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Olamijuwon E, Keenan K, Mushi MF, Kansiime C, Konje ET, Kesby M, Neema S, Asiimwe B, Mshana SE, Fredricks KJ, Sunday B, Bazira J, Sandeman A, Sloan DJ, Mwanga JR, Sabiiti W, Holden MTG. Treatment seeking and antibiotic use for urinary tract infection symptoms in the time of COVID-19 in Tanzania and Uganda. J Glob Health 2024; 14:05007. [PMID: 38236690 PMCID: PMC10795859 DOI: 10.7189/jogh.14.05007] [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] [Indexed: 01/22/2024] Open
Abstract
Background There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania. Methods In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as 'pre-COVID-19 phase' (February 2019 to February 2020), 'COVID-19 phase 1' (March 2020 to April 2020), and 'COVID-19 phase 2' (July 2021 to February 2022). Results In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda. Conclusions There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance.
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Affiliation(s)
- Emmanuel Olamijuwon
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Martha F Mushi
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Catherine Kansiime
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
| | - Eveline T Konje
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Mike Kesby
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Stella Neema
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
| | - Benon Asiimwe
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Kathryn J Fredricks
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Benjamin Sunday
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Joel Bazira
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Alison Sandeman
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Derek J Sloan
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Joseph R Mwanga
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Wilber Sabiiti
- School of Medicine, University of St Andrews, St Andrews, UK
| | | | - CARE Consortium
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- School of Public Health, College of Health Sciences, Makerere University Kampala, Uganda
- Department of Sociology and Anthropology, Makerere University, Kampala, Uganda
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Microbiology, Mbarara University of Science and Technology, Mbarara, Uganda
- School of Medicine, University of St Andrews, St Andrews, UK
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Lu Z, Sim JA, Wang JX, Forrest CB, Krull KR, Srivastava D, Hudson MM, Robison LL, Baker JN, Huang IC. Natural Language Processing and Machine Learning Methods to Characterize Unstructured Patient-Reported Outcomes: Validation Study. J Med Internet Res 2021; 23:e26777. [PMID: 34730546 PMCID: PMC8600437 DOI: 10.2196/26777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/20/2021] [Accepted: 08/12/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Assessing patient-reported outcomes (PROs) through interviews or conversations during clinical encounters provides insightful information about survivorship. OBJECTIVE This study aims to test the validity of natural language processing (NLP) and machine learning (ML) algorithms in identifying different attributes of pain interference and fatigue symptoms experienced by child and adolescent survivors of cancer versus the judgment by PRO content experts as the gold standard to validate NLP/ML algorithms. METHODS This cross-sectional study focused on child and adolescent survivors of cancer, aged 8 to 17 years, and caregivers, from whom 391 meaning units in the pain interference domain and 423 in the fatigue domain were generated for analyses. Data were collected from the After Completion of Therapy Clinic at St. Jude Children's Research Hospital. Experienced pain interference and fatigue symptoms were reported through in-depth interviews. After verbatim transcription, analyzable sentences (ie, meaning units) were semantically labeled by 2 content experts for each attribute (physical, cognitive, social, or unclassified). Two NLP/ML methods were used to extract and validate the semantic features: bidirectional encoder representations from transformers (BERT) and Word2vec plus one of the ML methods, the support vector machine or extreme gradient boosting. Receiver operating characteristic and precision-recall curves were used to evaluate the accuracy and validity of the NLP/ML methods. RESULTS Compared with Word2vec/support vector machine and Word2vec/extreme gradient boosting, BERT demonstrated higher accuracy in both symptom domains, with 0.931 (95% CI 0.905-0.957) and 0.916 (95% CI 0.887-0.941) for problems with cognitive and social attributes on pain interference, respectively, and 0.929 (95% CI 0.903-0.953) and 0.917 (95% CI 0.891-0.943) for problems with cognitive and social attributes on fatigue, respectively. In addition, BERT yielded superior areas under the receiver operating characteristic curve for cognitive attributes on pain interference and fatigue domains (0.923, 95% CI 0.879-0.997; 0.948, 95% CI 0.922-0.979) and superior areas under the precision-recall curve for cognitive attributes on pain interference and fatigue domains (0.818, 95% CI 0.735-0.917; 0.855, 95% CI 0.791-0.930). CONCLUSIONS The BERT method performed better than the other methods. As an alternative to using standard PRO surveys, collecting unstructured PROs via interviews or conversations during clinical encounters and applying NLP/ML methods can facilitate PRO assessment in child and adolescent cancer survivors.
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Affiliation(s)
- Zhaohua Lu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Jin-Ah Sim
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
- School of AI Convergence, Hallym University, Chuncheon, Republic of Korea
| | - Jade X Wang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Christopher B Forrest
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Kevin R Krull
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Deokumar Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Melissa M Hudson
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - Justin N Baker
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, United States
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, United States
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Semendric I, Pollock D, Haller OJ, George RP, Collins-Praino LE, Whittaker AL. "Chemobrain" in childhood cancer survivors - the impact on social, academic, and daily living skills: a qualitative systematic review protocol. JBI Evid Synth 2021; 20:222-228. [PMID: 34341312 DOI: 10.11124/jbies-21-00115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to examine children's experiences of chemotherapy-induced cognitive impairment--also known as "chemobrain"--and the impact of chemobrain on children's social, academic, and daily living skills. INTRODUCTION The effect of childhood chemotherapy treatment on cognition is of concern because of the vulnerable nature of children's developing brains and the potential to cause lifelong detriments socially, academically, and economically. Furthermore, this population is underrepresented in the chemobrain literature and in survivorship care plans. As cancer survivorship among this group increases, it is important to understand childhood experiences so that rehabilitation strategies and suitable supports can be put in place. INCLUSION CRITERIA This review of qualitative studies will focus on the pediatric population (0-18 years of age) during and/or following chemotherapy treatment to identify their experiences with chemobrain. The review will include any studies using a qualitative research methodology (eg, surveys, focus groups, interview transcripts), conducted in any geographic location, where experiences are presented from the child's perspective. Studies assessing children's experiences of cancer, other chemotherapy-related side effects, or the parent's personal experience will be excluded. METHODS A search of MEDLINE, Embase, PsycINFO, and CINAHL databases will be conducted. Full-text, English-only articles employing a qualitative research methodology will be included in the screening process. Two independent reviewers will retrieve and screen full-text studies, and assess methodological quality of the included studies. Meta-aggregation will be performed and a ConQual Summary of Findings will present the confidence in the findings. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021240573.
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Affiliation(s)
- Ines Semendric
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA Australia School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA, Australia
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