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Okoroafor SC, Christmals CD. Optimizing the roles of health workers to improve access to health services in Africa: an implementation framework for task shifting and sharing for policy and practice. BMC Health Serv Res 2023; 23:843. [PMID: 37559040 PMCID: PMC10410914 DOI: 10.1186/s12913-023-09848-z] [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: 03/20/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Globally, countries are taking actions to ensure that their population have improved access to people-centred and integrated health services. Attaining this requires improved access to health workers at all levels of health service delivery and equitably distributed by geographical location. Due to the persistent health worker shortages, countries have resorted to implementing task shifting and task sharing in various settings to optimally utilize existing health workers to improve access to health services. There are deliberations on the need for an implementation framework to guide the adoption and operationalization of task shifting and task sharing as a key strategy for optimally utilizing the existing health workforce towards the achievement of UHC. The objective of this study was to develop an implementation framework for task shifting and task sharing for policy and practice in Africa. METHODS A sequential multimethod research design supported by scoping reviews, and qualitative descriptive study was employed in this study. The evidence generated was synthesized into an implementation framework that was evaluated for applicability in Africa by 36 subject matter experts. RESULTS The implementation framework for task shifting and task sharing has three core components - context, implementation strategies and intended change. The implementation strategies comprise of iterative actions in the development, translation, and sustainment phases that to achieve an intended change. The implementation strategies in the framework include mapping and engagement of stakeholders, generating evidence, development, implementation and review of a road map (or action plan) and national and/or sub-national policies and strategies, education of health workers using manuals, job aids, curriculum and clinical guidelines, and monitoring, evaluation, reviews and learning. CONCLUSION The implementation framework for task shifting and task sharing in Africa serves as a guide on actions needed to achieve national, regional and global goals based on contextual evidence. The framework illustrates the rationale and the role of a combination of factors (enablers and barriers) in influencing the implementation of task shifting and task sharing in Africa.
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Affiliation(s)
- Sunny C Okoroafor
- Universal Health Coverage - Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda.
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa.
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Potchefstroom, South Africa
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Okoroafor SC, Christmals CD. Task Shifting and Task Sharing Implementation in Africa: A Scoping Review on Rationale and Scope. Healthcare (Basel) 2023; 11:1200. [PMID: 37108033 PMCID: PMC10138489 DOI: 10.3390/healthcare11081200] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 04/29/2023] Open
Abstract
Numerous studies have reported task shifting and task sharing due to various reasons and with varied scopes of health services, either task-shifted or -shared. However, very few studies have mapped the evidence on task shifting and task sharing. We conducted a scoping review to synthesize evidence on the rationale and scope of task shifting and task sharing in Africa. We identified peer-reviewed papers from PubMed, Scopus, and CINAHL bibliographic databases. Studies that met the eligibility criteria were charted to document data on the rationale for task shifting and task sharing, and the scope of tasks shifted or shared in Africa. The charted data were thematically analyzed. Sixty-one studies met the eligibility criteria, with fifty-three providing insights on the rationale and scope of task shifting and task sharing, and seven on the scope and one on rationale, respectively. The rationales for task shifting and task sharing were health worker shortages, to optimally utilize existing health workers, and to expand access to health services. The scope of health services shifted or shared in 23 countries were HIV/AIDS, tuberculosis, hypertension, diabetes, mental health, eyecare, maternal and child health, sexual and reproductive health, surgical care, medicines' management, and emergency care. Task shifting and task sharing are widely implemented in Africa across various health services contexts towards ensuring access to health services.
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Affiliation(s)
- Sunny C. Okoroafor
- Universal Health Coverage—Life Course Cluster, World Health Organization Country Office for Uganda, Kampala, Uganda
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
| | - Christmal Dela Christmals
- Centre for Health Professions Education, Faculty of Health Sciences, North-West University, Potchefstroom Campus, Building PC-G16, Office 101, 11 Hoffman Street, Potchefstroom 2520, South Africa
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Ciccacci F, Ismael F, Chume V, Ruth L, Mbula P, Orlando S, Majid NA, Marazzi MC. Enhancing retention in care in HIV-infected adolescents during COVID-19 in Mozambique: results from the DREAM program. Int J Adolesc Med Health 2023; 35:227-231. [PMID: 36708359 DOI: 10.1515/ijamh-2022-0107] [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: 12/01/2022] [Accepted: 01/17/2023] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Around 1,7 million adolescents aged 10-19 years worldwide are infected with HIV, 84% of them living in Sub-Saharan Africa. Mozambique is one of the countries with the highest prevalence of HIV in the world. According to UNAIDS, HIV services for adolescents should be tailored and specifically designed for them. METHODS We aimed to evaluate a package of activities to enhance the retention of HIV-infected adolescent in Mozambique. We retrospectively reviewed routine data from 7 health centers involved in 26 months, from March 2020 to May 2022. A package of tailored interventions was implemented in all the sites. We reviewed activity data from the included centers. RESULTS The median number of patients per center was 343 (IQR: 289-466) at the beginning of the period and 395 (IQR: 322-453) at the end. The median overall retention in care and rate of lost to follow-up at the beginning and the end of the period were respectively: 94.2% (IQR 91.9-97.3%) to 99.0% (IQR 96.8-99.5%), 1.5% (IQR 1-3.2%) to 0% (IQR 0.0-0.3%). The total number of deaths increased reaching a plateau after September 2021. All the indicators improved after the beginning of the intervention, also during COVID-19 pandemic. CONCLUSIONS Our data support the idea that enhancing retention in care for HIV positive adolescents need tailored interventions, based on deep rooting in the specific social context. Tailored intervention can resist external shock such as COVID-19.
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Affiliation(s)
- Fausto Ciccacci
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - Flavio Ismael
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Veronica Chume
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Lina Ruth
- DREAM program, Community of Sant'Egidio, Maputo, Mozambique
| | - Pedro Mbula
- DREAM program, Community of Sant'Egidio, Beira, Mozambique
| | - Stefano Orlando
- Department of Biomedicine and Prevention, University of Rome Torvergata, Rome, Italy
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Osório D, Munyangaju I, Nacarapa E, Muhiwa A, Nhangave AV, Ramos JM. Mother-to-child transmission of HIV infection and its associated factors in the district of Bilene, Gaza Province-Mozambique. PLoS One 2021; 16:e0260941. [PMID: 34890430 PMCID: PMC8664209 DOI: 10.1371/journal.pone.0260941] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/13/2021] [Indexed: 11/26/2022] Open
Abstract
Background Mother-to-child transmission of HIV infection is a significant problem in Mozambique. This study aims to determine the risk factors associated with mother-to-child transmission of HIV in rural Mozambique. Methods Retrospective case-control study in a rural area of Bilene District, on the coast of southern Mozambique, performed from January 2017 to June 2018. The analysis considered the clinical data of HIV exposed children with definitive HIV positive results and their respective infected mothers (cases), and the data of HIV exposed children with definitive HIV negative results and their respective infected mothers (controls) registered in At Risk Child Clinics from 1st January 2017 to 30th June 2018 at the Macia and Praia de Bilene health facilities in Bilene district, Gaza province–Mozambique. Results Ninety pregnant women with HIV were involved in the study, including 30 who had transmitted the infection to their children and 60 who had not. Statistical analysis, adjusted for maternal age and gestational age at first antenatal care visit, showed that independent risk factors for transmission were gestational age at first visit (adjusted odds ratio [aOR] 1.19, 95% confidence interval [CI] 1.05–1.36), non-adherence to combination antiretroviral therapy (56.7% vs. 5%; aOR 14.12, 95% CI 3.15–63.41); a viral load of 1000 copies/mL or more (90% vs. 5%; aOR: 156, 95% CI 22.91–1,062) and female sex of the neonate (80% vs. 51.7%; aOR: 4.43, 95% CI 1.33–15.87). Conclusion A high viral load and non-adherence to antiretroviral therapy are important predictors of mother-to-child HIV transmission.
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Affiliation(s)
- Dulce Osório
- General Medicine Department, Macia Health Center, Macia, Gaza, Mozambique
| | - Isabelle Munyangaju
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
- * E-mail:
| | - Edy Nacarapa
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
- Internal Medicine Department, Carmelo Hospital, Chokwe, Gaza, Mozambique
| | - Argentina Muhiwa
- Tinpswalo Association – Vincentian Association to Fight AIDS and TB, Maputo, Gaza, Mozambique
| | | | - Jose Manuel Ramos
- Internal Medicine Department, General University Hospital of Alicante and University Miguel Hernandez de Elche, Alicante, Spain
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Costantino C, Mazzucco W, Bonaccorso N, Cimino L, Conforto A, Sciortino M, Catalano G, D’Anna MR, Maiorana A, Venezia R, Corsello G, Vitale F. Educational Interventions on Pregnancy Vaccinations during Childbirth Classes Improves Vaccine Coverages among Pregnant Women in Palermo's Province. Vaccines (Basel) 2021; 9:vaccines9121455. [PMID: 34960202 PMCID: PMC8707644 DOI: 10.3390/vaccines9121455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/02/2021] [Accepted: 12/06/2021] [Indexed: 12/02/2022] Open
Abstract
Maternal immunization is considered the best intervention in order to prevent influenza infection of pregnant women and influenza and pertussis infection of newborns. Despite the existing recommendations, vaccination coverage rates in Italy remain very low. Starting from August 2018, maternal immunization against influenza and diphtheria-tetanus-pertussis were strongly recommended by the Italian Ministry of Health. We conducted a cross sectional study to estimate the effectiveness of an educational intervention, conducted during childbirth classes in three general hospitals in the Palermo metropolitan area, Italy, on vaccination adherence during pregnancy. To this end, a questionnaire on knowledge, attitudes, and immunization practices was structured and self-administered to a sample of pregnant women attending childbirth classes. Then, an educational intervention on maternal immunization, followed by a counseling, was conducted by a Public Health medical doctor. After 30 days following the interventions, the adherence to the recommended vaccinations (influenza and pertussis) was evaluated. At the end of the study 326 women were enrolled and 201 responded to the follow-up survey. After the intervention, among the responding pregnant women 47.8% received influenza vaccination (+44.8%), 57.7% diphtheria-tetanus-pertussis vaccination (+50.7%) and 64.2% both the recommended vaccinations (+54.8%). A significant association was found between pregnant women that received at least one vaccination during pregnancy and higher educational level (graduation degree/master’s degree), employment status (employed part/full-time) and influenza vaccination adherence during past seasons (at least one during last five years). The implementation of vaccination educational interventions, including counseling by healthcare professionals (HCPs), on maternal immunization during childbirth courses improved considerably the vaccination adherence during pregnancy.
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
- Correspondence:
| | - Walter Mazzucco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Nicole Bonaccorso
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Livia Cimino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Arianna Conforto
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Martina Sciortino
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Gabriele Catalano
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Maria Rosa D’Anna
- HCU Obstetrics and Gynecology, Buccheri La Ferla—Fatebenefratelli Hospital, 90100 Palermo, Italy;
| | - Antonio Maiorana
- HCU Obstetrics and Gynecology, ARNAS Ospedale Civico Di Cristina-Benfratelli Hospital, 90127 Palermo, Italy;
| | - Renato Venezia
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Giovanni Corsello
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
| | - Francesco Vitale
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) “G. D’Alessandro”, University of Palermo, 90127 Palermo, Italy; (W.M.); (N.B.); (L.C.); (A.C.); (M.S.); (G.C.); (R.V.); (G.C.); (F.V.)
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Leveraging HIV Care Infrastructures for Integrated Chronic Disease and Pandemic Management in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010751. [PMID: 34682492 PMCID: PMC8535610 DOI: 10.3390/ijerph182010751] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/31/2022]
Abstract
In Sub-Saharan Africa, communicable and other tropical infectious diseases remain major challenges apart from the continuing HIV/AIDS epidemic. Recognition and prevalence of non-communicable diseases have risen throughout Africa, and the reimagining of healthcare delivery is needed to support communities coping with not only with HIV, tuberculosis, and COVID-19, but also cancer, cardiovascular disease, diabetes, and depression. Many non-communicable diseases can be prevented or treated with low-cost interventions, yet implementation of such care has been limited in the region. In this Perspective piece, we argue that deployment of an integrated service delivery model is an urgent next step, propose a South African model for integration, and conclude with recommendations for next steps in research and implementation. An approach that is inspired by South African experience would build on existing HIV-focused infrastructure that has been developed by Ministries of Health with strong support from the U.S. President’s Emergency Response for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria. An integrated chronic healthcare model holds promise to sustainably deliver infectious disease and non-communicable disease care. Integrated care will be especially critical as health systems seek to cope with the unprecedented challenges associated with COVID-19 and future pandemic threats.
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Outcomes of retained and disengaged pregnant women living with HIV in Uganda. PLoS One 2021; 16:e0251413. [PMID: 34019568 PMCID: PMC8139492 DOI: 10.1371/journal.pone.0251413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/26/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Loss-to-follow-up among women living with HIV (WLWHIV) may lead to unfavorable outcomes for both mother and exposed infant. This study traced WLWHIV disengaged from care and their infants and compared their outcomes with those retained in care. Methods The study included WLWHIV who initiated ART during pregnancy at six public clinics in Uganda. A woman was defined as disengaged (DW) if she had not attended her 6-week post-partum visit by 10 weeks after her estimated date of delivery. DW were matched with retained women (RW) by age and duration on ART. Nurse counselors traced all selected DW via telephone and community visits to assess vital status, infant HIV sero-status and maternal HIV viral load through blood draws. Results Between July 2017 and July 2018, 734 women (359 DW and 375 RW) were identified for the study. Tracing was attempted on 349 DW and 160 (44.6%) were successfully located and enrolled in the study. They were matched with 162 RW. Among DW, 52 (32.5%) transferred to another health facility. Very few DW, 39.0% were HIV virally suppressed (<1000 copies/ml) compared to RW 89.5%, P<0.001). Among 138 babies born to DW, 4.3% tested positive for HIV compared to 1.4% among babies born to RW (P = 0.163). Conclusion Pregnant and breastfeeding WLWHIV who disengage from care are difficult to find in urban environments. Many have detectable viral loads, leading to the potential for an increased risk of MTCT. Efforts to reduce disengagement from care are critical for the successful elimination of MTCT in resource-limited settings.
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Adedeji TA, Adebisi SA, Adedeji NO, Jeje OA, Owolabi RS. Renal Phosphate Handling in Antiretroviral-naive HIV-Infected Patients. Infect Disord Drug Targets 2021; 21:202-210. [PMID: 32634086 DOI: 10.2174/1871526520666200707115259] [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: 01/03/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Human immunodeficiency virus (HIV) infection impairs renal function, thereby affecting renal phosphate metabolism. OBJECTIVES We prospectively estimated the prevalence of phosphate abnormalities (mild, moderate to life-threatening hypophosphataemia, and hyperphosphataemia) before initiating antiretroviral therapy (ART). METHODS A cross-sectional analysis was performed on 170 consecutive newly diagnosed ARTnaive, HIV-infected patients attending our HIV/AIDS clinics over a period of one year. Fifty (50) screened HIV-negative blood donors were used for comparison (controls). Blood and urine were collected simultaneously for phosphate and creatinine assay to estimate fractional phosphate excretion (FEPi %) and glomerular filtration rate (eGFR). RESULTS eGFR showed significant difference between patients' and controls' medians (47.89ml/ min/1.73m2 versus 60ml/min/1.73m2, p <0.001); which denotes a moderate chronic kidney disease in the patients. Of the 170 patients, 78 (45.9%) had normal plasma phosphate (0.6-1.4 mmol/L); 85 (50%) had hyperphosphataemia. Grades 1, 2 and 3 hypophosphataemia was observed in 3 (1.8%), 3 (1.8%), and 1(0.5%) patient(s) respectively. None had grade 4 hypophosphataemia. Overall, the patients had significantly higher median of plasma phosphate than the controls, 1.4 mmol/L (IQR: 1.0 - 2.2) versus 1.1 mmol/L (IQR: 0.3 - 1.6), p <0.001, implying hyperphosphataemia in the patients; significantly lower median urine phosphate than the controls, 1.5 mmol/L (IQR: 0.7 -2.1) versus 8.4 mmol/L (IQR: 3.4 - 16), p <0.001), justifying the hyperphosphataemia is from phosphate retention; but a non-significantly lower median FEPi% than the controls, 0.96% (IQR: 0.3 -2.2) versus 1.4% (IQR: 1.2 -1.6), p > 0.05. Predictors of FEPi% were age (Odds ratio, OR 0.9, p = 0.009); weight (OR 2.0, p < 0.001); CD4+ cells count predicted urine phosphate among males (p = 0.029). CONCLUSION HIV infection likely induces renal insufficiency with reduced renal phosphate clearance. Thus, hyperphosphataemia is highly prevalent, and there is mild to moderate hypophosphataemia but its life-threatening form (grade 4) is rare among ART-naive HIV patients.
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Affiliation(s)
| | | | - Nife Olamide Adedeji
- Department of Obstetrics and Gynaecology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olusola Akanni Jeje
- Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Rotimi Samuel Owolabi
- Department of Medicine (HIV Unit), University of Abuja Teaching Hospital, Abuja, Nigeria
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Costantino C, Cannizzaro E, Verso MG, Tramuto F, Maida CM, Lacca G, Alba D, Cimino L, Conforto A, Cirrincione L, Graziano G, Palmeri S, Pizzo S, Restivo V, Casuccio A, Vitale F, Mazzucco W. SARS-CoV-2 Infection in Healthcare Professionals and General Population During "First Wave" of COVID-19 Pandemic: A Cross-Sectional Study Conducted in Sicily, Italy. Front Public Health 2021; 9:644008. [PMID: 34055716 PMCID: PMC8155294 DOI: 10.3389/fpubh.2021.644008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/08/2021] [Indexed: 12/31/2022] Open
Abstract
On December 31, 2019, an outbreak of lower respiratory infections was documented in Wuhan caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since the beginning, SARS-CoV-2 has caused many infections among healthcare workers (HCWs) worldwide. Aims of this study were: a. to compare the distribution among the HCWs and the general population of SARS-CoV-2 infections in Western Sicily and Italy; b. to describe the characteristics of HCWs infected with SARS-CoV-2 in the western Sicilian healthcare context during the first wave of the epidemic diffusion in Italy. Incidence and mean age of HCWs infected with SARS-CoV-2 were comparable in Western Sicily and in the whole Italian country. The 97.6% of infections occurred in HCWs operating in non-coronavirus disease 2019 (COVID-19) working environments, while an equal distribution of cases between hospital and primary care services context was documented. Nurses and healthcare assistants, followed by physicians, were the categories more frequently infected by SARS-CoV-2. The present study suggests that healthcare workers are easily infected compared to the general population but that often infection could equally occur in hospital and non-hospital settings. Safety of HCWs in counteracting the COVID-19 pandemic must be strengthened in hospital [adequate provision of personal protective equipment (PPE), optimization of human resources, implementation of closed and independent groups of HCWs, creation of traffic control building and dedicated areas in every healthcare context] and non-hospital settings (influenza vaccination, adequate psychophysical support, including refreshments during working shifts, adequate rest, and family support).
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Affiliation(s)
- Claudio Costantino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Emanuele Cannizzaro
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Maria Gabriella Verso
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Fabio Tramuto
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Carmelo Massimo Maida
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Guido Lacca
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Davide Alba
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Livia Cimino
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Arianna Conforto
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Luigi Cirrincione
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Giorgio Graziano
- COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Sara Palmeri
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Stefano Pizzo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Vincenzo Restivo
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Alessandra Casuccio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy
| | - Francesco Vitale
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
| | - Walter Mazzucco
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro," University of Palermo, Palermo, Italy.,COVID-19 Surveillance Western Sicily Reference Laboratory, Palermo University Hospital, Palermo, Italy
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Marotta C, Nacareia U, Estevez AS, Tognon F, Genna GD, De Meneghi G, Occa E, Ramirez L, Lazzari M, Di Gennaro F, Putoto G. Mozambican Adolescents and Youths during the COVID-19 Pandemic: Knowledge and Awareness Gaps in the Provinces of Sofala and Tete. Healthcare (Basel) 2021; 9:healthcare9030321. [PMID: 33805689 PMCID: PMC7998514 DOI: 10.3390/healthcare9030321] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 01/25/2023] Open
Abstract
(1) Background: Mozambique has an average population age of 17 years and adolescents and youths have a pivotal role in SARS-CoV-2 pandemic control. (2) Methods: We conducted a cross-sectional study in order to assess the awareness and information needs with regard to COVID-19 among a sample of adolescents and youths from two different Mozambican provinces. (3) Results: Only 25% of adolescents and youths had a high level of awareness and only 543/2170 participants reported a high level of knowledge regarding COVID-19. In our multivariate model, significant predictors of reporting a high level of knowledge about COVID-19 include female sex (O.R. = 1.47; 95% confidence interval (CI) 1.23–2.89), having a house without a thatched roof (O.R. = 1.85; 95% CI 1.02–2.95) and HIV-positive status (O.R. = 1.56; 95% CI 1.36–2.87). (4) Conclusions: Our study highlights an important and relevant knowledge gap in adolescents and youths with respect to the COVID-19 pandemic. Involving young people and adolescents in the fight against SARS-CoV-2 is an essential strategy, especially in countries where the national average age is young, such as Mozambique, and where this epidemic can aggravate an already fragile health system.
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Affiliation(s)
- Claudia Marotta
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
| | - Ussene Nacareia
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Alba Sardon Estevez
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Francesca Tognon
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
- Dipartimento di Salute della Donna e del Bambino, Università degli Studi di Padova, 35121 Padova, Italy; (U.N.); (A.S.E.)
| | - Giselle Daiana Genna
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Giovanna De Meneghi
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Edoardo Occa
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Lucy Ramirez
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Marzia Lazzari
- Doctors with Africa CUAMM, Beira 2100, Mozambique; (G.D.G.); (G.D.M.); (E.O.); (L.R.); (M.L.)
| | - Francesco Di Gennaro
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
- Correspondence:
| | - Giovanni Putoto
- Operational Research Unit, Doctors with Africa CUAMM, 35121 Padua, Italy; (C.M.); (F.T.); (G.P.)
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11
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Fentress M, Ugarte-Gil C, Cervantes M, Rivas D, Moore D, Caliguiri P, Bergman K, Noazin S, Padovani A, Gilman RH. Lung Ultrasound Findings Compared with Chest X-Ray Findings in Known Pulmonary Tuberculosis Patients: A Cross-Sectional Study in Lima, Peru. Am J Trop Med Hyg 2020; 103:1827-1833. [PMID: 32815504 PMCID: PMC7646758 DOI: 10.4269/ajtmh.20-0542] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Lung ultrasound (LUS) is highly portable and has excellent diagnostic accuracy for pneumonia compared with conventional radiography, but the literature on its use in pulmonary tuberculosis (PTB) is limited. This study characterized LUS lesions in patients with PTB and compared them with chest X-ray (CXR) findings. Adult patients in Lima, Peru, with PTB were recruited within 1 week of starting antituberculosis treatment. Comprehensive LUS was performed in all patients at enrollment and assessed for consolidation, small subpleural consolidation (SPC, hypothesized to be a marker of CXR consolidation), cavity, pleural effusion, pathologic B-lines, and miliary pattern. Patient CXRs were digitized and interpreted by a board-certified radiologist. Fifty-one patients were included in the final analysis. Lung ultrasound detected either consolidation or SPC in 96.1% of participants. No significant difference was found between the LUS detection of a composite of consolidation or SPC, and CXR detection of consolidation (96.1% versus 98%, P > 0.99). The proportion of patients with cavity detected by LUS was significantly lower than that detected by CXR (5.9% versus 51%, P < 0.001). Overall, LUS detection of consolidation or SPC may be a sensitive marker for diagnosis of PTB. Lung ultrasound demonstrated poor ability to detect radiographically identified cavity, although previous studies suggest SPC could add specificity for the diagnosis of PTB. Based on its portability and evidence base for diagnosing other pulmonary diseases, LUS may have a role in screening and diagnosis of PTB in areas without ready access to CXR. Further studies should evaluate its diagnostic accuracy in patients with and without PTB.
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Affiliation(s)
- Matthew Fentress
- University of California, Davis, Sacramento, California.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Cesar Ugarte-Gil
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Universidad Peruana Cayetano Heredia, Lima, Peru.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | - David Moore
- London School of Hygiene and Tropical Medicine, London, United Kingdom.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Kevin Bergman
- Contra Costa Family Medicine Residency, University of California - San Francisco, Martinez, California
| | - Sassan Noazin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Robert H Gilman
- Associacion Benefica PRISMA, Lima, Peru.,Universidad Peruana Cayetano Heredia, Lima, Peru.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
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12
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Marotta C, Pisani L, Di Gennaro F, Cavallin F, Bah S, Pisani V, Haniffa R, Beane A, Trevisanuto D, Hanciles E, Schultz MJ, Koroma MM, Putoto G. Epidemiology, Outcomes, and Risk Factors for Mortality in Critically Ill Women Admitted to an Obstetric High-Dependency Unit in Sierra Leone. Am J Trop Med Hyg 2020; 103:2142-2148. [PMID: 32840199 DOI: 10.4269/ajtmh.20-0623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A better understanding of the context-specific epidemiology, outcomes, and risk factors for death of critically ill parturients in resource-poor hospitals is needed to tackle the still alarming in-hospital maternal mortality in African countries. From October 2017 to October 2018, we performed a 1-year retrospective cohort study in a referral maternity hospital in Freetown, Sierra Leone. The primary endpoint was the association between risk factors and high-dependency unit (HDU) mortality. Five hundred twenty-three patients (median age 25 years, interquartile range [IQR]: 21-30 years) were admitted to the HDU for a median of 2 (IQR: 1-3) days. Among them, 65% were referred with a red obstetric early warning score (OEWS) code, representing 1.17 cases per HDU bed per week; 11% of patients died in HDU, mostly in the first 24 hours from admission. The factors independently associated with HDU mortality were ward rather than postoperative referrals (odds ratio [OR]: 3.21; 95% CI: 1.48-7.01; P = 0.003); admissions with red (high impairment of patients' vital signs) versus yellow (impairment of vital signs) or green (little or no impairment of patients' vital signs) OEWS (OR: 3.66; 95% CI: 1.15-16.96; P = 0.04); responsiveness to pain or unresponsiveness on the alert, voice, pain unresponsive scale (OR: 5.25; 95% CI: 2.64-10.94; P ≤ 0.0001); and use of vasopressors (OR: 3.24; 95% CI: 1.32-7.66; P = 0.008). Critically ill parturients were predominantly referred with a red OEWS code and usually required intermediate care for 48 hours. Despite the provided interventions, death in the HDU was frequent, affecting one of 10 critically ill parturients. Medical admission, a red OEWS code, and a poor neurological and hemodynamic status were independently associated with mortality, whereas adequate oxygenation was associated with survival.
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Affiliation(s)
- Claudia Marotta
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
| | - Luigi Pisani
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | | | - Sarjoh Bah
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Vincenzo Pisani
- Princess Christian Maternity Hospital, Doctor with Africa CUAMM, Freetown, Sierra Leone
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Abi Beane
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | | | - Eva Hanciles
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Marcus J Schultz
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Michael M Koroma
- Department of Anesthesia and Intensive Care, University of Sierra Leone, Freetown, Sierra Leone
| | - Giovanni Putoto
- Section of Operational Research, Doctors with Africa Cuamm, Padova, Italy
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13
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Bajaria S, Abdul R, Exavery A, Minja E, Charles J, Mtenga S, Jere E, Geubbels E. Programmatic determinants of successful referral to health and social services for orphans and vulnerable children: A longitudinal study in Tanzania. PLoS One 2020; 15:e0239163. [PMID: 32946528 PMCID: PMC7500632 DOI: 10.1371/journal.pone.0239163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/31/2020] [Indexed: 11/18/2022] Open
Abstract
Background Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system. Methods Data for this secondary analysis come from the first two years (2017–2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations. Results During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26–49 versus 18–25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively. Conclusion CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.
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Affiliation(s)
- Shraddha Bajaria
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
- * E-mail:
| | - Ramadhani Abdul
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | | | | | - Sally Mtenga
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Eveline Geubbels
- Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania
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Malaria and COVID-19: Common and Different Findings. Trop Med Infect Dis 2020; 5:tropicalmed5030141. [PMID: 32899935 PMCID: PMC7559940 DOI: 10.3390/tropicalmed5030141] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 01/08/2023] Open
Abstract
Malaria and COVID-19 may have similar aspects and seem to have a strong potential for mutual influence. They have already caused millions of deaths, and the regions where malaria is endemic are at risk of further suffering from the consequences of COVID-19 due to mutual side effects, such as less access to treatment for patients with malaria due to the fear of access to healthcare centers leading to diagnostic delays and worse outcomes. Moreover, the similar and generic symptoms make it harder to achieve an immediate diagnosis. Healthcare systems and professionals will face a great challenge in the case of a COVID-19 and malaria syndemic. Here, we present an overview of common and different findings for both diseases with possible mutual influences of one on the other, especially in countries with limited resources.
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15
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Marotta C, Lochoro P, Pizzol D, Putoto G, Mazzucco W, Saracino A, Monno L, Di Gennaro F, Ictho J. Capacity assessment for provision of quality sexual reproductive health and HIV-integrated services in Karamoja, Uganda. Afr Health Sci 2020; 20:1053-1065. [PMID: 33402951 PMCID: PMC7751512 DOI: 10.4314/ahs.v20i3.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Sexual and reproductive health (SRH) and Human Immunodeficiency Virus (HIV) are crucial global health issues. Uganda continues to sustain a huge burden of HIV and AIDS. METHODS A cross-sectional health facility-based assessment was performed in November and December 2016 in Karamoja Region, northern Uganda. All the 126 health facilities (HFs) in Karamoja, including 5 hospitals and 121 Health Centers (HCs), covering 51 sub-counties of the 7 districts were assessed. We assessed the capacity of a) leadership and governance, b) human resource, c) service delivery, d) SRH and HIV service integration and e) users satisfaction and perceptions. RESULTS 64% of the established health staffing positions were filled leaving an absolute gap of 704 units in terms of human resources. As for service delivery capacity, on 5 domains assessed, the best performing was basic hygiene and safety measures in which 33% HCs scored "excellent", followed by the presence of basic equipment. The level of integration of SRH/HIV services was 55.56%. CONCLUSION HFs in Karamoja have capacity gaps in a number of health system building blocks. Many of these gaps can be addressed through improved planning. To invest in improvements for these services would have a great gain for Uganda.
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Affiliation(s)
- Claudia Marotta
- University of Palermo, Department of Science for Health Promotion and Mother to Child Care “G. D'Alessandro”, Palermo, Italy
| | | | - Damiano Pizzol
- Doctors With Africa Cuamm, Research Section Padua, Italy
| | | | - Walter Mazzucco
- University of Palermo, Department of Science for Health Promotion and Mother to Child Care “G. D'Alessandro”, Palermo, Italy
| | | | - Laura Monno
- Clinic of Infectious Diseases, University of Bari, Italy
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Cost-Utility of Intermediate Obstetric Critical Care in a Resource-Limited Setting: A Value-Based Analysis. Ann Glob Health 2020; 86:82. [PMID: 32742940 PMCID: PMC7380057 DOI: 10.5334/aogh.2907] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: Sierra Leone faces among the highest maternal mortality rates worldwide. Despite this burden, the role of life–saving critical care interventions in low–resource settings remains scarcely explored. A value-based approach may be used to question whether it is sustainable and useful to start and run an obstetric intermediate critical care facility in a resource–poor referral hospital. We also aimed to investigate whether patient outcomes in terms of quality of life justified the allocated resources. Objective: To explore the value-based dimension performing a cost-utility analysis with regard to the implementation and one-year operation of the HDU. The primary endopoint was the quality-adjusted life-years (QALYs) of patients admitted to the HDU, against direct and indirect costs. Secondary endpoints included key procedures or treatments performed during the HDU stay. Methods: The study was conducted from October 2, 2017 to October 1, 2018 in the obstetric high dependency unit (HDU) of Princess Christian Maternity Hospital (PCMH) in Freetown, Sierra Leone. Findings: 523 patients (median age 25 years, IQR 21–30) were admitted to HDU. The total 1 year investment and operation costs for the HDU amounted to €120,082 – resulting in €230 of extra cost per admitted patient. The overall cost per QALY gained was of €10; this value is much lower than the WHO threshold defining high cost effectiveness of an intervention, i.e. three times the current Sierra Leone annual per capita GDP of €1416. Conclusion: With an additional cost per QALY of only €10.0, the implementation and one-year running of the case studied obstetric HDU can be considered a highly cost-effective frugal innovation in limited resource contexts. The evidences provided by this study allow a precise and novel insight to policy makers and clinicians useful to prioritize interventions in critical care and thus address maternal mortality in a high burden scenario.
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Namburete EI, Di Gennaro F, Maria CJ, Bavaro DF, Brindicci G, Lattanzio R, Pizzol D, Monno L, Saracino A. Uncommon testicular localization of Disseminated TB: a case report from Mozambique. THE NEW MICROBIOLOGICA 2019; 42:184-187. [PMID: 31305938 PMCID: PMC9341280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 09/10/2019] [Indexed: 06/10/2023]
Abstract
Tuberculosis (TB) of the testicle is a rarely reported and poorly described disease localization. There are no well-defined clinical features suggestive of testicular TB, which makes the diagnosis difficult to establish, especially in low-income settings like Mozambique, where TB is endemic and often associated with HIV-infection; both considered leading causes of death worldwide. We reported the case of a 45-year-old male, HIV positive, naïve to antiretroviral treatment, admitted to the Department of Medicine of the Central Hospital of Beira to investigate chronic enlargement of the testicles.
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Affiliation(s)
| | | | | | | | - Gaetano Brindicci
- Clinic of Infectious Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Rossana Lattanzio
- Clinic of Infectious Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Damiano Pizzol
- Operational Research Unit, Doctors with Africa Cuamm, Maputo, Mozambique
| | - Laura Monno
- Clinic of Infectious Diseases, University of Bari “Aldo Moro,” Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, University of Bari “Aldo Moro,” Bari, Italy
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18
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Bobbio F, Di Gennaro F, Marotta C, Kok J, Akec G, Norbis L, Monno L, Saracino A, Mazzucco W, Lunardi M. Focused ultrasound to diagnose HIV-associated tuberculosis (FASH) in the extremely resource-limited setting of South Sudan: a cross-sectional study. BMJ Open 2019; 9:e027179. [PMID: 30944140 PMCID: PMC6500283 DOI: 10.1136/bmjopen-2018-027179] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Our cross-sectional study aimed at evaluating the diagnostic performance of Focused Assessment with Sonography for HIV-associated tuberculosis (FASH) to detect extrapulmonary tuberculosis in extremely resource-limited settings, with visceral leishmaniasis as a differential diagnosis with overlapping sonographic feature. DESIGN Cross-sectional study. SETTING Voluntary Counselling and Testing Centre (VCT) of Yirol Hospital, South Sudan. PARTICIPANTS From May to November 2017, 252 HIV-positive patients out of 624 newly admitted to VCT Centre were registered for antiretroviral treatment. According to the number of trained doctors available to practise ultrasound (US) scan, a sample of 100 patients were screened using the FASH protocol. INTERVENTIONS Following a full clinical examination, each patient was scanned with a portable US scanner in six different positions for pleural, pericardial, ascitic effusion, abdominal lymphadenopathy and hepatic/splenic microabscesses, according to the FASH protocol. A k39 antigen test for visceral leishmaniasis was also performed on patients with lymphadenopathy and/or splenomegaly. All demographic, clinical and HIV data, as well as FASH results and therapy adjustments, were recorded following the examination. RESULTS The FASH protocol allowed the detection of pathological US findings suggestive of tuberculosis in 27 out of the 100 patients tested. Overall, FASH results supported tuberculosis treatment indication for 16 of 21 patients, with the treatment being based exclusively on FASH findings in half of them (8 patients). The group of FASH-positive patients had a significantly higher proportion of patients with CD4 count below 0.2 x109/L (n=22, 81%) as compared with FASH-negative patients (n=35, 48%) (p=0.003). Moreover, 48% (n=13) of FASH-positive patients had CD4 below 100 cells/mm3. All patients tested had a negative result on k39 antigen test. CONCLUSION FASH was found to be a relevant diagnostic tool to detect signs of tuberculosis. Further research is needed to better define a patient profile suitable for investigation and also considering diagnostic accuracy.
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Affiliation(s)
| | | | - Claudia Marotta
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
| | - John Kok
- Yirol Hospital, Yirol, South Sudan
| | | | - Luca Norbis
- Ospedale San Raffaele, Milano, Lombardia, Italy
| | - Laura Monno
- Infectious Diseases, University of Bari, Bari, Italy
| | | | - Walter Mazzucco
- Department of Sciences for Health Promotion and Mother to Child Care G.D Alessandro, University of Palermo, Palermo, Italy
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Di Gennaro F, Marotta C, Pizzol D, Chhaganlal K, Monno L, Putoto G, Saracino A, Casuccio A, Mazzucco W. Prevalence and Predictors of Malaria in Human Immunodeficiency Virus Infected Patients in Beira, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092032. [PMID: 30227677 PMCID: PMC6163722 DOI: 10.3390/ijerph15092032] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 12/31/2022]
Abstract
Co-infection between malaria and HIV has major public health implications. The aims of this study were to assess the malaria prevalence and to identify predictors of positivity to malaria Test in HIV positive patients admitted to the health center São Lucas of Beira, Mozambique. A retrospective cross-sectional study was performed from January 2016 to December 2016. Overall, 701 adult HIV patients were enrolled, positivity to malaria test was found in 232 (33.0%). These patients were found to be more frequently unemployed (76.3%), aged under 40 (72.0%), with a HIV positive partner (22.4%) and with a CD4 cell count <200 (59.9%). The following variables were predictors of malaria: age under 40 (O.R. = 1.56; 95%CI: 1.22–2.08), being unemployed (O.R. = 1.74; 95%CI: 1.24–2.21), irregularity of cotrimoxazole prophylaxis’s (O.R. = 1.42; 95%CI: 1.10–1.78), CD4 cell count <200 (O.R. = 2.01; 95%CI: 1.42–2.32) and tuberculosis comorbidity (O.R. = 1.58; 95%CI: 1.17–2.79). In conclusion, high malaria prevalence was found in HIV patients accessing the out-patients centre of São Lucas of Beira. Our findings allowed us to identify the profile of HIV patients needing more medical attention: young adults, unemployed, with a low CD4 cell count and irregularly accessing to ART and cotrimoxazole prophylaxis.
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Affiliation(s)
- Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Damiano Pizzol
- Doctors with Africa-CUAMM, Research Unit, Beira 1363, Mozambique.
| | - Kajal Chhaganlal
- Center for Research in Infectious Diseases, Faculty of Health Sciences, Catholic University of Mozambique, Beira 1363, Mozambique.
| | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, 35128 Padova, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", 35128 Bari, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", via del Vespro, University of Palermo, 90217 Palermo, Italy.
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Marotta C, Di Gennaro F, Pizzol D, Madeira G, Monno L, Saracino A, Putoto G, Casuccio A, Mazzucco W. The At Risk Child Clinic (ARCC): 3 Years of Health Activities in Support of the Most Vulnerable Children in Beira, Mozambique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15071350. [PMID: 29954117 PMCID: PMC6069480 DOI: 10.3390/ijerph15071350] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
The concept of “children at risk” changes worldwide according to each specific context. Africa has a large burden of overall risk factors related to childhood health and development, most of which are of an infective or social origin. The aim of this study was to report and analyze the volumes of activities of fifteen At Risk Child Clinics (ARCCs) within the Beira District (Mozambique) over a 3 year-period in order to define the health profile of children accessing such health services. We retrospectively analyzed the data from all of the children accessing one of the 15 Beira ARCCs from January 2015 to December 2017. From this, 17,657 first consultations were registered. The motivations for accessing the services were in order of relevance: HIV exposure (n. 12,300; 69.7%), other risk conditions (n. 2542; 14.4%), Moderate Acute Malnutrition (MAM) (n. 1664; 9.4%), Severe Acute Malnutrition (SAM) (n. 772; 4.4%), and TB exposure (n. 542; 3.1%). During the first consultations, 16,865 children were screened for HIV (95.5%), and 7.89% tested HIV-positive. In our three years of experience, HIV exposure was the main indication for children to access the ARCCs in Mozambique. ARCCs could represent a strategic point to better understand health demands and to monitor the quality of care provided to this vulnerable population group, however significant effort is needed to improve the quality of the data collection.
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Affiliation(s)
- Claudia Marotta
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Francesco Di Gennaro
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | - Damiano Pizzol
- Research Unit, Doctors with Africa CUAMM, Beira 1363, Mozambique.
| | | | - Laura Monno
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Annalisa Saracino
- Department of Infectious Diseases, University of Bari "Aldo Moro", Bari 70124, Italy.
| | - Giovanni Putoto
- Research Section, Doctors with Africa CUAMM, Padova 35128, Italy.
| | - Alessandra Casuccio
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
| | - Walter Mazzucco
- Department of Science for Health Promotion and Mother to Child Care "G. D'Alessandro", University of Palermo, Via del Vespro, Palermo 90217, Italy.
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