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McCaw-Binns A, Asnani M. Reliability of self-reported data from the 2011 Ja-Kids birth cohort study: demographic, social, obstetric history, medical and outcome indicators. PSYCHOL HEALTH MED 2024; 29:1179-1193. [PMID: 34493112 DOI: 10.1080/13548506.2021.1975782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
The Ja-Kids Longitudinal Study (JA-Kids) aims to improve the health and development of Jamaican children by identifying social, demographic, environmental and clinical factors that help or hinder these processes. As clinical indicators relied on maternal reporting, we aim to evaluate the quality of the self-reported data. Women were recruited across Jamaica during pregnancy or at delivery from July 1-30 September 2011. Indicators were compared between women recruited while pregnant and at delivery to understand possible differences between the sub-populations. Variables reported more than once between pregnancy and delivery were assessed to evaluate level of agreement (reliability). Clinical indicators from the literature were contrasted with study findings to determine how maternal reporting align with published prevalence (validity). Intra-class correlation and the kappa (κ) statistic were used to assess reliability while chi-squared, Fisher's-exact or students-t were used to compare differences over time; p values ≤0.05 were considered statistically significant. Women recruited during pregnancy (n = 3970) were younger, less parous and possibly more socially disadvantaged than those recruited at delivery (n = 5803). Socio-demographic and selected clinical indicators showed good to moderate (0.421 < κ < 0.681) reporting consistency between pregnancy and delivery for previous C-section (κ = 0.681), pre-existing diabetes mellitus (κ = 0.616) and prior twin gestations (0.580). Most conditions however showed only fair agreement (0.21 < κ < 0.40) including previous gestational hypertension (κ = 0.387), asthma (κ = 0.365), premature rupture of membranes (κ = 0.324), eclampsia (κ = 0.257) and essential hypertension (κ = 0.213). Infectious conditions had poor reliability. Prevalence rates for most conditions, except sickle cell disease, were lower than the published literature. Complications and outcomes which were well defined for women were better reported than those requiring clinical judgment (e.g. prior C-section versus specific hypertensive disorders of pregnancy). NCDs with only episodic acute effects were not well reported, e.g. asthma, hypertension and sickle cell disease. Maternal reporting of pregnancy complications needs to be interpreted with caution.
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Affiliation(s)
- Affette McCaw-Binns
- Department of Community Health and Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Kingston, Jamaica
| | - Monika Asnani
- Caribbean Institute for Health Research- Sickle Cell Unit, the University of the West Indies, Kingston, Jamaica
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Ezenwosu OU, Olawepo JO, Lacroix-Willliamson LJ, Itanyi IU, Ogidi A, Onyeka TC, Gully M, Gregory M, Breeze JL, Ibemere S, Idemili-Aronu N, Molnar BE, Ezeanolue EE. Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative. BMC Pregnancy Childbirth 2024; 24:321. [PMID: 38671412 PMCID: PMC11046861 DOI: 10.1186/s12884-024-06498-9] [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: 09/26/2023] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.
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Affiliation(s)
- Osita U Ezenwosu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria.
- Department of Pediatrics, College of Medicine, University of Nigeria, Enugu, Nigeria.
| | - John O Olawepo
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Lorraine J Lacroix-Willliamson
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Ijeoma U Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Amaka Ogidi
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Tonia C Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Department of Anesthesia/Pain & Palliative Care Unit, University of Nigeria, Enugu, Nigeria
| | - Madeline Gully
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Maisha Gregory
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, USA
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Institute for Clinical Research and Health Policy Studies, Tufts University, Tufts Medical Center, Boston, MA, USA
| | - Stephanie Ibemere
- Duke University School of Nursing, Duke Global Health Institute, Durham, NC, USA
| | - Ngozi Idemili-Aronu
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
| | - Beth E Molnar
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Colombatti R, Hegemann I, Medici M, Birkegård C. Systematic Literature Review Shows Gaps in Data on Global Prevalence and Birth Prevalence of Sickle Cell Disease and Sickle Cell Trait: Call for Action to Scale Up and Harmonize Data Collection. J Clin Med 2023; 12:5538. [PMID: 37685604 PMCID: PMC10488271 DOI: 10.3390/jcm12175538] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited monogenic disorder with high prevalence throughout sub-Saharan Africa, the Mediterranean basin, the Middle East, and India. Sources of SCD epidemiology remain scarce and fragmented. A systematic literature review (SLR) to identify peer-reviewed studies on SCD epidemiology was performed, with a search of bibliographic databases and key conference proceedings from 1 January 2010 to 25 March 2022 (congress abstracts after 2018). The SLR followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Meta-analyses, using a binomial normal random-effects model, were performed to estimate global and regional prevalence and birth prevalence. Of 1770 journal articles and 468 abstracts screened, 115 publications met the inclusion criteria. Prevalence was highest in Africa (~800/100,000), followed by the Middle East (~200/100,000) and India (~100/100,000), in contrast to ~30/100,000 in Europe. Birth prevalence was highest in Africa (~1000/100,000) and lowest in North America (~50/100,000) and Europe (~30/100,000). This SLR confirmed that sub-Saharan and North-East Africa, India, the Middle East, and the Caribbean islands are global SCD hotspots. Publications including mortality data were sparse, and no conclusions could be drawn about mortality. The identified data were limited due to gaps in the published literature for large parts of the world population; the inconsistent reporting of SCD genotypes, diagnostic criteria, and settings; and a sparsity of peer-reviewed publications from countries with assumed high prevalence. This SLR demonstrated a lack of systematic knowledge and a need to provide uniform data collection on SCD prevalence and mortality.
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Affiliation(s)
- Raffaella Colombatti
- Clinic of Pediatric Hematology Oncology, Department of Child and Maternal Health, Azienda Ospedaliera, University of Padova, 35122 Padua, Italy
| | | | - Morten Medici
- Novo Nordisk A/S, 2860 Søborg, Denmark; (M.M.); (C.B.)
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Tutuba HJ, Jonathan A, Lloyd W, Masamu U, Marco E, Makani J, Ruggajo P, Kidenya BR, Minja IK, Balandya E. The efficacy of maternal health education and maternal screening on knowledge and the uptake of infant screening for sickle cell disease in Dar-Es-Salaam, Tanzania; a quasi experimental study. BMC Public Health 2023; 23:70. [PMID: 36627609 PMCID: PMC9832626 DOI: 10.1186/s12889-022-14859-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Globally, Sickle cell disease (SCD) is one of the most common genetic disease with high childhood mortality. Early identification of babies with SCD through newborn screening (NBS) and linking them to care are among the recommended interventions. The purpose of this study was to assess the efficacy of maternal health education and maternal screening for SCD on knowledge and the uptake of infant screening for SCD among mother-infant pairs attending antenatal clinics at Government health facilities in Dar-es-salaam, Tanzania. METHODS: This study was a pre-test post-test, quasi-experimental which involved pregnant women attending antenatal clinics at three hospitals; Mbagala hospital, Sinza hospital and Buguruni health center in Dar Es Salaam. A structured questionnaire was used in data collection. Knowledge on SCD was assessed for all participants before and after two sessions of health education. Participants in Mbagala and Buguruni were also screened for SCD using Sickle SCAN point-of-care test (BioMedomics Inc, USA). The efficacy for health education intervention was computed as the post-intervention minus baseline knowledge score. For proportions, a two-sample z-test was used. Univariate and multivariate logistic regression were used to analyze the efficacy of health education intervention and also predictors of infant diagnosis. RESULTS: For two sessions of health education intervention, a total of 467 pregnant women completed the sessions. During antenatal visits, a total of 218 were screened for SCD. The proportion of participants with good knowledge of SCD had significantly increased to 85.9% from 12.4% at baseline following the education intervention. In multivariate analysis, sharing the received education on SCD was an independent predictor of the efficacy of health education intervention. Maternal occupation, maternal SCD status as well as sharing the received education on SCD were independent predictors of the uptake of SCD infant diagnosis. CONCLUSION This study has demonstrated that maternal health education and maternal screening for SCD are feasible and efficacious interventions in raising knowledge and improving the uptake of infant diagnosis for SCD. These interventions are strongly recommended to be included in the comprehensive care package for pregnant women attending antenatal clinics, particularly in areas with a high burden of SCD.
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Affiliation(s)
- Hilda J. Tutuba
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Physiology, MUHAS, Dar-Es-Salaam, Tanzania
| | - Agnes Jonathan
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - William Lloyd
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Upendo Masamu
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Emanuela Marco
- grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Julie Makani
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Hematology and Blood Transfusion, Sickle Cell Program, MUHAS, Dar-Es-Salaam, Tanzania
| | - Paschal Ruggajo
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Internal Medicine, MUHAS, Dar-Es-Salaam, Tanzania
| | - Benson R. Kidenya
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.411961.a0000 0004 0451 3858Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Irene K. Minja
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Internal Medicine, MUHAS, Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Restorative Dentistry, MUHAS, Dar-Es-Salaam, Tanzania
| | - Emmanuel Balandya
- Sickle Pan-African Research Consortium (SPARCO), Dar-Es-Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Physiology, MUHAS, Dar-Es-Salaam, Tanzania
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Tutuba HJ, Jonathan A, Lloyd W, Luoga F, Marco E, Ndunguru J, Kidenya BR, Makani J, Ruggajo P, Minja IK, Balandya E. Prevalence of Hemoglobin-S and Baseline Level of Knowledge on Sickle Cell Disease Among Pregnant Women Attending Antenatal Clinics in Dar-Es-Salaam, Tanzania. Front Genet 2022; 13:805709. [PMID: 35480324 PMCID: PMC9035883 DOI: 10.3389/fgene.2022.805709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/22/2022] [Indexed: 01/30/2023] Open
Abstract
Background: Sickle cell disease (SCD) is the single most important genetic cause of childhood mortality globally. Newborn screening (NBS) is the recommended intervention aimed at early identification of babies with SCD and their linkage to care. To ensure success of NBS, pregnant women need to have the required knowledge on SCD and therefore motivation to screen their babies. Objective: The aim of this study was to determine the prevalence of hemoglobin-S and assess the baseline level of knowledge on SCD among pregnant women attending antenatal clinics in urban settings in Dar-es-Salaam, Tanzania. Methods: This cross-sectional study was conducted between August 2020 and February 2021, involving 600 pregnant women at 20-28 weeks of gestation attending antenatal clinics at Buguruni Health Center, Mbagala Hospital, and Sinza Hospital in Dar-es-Salaam, Tanzania. We administered a structured questionnaire to all participants to assess socio-demographic characteristics and baseline level of knowledge on SCD, where those scoring 7 or higher out of 10 questions were considered to have good knowledge. We screened for SCD a total of 300 participants from two centers (Buguruni Health Center and Mbagala Hospital) by using Sickle SCAN point-of-care test (BioMedomics Inc., United States). We used SPSS version 23 to analyze the data. On determining the association between level of knowledge and socio-demographic factors, we used Pearson's Chi-square and multivariate logistic regression in ascertaining the strength of associations. Results: Of the 600 participants, the majority were of the age between 26 and 35 years (51%), with the parity of 1-3 children (55.8%) and secondary level of education (43%), while 56% were self-employed. Only 14.7% had good knowledge on SCD. The majority of the participants had ever heard of SCD (81.3%), most of them heard from the streets (42.4%), and only 2.4% heard from hospitals. Of all 600 study participants, only 2 (0.3%) knew their SCD status while 7.7% declared having a family history of SCD. A proficient level of knowledge on SCD is associated with a high level of education, occupation, and knowing personal status of SCD. Among 300 participants who were screened for SCD, 252 were Hb-AA (84%), 47 were Hb-AS (15.7%), and 1 (0.3%) was Hb-SS. Conclusion: Despite the high prevalence of hemoglobin-S among pregnant women attending antenatal clinics in urban settings in Tanzania, there is a poor level of knowledge on SCD and personal knowledge of SCD status. Maternal screening and health education on SCD should be included as part of the comprehensive package for health promotion at antenatal clinics.
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Affiliation(s)
- Hilda J. Tutuba
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania,Department of Physiology, MUHAS, Dar-es-Salaam, Tanzania,*Correspondence: Hilda J. Tutuba,
| | - Agnes Jonathan
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - William Lloyd
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - Fredrick Luoga
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - Emanuela Marco
- Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - Joyce Ndunguru
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - Benson R. Kidenya
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Department of Biochemistry and Molecular Biology, Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Julie Makani
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences (MUHAS), Dar-es-Salaam, Tanzania
| | - Paschal Ruggajo
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Department of Internal Medicine, MUHAS, Dar-es-Salaam, Tanzania
| | - Irene K. Minja
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Department of Restorative Dentistry, MUHAS, Dar-es-Salaam, Tanzania
| | - Emmanuel Balandya
- Sickle Pan-African Research Consortium (SPARCO), Dar-es-Salaam, Tanzania,Department of Physiology, MUHAS, Dar-es-Salaam, Tanzania
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Kweka BV, Fredrick C, Kitilya B, Jeremiah K, Lyimo E, Filteau S, Rehman AM, Friis H, Olsen MF, Faurholt-Jepsen D, Krogh-Madsen R, PrayGod G. Association of sickle cell trait with β-cell dysfunction and physical activity in adults living with and without HIV in Tanzania. APMIS 2022; 130:230-239. [PMID: 35167170 PMCID: PMC9314065 DOI: 10.1111/apm.13214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/11/2022] [Indexed: 12/15/2022]
Abstract
This study aimed to investigate sickle cell trait (SCT) associations with physical activity, markers of insulin secretion and resistance, and glucose among people living with HIV infection (PLWH), both antiretroviral therapy (ART) naive and experienced, and HIV-uninfected adults. This was a cross-sectional study conducted in Mwanza, Northwestern Tanzania. We used data of 668 participants attained from two sub-studies of CICADA study. Mean age was 40 (SD 11.5) years, 402 (61.7%) were females and 157 (24.1%) had SCT. PLWH were 422 (64.7%), of these, 80 (18.9%) were on ART. People with SCT had higher risk of having an isolated β-cell dysfunction compared to those without SCT (RRR = 1.82, CI: 1.10, 3.01, p = 0.02). People with SCT but without HIV infection had lower average acceleration on the trunk longitudinal axis (ACCx) and higher level of self-reported physical activity. 30 min oral glucose tolerance test among PLWH on ART was higher in those with SCT compared to those without SCT. People with SCT are at higher risk of having β-cell dysfunction and those with SCT on ART are at more risk of developing diabetes. Future studies to investigate the interaction between SCT and HIV/ART on risk of diabetes should be considered.
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Affiliation(s)
- Belinda V Kweka
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Cyprian Fredrick
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Brenda Kitilya
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Kidola Jeremiah
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Eric Lyimo
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Suzanne Filteau
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrea M Rehman
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Henrik Friis
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Mette F Olsen
- Department of Nutrition, Exercise, and Sports, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | | | - Rikke Krogh-Madsen
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Copenhagen, Denmark
| | - George PrayGod
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
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Olawepo JO, Ezeanolue EE, Ekenna A, Ogunsola OO, Itanyi IU, Jedy-Agba E, Egbo E, Onwuchekwa C, Ezeonu A, Ajibola A, Olakunde BO, Majekodunmi O, Ogidi AG, Chukwuorji J, Lasebikan N, Dakum P, Okonkwo P, Oyeledun B, Oko J, Khamofu H, Ikpeazu A, Nwokwu UE, Aliyu G, Shittu O, Rositch AF, Powell BJ, Conserve DF, Aarons GA, Olutola A. Building a national framework for multicentre research and clinical trials: experience from the Nigeria Implementation Science Alliance. BMJ Glob Health 2022; 7:bmjgh-2021-008241. [PMID: 35450861 PMCID: PMC9024272 DOI: 10.1136/bmjgh-2021-008241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/25/2022] [Indexed: 01/21/2023] Open
Abstract
There is limited capacity and infrastructure in sub-Saharan Africa to conduct clinical trials for the identification of efficient and effective new prevention, diagnostic and treatment modalities to address the disproportionate burden of disease. This paper reports on the process to establish locally driven infrastructure for multicentre research and trials in Nigeria known as the Nigeria Implementation Science Alliance Model Innovation and Research Centres (NISA-MIRCs). We used a participatory approach to establish a research network of 21 high-volume health facilities selected from all 6 geopolitical zones in Nigeria capable of conducting clinical trials, implementation research using effectiveness-implementation hybrid designs and health system research. The NISA-MIRCs have a cumulative potential to recruit 60 000 women living with HIV and an age-matched cohort of HIV-uninfected women. We conducted a needs assessment, convened several stakeholder outreaches and engagement sessions, and established a governance structure. Additionally, we selected and trained a core research team, developed criteria for site selection, assessed site readiness for research and obtained ethical approval from a single national institutional review board. We used the Exploration, Preparation, Implementation, Sustainment framework to guide our reporting of the process in the development of this network. The NISA-MIRCs will provide a nationally representative infrastructure to initiate new studies, support collaborative research, inform policy decisions and thereby fill a significant research infrastructure gap in Africa’s most populous country.
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Affiliation(s)
- John Olajide Olawepo
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.,Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria .,Healthy Sunrise Foundation, Las Vegas, Nevada, USA
| | - Adanma Ekenna
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Emmanuel Egbo
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | | | - Alexandra Ezeonu
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - Abiola Ajibola
- Center for Integrated Health Programs (CIHP), Abuja, FCT, Nigeria
| | - Babayemi O Olakunde
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Community Prevention and Care Services, National Agency for Control of AIDS (NACA), Abuja, FCT, Nigeria
| | | | - Amaka G Ogidi
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria
| | - JohnBosco Chukwuorji
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Department of Psychology, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research (CTAIR), University of Nigeria, Nsukka, Enugu, Nigeria.,Oncology Center, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Patrick Dakum
- Institute of Human Virology Nigeria, Abuja, FCT, Nigeria
| | | | - Bolanle Oyeledun
- Center for Integrated Health Programs (CIHP), Abuja, FCT, Nigeria
| | - John Oko
- Caritas Nigeria, Abuja, FCT, Nigeria
| | | | - Akudo Ikpeazu
- National AIDS, Viral Hepatitis and Sexually Transmitted Infections Control Programme, Federal Ministry of Health, Abuja, FCT, Nigeria
| | | | - Gambo Aliyu
- National Agency for the Control of AIDS (NACA), Abuja, FCT, Nigeria
| | - Oladapo Shittu
- Federal University of Health Sciences Otukpo, Otukpo, Benue State, Nigeria
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Byron J Powell
- Center for Mental Health Services Research, Brown School at Washington University in St Louis, St Louis, Missouri, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Ayodotun Olutola
- Center for Clinical Care and Clinical Research, Abuja, FCT, Nigeria
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Dokekias AE, Ocko Gokaba LT, Louokdom JS, Ocini LN, Galiba Atipo Tsiba FO, Ondzotto Ibatta CI, Kouandzi QN, Tamekue ST, Bango JC, Nziengui Mboumba JV, Kobawila SC. Neonatal Screening for Sickle Cell Disease in Congo. Anemia 2022; 2022:9970315. [PMID: 35154827 PMCID: PMC8831066 DOI: 10.1155/2022/9970315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 11/21/2021] [Accepted: 01/07/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Sickle cell disease is an autosomal recessive inherited disorder due to the mutation of a gene coding for the globin beta chain. The aim of this study is to update the epidemiological data on hemoglobinoses, in particular sickle cell disease in newborns in Congo. MATERIALS AND METHODS This was a descriptive cross-sectional study, conducted from October 1, 2019, to March 31, 2020, throughout the Congolese national territory. It involved all full-term newborns, without distinction of nationality, aged 5 days or less, and whose parents consented to participate in the study. The blood samples, taken at the heel and collected on Whatman blotting paper, were analyzed using the HPLC Variant NBS machine. RESULTS In 2897 newborns (NN) screened, hemoglobin abnormalities were found in 603 NN (20.81%). The mean age of these newborns was 1 day (extremes 0 and 5 days). The male-to-female ratio was 1.03. Abnormal hemoglobins were mainly Hb S (n = 597 (97.71%)); Hb C (n = 5 (0.82%)); and variants (n = 7 (1.15%)). The national prevalence of major sickle cell (MSC) syndromes and sickle cell trait was 1.35% and 19.43%, respectively. The prevalence ranged from 1.77% to 2.56% for MSS in four departments and from 20.5% to 25.8% for the sickle cell trait in six other departments. CONCLUSION Data on homozygous sickle cell disease remain consistent with previous studies. However, further studies should clarify the molecular anomalies of the variants observed in our samples.
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Affiliation(s)
- Alexis Elira Dokekias
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | - Lethso Thibaut Ocko Gokaba
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | - Josué Simo Louokdom
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
| | - Lydie Ngolet Ocini
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | - Firmine Olivia Galiba Atipo Tsiba
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
- Université Marien Ngouabi, Brazzaville, Congo
| | | | - Quentin Ngoma Kouandzi
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
| | - Serge Talomg Tamekue
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
| | - Jayne Chelsea Bango
- Centre National de Référence de la Drépanocytose ‘' Antoinette SASSOU N'GUESSO, Brazzaville, Congo
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Routine Screening for Sickle Cell Disease during Pregnancy: Epidemiological and Haemoglobin Profile in Congo. JOURNAL OF NEONATAL BIOLOGY 2022; 11:1000335. [PMID: 35928545 PMCID: PMC9348352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sickle-cell disease, a genetic condition with a high prevalence in sub-Saharan Africa, is transmitted in an autosomal recessive mode. Its screening during pregnancy makes it possible to identify carriers of the S gene which constitute a risk for the unborn child. In order to promote the use of immuno-chromatographic tests, we have set ourselves the task of establishing the epidemiological profile and determining the Emmel test performance. Analytical cross-sectional study of three months duration carried out in the 12 departments of Congo in pregnant women, from 12 weeks of amenorrhea, Admitted for Antenatal Consultation (ANC). The studied variables were epidemiological, Emmel test and immuno-chromatographic profile of haemoglobin. 782 pregnant women screened, of which 27.88% were AS sickle cell trait and 1.79% homozygous SS. The median age of sickle cell patients was 29 years vs. 25 years (p=0.10). High education level, married status, history of transfusion and sickle cell disease, and high ANC number were more common in pregnant sickle cell patients (p<0.05).The frequency of sickle cell trait ranged from 16.67 to 31.17% and homozygous forms from 0 to 66.67% depending on the department. The sensitivity and specificity of the Emmel test were 46% and 99% with PPV and NPV of 95% and 81% respectively. Sickle cell disease carriage, which is high in both forms, is more often of interest to young, educated, married pregnant women and follow-up by health personnel other than the doctor in rural areas.
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Community based screening for sickle haemoglobin among pregnant women in Benue State, Nigeria: I-Care-to-Know, a Healthy Beginning Initiative. BMC Pregnancy Childbirth 2021; 21:498. [PMID: 34238241 PMCID: PMC8268197 DOI: 10.1186/s12884-021-03974-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Haemoglobin genotype screening at prenatal care offers women an opportunity to be aware of their genotype, receive education on sickle cell disease (SCD) and may increase maternal demand for SCD newborn screening. In developed countries, most pregnant women who access prenatal care and deliver at the hospital receive haemoglobin genotype screening. In settings with low prenatal care attendance and low hospital deliveries, community-based screening may provide similar opportunity for pregnant women. We assessed the feasibility and acceptability of integrating haemoglobin genotype screening into an existing community-based HIV program. Methods Onsite community-based integrated testing for HIV, hepatitis B virus and haemoglobin electrophoresis, were conducted for pregnant women and their male partners. Community Health Advisors implementing the NIH and PEPFAR-supported Healthy Beginning Initiative (HBI) program provided education on SCD, collected blood sample for haemoglobin electrophoresis and provided test results to participants enrolled into the HBI program. We concurrently conducted a cross-sectional study using a pretested, semi-structured, interviewer administered questionnaire to collect demographic data and assess awareness of individual haemoglobin “genotype” among HBI pregnant women participants. Results In this study, 99.9% (10,167/10,168) of pregnant women who received education on SCD accepted and completed the survey, had blood drawn for haemoglobin electrophoresis and received their results. A majority of participating pregnant women (97.0%) were not aware of their haemoglobin “genotype”. Among the participants who were incorrect about their haemoglobin “genotype”, 41.1% (23/56) of women who reported their haemoglobin “genotype” as AA were actually AS. The odds of haemoglobin “genotype” awareness was higher among participants who were in younger age group, completed tertiary education, had less number of pregnancies, and attended antenatal care. Overall prevalence of sickle cell trait (AS) was 18.7%. Conclusions It is feasible to integrate haemoglobin “genotype” testing into an existing community-based maternal-child program. Most pregnant women who were unaware of their haemoglobin “genotype” accepted and had haemoglobin genotype testing, and received their test results. Increasing parental awareness of their own haemoglobin “genotype” could increase their likelihood of accepting newborn screening for SCD. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03974-4.
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Iheanacho T, Nduanya UC, Slinkard S, Ogidi AG, Patel D, Itanyi IU, Naeem F, Spiegelman D, Ezeanolue EE. Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression. Glob Ment Health (Camb) 2021; 8:e5. [PMID: 34026236 PMCID: PMC8127631 DOI: 10.1017/gmh.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. METHODS We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. RESULTS The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). CONCLUSION These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.
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Affiliation(s)
| | - Ujunwa Callista Nduanya
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Psychiatry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | | | | | - Echezona E. Ezeanolue
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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Berghs M, Ola B, Cronin De Chavez A, Ebenso B. Time to apply a social determinants of health lens to addressing sickle cell disorders in sub-Saharan Africa. BMJ Glob Health 2020; 5:e002601. [PMID: 32723757 PMCID: PMC7388876 DOI: 10.1136/bmjgh-2020-002601] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/05/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Maria Berghs
- Unit for the Social Study of Thalassaemia and Sickle Cell, School of Allied Health Sciences, De Montfort University, Leicester, UK
| | - Bola Ola
- Department of Psychiatry, Faculty of Clinical Sciences, Lagos State University, Lagos, Nigeria
| | | | - Bassey Ebenso
- Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
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Therrell BL, Lloyd-Puryear MA, Ohene-Frempong K, Ware RE, Padilla CD, Ambrose EE, Barkat A, Ghazal H, Kiyaga C, Mvalo T, Nnodu O, Ouldim K, Rahimy MC, Santos B, Tshilolo L, Yusuf C, Zarbalian G, Watson MS. Empowering newborn screening programs in African countries through establishment of an international collaborative effort. J Community Genet 2020; 11:253-268. [PMID: 32415570 PMCID: PMC7295888 DOI: 10.1007/s12687-020-00463-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/02/2020] [Indexed: 02/02/2023] Open
Abstract
In an effort to explore new knowledge and to develop meaningful collaborations for improving child health, the First Pan African Workshop on Newborn Screening was convened in June 2019 in Rabat, Morocco. Participants included an informal network of newborn screening stakeholders from across Africa and global experts in newborn screening and sickle cell disease. Over 150 attendees, representing 20 countries, were present including 11 African countries. The agenda focused on newborn screening rationale, techniques, system development, implementation barriers, ongoing research, and collaborations both globally and across Africa. We provide an overview of the workshop and a description of the newborn screening activities in the 11 African countries represented at the workshop, with a focus on sickle cell disease.
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Affiliation(s)
- Bradford L Therrell
- National Newborn Screening and Global Resource Center, University of Texas Health Science Center at San Antonio, Austin, TX, USA.
| | | | - Kwaku Ohene-Frempong
- Sickle Cell Foundation of Ghana, National Newborn Screening Program for Sickle Cell Disease, Accra, Ghana
| | - Russell E Ware
- Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Emmanuela E Ambrose
- Bugando Medical Centre and Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Amina Barkat
- Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Hassan Ghazal
- National Center for Scientific and Technological Research, Rabat, Morocco
| | - Charles Kiyaga
- Central Public Health Laboratories, Ministry of Health, Kampala, Uganda
| | - Tisungane Mvalo
- University of North Carolina Project Malawi, Lilongwe, Malawi
| | - Obiageli Nnodu
- Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Karim Ouldim
- Faculty of Medicine and Pharmacy, University Sidi Mohamed Ben Abdellah, Fes, Morocco
| | - Mohamed Chérif Rahimy
- National Sickle Cell Disease Center, Faculty of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
| | - Brígida Santos
- Centro de Apoio ao Doente Anémico, Hospital Pediátrico David Bernardino, Luanda, Angola
| | - Léon Tshilolo
- Centre Hospitalier Monkole, Kinshasa, Democratic Republic of the Congo
| | - Careema Yusuf
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Guisou Zarbalian
- Association of Public Health Laboratories, Silver Spring, MD, USA
| | - Michael S Watson
- American College of Medical Genetics and Genomics, Bethesda, MD, USA
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Ezenwosu OU, Chukwu BF, Ezenwosu IL, Ikefuna AN, Emodi IJ, Ezeanolue EE. Knowledge and awareness of individual sickle cell genotype among adolescents in a unity school in Southeast, Nigeria: a cross-sectional study. Int J Adolesc Med Health 2020; 33:395-400. [PMID: 32549154 DOI: 10.1515/ijamh-2019-0149] [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: 07/04/2019] [Accepted: 09/08/2019] [Indexed: 11/15/2022]
Abstract
Objective Our study sought to assesses the knowledge and awareness of individual sickle cell genotype among adolescents. Methods Participants were recruited from a large school in Southeast Nigeria where adult prevalence of sickle cell trait is 25%. Data was collected through a 50-item survey with previously pretested questions that assessed awareness of individual genotype, general knowledge of sickle cell disease, perception of sickle cell trait and sickle cell anaemia (SCA). Additionally, self-reported genotype was compared to the school's admission records to determine accuracy of self-reported genotype. The knowledge scores were summed on a binary basis with one point assigned for a correct answer while zero was given for an incorrect response. Results Four hundred and nine (409) students were approached and enrolled in the study. A vast majority (94%) of the respondents reported being aware of their genotype and two-thirds had the awareness during school admission. However, in specific knowledge of sickle cell, majority (89.7%) of the participants miscalculated the probability of having a child with SCA in married carrier couple and 71.9% misidentified the proportion of Nigerians with sickle cell trait. Assessing level of knowledge of sickle cell, only very few of the adolescents (7.3%) were found with the expected high knowledge scores of 7-8. Conclusion Although a significant proportion of respondents were aware of their genotype, most were unaware of the implications of sickle cell trait and thought that people with sickle cell trait also have symptoms of sickle cell disease. Also, only a few of the respondents have the expected level of sickle cell knowledge. A focused educational intervention among this age group is crucial as they embark on making reproductive health decisions.
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Affiliation(s)
- Osita U Ezenwosu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
- University of Nigeria, Centre for Translational and Implementation Research, Enugu, Nigeria
| | - Barthlomew F Chukwu
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ifeyinwa L Ezenwosu
- Department of Community Medicine, University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
| | - Anthony N Ikefuna
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
| | - Ifeoma J Emodi
- Department of Paediatrics, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria
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Faucett WA, Peay H, Coughlin CR. Genetic Testing: Consent and Result Disclosure for Primary Care Providers. Med Clin North Am 2019; 103:967-976. [PMID: 31582007 PMCID: PMC6779337 DOI: 10.1016/j.mcna.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Historically, both pretest and posttest genetic counseling has been standard of care for genetic testing. This model should be adapted for primary care providers (PCPs) willing to learn critical information about the test and key concepts that patients need to make an informed testing decision. It is helpful for PCPs to discuss a few initial patients with a genetic counselor to prepare for the key concepts of pretest and posttest counseling. This article provides guidance about the recommended level of involvement of PCPs based on the test indication, test complexity, disorder management, and the potential for psychosocial sequela.
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Affiliation(s)
- W Andrew Faucett
- Office of the Chief Scientific Officer, Geisinger, MC 30-42, 100 North Academy Avenue, Danville, PA 17822, USA.
| | - Holly Peay
- Center for Newborn Screening, Ethics, and Disability Studies, RTI International, 3040 East Institute Drive, Research Triangle Park, NC 27709, USA
| | - Curtis R Coughlin
- Department of Pediatrics, Section of Genetics, University of Colorado Anschutz Medical Campus, East 17th Avenue, Aurora, CO 80045, USA
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Banza MI, Mulefu JP, Lire LI, N'dwala YTB, Tshiamala IB, Cabala VDPK. [Digestives diseases associated to sickle cell anemia in Lubumbashi: epidemiological and clinical aspects]. Pan Afr Med J 2019; 33:253. [PMID: 31692839 PMCID: PMC6814946 DOI: 10.11604/pamj.2019.33.253.18017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 07/07/2019] [Indexed: 02/06/2023] Open
Abstract
Introduction la drépanocytose est une maladie génétique de transmission autosomique liée à une anomalie de structure de l'hémoglobine qui aboutit à la formation de l'hémoglobine S. Le but de notre étude est de colliger les cas de pathologies digestives rencontrées chez les drépanocytaires de Lubumbashi et d'en ressortir les caractéristiques épidémiologiques et cliniques. Méthodes il s'agit d'une étude rétrospective, descriptive transversale réalisée au Centre de Recherche de la Drépanocytose de Lubumbashi. Elle a concerné les dossiers des patients suivi pour drépanocytose ayant présenté une pathologie digestive au cours de notre période de 3 ans (de janvier 2015 à décembre 2017). Le recueil des données s'est fait grâce à une fiche d'enquête comportant différents paramètres d'étude comprenant: l'âge, le sexe, le motif de consultation, le diagnostic, le type de crise vaso-occlusive, les examens paracliniques réalisés, le traitement à l'hydroxyurée. Résultats nous avons colligé 206 dossiers (N=206) des patients drépanocytaires ayant fait une pathologie digestive sur un total de 403 dossiers examinés, ce qui représente une fréquence de 51,11% des pathologies digestives chez les drépanocytaires. Les 2 sexes sont représentés avec une légère prédominance féminine (51,94%) et un sexe ratio H/F: 0,92. La tranche d'âge la plus représentée est celle comprise entre 1 et 6 ans (32,52%), la moyenne d'âge: 11,8ans; écart-type: 21,9; âges extrêmes: 13 mois et 38 ans. Le motif de consultation est dominé par la fièvre (60,67%), la douleur abdominale (44,66%) et les troubles digestifs (30,09%). Les crises vaso-occlusives abdominales sont retrouvées chez 65 patients (31,55%) parmi lesquels 36 patients ont présenté 1 seule crise, 24 en ont présenté 2 et 5 patients en ont présenté 3. Les pathologies intestinales étaient présentes chez 121 patients (69,41%) dominées par la parasitose intestinale (retrouvée chez 58 patients dont l'examen des selles a mis en évidence 4 parasites: le Yersinia enterocolitis, l'entamoeba histolytica, le Giardia intestinalis et le clostridium difficile); les pathologies gastriques retrouvées chez 105 patients (50,97%) reparties en ulcère gastro-duodénal (45 patients) et gastrite (60 patients); la pathologie vésiculo-biliaire présente chez 40 patients (19,41%) comprenant la lithiase vésiculaire sans cholécystite 32 patients, la cholécystite lithiasique 5 patients et 3 cas de lithiase de la voie biliaire principale; 1 seul cas de pancréatite aigue diagnostiquée. Les pathologies associées les plus retrouvées dans notre étude sont respiratoires avec 169 cas (82,03%), oto-rhino-laryngologiques avec 157 cas (76,21%), les crises vaso-occlusives osseuses (146 cas soit 70,87%), pathologies uro-génitales avec 64 cas (31,06%) et le paludisme chez 51 patients (24,75%). Les atteintes spléniques et hépatiques ont constitué chacun 47 cas (22,81%) et 18 cas (8,73%). L'échographie a était demandé chez 79 patients mais seulement 31 d'entre-eux l'ont réalisé, faute de moyen financier car il coute sur place 20 dollars américains. En cas de splénomégalie cliniquement évidente, le corps de Jolly a été demandé chez 23 patients mais seulement 2 patients l'ont réalisé vu qu'il coute 10 dollars américains. L'hémogramme de routine fait de l'hémoglobine, hématocrite, bilan inflammatoire et la goutte épaisse a été réalisée chez tous nos patients mais le bilan hépatique, les examens des selles, des urines sont préconisés en fonction de la plainte. Sur nos 206 patients, 60 seulement d'entre eux étaient sous traitement à l'hydroxyurée (29,16%). Conclusion les pathologies digestives sont fréquentes chez les drépanocytaires et représentent quasiment la moitié de l'effectif drépanocytaire. Malheureusement, la meilleure prise en charge reste butée à la pauvreté manifeste de la population limitants les examens paracliniques très utiles dans la pathologie digestive rencontrée chez le drépanocytaire.
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Affiliation(s)
- Manix Ilunga Banza
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Jules Panda Mulefu
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Lire Ipani Lire
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Yannick Tietie Ben N'dwala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Israel Badypwyla Tshiamala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Vincent de Paul Kaoma Cabala
- Université de Lubumbashi, Faculté de Médecine, Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Lubumbashi, République Démocratique du Congo
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Mboowa G, Sserwadda I. Role of genomics literacy in reducing the burden of common genetic diseases in Africa. Mol Genet Genomic Med 2019; 7:e00776. [PMID: 31131548 PMCID: PMC6625136 DOI: 10.1002/mgg3.776] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/12/2019] [Accepted: 05/14/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In Africa, health practitioners and the current knowledge of the public on genetics and genomics is still very low and yet this has potential to reduce the burden of common genetic diseases. Many initiatives have promoted genomic research, infrastructure, and capacity building in Africa. What remains to be done is to improve genomics literacy among populations and communities while utilizing an array of strategies. Genomic literacy and awareness are key in the management of genetic diseases which includes diagnosis, prevention of complications and therapy. Africa is characterized by great cultural and language diversity thereby requiring a multidisciplinary approach to improving public and community genomics literacy and engagement. However, this is further complicated by having the fact that sub-Saharan Africa is comprised of countries with the lowest literacy rates in the world. METHODS We applied the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to review genomic literacy in Africa using PubMed database. RESULTS We found very limited evidence of genomics literacy for genetic diseases in Africa. CONCLUSION We propose a number of approaches that if adopted will significantly increase the genomic literacy and reduce the burden of genetic diseases in Africa.
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Affiliation(s)
- Gerald Mboowa
- Department of Immunology and Molecular BiologyCollege of Health Sciences, Makerere UniversityKampalaUganda
- Department of Medical MicrobiologyCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Ivan Sserwadda
- Department of Immunology and Molecular BiologyCollege of Health Sciences, Makerere UniversityKampalaUganda
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Ezugwu EC, Osamor PE, Wendler D. Ethical issues in denial of church wedding based on couple's hemoglobin genotype in Enugu, south eastern Nigeria. BMC Med Ethics 2019; 20:37. [PMID: 31142291 PMCID: PMC6542068 DOI: 10.1186/s12910-019-0376-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 05/23/2019] [Indexed: 11/25/2022] Open
Abstract
Background Sickle cell anemia (SCA) is a major genetic disease with the greatest burden in sub-Saharan Africa. To try to help reduce this burden, some churches in Nigeria conduct premarital sickle cell hemoglobin screening and refuse to conduct weddings when both individuals are identified as carriers of sickle cell trait. Main body This paper explores the ethical challenges involved in such denials. We assess whether churches have the right to decline to marry adults who understand the risks and still prefer to get married, and whether couples should be denied church weddings based on the risk that their child may suffer from sickle cell anemia. We examine the moral and ethical dimensions of such denials and explore the underlying socio-cultural context involving the purpose of marriage and the meaning of the wedding ceremony in societies where premarital screening is one of the few tools available to reduce the risk of having children with SCA. The potential role of the church is also examined against the background of church beliefs, the duty of the church to its members and its role in reducing the suffering of its members and /or their children. Conclusion We argue that the church should impose these burdens on couples only if doing so promotes a sufficiently compelling goal and there is no less burdensome way to achieve it. We then argue that the goal of reducing the number of individuals in Nigeria who have SCA is compelling. However, testing earlier in life offers a less burdensome and potentially even more effective means of achieving this goal. This suggests that, advocating for earlier screening and helping to support these programs, would likely better promote the church’s own goals of helping its parishioners, increasing the number of church weddings, and reducing the burden of SCA in Nigeria.
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Affiliation(s)
- Euzebus C Ezugwu
- Department of Obstetrics & Gynecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, PMB 01129, Enugu State, 400001, Nigeria.
| | - Pauline E Osamor
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, 20892-1156, USA
| | - David Wendler
- Department of Bioethics, Clinical Center, National Institutes of Health, Bethesda, MD, 20892-1156, USA
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Toye ET, Van Marle G, Hutchins W, Abgabiaje O, Okpuzor JO. Single tube allele specific PCR: a low cost technique for molecular screening of sickle cell anaemia in Nigeria. Afr Health Sci 2018; 18:995-1002. [PMID: 30766565 PMCID: PMC6354853 DOI: 10.4314/ahs.v18i4.20] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Sickle cell anaemia (SCA) is a hereditary blood disorder caused by a single mutation in the haemoglobin gene. The disease burden of SCA is highest in Nigeria. The allele specific polymerase chain reaction (ASPCR) method is applicable for the direct detection of known single nucleotide polymorphisms (SNPs). Objective To investigate the use of the single tube ASPCR as an accurate and affordable method for SCA screening in Nigeria. Methods DNA was extracted from study subjects with normal haemoglobin, HbAA (20), sickle cell anaemia, HbSS (20) and carriers, HbAS (1). Haemoglobin was genotyped by ASPCR using two primer sets that amplifies the wildtype and mutant haemoglobins in each sample. Amplicon sizes were analyzed by gel electrophoresis. Results Amplicons were visible after electrophoresis at regions 517 base pair (bp) for HbA and 267 bp for HbS. ASPCR correctly and unambiguously detected the presence or absence of haemoglobins A and S from all samples collected, demonstrating its accuracy and precision for the screening of SCA. Conclusion This study validates ASPCR as an effective, low cost approach for the clinical screening of SCA in Nigeria. ASPCR is also applicable for other genetic diseases, paternity testing, and forensics where more expensive fluorescence-based approaches are not obtainable.
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Gbadamosi SO, Eze C, Olawepo JO, Iwelunmor J, Sarpong DF, Ogidi AG, Patel D, Oko JO, Onoka C, Ezeanolue EE. A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study. J Med Internet Res 2018; 20:e18. [PMID: 29335234 PMCID: PMC5789164 DOI: 10.2196/jmir.8716] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/08/2017] [Accepted: 01/02/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. OBJECTIVE Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. METHODS We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. RESULTS We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. CONCLUSIONS Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. TRIAL REGISTRATION ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE).
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Affiliation(s)
- Semiu Olatunde Gbadamosi
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | - Chuka Eze
- Vitira Health, Arlington, VA, United States
| | | | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, St Louis University, St Louis, MO, United States
| | - Daniel F Sarpong
- Center for Minority Health and Health Disparities Research and Education, Xavier University, New Orleans, LA, United States
| | | | - Dina Patel
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
| | | | | | - Echezona Edozie Ezeanolue
- Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, Las Vegas, NV, United States
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21
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Mukinayi BM, Kalenda DK, Mbelu S, Gulbis B. [Awareness and attitudes of 50 congolese families affected by sickle cell disease: a local survey]. Pan Afr Med J 2018; 29:24. [PMID: 29875906 PMCID: PMC5987149 DOI: 10.11604/pamj.2018.29.24.12276] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/11/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Sickle cell disease is a very common disease in the Democratic Republic of the Congo, but it is poorly known despite having an impact on the morbi-mortality. Our study aimed to evaluate the extent of awareness and attitudes of families affected by sickle cell disease as well as the impact of this disease in their daily lives. Methods We conducted a cross-sectional study of a unique non-random sampling from 50 families affected by sickle cell disease in Mbujimayi, Democratic Republic of the Congo, from 15 June to 15 August 2015. Participants were interviewed using a standardized questionnaire. Results This study focuses on 50 families affected by sickle cell disease; medical characteristics were found only in first children affected by sickle cell disease in each household. Less than 10% of families had minimally ill children. Fifty families were interviewed, of whom 22 had more than one child with sickle cell disease. The average age at diagnosis was 1 years. Diagnosis was based on clinical examination in 42% (21) of cases. Each first child affected by sickle cell disease had an average of 3.4 crises per year, 4 episodes of fever per year, received an average of 1.9 transfusions per year and was hospitalized an average of 3 times per year. Thirty-one families (62%) didn't have sufficient monthly income to help their children to manage sickle cell disese, 48 (96%) families hoped that a reference sickle cell centre would be established in Mbujimayi and 47 (94%) would accept to subscribe to health insurance if the annual amount were between $50 and $100. Conclusion The extent of awareness among families directly affected by sickle cell disease in Mbujimayi, Democratic Republic of the Congo, is low. This has a direct impact on the management of children with sickle cell disease. The socioeconomic status of these families is also a factor which should be taken into account. The establishement of a reference center and the possibility to fix an annual amount for the treatment of patients would be a strategic approach to implement the awareness and the attitudes of families in relation to this disease having a direct impact on the morbi-mortality of patients.
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Affiliation(s)
- Benoît Mbiya Mukinayi
- Faculté de Médecine, Université de Mbujimayi, Mbujimayi, République Démocratique du Congo
| | - Didier Kalombo Kalenda
- Faculté de Médecine, Université de Mbujimayi, Mbujimayi, République Démocratique du Congo
| | - Stéphanie Mbelu
- Faculté de Médecine, Université de Mbujimayi, Mbujimayi, République Démocratique du Congo
| | - Béatrice Gulbis
- Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgique
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Becker TK, Hansoti B, Bartels S, Hayward AS, Hexom BJ, Lunney KM, Marsh RH, Osei-Ampofo M, Trehan I, Chang J, Levine AC. Global Emergency Medicine: A Review of the Literature From 2016. Acad Emerg Med 2017; 24:1150-1160. [PMID: 28474823 DOI: 10.1111/acem.13216] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 04/27/2017] [Accepted: 04/27/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year 13,890 articles written in four languages were identified by our search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. An additional two reviewers searched the gray literature. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 716 articles met our inclusion criteria and underwent full review. Fifty-nine percent were categorized as emergency care in resource-limited settings, 17% as EM development, and 24% as disaster and humanitarian response. Nineteen articles received scores of 18.5 or higher out of a maximum score of 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed Cohen's kappa of 0.441. CONCLUSIONS In 2016, the total number of articles identified by our search continued to increase. The proportion of articles in each of the three categories remained stable. Studies and reviews with a focus on infectious diseases, pediatrics, and the use of ultrasound in resource-limited settings represented the majority of articles selected for final review.
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Affiliation(s)
- Torben K. Becker
- Department of Critical Care Medicine; University of Pittsburgh Medical Center; Pittsburgh PA
| | - Bhakti Hansoti
- Department of Emergency Medicine; Johns Hopkins University; Baltimore MD
| | - Susan Bartels
- Department of Emergency Medicine; Queen's University; Kingston Ontario Canada
- Harvard Humanitarian Initiative; Cambridge MA
| | | | - Braden J. Hexom
- Department of Emergency Medicine; Rush University Medical Center; Chicago IL
| | - Kevin M. Lunney
- TheMedical Corps, US Navy, and the Navy Trauma Training Center; Los Angeles County and University of Southern California; Los Angeles CA
| | - Regan H. Marsh
- Department of Emergency Medicine; Brigham and Women's Hospital; Boston MA
- Partners In Health; Boston MA
| | - Maxwell Osei-Ampofo
- Emergency Medicine Directorate; Komfo Anokye Teaching Hospital, and Kwame Nkrumah University of Science and Technology; Kumasi Ghana
| | - Indi Trehan
- Partners In Health; Harper Liberia
- Department of Pediatrics and Institute for Public Health; Washington University in St. Louis; St. Louis MO
- Department of Paediatrics and Child Health; University of Malawi; Blantyre Malawi
| | | | - Adam C. Levine
- Department of Emergency Medicine; Warren Alpert Medical School of Brown University; Providence RI
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