined treatment program and adding CHWs as treatment providers can improve coverage while maintaining non-inferior effectiveness, reducing the expenditure on nutritional intrants, and ensuring the continuum of care for the most vulnerable children.
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Affiliation(s)
- Noemí López-Ejeda
- EPINUT Research Group (ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | | | - Salimata Samake
- Nutrition and Health Department, Action Against Hunger, Bamako, Mali
| | | | - Luis Javier Sánchez-Martínez
- EPINUT Research Group (ref. 920325), Unit of Physical Anthropology, Department of Biodiversity, Ecology and Evolution, Faculty of Biological Sciences, Complutense University of Madrid, Madrid, Spain
| | - Mahamadou N’tji Samake
- Nutrition Directorate of the General Directorate of Health and Public Hygiene, Ministry of Health, Bamako, Mali
| | - Aliou Bagayoko
- Nutrition Directorate of the General Directorate of Health and Public Hygiene, Ministry of Health, Bamako, Mali
| | - Magloire Bunkembo
- Nutrition and Health Department, Action Against Hunger, Bamako, Mali
| | - Fanta Touré
- West and Central Africa Regional Office, Action Against Hunger, Dakar, Senegal
| | - Antonio Vargas
- Nutrition and Health Department, Action Against Hunger, Madrid, Spain
| | - Saul Guerrero
- Child Nutrition and Development Office, UNICEF, New York, NY, United States
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10
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Faggion CM, Atieh MA, Tsagris M, Seehra J, Pandis N. A case study evaluating the effect of clustering, publication bias, and heterogeneity on the meta-analysis estimates in implant dentistry. Eur J Oral Sci 2024; 132:e12962. [PMID: 38030576 DOI: 10.1111/eos.12962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
Meta-analyses may provide imprecise estimates when important meta-analysis parameters are not considered during the synthesis. The aim of this case study was to highlight the influence of meta-analysis parameters that can affect reported estimates using as an example pre-existing meta-analyses on the association between implant survival and sinus membrane perforation. PubMed was searched on 7 July 2021 for meta-analyses comparing implant failure in perforated and non-perforated sinus membranes. Primary studies identified in these meta-analyses were combined in a new random-effects model with odds ratios (ORs), confidence intervals (CIs), and prediction intervals reported. Using this new meta-analysis, further meta-analyses were then undertaken considering the clinical, methodological, and statistical heterogeneity of the primary studies, publication bias, and clustering effects. The meta-analyses with the greatest number and more homogeneous studies provided lower odds of implant failure in non-perforated sites (OR 0.49, 95 % CI = [0.26, 0.92]). However, when considering heterogeneity, publication bias, and clustering (number of implants), the confidence in these results was reduced. Interpretation of estimates reported in systematic reviews can vary depending on the assumptions made in the meta-analysis. Users of these analyses need to carefully consider the impact of heterogeneity, publication bias, and clustering, which can affect the size, direction, and interpretation of the reported estimates.
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Affiliation(s)
- Clovis Mariano Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| | - Momen A Atieh
- Mohammed bin Rashid University of Medicine and Health Sciences, Hamdan bin Mohammed College of Dental Medicine, Dubai, United Arab Emirates
- Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
- School of Dentistry, University of Jordan, Amman, Jordan
| | - Michail Tsagris
- Department of Economics, University of Crete, Rethimnon, Greece
| | - Jadbinder Seehra
- Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, UK
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Bern, Switzerland
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11
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Zahrieh D, Kandler BW, Le-Rademacher J. The symbolic two-step method applied to cancer care delivery research: Safeguarding against designing an underpowered cluster randomized trial with a continuous outcome by accounting for the imprecision in the within- and between-center variation. Clin Trials 2024:17407745231219680. [PMID: 38243404 DOI: 10.1177/17407745231219680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Knowing the predictive factors of the variation in a center-level continuous outcome of interest is valuable in the design and analysis of parallel-arm cluster randomized trials. The symbolic two-step method for sample size planning that we present incorporates this knowledge while simultaneously accounting for patient-level characteristics. Our approach is illustrated through application to cluster randomized trials in cancer care delivery research. The required number of centers (clusters) depends on the between- and within-center variance; the within-center variance is a function of estimates obtained by regressing the log within-center variance on predictive factors. Obtaining accurate estimates of the components needed to characterize the within-center variation is challenging. METHODS Using our previously derived sample size formula, our objective in the current research is to directly account for the imprecision in these estimates, using a Bayesian approach, to safeguard against designing an underpowered study when using the symbolic two-step method. Using estimates of the required components, including the number of centers that contribute to those estimates, we make formal allowance for the imprecision in these estimates on which a sample size will be based. RESULTS The mean of the distribution for power is consistently smaller than the single point estimate that the sample size formula yields. The reduction in power is more pronounced in the presence of increased uncertainty about the estimates with the reduction becoming more attenuated with increased numbers of centers that contribute to the estimates. CONCLUSIONS Accounting for imprecision in the estimates of the components required for sample size estimation using the symbolic two-step method in the design of a cluster randomized trial yields conservative estimates of power.
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Affiliation(s)
- David Zahrieh
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
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12
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Tong G, Tong J, Jiang Y, Esserman D, Harhay MO, Warren JL. Hierarchical Bayesian modeling of heterogeneous outcome variance in cluster randomized trials. Clin Trials 2024:17407745231222018. [PMID: 38197388 DOI: 10.1177/17407745231222018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Heterogeneous outcome correlations across treatment arms and clusters have been increasingly acknowledged in cluster randomized trials with binary endpoints, where analytical methods have been developed to study such heterogeneity. However, cluster-specific outcome variances and correlations have yet to be studied for cluster randomized trials with continuous outcomes. METHODS This article proposes models fitted in the Bayesian setting with hierarchical variance structure to quantify heterogeneous variances across clusters and explain it with cluster-level covariates when the outcome is continuous. The models can also be extended to analyzing heterogeneous variances in individually randomized group treatment trials, with arm-specific cluster-level covariates, or in partially nested designs. Simulation studies are carried out to validate the performance of the newly introduced models across different settings. RESULTS Simulations showed that overall the newly introduced models have good performance, reporting low bias and approximately 95% coverage for the intraclass correlation coefficients and regression parameters in the variance model. When variances are heterogeneous, our proposed models had improved model fit over models with homogeneous variances. When used to analyze data from the Kerala Diabetes Prevention Program study, our models identified heterogeneous variances and intraclass correlation coefficients across clusters and examined cluster-level characteristics associated with such heterogeneity. CONCLUSION We proposed new hierarchical Bayesian variance models to accommodate cluster-specific variances in cluster randomized trials. The newly developed methods inform the understanding of how an intervention strategy is implemented and disseminated differently across clusters and can help improve future trial design.
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Affiliation(s)
- Guangyu Tong
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Jiaqi Tong
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Yi Jiang
- Department of Biostatistics, Penn State College of Medicine, Hershey, PA, USA
| | - Denise Esserman
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joshua L Warren
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
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Marks S, Arogundade E, Carew MT, Chen S, Banks LM, Kuper H, Adegoke F, Davey C. Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation. Trials 2024; 25:28. [PMID: 38183143 PMCID: PMC10768103 DOI: 10.1186/s13063-023-07892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project's impact. METHODS A pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to 'standard' state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine. DISCUSSION Defining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized 'access to family planning' based on a composite of beliefs about using services if needed. TRIAL REGISTRATION ISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.
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Affiliation(s)
- Sarah Marks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.
| | | | - Mark T Carew
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Shanquan Chen
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Calum Davey
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
- Centre for Evaluation, London School of Hygiene & Tropical Medicine, London, UK
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Sivaramakrishnan D, Baker G, Parker RA, Manner J, Lloyd S, Jepson R. A mixed method evaluation of a theory based intervention to reduce sedentary behaviour in contact centres- the stand up for health stepped wedge feasibility study. PLoS One 2023; 18:e0293602. [PMID: 38100490 PMCID: PMC10723690 DOI: 10.1371/journal.pone.0293602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/16/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Contact centres have higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health (SUH) is a theory-based intervention developed using the 6SQuID framework to reduce sedentary behaviour in contact centre workers. The aim of this study was to test acceptability and feasibility of implementing SUH in UK contact centres. METHODS The study was conducted in 2020-2022 (pre COVID and during lockdown) and used a stepped-wedge cluster randomised trial design including a process evaluation. The intervention included working with contact centre managers to develop and implement a customised action plan aligning with SUH's theory of change. Workplace sedentary time, measured using activPAL™ devices, was the primary outcome. Secondary outcomes included productivity, mental wellbeing, musculoskeletal health and physical activity. Empirical estimates of between-centre standard deviation and within-centre standard deviation of outcomes from pre-lockdown data were calculated to inform sample size calculations for future trials. The process evaluation adopted the RE-AIM framework to understand acceptability and feasibility of implementing the intervention. Interviews and focus groups were conducted with contact centre employees and managers, and activity preferences were collected using a questionnaire. RESULTS A total of 11 contact centres participated: 155 employees from 6 centres in the pre-lockdown data collection, and 54 employees from 5 centres post-lockdown. Interviews and focus groups were conducted with 33 employees and managers, and 96 participants completed an intervention activity preference questionnaire. Overall, the intervention was perceived as acceptable and feasible to deliver. Most centres implemented several intervention activities aligned with SUH's theory of change and over 50% of staff participated in at least one activity (pre-lockdown period). Perceived benefits including reduced sedentary behaviour, increased physical activity, and improved staff morale and mood were reported by contact centre employees and managers. CONCLUSIONS SUH demonstrates potential as an appealing and acceptable intervention, impacting several wellbeing outcomes. TRIAL REGISTRATION The trial has been registered on the ISRCTNdatabase: http://www.isrctn.com/ISRCTN11580369.
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Affiliation(s)
- Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, United Kingdom
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, United Kingdom
| | - Richard A. Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jillian Manner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, United Kingdom
| | - Scott Lloyd
- Public Health South Tees, Middlesbrough Council and Redcar & Cleveland Borough Council, Middlesbrough, United Kingdom
- Fuse–UKCRC Centre for Translational Research in Public Health, Population Health Sciences Institute, William Leech Building, Newcastle University, Newcastle upon Tyne, United Kingdom
- Teesside University, Middlesbrough, United Kingdom
| | - Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, United Kingdom
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Alghamdi KS, Petzold M, Alsugoor MH, Makeen HA, Al Monif KH, Hussain-Alkhateeb L. Community pharmacists' perspectives towards automated pharmacy systems and extended community pharmacy services: An online cross-sectional study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2023; 12:100363. [PMID: 38023630 PMCID: PMC10679933 DOI: 10.1016/j.rcsop.2023.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/05/2023] [Accepted: 11/05/2023] [Indexed: 12/01/2023] Open
Abstract
Background Private sector partnerships through community pharmacies are essential for effective healthcare integration to achieve the United Nations 2030 Agenda for Sustainable Development Goals. This partnership can provide significant clinical outcomes and reduce health system expenditures by delivering services focused on patient-centred care, such as public health screening and medication therapy management. Objectives To assess the understanding of the proposed strategic and health system reform in Saudi Arabia by exploring community pharmacists' perspectives towards the capacity and readiness of community pharmacies to use automated pharmacy systems, provide extended community pharmacy services, and identify perceived barriers. Materials and methods This multicentre, cross-sectional, web-based survey was conducted in Saudi Arabia (October-December 2021). Graphical and numerical statistics were used to describe key dimensions by the background and characteristics of the respondents, and multiple ordinal logistic regression analyses were sought to assess their associations. Results Of the 403 consenting and participating community pharmacists, most were male (94%), belonged to chain pharmacies (77%), and worked >48 h per week (72%). Automated pharmacy systems, such as electronic prescriptions, were never utilised (50%), and health screening services, such as blood glucose (76%) and blood pressure measurement (74%), were never provided. Services for medication therapy management were somewhat limited. Age groups ≤40 years, chain pharmacies, >10 years of experience and ≥ 3 pharmacists in place with <100 daily medication prescriptions and Jazan province were significantly more likely to provide all medication therapy management services than others. Operational factors were the barriers most significantly associated with the independent variables. Conclusion The results showed that most services and automated pharmacy systems remained limited and well-needed. When attempting to implement these services to drive change, community pharmacies face numerous challenges, and urgent efforts by private and government sectors are essential to improve pharmaceutical care in community pharmacy settings.
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Affiliation(s)
- Khalid S. Alghamdi
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Faculty of Clinical Pharmacy, Al Baha University, Al Baha, Saudi Arabia
| | - Max Petzold
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
| | - Mahdi H. Alsugoor
- Department of Emergency Medical Services, Faculty of Health Sciences, Al-Qunfudah, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hafiz A. Makeen
- Clinical Pharmacy Department, College of Pharmacy, Jazan University, Jazan, Saudi Arabia
| | - Kudaisi H. Al Monif
- Medical Supply Department, Najran Health Affairs, Ministry of Health, Najran, Saudi Arabia
| | - Laith Hussain-Alkhateeb
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Sweden
- Population Health Research Section, King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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16
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Eastment MC, Wanje G, Richardson BA, Mwaringa E, Patta S, Sherr K, Barnabas RV, Mandaliya K, Jaoko W, Mcclelland RS. Results of a cluster randomized trial testing the Systems Analysis and Improvement Approach to increase cervical cancer screening in family planning clinics in Mombasa County, Kenya. Implement Sci 2023; 18:66. [PMID: 38012647 PMCID: PMC10680234 DOI: 10.1186/s13012-023-01322-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer death in Kenyan women. Integrating cervical cancer screening into family planning (FP) clinics is a promising strategy to improve health for reproductive-aged women. The objective of this cluster randomized trial was to test the efficacy of an implementation strategy, the Systems Analysis and Improvement Approach (SAIA), as a tool to increase cervical cancer screening in FP clinics in Mombasa County, Kenya. METHODS Twenty FP clinics in Mombasa County were randomized 1:1 to SAIA versus usual procedures. SAIA has five steps: (1) cascade analysis tool to understand the cascade and identify inefficiencies, (2) sequential process flow mapping to identify bottlenecks, (3) develop and implement workflow modifications (micro-interventions) to address identified bottlenecks, (4) assess the micro-intervention in the cascade analysis tool, and (5) repeat the cycle. Prevalence ratios were calculated using Poisson regression with robust standard errors to compare the proportion of visits where women were screened for cervical cancer in SAIA clinics compared to control clinics. RESULTS In the primary intent-to-treat analysis in the last quarter of the trial, 2.5% (37/1507) of visits with eligible FP clients at intervention facilities included cervical cancer screening compared to 3.7% (66/1793) in control clinics (prevalence ratio [PR] 0.67, 95% CI 0.45-1.00). When adjusted for having at least one provider trained to perform cervical cancer screening at baseline, there was no significant difference between screening in intervention clinics compared to control clinics (adjusted PR 1.14, 95% CI 0.74-1.75). CONCLUSIONS The primary analysis did not show an effect on cervical cancer screening. However, the COVID-19 pandemic and a healthcare worker strike likely impacted SAIA's implementation with significant disruptions in FP care delivery during the trial. While SAIA's data-informed decision-making and clinic-derived solutions are likely important, future work should directly study the mechanisms through which SAIA operates and the influence of contextual factors on implementation. TRIAL REGISTRATION ClinicalTrials.gov, NCT03514459. Registered on April 19, 2018.
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Affiliation(s)
- McKenna C Eastment
- Departments of Medicine, University of Washington, Seattle, WA, 98104, USA.
| | - George Wanje
- Global Health, University of Washington, Seattle, WA, USA
| | - Barbra A Richardson
- Global Health, University of Washington, Seattle, WA, USA
- Biostatistics, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Shem Patta
- Mombasa County Department of Health, Mombasa, Kenya
| | - Kenneth Sherr
- Global Health, University of Washington, Seattle, WA, USA
| | - Ruanne V Barnabas
- Departments of Medicine, University of Washington, Seattle, WA, 98104, USA
- Global Health, University of Washington, Seattle, WA, USA
- Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Walter Jaoko
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
| | - R Scott Mcclelland
- Departments of Medicine, University of Washington, Seattle, WA, 98104, USA
- Global Health, University of Washington, Seattle, WA, USA
- Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medical Microbiology and Immunology, University of Nairobi, Nairobi, Kenya
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Priyambada Mitra T, Djerboua M, Mahmood S, Nettel-Aguirre A, Caird JK, Emery C, Hagel B, Russell K. Effectiveness of an injury prevention video on risky behaviours in youth snow sports: A randomized controlled trial. Paediatr Child Health 2023; 28:404-410. [PMID: 37885602 PMCID: PMC10599488 DOI: 10.1093/pch/pxad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/13/2023] [Indexed: 10/28/2023] Open
Abstract
Objectives Ski and snowboard-related injuries are common among Canadian youth. Analyzing the role of risky behaviours that contribute to injury risk is essential for gaining an understanding of injury prevention opportunities. The objective was to determine if rates of risky behaviour seen at the ski hill were lower for children and adolescents exposed to an educational injury prevention video. Methods This single-blinded cluster randomized controlled trial included students (ages 7-16) from 18 Calgary schools who were enrolled in novice levelled school-sanctioned ski and snowboard programs. Consenting schools were randomly assigned to the intervention or control. The control group followed standard preparation including watching a general ski hill orientation video that was created by the ski hill. The intervention group viewed the intervention video focussed on injury prevention. The Risky Behaviour and Actions Assessment Tool was used by blinded research assistants to observe and record students' risky behaviours at an Alberta ski hill. Results In total, 407 observations estimated the rate of risky behaviour. The overall rate of risky behaviour was 23.31/100 person runs in the control group and 22.95/100 person runs in the intervention group. The most commonly observed risky behaviours in both groups were skiing too close to other skiers/snowboarders and near collision with an object/person. Conclusions Both groups showed similar rates of risky behaviour and demonstrated the same most common type of behaviour. Practical applications: future work should focus on mitigating common risky behaviours.
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Affiliation(s)
- Tatum Priyambada Mitra
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta
- MD Program, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Maya Djerboua
- Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Sheharzad Mahmood
- MD Program, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, University of Calgary, Calgary, Alberta
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta
- School of Mathematics and Applied Statistics, University of Wollongong, Australia
| | - Jeff K Caird
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta
- Department of Psychology, University of Calgary, Calgary, Alberta
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta
- Department of Pediatrics, University of Calgary, Calgary, Alberta
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Brent Hagel
- Sport Injury Prevention Research Centre, University of Calgary, Calgary, Alberta
- Department of Pediatrics, University of Calgary, Calgary, Alberta
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, Alberta
- O’Brien Institute of Public Health, University of Calgary, Calgary, Alberta
| | - Kelly Russell
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba
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Oporia F, Kibira SPS, Jagnoor J, Kobusingye O, Makumbi FE, Isunju JB, Nuwaha F. Peer-led training improves lifejacket wear among occupational boaters: Evidence from a cluster randomized controlled trial on Lake Albert, Uganda. PLoS One 2023; 18:e0292754. [PMID: 37862363 PMCID: PMC10588873 DOI: 10.1371/journal.pone.0292754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/21/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND The burden of drowning among occupational boaters in low and middle-income countries is highest globally. In Uganda, over 95% of people who drowned from boating-related activities were not wearing lifejackets at the time of the incident. We implemented and evaluated a peer-led training program to improve lifejacket wear among occupational boaters on Lake Albert, Uganda. METHODS We conducted a two-arm cluster randomized controlled trial in which fourteen landing sites were randomized to the intervention and non-intervention arm with a 1:1 allocation ratio. In the intervention arm, a six-month peer-to-peer training program on lifejacket wear was implemented while the non-intervention arm continued to receive the routine Marine Police sensitizations on drowning prevention through its community policing program. The effect of the intervention was assessed on self-reported and observed lifejacket wear using a test of differences in proportions of wear following the intention to treat principle. The effect of contamination was assessed using mixed effect modified Poisson regression following the As Treated analysis principle at 95% CI. Results are reported according to the CONSORT statement-extension for cluster randomized trials. RESULTS Self-reported lifejacket wear increased markedly from 30.8% to 65.1% in the intervention arm compared to the non-intervention arm which rose from 29.9% to 43.2%. Observed wear increased from 1.0% to 26.8% in the intervention arm and from 0.6% to 8.8% in the non-intervention arm. The test of differences in proportions of self-reported lifejacket wear (65.1%- 43.2% = 21.9%, p-value <0.001) and observed wear (26.8%- 8.8% = 18%, p-value <0.001) showed statistically significant differences between the intervention and non-intervention arm. Self-reported lifejacket wear was higher among boaters who received peer training than those who did not (Adj. PR 1.78, 95% CI 1.38-2.30). CONCLUSION This study demonstrated that peer-led training significantly improves lifejacket wear among occupational boaters. The government of Uganda through the relevant ministries, and the Landing Site Management Committees should embrace and scale up peer-led training programs on lifejacket wear to reduce drowning deaths.
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Affiliation(s)
- Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Simon P. S. Kibira
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Jagnoor Jagnoor
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- The George Institute for Global Health, University of New South Wales, Camperdown, New South Wales, Australia
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - John Bosco Isunju
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Nuwaha
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Borchardt MA, Kieke BA, Spencer SK, Lambertini E, Burch TR, Loge FJ. Community intervention trial for estimating risk of acute gastrointestinal illness from groundwater-supplied non-disinfected drinking water. JOURNAL OF WATER AND HEALTH 2023; 21:1209-1227. [PMID: 37756190 PMCID: wh_2023_071 DOI: 10.2166/wh.2023.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
By community intervention in 14 non-disinfecting municipal water systems, we quantified sporadic acute gastrointestinal illness (AGI) attributable to groundwater. Ultraviolet (UV) disinfection was installed on all supply wells of intervention communities. In control communities, residents continued to drink non-disinfected groundwater. Intervention and control communities switched treatments by moving UV disinfection units at the study midpoint (crossover design). Study participants (n = 1,659) completed weekly health diaries during four 12-week surveillance periods. Water supply wells were analyzed monthly for enteric pathogenic viruses. Using the crossover design, groundwater-borne AGI was not observed. However, virus types and quantity in supply wells changed through the study, suggesting that exposure was not constant. Alternatively, we compared AGI incidence between intervention and control communities within the same surveillance period. During Period 1, norovirus contaminated wells and AGI attributable risk from well water was 19% (95% CI, -4%, 36%) for children <5 years and 15% (95% CI, -9%, 33%) for adults. During Period 3, echovirus 11 contaminated wells and UV disinfection slightly reduced AGI in adults. Estimates of AGI attributable risks from drinking non-disinfected groundwater were highly variable, but appeared greatest during times when supply wells were contaminated with specific AGI-etiologic viruses.
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Affiliation(s)
- Mark A Borchardt
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA; Current address: USDA-ARS, U.S. Dairy Forage Research Center, Environmentally Integrated Dairy Management Research Unit, Marshfield, WI, USA E-mail:
| | - Burney A Kieke
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, WI, USA
| | - Susan K Spencer
- National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield, WI, USA; Current address: USDA-ARS, U.S. Dairy Forage Research Center, Environmentally Integrated Dairy Management Research Unit, Marshfield, WI, USA
| | - Elisabetta Lambertini
- Department of Civil and Environmental Engineering, University of California, Davis, CA, USA; Current address: Global Alliance for Improved Nutrition, Washington, DC, USA
| | - Tucker R Burch
- U.S. Dairy Forage Research Center, U.S. Department of Agriculture - Agricultural Research Service, Marshfield, WI, USA
| | - Frank J Loge
- Department of Civil and Environmental Engineering, University of California, Davis, CA, USA
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Zenebe GA, Alemu W, Yehualashet D, Nakachew M. Improving data use in decision-making and utilization of maternal healthcare services through a data-informed platform for health approaches in districts of the Gedeo Zone, southern Ethiopia, 2023: a cluster-randomized control trial. FRONTIERS IN HEALTH SERVICES 2023; 3:1125399. [PMID: 37670893 PMCID: PMC10475933 DOI: 10.3389/frhs.2023.1125399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 08/07/2023] [Indexed: 09/07/2023]
Abstract
Background In low-resource countries such as Ethiopia, the utilization of local data for planning and decision-making health systems was frequently constrained. In addition, despite several government initiatives, maternal health services were not completely utilized. On the other hand, efforts to effectively utilize the local data available to improve the utilization level of maternal healthcare services were insufficient, necessitating the need for a different approach. Objective This implementation study aims to test and validate the effectiveness of a data-informed platform for health (DIPH) strategies on data use for decision-making and utilization of maternal health services in districts of the Gedeo Zone, southern Ethiopia. Methods A two-arm parallel group, type II hybrid, cluster-randomized control trial design has been implemented to conduct the study between 1 September 2022 and 29 February 2024. Six woredas/districts have been assigned to the intervention arm and the other six to the control arm. Baseline and end-line data have been collected from 120 eligible health management staff (from both intervention arm and control arm). In the intervention arm, district health management staff have been given specialized training and continuous technical assistance as a package called the DIPH strategy by embedding it with the district's current decision-making platform such as Performance Review Team meetings. The DIPH strategy has mainly focused on five-step approaches such as situational assessment, stakeholder engagement, defining/setting priorities, planning, and follow-up. Health management staff in the control arm have performed their regular daily activities. The χ2 and t-tests have been used to check the effect of the intervention. In addition, difference-in-differences estimates have been calculated because the change may inherently occur over time. A P-value of <0.05 and a 95% confidence interval have been used to declare the significance of the intervention. Discussion The findings of this study were supposed to give insights into implementation strategies that improve data use in decision-making and utilization of maternal healthcare services at the woreda level and uncover contextual factors that boost the response of these strategies.
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Affiliation(s)
- Getachew Assefa Zenebe
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Wagaye Alemu
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Daniel Yehualashet
- Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Mequanint Nakachew
- School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
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21
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Shrestha R, Sapkota D, Mehra D, Ekström AM, Deuba K. Feasibility and Effectiveness of an Intervention to Reduce Intimate Partner Violence and Psychological Distress Among Women in Nepal: Protocol for the Domestic Violence Intervention (DeVI) Cluster-Randomized Trial. JMIR Res Protoc 2023; 12:e45917. [PMID: 37581909 PMCID: PMC10466145 DOI: 10.2196/45917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) disproportionately affects people in low-and middle-income countries (LMICs), such as Nepal. Women experiencing IPV are at higher risk of developing depression, anxiety, and posttraumatic stress disorder. The shortage of trained frontline health care providers, coupled with stigma related to IPV and mental health disorders, fuels low service uptake among women experiencing IPV. The Domestic Violence Intervention (DeVI) combines the Problem Management Plus counseling program developed by the World Health Organization with a violence prevention component. OBJECTIVE This study aims to implement and evaluate the feasibility, acceptability, and effectiveness of DeVI in addressing psychological distress and enabling the secondary prevention of violence for women experiencing IPV. METHODS A parallel cluster-randomized trial will be conducted across 8 districts in Madhesh Province in Nepal, involving 24 health care facilities. The study will include women aged 18-49 years who are either nonpregnant or in their first trimester, have experienced IPV within the past 12 months, have a 12-item General Health Questionnaire (GHQ-12) score of 3 or more (indicating current mental health issues), and have lived with their husbands or in-laws for at least 6 months. A total sample size of 912 was estimated at 80% power and α<.05 statistical significance level to detect a 15% absolute risk reduction in the IPV frequency and a 50% reduction in the GHQ-12 score in the intervention arm. The health care facilities will be randomly assigned to either the intervention or the control arm in a 1:1 ratio. Women visiting the health care facilities in the intervention and control arms will be recruited into the respective arms. In total, 38 participants from each health care facility will be included in the trial to meet the desired sample size. Eligible participants allocated to either arm will be assessed at baseline and follow-up visits after 6, 17, and 52 weeks after baseline. RESULTS This study received funding in 2019. As of December 29, 2022, over 50% of eligible women had been recruited from both intervention and control sites. In total, 269 eligible women have been enrolled in the intervention arm and 309 eligible women in the control arm. The trial is currently in the recruitment phase. Data collection is expected to be completed by December 2023, after which data analysis will begin. CONCLUSIONS If the intervention proves effective, it will provide evidence of how nonspecialist mental health care providers can address the harmful effects of IPV in resource-constrained settings with a high burden of IPV, such as Nepal. The study findings could also contribute evidence for integrating similar services into routine health programs in LMICs to prevent IPV and manage mental health problems among women experiencing IPV. TRIAL REGISTRATION ClinicalTrials.gov NCT05426863; https://clinicaltrials.gov/ct2/show/NCT05426863. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45917.
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Affiliation(s)
- Rachana Shrestha
- Public Health and Environment Research Center, Lalitpur, Nepal
- Knowledge to Action, Lalitpur, Nepal
| | | | - Devika Mehra
- Mamta Health Institute for Mother and Child, New Delhi, India
- Medeon Science Park, Malmo, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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22
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Ruel T, Mwangwa F, Balzer LB, Ayieko J, Nyabuti M, Mugoma WE, Kabami J, Kamugisha B, Black D, Nzarubara B, Opel F, Schrom J, Agengo G, Nakigudde J, Atuhaire HN, Schwab J, Peng J, Camlin C, Shade SB, Bukusi E, Kapogiannis BG, Charlebois E, Kamya MR, Havlir D. A multilevel health system intervention for virological suppression in adolescents and young adults living with HIV in rural Kenya and Uganda (SEARCH-Youth): a cluster randomised trial. Lancet HIV 2023; 10:e518-e527. [PMID: 37541706 PMCID: PMC11158418 DOI: 10.1016/s2352-3018(23)00118-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/11/2023] [Accepted: 05/17/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Social and cognitive developmental events can disrupt care and medication adherence among adolescents and young adults living with HIV in sub-Saharan Africa. We hypothesised that a dynamic multilevel health system intervention helping adolescents and young adults and their providers navigate life-stage related events would increase virological suppression compared with standard care. METHODS We did a cluster randomised, open-label trial of young individuals aged 15-24 years with HIV and receiving care in eligible clinics (operated by the government and with ≥25 young people receiving care) in rural Kenya and Uganda. After clinic randomisation stratified by region, patient population, and previous participation in the SEARCH trial, participants in intervention clinics received life-stage-based assessment at routine visits, flexible clinic access, and rapid viral load feedback. Providers had a secure mobile platform for interprovider consultation. The control clinics followed standard practice. The primary, prespecified endpoint was virological suppression (HIV RNA <400 copies per mL) at 2 years of follow-up among participants who enrolled before Dec 1, 2019, and received care at the study clinics. This trial is registered with ClinicalTrials.gov, NCT03848728, and is closed to recruitment. FINDINGS 28 clinics were enrolled and randomly assigned (14 control, 14 intervention) in January, 2019. Between March 14, 2019, and Nov 26, 2020, we recruited 1988 participants at the clinics, of whom 1549 were included in the analysis (785 at intervention clinics and 764 at control clinics). The median participant age was 21 years (IQR 19-23) and 1248 (80·6%) of 1549 participants were female. The mean proportion of participants with virological suppression at 2 years was 88% (95% CI 85-92) for participants in intervention clinics and 80% (77-84) for participants in control clinics, equivalent to a 10% beneficial effect of the intervention (risk ratio [RR] 1·10, 95% CI 1·03-1·16; p=0·0019). The intervention resulted in increased virological suppression within all subgroups of sex, age, and care status at baseline, with greatest improvement among those re-engaging in care (RR 1·60, 95% CI 1·00-2·55; p=0·025). INTERPRETATION Routine and systematic life-stage-based assessment, prompt adherence support with rapid viral load testing, and patient-centred, flexible clinic access could help bring adolescents and young adults living with HIV closer towards a goal of universal virological suppression. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health.
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Affiliation(s)
- Theodore Ruel
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Laura B Balzer
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | | | | | | | - Jane Kabami
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | | | - Douglas Black
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Fred Opel
- Kenya Medical Research Institute, Kisumu, Kenya
| | - John Schrom
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | - Janet Nakigudde
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Josh Schwab
- Division of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA
| | - James Peng
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Carol Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Starley B Shade
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | | - Bill G Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Edwin Charlebois
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Moses R Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Diane Havlir
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Lempesi E, Pandis N, Faggion C, Seehra J. Is clustering accounted for in studies published in periodontology and oral implantology specialty journals? J Periodontol 2023; 94:967-975. [PMID: 36799353 DOI: 10.1002/jper.22-0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/27/2023] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Clustering effects can be encountered in periodontology and implant dentistry research. The aim of this study was to identify studies with clustering effects published in periodontology and oral implantology specialty journals and to assess the frequency by which clustered designs are correctly accounted for in the statistical analysis. METHODS Ten periodontology and oral implantology journals were searched to identify studies with clustering effects published between January 1, 2019 and July 31, 2021. Descriptive statistics and frequency distributions were calculated. Associations between the correct statistical handling of clustering effects and study characteristics were explored. RESULTS A total of 695 studies were included of which 45.0% correctly accounted for clustering effects in the statistical analysis. Certain journals (p < 0.01) and animal studies (p < 0.01) had lower odds of correctly accounting for clustering effects in the statistical analysis, whereas per unit increase in impact factor (p < 0.001), involvement of statistician (p < 0.001) and when the study design included either repeated measures only (p < 0.01) or both clustering and repeated measures (p < 0.001) had higher odds. The most commonly used tests were the mixed models or generalized estimating equations (64.2%). CONCLUSIONS Greater awareness of the importance of accounting for clustering effects is required to prevent incorrect inferences being drawn. Incorrect inferences are related to lack of data independence and the artificial inflation of the sample size which can result in statistically significant results which are not genuine. This issue can be further exaggerated in combination with publication bias.
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Affiliation(s)
- Evangelia Lempesi
- Department of Orthodontics and Dentofacial Orthopedics, Hellenic Air Force General, Hospital, Athens, Greece
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, School of Dentistry, University of Bern, Bern, Switzerland
| | - Clovis Faggion
- Department of Periodontology and Operative Dentistry, Faculty of Dentistry, University Hospital Münster, Münster, Germany
| | - Jadbinder Seehra
- Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, London, United Kingdom
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Zerdo Z, Bastiaens H, Anthierens S, Massebo F, Masne M, Biresaw G, Shewangizaw M, Tunje A, Chisha Y, Yohannes T, Van Geertruyden JP. Effect of malaria prevention education on bed net utilization, incidence of malaria and treatment seeking among school-aged children in Southern Ethiopia; cluster randomized controlled trial. BMC Infect Dis 2023; 23:486. [PMID: 37474930 PMCID: PMC10360348 DOI: 10.1186/s12879-023-08464-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/15/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND School-aged children (SAC) have an increased risk to contract malaria and play a major role in its transmission dynamics. However, their malaria prevention experience is poor. Thus, the effect of malaria prevention education (MPE) on bed net utilization, treatment seeking from a health facility and cumulative incidence of malaria was evaluated in Southern Ethiopia. METHODS A two arm cluster randomized controlled trial was conducted by recruiting 2038 SAC from 32 schools. Structured questionnaire was used to collect data on socio-demographic, economic, bed net ownership, bed net utilization, whether the participated child suffered from malaria and has got treatment from a health facility. Generalized mixed effect logistic regression using school as random variable was used to assess the effect of the intervention on the outcome variables. RESULTS The ownership of bed net in households of the control and intervention schools was similar respectively with 84.6 and 88.6% (Crude Odds Ratio (COR): 1.5; 95%CI: 0.5-4.8). The percentage of SAC slept under the bed net the night before the survey was also similar (55.1% versus 54.0%); COR:1.04; 95%CI: 0.5-2.4). Bed net utilization was affected by household size to the bed net ratio ≤ 2 (Adjusted Odds Ratio (AOR) = 1.6; 95%CI:1.3-2.1), bed net utilization at baseline of the study (AOR = 2.3; 95%CI:1.5-3.6), and history of malaria attack in the last twelve months (AOR = 1.3; 95%CI:1.01-1.8). Reported cumulative incidence of malaria and treatment seeking from a health facility by SAC was similar between intervention and control arms: -2.1% (COR = 0.8; 95%CI: 0.5-1.5) and 9.6% (COR = 1.4; 95%CI: 0.4-4.3) respectively. The reported incidence of malaria was affected by altitude (AOR = 0.5; 95%CI: 0.3-0.8), low and medium wealth index (AOR = 0.7; 95%CI: 0.5-0.96 and AOR = 0.7; 95%CI: 0.5-0.98), adequate bed net number for household members (AOR = 0.7; 95%CI:0.5-0.9) and bed net utilization (AOR = 1.3; 95%CI:1.1-1.8). CONCLUSIONS MPE had no significant effect on the use of malaria prevention measures considered, treatment seeking from a health facility and reported cumulative incidence of malaria though bed net use was associated with malaria incidence. Before organizing any health education program, sustainable implementation efforts have to be warranted especially in SAC, a neglected but relevant vulnerable and reservoirs. TRIAL REGISTRATION Pan African Clinical Trials Registry PACTR202001837195738, registered 21/01/2020.
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Affiliation(s)
- Zerihun Zerdo
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Hilde Bastiaens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of family medicine and population health, Antwerp University, Antwerp, Belgium
| | - Fekadu Massebo
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Matewos Masne
- Department of Biology, College of Natural Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Gelila Biresaw
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Misgun Shewangizaw
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abayneh Tunje
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Yilma Chisha
- Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tsegaye Yohannes
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
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Wu Y, Min H, Li M, Shi Y, Ma A, Han Y, Gan Y, Guo X, Sun X. Effect of Artificial Intelligence-based Health Education Accurately Linking System (AI-HEALS) for Type 2 diabetes self-management: protocol for a mixed-methods study. BMC Public Health 2023; 23:1325. [PMID: 37434126 DOI: 10.1186/s12889-023-16066-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/06/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patients with type 2 diabetes (T2DM) have an increasing need for personalized and Precise management as medical technology advances. Artificial intelligence (AI) technologies on mobile devices are being developed gradually in a variety of healthcare fields. As an AI field, knowledge graph (KG) is being developed to extract and store structured knowledge from massive data sets. It has great prospects for T2DM medical information retrieval, clinical decision-making, and individual intelligent question and answering (QA), but has yet to be thoroughly researched in T2DM intervention. Therefore, we designed an artificial intelligence-based health education accurately linking system (AI-HEALS) to evaluate if the AI-HEALS-based intervention could help patients with T2DM improve their self-management abilities and blood glucose control in primary healthcare. METHODS This is a nested mixed-method study that includes a community-based cluster-randomized control trial and personal in-depth interviews. Individuals with T2DM between the ages of 18 and 75 will be recruited from 40-45 community health centers in Beijing, China. Participants will either receive standard diabetes primary care (SDPC) (control, 3 months) or SDPC plus AI-HEALS online health education program (intervention, 3 months). The AI-HEALS runs in the WeChat service platform, which includes a KBQA, a system of physiological indicators and lifestyle recording and monitoring, medication and blood glucose monitoring reminders, and automated, personalized message sending. Data on sociodemography, medical examination, blood glucose, and self-management behavior will be collected at baseline, as well as 1,3,6,12, and 18 months later. The primary outcome is to reduce HbA1c levels. Secondary outcomes include changes in self-management behavior, social cognition, psychology, T2DM skills, and health literacy. Furthermore, the cost-effectiveness of the AI-HEALS-based intervention will be evaluated. DISCUSSION KBQA system is an innovative and cost-effective technology for health education and promotion for T2DM patients, but it is not yet widely used in the T2DM interventions. This trial will provide evidence on the efficacy of AI and mHealth-based personalized interventions in primary care for improving T2DM outcomes and self-management behaviors. TRIAL REGISTRATION Biomedical Ethics Committee of Peking University: IRB00001052-22,058, 2022/06/06; Clinical Trials: ChiCTR2300068952, 02/03/2023.
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Affiliation(s)
- Yibo Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Hewei Min
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Mingzi Li
- School of Nursing, Peking University, Beijing, China
| | - Yuhui Shi
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Aijuan Ma
- Beijing Center for Disease Control and Prevention, Beijing, China
| | - Yumei Han
- Beijing Medical Examination Center, Beijing, China
| | - Yadi Gan
- Daxing District Center for Disease Control and Prevention of Beijing, Beijing, China
| | - Xiaohui Guo
- Peking University First Hospital, Beijing, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
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Kulwa KBM, Mamiro PS, Kolsteren PW. Nutrition Education Package Focusing on Infant and Young Child Feeding in Tanzania. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:493-508. [PMID: 37245148 DOI: 10.1016/j.jneb.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of a nutrition education package on feeding practices, nutrient intakes and growth of infants in rural Tanzania. DESIGN Cluster-randomized controlled trial in 18 villages allocated to nutrition education package (n = 9) or routine health education (n = 9 villages), measured at baseline (6 months) and end of the trial (12 months). SETTING Mpwapwa district. PARTICIPANTS Infants aged 6-12 months and their mothers. INTERVENTION(S) Six months of nutrition education package (group education, counseling, cooking demonstrations) and regular home visits by village health workers. MAIN OUTCOME MEASURE(S) Primary outcome measure was the mean change in length-for-age z-scores. Secondary outcomes included mean changes in weight-for-length z-scores (WLZ), intakes of energy, fat, iron and zinc, the proportion of children consuming foods from ≥ 4 food groups (ie, dietary diversity) and consuming the recommended number of semisolid/soft meals and snacks per day (ie, meal frequency). ANALYSIS Multilevel mixed-effects regression models. RESULTS Mean change in length-for-age z-scores (β = 0.20, P = 0.02), energy (in kcal) (β = 43.8, P = 0.02), and fat (in grams) (β =2.7, P = 0.03) intakes were significant in the intervention but not in the control group. There was no effect on iron and zinc intakes. More infants in the intervention than the control group consumed meals from ≥ 4 food groups (71.8% vs 45.3%, P = 0.002). The mean increase in meal frequency (β = 0.29, P = 0.02) and dietary diversity (β = 0.40, P = 0.01) were more significant in the intervention than control. CONCLUSIONS AND IMPLICATIONS The nutrition education package is feasible and can be implemented with high coverage, demonstrating the potential to improve feeding practices, nutrient intake and growth in rural Tanzania.
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Affiliation(s)
- Kissa B M Kulwa
- Department of Human Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania.
| | - Peter S Mamiro
- Department of Human Nutrition and Consumer Sciences, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Patrick W Kolsteren
- Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
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Alam NH, Faruque AS, Ashraf H, Chisti MJ, Ahmed T, Sultana M, Khalequzzaman M, Ali S, Ahmed S, Nasrin S, Tariqujjaman M, Haque KE, Amin R, Mollah AH, Kabir L, Shahidullah M, Khanam W, Islam K, Kim M, Vandenent M, Duke T, Gyr N, Fuchs GJ. Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trial. EClinicalMedicine 2023; 60:102023. [PMID: 37304498 PMCID: PMC10250158 DOI: 10.1016/j.eclinm.2023.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2-59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, -3.9 percentage point; 95% confidence interval (CI), -4.8 to -1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.
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Affiliation(s)
- Nur H. Alam
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Abu S. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Hasan Ashraf
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Shahjahan Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Ruhul Amin
- Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Lutful Kabir
- Sir Salimullah Medical College Hospital, Dhaka, Bangladesh
| | | | - Wahida Khanam
- Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh
| | - Khaleda Islam
- Primary Health Care, Ministry of Health and Family Planning, Government of Bangladesh, Bangladesh
| | | | | | - Trevor Duke
- Melbourne Children Hospital, Melbourne, Australia
| | | | - George J. Fuchs
- College of Medicine and College of Public Health, University of Kentucky, USA
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Younoussa A, Samidine SN, Bergeman AT, Piubello A, Attoumani N, Grillone SH, Braet SM, Tsoumanis A, Baco A, Mzembaba A, Salim Z, Amidy M, Grillone S, Snijders R, Corstjens P, Ortuno-Gutierrez N, Hoof C, Geluk A, de Jong BC, Hasker E. Protocol, rationale and design of BE-PEOPLE (Bedaquiline enhanced exposure prophylaxis for LEprosy in the Comoros): a cluster randomized trial on effectiveness of rifampicin and bedaquiline as post-exposure prophylaxis of leprosy contacts. BMC Infect Dis 2023; 23:310. [PMID: 37161571 PMCID: PMC10169125 DOI: 10.1186/s12879-023-08290-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Leprosy is an ancient infectious disease with an annual global incidence of around 200,000 over the past decade. Since 2018, the World Health Organization (WHO) recommends single-dose rifampicin as post-exposure prophylaxis (SDR-PEP) for contacts of leprosy patients. The Post ExpOsure Prophylaxis for Leprosy (PEOPLE) trial evaluated PEP with a double dose of rifampicin in Comoros and Madagascar. Preliminary results of this trial show some reduction in leprosy incidence in intervention villages but a stronger regimen may be beneficial. The objective of the current Bedaquiline Enhanced ExpOsure Prophylaxis for LEprosy trial (BE-PEOPLE) is to explore effectiveness of a combination of bedaquiline and rifampicin as PEP. METHODS BE-PEOPLE is a cluster-randomized trial in which 44 clusters in Comoros will be randomized to two study arms. Door-to-door screening will be conducted annually during four years, leprosy patients identified will be offered standard of care treatment. Based on study arm, contacts aged five years and above and living within a 100-meter radius of an index case will either receive bedaquiline (400-800 mg) and rifampicin (150-600 mg) or only rifampicin (150-600 mg). Contacts aged two to four years will receive rifampicin only. Household contacts randomized to the bedaquiline plus rifampicin arm will receive a second dose four weeks later. Incidence rate ratios of leprosy comparing contacts who received either of the PEP regimens will be the primary outcome. We will monitor resistance to rifampicin and/or bedaquiline through molecular surveillance in all incident tuberculosis and leprosy patients nationwide. At the end of the study, we will assess anti-M. leprae PGL-I IgM seropositivity as a proxy for the population burden of M. leprae infection in 8 villages (17,000 individuals) that were surveyed earlier as part of the PEOPLE trial. DISCUSSION The COLEP trial on PEP in Bangladesh documented a reduction of 57% in incidence of leprosy among contacts treated with SDR-PEP after two years, which led to the WHO recommendation of SDR-PEP. Preliminary results of the PEOPLE trial show a lesser reduction in incidence. The BE-PEOPLE trial will explore whether reinforcing SDR-PEP with bedaquiline increases effectiveness and more rapidly reduces the incidence of leprosy, compared to SDR-PEP alone. TRIAL REGISTRATION NCT05597280. Protocol version 5.0 on 28 October 2022.
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Affiliation(s)
- Assoumani Younoussa
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Said Nourdine Samidine
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Auke T Bergeman
- Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Nissad Attoumani
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Silahi Halifa Grillone
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | | | | | - Abdallah Baco
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Aboubacar Mzembaba
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Zahara Salim
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Mohamed Amidy
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | - Saverio Grillone
- National Tuberculosis and Leprosy control Program, The Union of Comoros, Moroni, Comoros
| | | | - Paul Corstjens
- Leiden University Medical Center, Leiden, the Netherlands
| | - Nimer Ortuno-Gutierrez
- Damien Foundation, Brussels, Belgium.
- Programs Department, Damien Foundation, Brussels, Belgium.
| | | | | | | | - Epco Hasker
- Institute of Tropical Medicine, Antwerp, Belgium
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Capone D, Bivins A, Brown J. Producing ratio measures of effect with quantitative microbial risk assessment. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023. [PMID: 35689350 DOI: 10.17605/osf.io/jwzy9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Estimating the risk of infections or other outcomes incident to pathogen exposure is a primary goal of quantitative microbial risk assessment (QMRA). Such estimates are useful to predict population-level risks, to evaluate exposures based on normative or tolerable risk guidelines, and to interpret the likely public health relevance of microbial measurements in environmental media. To evaluate alternative control measures (interventions), ratio estimates of effect (e.g., odds and risk ratios) are needed that are more broadly interpretable in the health sciences and consistent with convention in epidemiology. In this paper, we propose a general method for estimating widely used ratio measures of effect derived from stochastic QMRA approaches, including the generation of appropriate confidence intervals. Such QMRA-derived ratios can be used as a basis for evaluating interventions via hypothesis testing and for inclusion in systematic reviews and meta-analyses in a form consistent with risk estimation approaches commonly used in epidemiology.
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Affiliation(s)
- Drew Capone
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aaron Bivins
- Department of Civil & Environmental Engineering, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Joe Brown
- Department of Environmental Sciences and Engineering, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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30
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Capone D, Bivins A, Brown J. Producing ratio measures of effect with quantitative microbial risk assessment. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:917-927. [PMID: 35689350 PMCID: PMC9734285 DOI: 10.1111/risa.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 05/06/2023]
Abstract
Estimating the risk of infections or other outcomes incident to pathogen exposure is a primary goal of quantitative microbial risk assessment (QMRA). Such estimates are useful to predict population-level risks, to evaluate exposures based on normative or tolerable risk guidelines, and to interpret the likely public health relevance of microbial measurements in environmental media. To evaluate alternative control measures (interventions), ratio estimates of effect (e.g., odds and risk ratios) are needed that are more broadly interpretable in the health sciences and consistent with convention in epidemiology. In this paper, we propose a general method for estimating widely used ratio measures of effect derived from stochastic QMRA approaches, including the generation of appropriate confidence intervals. Such QMRA-derived ratios can be used as a basis for evaluating interventions via hypothesis testing and for inclusion in systematic reviews and meta-analyses in a form consistent with risk estimation approaches commonly used in epidemiology.
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Affiliation(s)
- Drew Capone
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Aaron Bivins
- Louisiana State University, Baton Rouge, Louisiana, USA
| | - Joe Brown
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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31
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Kutywayo A, Frade S, Chidumwa G, Mahuma T, Naidoo NP, Mullick S. Experiences of violence among female and male grade eight learners: baseline findings from the Girls Achieve Power (GAP Year) trial across three South African townships. Gates Open Res 2023. [DOI: 10.12688/gatesopenres.13276.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Background: South African adolescents experience disproportionally high rates of violence, with lifelong health, social and economic impacts. Few papers present risk factors associated with experiences of adolescent violence. Methods: A baseline cross-sectional survey was done (April 2017 – Sept 2018) with 3432 grade 8 learners in the Girls Achieve Power (GAP Year) trial from 26 high schools in three townships (Soweto and Tembisa, Gauteng and Khayelitsha, Western Cape). Collected data on lifetime experiences of different types of violence, perpetrators, and place of violence. Descriptive statistics and logistic regression were used to enumerate experiences of, and factors associated with violence. Results: A total of 2383 respondents are included. Most (63.1%) were girls, 81.5% aged 12-14. In total 25.9% had ever experienced violence, higher among boys (p=<0.001). Physical violence was most common (35.7%), then psychological (21.8%), sexual (13.1%), neglect (10.6%), cyberbullying (7.6%), corporal punishment (6.5%) and economic abuse (4.8%). Boys experienced more physical violence (36.0%); girls experienced more psychological violence (22.2%). Gauteng had double the reports of sexual violence (18.4% vs 7.6%, p<0.001). Violence happened most at school (27.4%), followed by the park (19.8%) or their friends’ home (12.9%). Multivariate analysis showed that boys (aOR 1.68; 95% CV 1.32-2.14; p<0.001), those aged 15-17 years (aOR 1.41; 95% CV 1.04-1.89; p=0.025), those who ever used substances (aOR 1.90; 95% CI 1.9-2.28; p<0.001), and those who sometimes feel worthless (aOR 1.33; 95% CI 1.09-1.63, p=0.005) were at higher odds of ever experiencing violence. Those who had ever had sex were more likely to have ever experienced violence (aOR 1.42; 95% CI 1.10-1.83; p=0.008). Conclusion: Urgently need wider adoption, scaling, and sustaining of evidence-based primary violence prevention and structural interventions are required to reduce the high burden of adolescent violence. Stakeholders across the ecological model are needed to tackle harmful cultural norms that perpetuate violence.
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Nicol E, Basera W, Mukumbang FC, Cheyip M, Mthethwa S, Lombard C, Jama N, Pass D, Laubscher R, Bradshaw D. Linkage to HIV Care and Early Retention in Care Rates in the Universal Test-and-Treat Era: A Population-based Prospective Study in KwaZulu-Natal, South Africa. AIDS Behav 2023; 27:1068-1081. [PMID: 36098845 PMCID: PMC10020822 DOI: 10.1007/s10461-022-03844-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/01/2022]
Abstract
HIV linkage, and retention are key weaknesses in South Africa's national antiretroviral therapy (ART) program, with the greatest loss of patients in the HIV treatment pathway occurring before ART initiation. This study investigated linkage-to and early-retention-in-care (LTRIC) rates among adults newly diagnosed with HIV in a high-HIV prevalent rural district. We conducted an observational prospective cohort study to investigate LTRIC rates for adults with a new HIV diagnosis in South Africa. Patient-level survey and clinical data were collected using a one-stage-cluster design from 18 healthcare facilities and triangulated between HIV and laboratory databases and registered deaths from Department of Home Affairs. We used Chi-square tests to assess associations between categorical variables, and results were stratified by HIV status, sex, and age. Of the 5,637 participants recruited, 21.2% had confirmed HIV, of which 70.9% were women, and 46.5% were aged 25-34 years. Although 82.7% of participants were linked-to-care within 3 months, only 46.1% remained-in-care 12 months after initiating ART and 5.2% were deceased. While a significantly higher proportion of men were linked-to-care at 3 months compared to women, a significant proportion of women (49.5%) remained-in-care at 12 months than men (38.0%). Post-secondary education and child support grants were significantly associated with retention. We found high linkage-to-care rates, but less than 50% of participants remained-in-care at 12 months. Significant effort is required to retain people living with HIV in care, especially during the first year after ART initiation. Our findings suggest that interventions could target men to encourage HIV testing.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa.
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa.
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Ferdinand C Mukumbang
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Mireille Cheyip
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | | | - Carl Lombard
- Biostatistics, South African Medical Research Council, Cape Town, South Africa
| | - Ngcwalisa Jama
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
| | - Ria Laubscher
- Biostatistics, South African Medical Research Council, Cape Town, South Africa
| | - Debbie Bradshaw
- Burden of Disease Research Unit, South African Medical Research Council, Tygerberg, 7505, Cape Town, P.O. Box 19070, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Sargeant JM, Ruple A, Selmic LE, O'Connor AM. The standards of reporting trials in pets (PetSORT): Explanation and elaboration. Front Vet Sci 2023; 10:1137781. [PMID: 37065227 PMCID: PMC10103631 DOI: 10.3389/fvets.2023.1137781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Well-designed randomized controlled trials (RCTs) provide the best evidence of the primary research designs for evaluating the effectiveness of interventions. However, if RCTs are incompletely reported, the methodological rigor with which they were conducted cannot be reliably evaluated and it may not be possible to replicate the intervention. Missing information also may limit the reader's ability to evaluate the external validity of a trial. Reporting guidelines are available for clinical trials in human healthcare (CONSORT), livestock populations (REFLECT), and preclinical experimental research involving animals (ARRIVE 2.0). The PetSORT guidelines complement these existing guidelines, providing recommendations for reporting controlled trials in pet dogs and cats. The rationale and scientific background are explained for each of the 25 items in the PetSORT reporting recommendations checklist, with examples from well-reported trials.
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Affiliation(s)
- Jan M. Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Audrey Ruple
- Department of Population Health Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, VA, United States
- *Correspondence: Audrey Ruple
| | - Laura E. Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH, United States
| | - Annette M. O'Connor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
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Jacobsson J, Kowalski J, Timpka T, Hansson PO, Spreco A, Dahlstrom O. Universal prevention through a digital health platform reduces injury incidence in youth athletics (track and field): a cluster randomised controlled trial. Br J Sports Med 2023; 57:364-370. [PMID: 36564148 PMCID: PMC9985750 DOI: 10.1136/bjsports-2021-105332] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To examine whether universal prevention via a digital health platform can reduce the injury incidence in athletics athletes aged 12-15 years and if club size had an influence on the effect of the intervention. METHODS This was a cluster randomised trial where young athletics athletes were randomised through their club following stratification by club size into intervention (11 clubs; 56 athletes) and control (10 clubs; 79 athletes) groups. The primary endpoint was time from baseline to the first self-reported injury. Intervention group parents and coaches were given access to a website with health information adapted to adolescent athletes and were encouraged to log in and explore its content during 16 weeks. The control group continued training as normal. Training exposure and injury data were self-reported by youths/parents every second week, that is, eight times. The primary endpoint data were analysed using the log-rank test. Cox proportional hazards regression was used to analyse the second study aim with intervention status and club size included in the explanatory models. RESULTS The proportion of completed training reports was 85% (n=382) in the intervention group and 86% (n=545) in the control group. The injury incidence was significantly lower (HR=0.62; χ2=3.865; p=0.049) in the intervention group. The median time to first injury was 16 weeks in the intervention group and 8 weeks in the control group. An interaction effect between the intervention and stratification factor was observed with a difference in injury risk between athletes in the large clubs in the intervention group versus their peers in the control group (HR 0.491 (95% CI 0.242 to 0.998); p=0.049). CONCLUSIONS A protective effect against injury through universal access to health information adapted for adolescent athletes was observed in youth athletics athletes. The efficacy of the intervention was stronger in large clubs. TRIAL REGISTRATION NUMBER NCT03459313.
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Affiliation(s)
- Jenny Jacobsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | | | - Toomas Timpka
- Athletics Research Center, Linkoping University, Linkoping, Sweden.,Medical Committee, Swedish Athletics, Stockholm, Sweden
| | | | - Armin Spreco
- Athletics Research Centre, Linköping University, Linköping, Sweden
| | - Orjan Dahlstrom
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
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Chaccour C, Casellas A, Hammann F, Ruiz-Castillo P, Nicolas P, Montaña J, Mael M, Selvaraj P, Duthaler U, Mrema S, Kakolwa M, Lyimo I, Okumu F, Marathe A, Schürch R, Elobolobo E, Sacoor C, Saute F, Xia K, Jones C, Rist C, Maia M, Rabinovich NR. BOHEMIA: Broad One Health Endectocide-based Malaria Intervention in Africa-a phase III cluster-randomized, open-label, clinical trial to study the safety and efficacy of ivermectin mass drug administration to reduce malaria transmission in two African settings. Trials 2023; 24:128. [PMID: 36810194 PMCID: PMC9942013 DOI: 10.1186/s13063-023-07098-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 01/17/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Residual malaria transmission is the result of adaptive mosquito behavior that allows malaria vectors to thrive and sustain transmission in the presence of good access to bed nets or insecticide residual spraying. These behaviors include crepuscular and outdoor feeding as well as intermittent feeding upon livestock. Ivermectin is a broadly used antiparasitic drug that kills mosquitoes feeding on a treated subject for a dose-dependent period. Mass drug administration with ivermectin has been proposed as a complementary strategy to reduce malaria transmission. METHODS A cluster randomized, parallel arm, superiority trial conducted in two settings with distinct eco-epidemiological conditions in East and Southern Africa. There will be three groups: human intervention, consisting of a dose of ivermectin (400 mcg/kg) administered monthly for 3 months to all the eligible population in the cluster (>15 kg, non-pregnant and no medical contraindication); human and livestock intervention, consisting human treatment as above plus treatment of livestock in the area with a single dose of injectable ivermectin (200 mcg/kg) monthly for 3 months; and controls, consisting of a dose of albendazole (400 mg) monthly for 3 months. The main outcome measure will be malaria incidence in a cohort of children under five living in the core of each cluster followed prospectively with monthly RDTs DISCUSSION: The second site for the implementation of this protocol has changed from Tanzania to Kenya. This summary presents the Mozambique-specific protocol while the updated master protocol and the adapted Kenya-specific protocol undergo national approval in Kenya. BOHEMIA will be the first large-scale trial evaluating the impact of ivermectin-only mass drug administration to humans or humans and cattle on local malaria transmission TRIAL REGISTRATION: ClinicalTrials.gov NCT04966702 . Registered on July 19, 2021. Pan African Clinical Trials Registry PACTR202106695877303.
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Affiliation(s)
- Carlos Chaccour
- ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain. .,Universidda de Navarra, Pamplona, Spain. .,Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain.
| | - Aina Casellas
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Felix Hammann
- grid.411656.10000 0004 0479 0855University Hospital of Bern, Inselspital, Bern, Switzerland
| | - Paula Ruiz-Castillo
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Patricia Nicolas
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Julia Montaña
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Mary Mael
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain
| | - Prashant Selvaraj
- grid.418309.70000 0000 8990 8592Bill and Melinda Gates Foundation, Seattle, USA
| | - Urs Duthaler
- grid.6612.30000 0004 1937 0642University Basel, Basel, Switzerland
| | - Sigilbert Mrema
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Mwaka Kakolwa
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Issa Lyimo
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Fredros Okumu
- grid.414543.30000 0000 9144 642XIfakara Health Institute, Ifakara, Tanzania
| | - Achla Marathe
- grid.27755.320000 0000 9136 933XUniversity of Virginia, Charlottesville, USA
| | - Roger Schürch
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Eldo Elobolobo
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Charfudin Sacoor
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Francisco Saute
- grid.452366.00000 0000 9638 9567Centro de Investigação em Saúde de Manhiça, Manhica, Mozambique
| | - Kang Xia
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Caroline Jones
- grid.33058.3d0000 0001 0155 5938KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Cassidy Rist
- grid.438526.e0000 0001 0694 4940Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Marta Maia
- grid.33058.3d0000 0001 0155 5938KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - N. Regina Rabinovich
- grid.434607.20000 0004 1763 3517ISGlobal, Barcelona Institute for Global Health, Barcelona, Spain ,grid.38142.3c000000041936754XTH Chan Harvard School of Public Health, Boston, USA
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Nicol E, Basera W, Lombard C, Jonas K, Ramraj T, Govindasamy D, Hlongwa M, McClinton-Appollis T, Mehlomakulu V, Naqvi N, Bedford J, Drummond J, Cheyip M, Dladla S, Pass D, Funani N, Mathews C. Strengthening health system's capacity for linkage to HIV care for adolescent girls and young women and adolescent boys and young men in South Africa (SheS'Cap-Linkage): Protocol for a mixed methods study in KwaZulu-Natal, South Africa. PLoS One 2023; 18:e0271942. [PMID: 36780479 PMCID: PMC9925067 DOI: 10.1371/journal.pone.0271942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 01/20/2023] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) aged 15-24 years and adolescent boys and young men (ABYM) aged 15-34 years represent one of the populations at highest risk for HIV-infection in South Africa. The National Department of Health adopted the universal test and treat (UTT) strategy in 2016, resulting in increases in same-day antiretroviral therapy initiations and linkage to care. Monitoring progress towards attainment of South Africa's 95-95-95 targets amongst AGYW and ABYM relies on high quality data to identify and address gaps in linkage to care. The aim of this study is to describe the current approaches for engaging AGYW and ABYM in the treatment continuum to generate knowledge that can guide efforts to improve linkage to, and retention in, HIV care among these populations in KwaZulu-Natal, South Africa. METHODS AND ANALYSIS This is a mixed methods study, which will be conducted in uMgungundlovu district of KwaZulu-Natal, over a 24-month period, in 22 purposively selected HIV testing and treatment service delivery points (SDPs). For the quantitative component, a sample of 1100 AGYW aged 15-24 years and ABYM aged 15-35 years old will be recruited into the study, in addition to 231 healthcare providers (HCPs) involved in the implementation of the UTT program. The qualitative component will include 30 participating patients who were successfully linked to care, 30 who were not, and 30 who have never tested for HIV. Key informant interviews will also be conducted with 24 HCPs. Logistic regression will be used to model the primary outcomes on SDP types, while a time to event analysis will be conducted using a Cox regression model and adjusting the standard errors of the hazard ratio for the clustering of participants within SDPs. For qualitative data, a general inductive approach of analysis will be used. DISSEMINATION Findings from the study will be communicated to the study population and results will be presented to stakeholders and at appropriate local and international conferences. Outputs will also include a policy brief, peer reviewed journal articles and research capacity building through research degrees.
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Affiliation(s)
- Edward Nicol
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Wisdom Basera
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Carl Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Kim Jonas
- Health System Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Trisha Ramraj
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Darshini Govindasamy
- Health System Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mbuzeleni Hlongwa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Vuyelwa Mehlomakulu
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nuha Naqvi
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jason Bedford
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Jennifer Drummond
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Mireille Cheyip
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Sibongile Dladla
- Division of Global HIV & TB, Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Desiree Pass
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Noluntu Funani
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Cathy Mathews
- Health System Research Unit, South African Medical Research Council, Cape Town, South Africa
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Sudiskumar N, Cobourne MT, Pandis N, Seehra J. Accounting for clustering is still not routinely undertaken in orthodontic studies. Eur J Orthod 2023; 45:45-50. [PMID: 36287245 DOI: 10.1093/ejo/cjac066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of this study was to identify studies with clustering effects published in orthodontic journals and to assess the frequency by which clustered designs are correctly accounted for in the statistical analysis. Factors associated with appropriate management of clustering effects during the statistical analysis were explored. MATERIALS AND METHOD A search of three leading orthodontic journals was undertaken to identify studies with clustering effects published between 1 January 2019 and 31 December 2021. Descriptive statistics and frequency distributions were calculated. Associations between the correct statistical handling of clustering effects and study characteristics were explored via univariable and multivariable analyses. RESULTS Three hundred and sixty-two studies were considered to have clustering effects. Only 22.4 per cent of studies correctly accounted for clustering effects in the statistical analysis with no improvement compared to a previous study in 2012 using the same journals. An association between the use of the correct analysis to account for clustering and the following study characteristics was detected: involvement of statistician, study type, significance of the results, and accounting for clustering in the sample size calculations. In the univariable analysis, interventional studies, non-significant results, and the involvement of a statistician were associated with higher odds of the use of the correct analysis. Of the studies correctly accounting for clustering, the most used tests were repeated measures ANOVA (43.3 per cent) and mixed models (40.7 per cent). CONCLUSIONS Compared to previous research, there appears to be no improvement in accounting for clustering effects in studies published in orthodontic journals. To prevent incorrect inferences being drawn, clustering effects need to be recognised and accounted for in orthodontic studies. Recommendations to improve the accounting of clustering effects, at both the study level and during the statistical analysis are suggested.
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Affiliation(s)
- Nishanti Sudiskumar
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Department of Orthodontics, Floor 22, Guy's Hospital, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, UK
| | - Martyn T Cobourne
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Department of Orthodontics, Floor 22, Guy's Hospital, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, UK.,Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Floor 27, Guy's Hospital, London, SE1 9RT, UK
| | - Nikolaos Pandis
- Department of Orthodontics and Dentofacial Orthopedics, Dental School/Medical Faculty, University of Bern, Freiburgstrasse 7 CH-3010, Bern, Switzerland
| | - Jadbinder Seehra
- Department of Orthodontics, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Department of Orthodontics, Floor 22, Guy's Hospital, Guy's and St Thomas NHS Foundation Trust, London, SE1 9RT, UK.,Centre for Craniofacial Development & Regeneration, Faculty of Dentistry, Oral & Craniofacial Sciences, King's College London, Floor 27, Guy's Hospital, London, SE1 9RT, UK
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Chao CR, Cannizzaro NT, Hahn EE, Tewari D, Ngo-Metzger Q, Hsu C, Shen E, Wride P, Hodeib M, Gould M, Mittman BS. A study protocol for a cluster randomized pragmatic trial for comparing strategies for implementing primary HPV testing for routine cervical cancer screening in a large health care system. Contemp Clin Trials 2023; 124:106994. [PMID: 36336248 DOI: 10.1016/j.cct.2022.106994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited guidance exists regarding implementation strategies that best facilitate cancer screening practice substitution and achieve optimal stakeholder-centered outcomes. Here we describe the protocol for a randomized pragmatic trial comparing two implementation strategies to facilitate substitution of primary HPV screening for Pap and HPV co-testing to perform routine cervical cancer screening of women aged 30-65 years at Kaiser Permanente Southern California (KPSC). METHODS Twelve service areas within KPSC will be randomized to a "centrally-administered system-wide implementation + local-tailored implementation" strategy or a "centrally-administered system-wide implementation only" strategy. The centrally-administered strategy comprises clinician and staff educational activities. Sites in the local-tailored arm will then conduct a structured local needs assessment followed by site-specific selection and deployment of implementation interventions. Surveys and interviews will be conducted among women and providers from the primary care and ob/gyn departments prior to the system-wide transition, shortly after the transition, and after the completion of local-tailored interventions. A stakeholder advisory committee will assist with study design, defining stakeholder-centered outcomes, and developing data collection tools. RESULTS The primary outcome of interest is uptake of primary HPV screening. Secondary provider-centered outcomes include provider knowledge, delivery of patient education, satisfaction with the practice substitution process, and resistance to primary HPV screening. Secondary patient-centered outcomes include patient knowledge, stigma, and satisfaction with the screening process. Intervention fidelity will also be measured via surveys. CONCLUSIONS Findings from this study will help inform future use of a local-tailored implementation strategy for adopting primary HPV screening at large health care systems. Findings may also be applicable to other types of practice substitution.
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Affiliation(s)
- Chun R Chao
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Nancy T Cannizzaro
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Erin E Hahn
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Devansu Tewari
- Department of Obstetrics and Gynecology, Kaiser Permanente, Irvine, Gynecologic Oncology Division, KPSC - Orange County Women's Health Services, 6650 Alton Pkwy, Irvine, CA 92618, USA.
| | - Quyen Ngo-Metzger
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Ave., Pasadena, CA, 91101, USA.
| | - Chunyi Hsu
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Ernest Shen
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
| | - Patricia Wride
- Department of Obstetrics and Gynecology, Kaiser Permanente, Irvine, Gynecologic Oncology Division, KPSC - Orange County Women's Health Services, 6650 Alton Pkwy, Irvine, CA 92618, USA.
| | - Melissa Hodeib
- Department of Obstetrics and Gynecology, Kaiser Permanente, KPSC Riverside Medical Center, 10800 Magnolia Ave, Riverside, CA 92505, USA.
| | - Michael Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 98 South Los Robles Ave., Pasadena, CA, 91101, USA.
| | - Brian S Mittman
- Department of Research and Evaluation, Kaiser Permanente, 100 S. Los Robles Ave, Pasadena, CA 91101, USA.
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Wang Z, Rong W, Xu T. Effect of Fluoride Varnish in Preventing Dental Caries of First Permanent Molars: A 24-Month Cluster Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16656. [PMID: 36554536 PMCID: PMC9779547 DOI: 10.3390/ijerph192416656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Caries is a prevalent health problem. This study evaluated the effect of fluoride varnish in preventing dental caries of first permanent molars. METHODS The study was designed as a stratified cluster randomized controlled trial, with classes as the unit of randomization. Classes stratified by district were followed for 24 months. All eligible children of the selected classes were included for the trial. The children in the test group were biannually applied fluoride varnish. The outcomes were measured at an individual level. RESULTS In total, 107 classes (51 in the test group, 56 in the control group) were recruited for the trial. Of the 5397 participants, 5005 children (2385 in the test group, 2620 in the control group) completed the study. At the 24-month follow-up, the mean decayed and filled surface increment of the first permanent molars of the children in the test group was significantly lower than that of the children in the control group (0.38 versus 0.61). The caries incidence of the first permanent molars in the test group was 17.0%, while that of the control group was 23.7%, with a PF of 28.3%. CONCLUSIONS Semi-annual application of fluoride varnish is effective in reducing the caries increments of first permanent molars.
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Affiliation(s)
- Zhaoyou Wang
- Department of Stomotology, Peking University Third Hospital, Beijing 100191, China
| | - Wensheng Rong
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
| | - Tao Xu
- Department of Preventive Dentistry, Peking University School and Hospital of Stomatology, Beijing 100081, China
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40
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Hickman SE, Mitchell SL, Hanson LC, Tu W, Stump TE, Unroe KT. The design and conduct of a pragmatic cluster randomized trial of an advance care planning program for nursing home residents with dementia. Clin Trials 2022; 19:623-635. [PMID: 35815777 PMCID: PMC9691516 DOI: 10.1177/17407745221108992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND/AIMS A significant number of people with Alzheimer's disease or related dementia diagnoses will be cared for in nursing homes near the end of life. Advance care planning (ACP), the process of eliciting and documenting patient-centered preferences for care, is considered essential to providing high quality care for this population. Nursing homes are currently required by regulations to offer ACP to residents and families, but no training requirements exist for nursing home staff, and approaches to fulfilling this regulatory and ethical responsibility vary. As a result, residents may receive care inconsistent with their goals, such as unwanted hospitalizations. Pragmatic trials offer a way to develop and test ACP in real-world settings to increase the likelihood of adoption of sustainable best practices. METHODS The "Aligning Patient Preferences-a Role Offering Alzheimer's patients, Caregivers, and Healthcare Providers Education and Support (APPROACHES)" project is designed to pragmatically test and evaluate a staff-led program in 137 nursing homes (68 = intervention, 69 = control) owned by two nursing home corporations. Existing nursing home staff receive standardized training and implement the ACP Specialist program under the supervision of a corporate lead. The primary trial outcome is the annual rate of hospital transfers (admissions and emergency department visits). Consistent with the spirit of a pragmatic trial, study outcomes rely on data already collected for quality improvement, clinical, or billing purposes. Configurational analysis will also be performed to identify conditions associated with implementation. RESULTS Partnerships with large corporate companies enable the APPROACHES trial to rely on corporate infrastructure to roll out the intervention, with support for a corporate implementation lead who is charged with the initial introduction and ongoing support for nursing home-based ACP Specialists. These internal champions connect the project with other company priorities and use strategies familiar to nursing home leaders for the initiation of other programs. Standardized data collection across nursing homes also supports the conduct of pragmatic trials in this setting. DISCUSSION Many interventions to improve care in nursing homes have failed to demonstrate an impact or, if successful, maintain an impact over time. Pragmatic trials, designed to test interventions in real-world contexts that are evaluated through existing data sources collected routinely as part of clinical care, are well suited for the nursing home environment. A robust program that increases access to ACP for nursing home residents has the potential to increase goal-concordant care and is expected to reduce hospital transfers. If successful, the ACP Specialist Program will be primed for rapid translation into nursing home practice to reduce unwanted, burdensome hospitalizations and improve the quality of care for residents with dementia.
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Affiliation(s)
- Susan E Hickman
- School of Nursing, Indiana University, Indianapolis,
Indiana, U.S.,RESPECT (Research in Palliative and End-of-Life
Communication and Training) Signature Center, Indiana University Purdue University
Indianapolis, Indianapolis, Indiana, U.S.,Division of General Internal Medicine and Geriatrics, Department of Medicine, School of Medicine, Indiana University, Indiana, U.S.,IU Center for Aging Research, Regenstrief Institute Inc.,
Indianapolis, Indiana, U.S
| | - Susan L Mitchell
- Harvard Medical School, Boston, Massachusetts, U.S.,Beth Israel Deaconess Medical Center, Boston,
Massachusetts, U.S.,Marcus Institute for Aging Research, Boston, Massachusetts,
U.S
| | - Laura C Hanson
- School of Medicine, University of North Carolina, Chapel Hill,
North Carolina
| | - Wanzhu Tu
- IU Center for Aging Research, Regenstrief Institute Inc.,
Indianapolis, Indiana, U.S.,Department of Biostatistics & Health Data ScienceS, School of Medicine,
Indiana University, Indiana, U.S
| | - Timothy E Stump
- Department of Biostatistics & Health Data ScienceS, School of Medicine,
Indiana University, Indiana, U.S
| | - Kathleen T Unroe
- RESPECT (Research in Palliative and End-of-Life
Communication and Training) Signature Center, Indiana University Purdue University
Indianapolis, Indianapolis, Indiana, U.S.,Division of General Internal Medicine and Geriatrics, Department of Medicine, School of Medicine, Indiana University, Indiana, U.S.,IU Center for Aging Research, Regenstrief Institute Inc.,
Indianapolis, Indiana, U.S
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Jepson R, Baker G, Sivaramakrishnan D, Manner J, Parker R, Lloyd S, Stoddart A. Feasibility of a theory-based intervention to reduce sedentary behaviour among contact centre staff: the SUH stepped-wedge cluster RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/iexp0277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background
Sedentary behaviour is linked to increased risk of type 2 diabetes, cardiovascular disease, musculoskeletal issues and poor mental well-being. Contact (call) centres are associated with higher levels of sedentary behaviour than other office-based workplaces. Stand Up for Health is an adaptive intervention designed to reduce sedentary behaviour in contact centres.
Objectives
The objectives were to test the acceptability and feasibility of implementing the intervention; to assess the feasibility of the study design and methods; to scope the feasibility of a future health economic evaluation; and to consider the impact of COVID-19 on the intervention. All sites received no intervention for between 3 and 12 months after the start of the study, as a waiting list control.
Design
This was a cluster-randomised stepped-wedge feasibility design.
Setting
The trial was set in 11 contact centres across the UK.
Participants
Eleven contact centres and staff.
Intervention
Stand Up for Health involved two workshops with staff in which staff developed activities for their context and culture. Activities ranged from using standing desks to individual goal-setting, group walks and changes to workplace policies and procedures.
Main outcome measures
The primary outcome was accelerometer-measured sedentary time. The secondary outcomes were subjectively measured sedentary time, overall sedentary behaviour, physical activity, productivity, mental well-being and musculoskeletal health.
Results
Stand Up for Health was implemented in 7 out of 11 centres and was acceptable, feasible and sustainable (objective 1). The COVID-19 pandemic affected the delivery of the intervention, involvement of contact centres, data collection and analysis. Organisational factors were deemed most important to the success of Stand Up for Health but also the most challenging to change. There were also difficulties with the stepped-wedge design, specifically maintaining contact centre interest (objective 2). Feasible methods for estimating cost-efficiency from an NHS and a Personal Social Services perspective were identified, assuming that alternative feasible effectiveness methodology can be applied. Detailed activity-based costing of direct intervention costs was achieved and, therefore, deemed feasible (objective 3). There was significantly more sedentary time spent in the workplace by the centres that received the intervention than those that did not (mean difference 84.06 minutes, 95% confidence interval 4.07 to 164.1 minutes). The other objective outcomes also tended to favour the control group.
Limitations
There were significant issues with the stepped-wedge design, including difficulties in maintaining centre interest and scheduling data collection. Collection of accelerometer data was not feasible during the pandemic.
Conclusions
Stand Up for Health is an adaptive, feasible and sustainable intervention. However, the stepped-wedge study design was not feasible. The effectiveness of Stand Up for Health was not demonstrated and clinically important reductions in sedentary behaviour may not be seen in a larger study. However, it may still be worthwhile conducting an effectiveness study of Stand Up for Health incorporating activities more relevant to hybrid workplaces.
Future work
Future work could include developing hybrid (office and/or home working) activities for Stand Up for Health; undertaking a larger effectiveness study and follow-up economic analysis (subject to its success); and exploring organisational features of contact centres that affect the implementation of interventions such as Stand Up for Health.
Trial registration
This trial is registered as ISRCTN11580369.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 13. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ruth Jepson
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Graham Baker
- Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Divya Sivaramakrishnan
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Jillian Manner
- Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, Edinburgh, UK
| | - Richard Parker
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Scott Lloyd
- Public Health South Tees, Middlesbrough Council and Redcar & Cleveland Borough Council, Middlesbrough, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
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Becker S, Amin R, Chakraborty N, Zimmerman L. An experiment of health services and additional microcredit in 128 villages of Bangladesh. JOURNAL OF HEALTH, POPULATION AND NUTRITION 2022; 41:14. [PMID: 35501930 PMCID: PMC9059407 DOI: 10.1186/s41043-022-00292-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Background Studies in the literature have found mixed results on the effect of microcredit on health outcomes. Of the five previous experimental studies that included microcredit and a health intervention, three reported no significant changes in health status or behaviors. The purpose of this study was to test for marginal and interactive effects of increased microcredit and provision of basic health services. Methods This study had a 4-celled experimental design in 128 villages in rural Bangladesh. For villages in one cell, an additional microcredit worker was assigned. For those in a second cell, a health assistant visited households each month, provided simple medicines and announced a satellite clinic held monthly in each village. For a third cell, both interventions were combined, and villages in a fourth cell served as control. A baseline survey was completed and a follow-up survey was done three years later. Outcome measures were food security, contraceptive use, having a trained birth attendant at last birth, and measles immunization. Results Comparison of follow-up with baseline levels of the four outcome measures (for 3787 households (96% completeness) and 3687 women (94% completeness)) showed significant improvement in food security in all study arms and a significant increase in trained birth attendant at last birth in the health services villages. Due to confusion within Grameen Bank about which workers would provide the additional microcredit work, that intervention was poorly implemented so in multivariate analyses, the data for that intervention arm were grouped with data from the control arm. Logistic regression with values of the outcomes at follow-up as dependent variable and study arm and women’s schooling as covariates showed no significant effects of either separate or grouped study arms. Conclusion Two of the three health behaviors showed no significant changes over time but having a trained birth attendant at last delivery did increase significantly in the health services arm. Therefore, community health education can sometimes be effective in promoting healthy behaviors. Trial registration This was a field trial rather than a clinical trial, so trial registration was unnecessary.
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43
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Weldearegay HG, Kahsay AB, Godefay H, Petrucka P, Medhanyie AA. The effect of catchment based mentorship on quality of maternal and newborn care in primary health care facilities in Tigray Region, Northern Ethiopia: A controlled quasi-experimental study. PLoS One 2022; 17:e0277207. [PMID: 36395101 PMCID: PMC9671353 DOI: 10.1371/journal.pone.0277207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/23/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In Ethiopia, quality of maternal and newborn care is poor. This situation has persisted, despite the wide implementation of several capacity building-oriented interventions including clinical mentoring for skilled birth attendants that were anticipated to translate in to high-quality maternal and newborn care on each encounter. The effectiveness of mentoring programs is not yet well documented in the research literature. Therefore, we evaluated the effect of a catchment based clinical mentorship in improving the quality of maternal and newborn care in primary level facilities of Tigray, Northern Ethiopia. METHODS We conducted a controlled quasi-experimental pre-post study among 19 primary health care facilities, with 10 facilities assigned to the group where the catchment based clinical mentorship program was implemented (intervention group), and 9 facilities to the control group. We assigned the group based on administrative criteria, number of deliveries in each facility, accessibility, and ease of implementation of the intervention. A sample of 1320 women(662 at baseline; 658 at post intervention) and 233 skilled birth attendants(121 at baseline and 112 at end line) were included. We collected data from mothers, skilled birth attendants and facilities. The first round of data collection (baseline) took place two weeks prior the inauguration of the intervention, 05 October to 04 November 2019. The end line data collection occurred from 22 May to 03 July 2020. The primary Outcome was "receipt quality of maternal/newborn care". We analyzed the data using difference in differences (DiD) and logistic regression with Generalized Estimating Equation. The level of significance of predictors was declared at p-value less than 0.05in the multivariable analysis. INTERVENTION We deployed a team of local clinical mentors working at primary hospitals to provide clinical mentorship, and direct feedback in routine and emergency obstetrical and newborn care to the mentees (all skilled birth attendants performing maternal and newborn health services) functioning in their catchment rural health centers for duration of six months. While visiting a facility, mentors remain at the facility each lasting at least five to seven days per month, over the course of intervention period. RESULTS A significantly higher proportion of women at intervention facilities received quality of care services, compared with women at comparison facilities. (DiD = 18.4%, p<0.001). Moreover, following the implementation of the intervention we detected a difference in the occurrences of maternal complication outcome during delivery and immediately after birth. This was decreased by 4.5%, with significant differences between intervention and comparison sites (DiD = 4.5%, p = 0.013). We also found a favorable difference in occurrences of neonatal obstetric complications, with a decrease of 4.8% in the intervention site and almost no change in the comparison site (DiD = 4.8%, p = 0.002). Among the determinants of quality of care, we found that providers' job satisfaction (AoR = 2.95, 95%CI: 1.26 to 6.91), and making case presentation at regular basis(AoR = 1.89, 95%CI: 1.05 to 3.39) were significantly associated to improve the quality of care. However, delivery load(AoR = 0.95, 95%CI: 0.93 to 0.98) was negatively associated with quality of care. CONCLUSIONS We conclude that the catchment based clinical mentorship intervention is effective to improve quality of care and reduce childbirth complications in northern Ethiopia. This finding further elaborated that incorporating maternal and newborn health catchment based clinical mentorship activities into the existing health system strengthening strategies can catalyze improvement processes to quality practice and health systems. This is seen as a necessary step to achieve the effective quality universal health care required to meet the health-related Sustainable Development Goals. Besides, more attention needs to be given to develop interventions and strategies that directly enhance providers' job satisfaction and reduce delivery work load.
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Affiliation(s)
| | | | | | - Pammla Petrucka
- University of Saskatchewan, College of Nursing, Saskatoon, Canada
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
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Bonafide CP, Xiao R, Schondelmeyer AC, Pettit AR, Brady PW, Landrigan CP, Wolk CB, Cidav Z, Ruppel H, Muthu N, Williams NJ, Schisterman E, Brent CR, Albanowski K, Beidas RS. Sustainable deimplementation of continuous pulse oximetry monitoring in children hospitalized with bronchiolitis: study protocol for the Eliminating Monitor Overuse (EMO) type III effectiveness-deimplementation cluster-randomized trial. Implement Sci 2022; 17:72. [PMID: 36271399 PMCID: PMC9587657 DOI: 10.1186/s13012-022-01246-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Methods of sustaining the deimplementation of overused medical practices (i.e., practices not supported by evidence) are understudied. In pediatric hospital medicine, continuous pulse oximetry monitoring of children with the common viral respiratory illness bronchiolitis is recommended only under specific circumstances. Three national guidelines discourage its use for children who are not receiving supplemental oxygen, but guideline-discordant practice (i.e., overuse) remains prevalent. A 6-hospital pilot of educational outreach with audit and feedback resulted in immediate reductions in overuse; however, the best strategies to optimize sustainment of deimplementation success are unknown. Methods The Eliminating Monitor Overuse (EMO) trial will compare two deimplementation strategies in a hybrid type III effectiveness-deimplementation trial. This longitudinal cluster-randomized design will be conducted in Pediatric Research in Inpatient Settings (PRIS) Network hospitals and will include baseline measurement, active deimplementation, and sustainment phases. After a baseline measurement period, 16–19 hospitals will be randomized to a deimplementation strategy that targets unlearning (educational outreach with audit and feedback), and the other 16–19 will be randomized to a strategy that targets unlearning and substitution (adding an EHR-integrated clinical pathway decision support tool). The primary outcome is the sustainment of deimplementation in bronchiolitis patients who are not receiving any supplemental oxygen, analyzed as a longitudinal difference-in-differences comparison of overuse rates across study arms. Secondary outcomes include equity of deimplementation and the fidelity to, and cost of, each deimplementation strategy. To understand how the deimplementation strategies work, we will test hypothesized mechanisms of routinization (clinicians developing new routines supporting practice change) and institutionalization (embedding of practice change into existing organizational systems). Discussion The EMO trial will advance the science of deimplementation by providing new insights into the processes, mechanisms, costs, and likelihood of sustained practice change using rigorously designed deimplementation strategies. The trial will also advance care for a high-incidence, costly pediatric lung disease. Trial registration ClinicalTrials.gov,NCT05132322. Registered on November 10, 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01246-z.
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Affiliation(s)
- Christopher P Bonafide
- Section of Hospital Medicine, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia Hub for Clinical Collaboration, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA. .,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA. .,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
| | - Rui Xiao
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 206 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Amanda C Schondelmeyer
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, 45229, USA.,Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave ML 9016, Cincinnati, OH, 45229, USA
| | | | - Patrick W Brady
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave ML 9016, Cincinnati, OH, 45229, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Christopher P Landrigan
- Division of General Pediatrics, Boston Children's Hospital, Enders 1, 300 Longwood Ave, Boston, MA, 02115, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Courtney Benjamin Wolk
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, USA
| | - Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Halley Ruppel
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, USA
| | - Naveen Muthu
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, 2716 South Street, Philadelphia, PA, 19146, USA
| | - Nathaniel J Williams
- School of Social Work, Boise State University, 1910 W. University Drive, Boise, ID, 83725, USA.,Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, USA
| | - Enrique Schisterman
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, 206 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA
| | - Canita R Brent
- Section of Hospital Medicine, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia Hub for Clinical Collaboration, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Kimberly Albanowski
- Section of Hospital Medicine, Children's Hospital of Philadelphia, Children's Hospital of Philadelphia Hub for Clinical Collaboration, 3500 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rinad S Beidas
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Philadelphia, PA, 19104, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3600 Civic Center Boulevard, 8th Floor, Philadelphia, PA, 19104, USA.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Njiru H, Njogu E, Gitahi MW, Kabiru E. Effectiveness of public health education on the uptake of iron and folic acid supplements among pregnant women: a stepped wedge cluster randomised trial. BMJ Open 2022; 12:e063615. [PMID: 36691203 PMCID: PMC9462084 DOI: 10.1136/bmjopen-2022-063615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/22/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Iron deficiency is the most prevalent micronutrient deficiency in pregnancy globally responsible for nearly 120 000 maternal deaths per year and a fifth of maternal mortality. Over 46% of pregnant women in Africa and 62% of pregnant women in Kenya are anaemic. Anaemia has severe economic and health consequences. Daily iron and folic acid supplementation (IFAS) is an efficacious strategy recommended in pregnancy to reduce the risk of anaemia and improve maternal and neonatal survival. However, most pregnant women do not consume IFAS as recommended. Limited knowledge on IFAS, its benefits and its connection with anaemia, and mitigation of its side effects lead to poor consumption. The main objective of this trial is to determine the effectiveness of public health education on uptake of antenatal IFAS. METHODS AND ANALYSIS A stepped wedge cluster randomised trial with antenatal clinics as units of randomisation. Twelve clusters will be randomised to receive the intervention and levels of IFAS uptake compared with preintervention period. The 9-month trial will enrol 1205 pregnant women. The primary outcome will be the proportion of pregnant women effectively taking up IFAS measured through self-reports, residual pill count and inspection of pill reminder cards. Routine clinical data on haemoglobin counts and fetal growth monitoring will also be used. Descriptive and bivariate analysis will be conducted in Stata using Pearson's χ2 test for association, and multivariate logistic regression to identify determinants of uptake. The potential public health benefits will be estimated using the number needed to treat and the preventable fraction. ETHICS AND DISSEMINATION Ethical approval was granted by Kenyatta University Ethics Review Committee (PKU/2443/11575). The research permit is obtained from Kenya National Commission for Science, Technology and Innovation (NACOSTI/P/22/16168). Findings will be disseminated through peer-reviewed publications and public health conferences. TRIAL REGISTRATION NUMBER PACTR202202775997127.
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Affiliation(s)
- Haron Njiru
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
| | - Eunice Njogu
- Department of Food, Nutrition and Dietetics, Kenyatta University, Nairobi, Kenya
| | - Mary W Gitahi
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
| | - Ephantus Kabiru
- Department of Community Health and Epidemiology, Kenyatta University, Nairobi, Kenya
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Kaswaswa K, MacPherson P, Kumwenda M, Mpunga J, Thindwa D, Nliwasa M, Mwapasa M, Odland J, Tomoka T, Chipungu G, Mukaka M, Corbett EL. Effect of patient-delivered household contact tracing and prevention for tuberculosis: A household cluster-randomised trial in Malawi. PLoS One 2022; 17:e0269219. [PMID: 36074775 PMCID: PMC9455850 DOI: 10.1371/journal.pone.0269219] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 05/15/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Household contact tracing provides TB screening and TB preventive therapy (TPT) to contacts at high risk of TB disease. However, it is resource intensive, inconvenient, and often poorly implemented. We investigated a novel model aiming to improve uptake. METHODS Between May and December 2014, we randomised patient with TB who consented to participate in the trial to either standard of care (SOC) or intervention (PACTS) arms. Participants randomised to PACTS received one screening/triage tool (adapted from WHO integrated management of adolescent and adult illnesses [IMAI] guidelines) and sputum pots for each reported household contact. The tool guided participants through symptom screening; TPT (6-months of isoniazid) eligibility; and sputum collection for contacts. Patients randomised to SOC were managed in accordance with national guidelines, that is, they received verbal instruction on who to bring to clinics for investigation using national guidelines. MAIN OUTCOME AND MEASURES The primary outcome was the proportion of adult contacts receiving treatment for TB within 3 months of randomisation. Secondary outcomes were the proportions of child contacts under age 5 years (U5Y) who were commenced on, and completed, TPT. Data were analyzed by logistic regression with random effects to adjust for household clustering. RESULTS Two hundred and fourteen index TB participants were block-randomized from two sites (107 PACTS, reporting 418 contacts; and 107 SOC, reporting 420 contacts). Overall, 62.8% of index TB participants were HIV-positive and 52.1% were TB culture-positive. 250 otherwise eligible TB patients declined participation and 6 households (10 PACTS, 6 SOC) were lost to follow-up and were not included in the analysis. By three months, nine contacts (PACTS: 6, [1.4%]; SOC: 3, [0.7%]) had TB diagnosed, with no difference between groups (adjusted odds ratio [aOR]: 2.18, 95% CI: 0.60-7.95). Eligible PACTS contacts (37/96, 38.5%) were more likely to initiate TPT by 3-months compared to SOC contacts (27/101, 26.7%; aOR 2.27, 95% CI: 1.04-4.98). U5Y children in the PACTS arm (47/81 58.0%) were more likely to have initiated TPT before the 3-month visit compared to SOC children (36/89, 41.4%; aOR: 2.31, 95% CI: 1.05-5.06). CONCLUSIONS AND RELEVANCE A household-centred patient-delivered symptom screen and IPT eligibility assessment significantly increased timely TPT uptake among U5Y children, but did not significantly increase TB diagnosis. This model needs to be optimized for acceptability, given low participation, and investigated in other low resource settings. CLINICAL TRIAL REGISTRATION TRIAL REGISTRATION NUMBER: ISRCTN81659509 https://www.isrctn.com/ISRCTN81659509?q=&filters=conditionCategory:Respiratory,recruitmentCountry:Malawi,ageRange:Mixed&sort=&offset=1&totalResults=1&page=1&pageSize=10&searchType=basic-search. 19 July 2012.
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Affiliation(s)
- Kruger Kaswaswa
- College of Medicine, Blantyre, Malawi
- Malawi National TB Control Programme, Blantyre, Malawi
| | - Peter MacPherson
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Moses Kumwenda
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - James Mpunga
- Malawi National TB Control Programme, Blantyre, Malawi
| | - Deus Thindwa
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Marriott Nliwasa
- College of Medicine, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- University of Tromso, Tromso, Norway
| | | | - Jon Odland
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | | | | | - Mavuto Mukaka
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Faculty of Tropical Medicine, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand
| | - Elizabeth L. Corbett
- College of Medicine, Blantyre, Malawi
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
- London School of Hygiene and Tropical Medicine, London, United Kingdom
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Gorgens M, Ketende S, Longosz AF, Mabuza M, Nkambule M, Dlamini T, Sikwibele K, Tsododo V, Chipepera T, Ndikandika ML, Heard W, Maphalala G, Dlamini L, Wilson D, de Walque D, Mabuza K. The impact of financial incentives on HIV incidence among adolescent girls and young women in Eswatini: Sitakhela Likusasa, a cluster randomised trial. BMJ Glob Health 2022; 7:bmjgh-2021-007206. [PMID: 36113889 PMCID: PMC9486177 DOI: 10.1136/bmjgh-2021-007206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/29/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Incentives conditional on school attendance or on remaining free of sexually transmitted infections have produced mixed results in reducing HIV incidence. METHODS HIV-negative adolescent girls and young women aged 15-22%-50% of whom were out of school-were recruited from 293 clusters in Eswatini from urban (30%) and rural areas (70%).Financial incentives conditional on education attendance were randomly allocated at the cluster level. All participants were further individually randomised into eligibility for a raffle incentive conditional on random selection into the raffle, on negative tests for syphilis and Trichomonas vaginalis and on being a raffle winner, creating four subarms in a 2×2 factorial design: no-intervention, raffle incentive, education incentive and raffle & education incentive. Randomisation was unblinded to participants.Logistic regressions were used in intention-to-treat analysis of HIV incidence over 3 years to estimate the impact of incentives conditional on school attendance and raffle incentives conditional on remaining sexually transmitted infection free. RESULTS The study recruited 4389 HIV-negative participants, who were distributed into four subarms: no intervention (n=1068), raffle incentive (n=1162), education incentive (n=1088) and raffle and education incentive (n=1071).At endline, 272 participants from 3772 for whom endline data were collected, tested positive for HIV. HIV incidence among participants in education treatment arm was significantly lower than in the education control arm, 6.34% (119/1878) versus 8.08% (153/1894) (p=0.041); OR: 0.766 (0.598 to 0.981); adjusted OR (aOR): 0.754 (0.585 to 0.972). Compared with the no intervention subarm, HIV incidence in the raffle and education incentive subarm was significantly lower, 5.79% (54/878) versus 8.84% (80/905); OR: 0.634 (0.443 to 0.907); aOR: 0.622 (0.433 to 0.893), while it was not significantly lower in the raffle incentive subarm. CONCLUSION Financial incentives conditional on education participation significantly reduced HIV infection among adolescent girls and young women in Eswatini and appear to be a promising tool for prevention in high HIV prevalence settings. TRIAL REGISTRATION NUMBER Western Institutional Review Board-protocol number 20 141 630.Eswatini National Health Research Review Board-FWA00026661.Pan African Clinical Trials Registry-PACTR201811609257043.
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Affiliation(s)
- Marelize Gorgens
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Sosthenes Ketende
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Andrew F Longosz
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Mbuso Mabuza
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini
| | - Muziwethu Nkambule
- Independent (formerly with the National Emergency Response Council on HIV and AIDS), Mbabane, Eswatini
| | - Tengetile Dlamini
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini
| | - Kelvin Sikwibele
- Institute for Health Measurement Southern Africa, Mbabane, Eswatini
| | - Vimbai Tsododo
- Institute for Health Measurement Southern Africa, Mbabane, Eswatini
| | - Tendai Chipepera
- Institute for Health Measurement Southern Africa, Mbabane, Eswatini
| | | | - Wendy Heard
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Gugu Maphalala
- Eswatini National Reference Laboratory and National Blood Bank, Ministry of Health, Mbabane, Eswatini
| | - Lindiwe Dlamini
- Department of Guidance and Counselling, Eswatini Ministry of Education and Training, Mbabane, Eswatini
| | - David Wilson
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, DC, USA
| | - Damien de Walque
- Development Research Group, World Bank Group, Washington, DC, USA
| | - Khanya Mabuza
- National Emergency Response Council on HIV and AIDS (NERCHA), Mbabane, Eswatini
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Shaughnessy R, Hernandez M, Haverinen-Shaughnessy U. Effects of classroom cleaning on student health: a longitudinal study. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:767-773. [PMID: 35379911 PMCID: PMC8978505 DOI: 10.1038/s41370-022-00427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND School districts across the world have been grappling with how to keep their schools open, students healthy, and prevent the spread of viruses in their communities. OBJECTIVE The aims of this study included assessing both (1) the effectiveness of enhanced classroom cleaning and disinfecting protocol on surface biocontamination and (2) the associations between surface biocontamination and student absence due to illnesses. METHODS Cleaning effectiveness was assessed using quantitative adenosine triphosphate (ATP) measurements during a 10-week study period in a sample of 34 public schools (15,814 students), of a district located in the Western US. The schools were randomly assigned to 17 intervention schools implementing enhanced cleaning and disinfecting protocol and 17 control schools cleaning as usual. General estimating equations (GEEs) were used for modeling associations between ATP levels and weekly aggregates of student absences due to respiratory and gastrointestinal illnesses, which were recorded by the schools according to district wide protocol. RESULTS The weekly average ATP levels on logarithmic scale were 5.02 (SD 0.53) and 5.26 (SD 0.48) in the intervention and control schools, respectively, where the difference is statistically significant (p < 0.001). The probability of weekly absence due to gastrointestinal illness was significantly associated with ATP levels (parameter estimate 1.16, 95% CI 1.01-1.34, per unit (log) increase of weekly average ATP), where the model accounts for student level, gender, ethnic group, and socioeconomic status as well as for school level attendance, total absence ratio, and ventilation adequacy in classrooms. Associations were not found between ATP levels and weekly probability of any absence, or absence due to respiratory illness. SIGNIFICANCE Enhanced cleaning resulted in a significantly lower level of biocontamination on desktops in the intervention group. In addition, a statistically significant association was established between ATP levels on classroom desks and probability of absence due to gastrointestinal illness. IMPACT We found that enhanced cleaning protocol, including bi-weekly cleaning of classroom desks, as well as training of custodians and teachers, monitoring of effectiveness, and feedback, yielded a moderate but statistically significantly lower level of biocontamination on desktops, indicated by quantitative ATP monitoring. Within the range of weekly average desktop ATP levels observed, the probability of reported absence due to gastrointestinal illness is estimated to increase from 0.021 to 0.026. Based on the results, enhanced surface cleaning and monitoring its effectiveness is a possible district, state, or even national level policy to support healthy school environments.
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Data S, Mirette D, Cherop M, Bajunirwe F, Kyakwera C, Robinson T, Josephine NN, Abesiga L, Namata T, Brenner JL, Singhal N, Twine M, Wishart I, McIntosh H, Cheng A. Peer Learning and Mentorship for Neonatal Management Skills: A Cluster-Randomized Trial. Pediatrics 2022; 150:188489. [PMID: 35794462 DOI: 10.1542/peds.2021-054471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Clinical knowledge and skills acquired during training programs like Helping Babies Breathe (HBB) and Essential Care for Every Baby (ECEB) decay within weeks or months. We assessed the effect of a peer learning intervention paired with mentorship on retention of HBB and ECEB skills, knowledge, and teamwork in 5 districts of Uganda. METHODS We randomized participants from 36 Ugandan health centers to control and intervention arms. Intervention participants received HBB and ECEB training, a 1 day peer learning course, peer practice scenarios for facility-based practice, and mentorship visits at 2 to 3 and 6 to 7 months. Control arm participants received HBB and ECEB training alone. We assessed clinical skills, knowledge, and teamwork immediately before and after HBB/ECEB training and at 12 months. RESULTS Peer learning (intervention) participants demonstrated higher HBB and ECEB skills scores at 12 months compared with control (HBB: intervention, 57.9%, control, 48.5%, P = .007; ECEB: intervention, 61.7%, control, 49.9%, P = .004). Knowledge scores decayed in both arms (intervention after course 91.1%, at 12 months 84%, P = .0001; control after course 90.9%, at 12 months 82.9%, P = .0001). This decay at 12 months was not significantly different (intervention 84%, control 82.9%, P = .24). Teamwork skills were similar in both arms immediately after training and at 12 months (intervention after course 72.9%, control after course 67.2%, P = .02; intervention at 12 months 70.7%, control at 12 months 67.9%, P = .19). CONCLUSIONS A peer learning intervention resulted in improved HBB and ECEB skills retention after 12 months compared with HBB and ECEB training alone.
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Affiliation(s)
- Santorino Data
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Dube Mirette
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Moses Cherop
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Traci Robinson
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | | | - Lenard Abesiga
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tamara Namata
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jennifer L Brenner
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.,Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Nalini Singhal
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Margaret Twine
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ian Wishart
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada
| | - Heather McIntosh
- Indigenous Local and Global Health Office, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Adam Cheng
- KidSIM Simulation Program, Alberta Children's Hospital, Calgary, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Pleaner M, Kutywayo A, Beksinska M, Mabetha K, Naidoo N, Mullick S. Contraception knowledge and uptake among in-school adolescents in three South African townships: Baseline findings from the Girls Achieve Power (GAP Year) Trial. Gates Open Res 2022; 6:67. [DOI: 10.12688/gatesopenres.13636.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 11/20/2022] Open
Abstract
Background: South African adolescents experience barriers to sexual and reproductive health (SRH) knowledge and uptake. This study provides insight into contraceptive and other SRH service knowledge, perceptions, and uptake among adolescents in high HIV prevalence settings. Methods: A baseline cross sectional survey was conducted among 3432 grade 8s enrolled into the Girls Achieve Power (GAP Year) trial from 26 public high schools across three South African townships (Soweto, Thembisa and Khayelitsha) (2017 - 2018). An interviewer-led survey collected information on SRH knowledge and perceptions; an audio computer-assisted self-interviewing technique gathered SRH service uptake. Descriptive analysis indicates frequency distribution of socio-demographics and knowledge, uptake and perceptions of SRH services. Chi-square test tested for associations between age and sex and selected variables that measure SRH knowledge and uptake. Results: In total, 2383 learners, completed both survey components. Of these, 63.1% (n=1504) were female and 81.4% (n=1938) aged 12-14. Almost a fifth (18.3%, n=436) had ever had sex and less than 1% had accessed SRH services in the last year. Of the 157 females who had ever had sex, 50.9% had ever used contraception. Of those who had sex in the last three months, 59.0% reported using a contraceptive method. Condom use was inconsistent: almost all females said they had not used or could not remember if a condom was used at last sex. Conclusion: This paper contributes to the evidence strengthening learner SRH education, including the national Integrated School Health Programme. Key themes include the need for age-appropriate, differentiated comprehensive sexuality education (CSE) for the range of ages found in the same grade in South African schools. Education on different contraceptive methods, informed decision-making, and emergency contraception is key. School-based interventions should embrace integrated HIV, STI, and pregnancy prevention messages. Closer links with health services need to be constantly fostered and reinforced.
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