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Afolabi MO, Diaw A, Fall EHB, Sall FB, Diédhiou A, Seck A, Camara B, Niang D, Manga IA, Mbaye I, Sougou NM, Sow D, Greenwood B, Ndiaye JLA. Provider and User Acceptability of Integrated Treatment for the Control of Malaria and Helminths in Saraya, South-Eastern Senegal. Am J Trop Med Hyg 2023; 109:1047-1056. [PMID: 37722662 PMCID: PMC10622492 DOI: 10.4269/ajtmh.23-0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/07/2023] [Indexed: 09/20/2023] Open
Abstract
Integration of vertical programs for the control of malaria, schistosomiasis, and soil-transmitted helminthiasis has been recommended to achieve elimination of malaria and neglected tropical diseases (NTD) by 2030. This qualitative study was conducted within the context of a randomized controlled trial to explore the perceptions and views of parents/caregivers of at-risk children and healthcare providers to determine their acceptability of the integrated malaria-helminth treatment approach. Randomly selected parents/caregivers of children enrolled in the trial, healthcare providers, trial staff, malaria, and NTD program managers were interviewed using purpose-designed topic guides. Transcripts obtained from the interviews were coded and common themes identified using content analysis were triangulated. Fifty-seven study participants comprising 26 parents/caregivers, 10 study children aged ≥ 10 years, 15 trial staff, four healthcare providers, and two managers from the Senegal Ministry of Health were interviewed. Thirty-eight of the participants (66.7%) were males, and their ages ranged from 10 to 65 years. Overall, the integrated malaria-helminth treatment approach was considered acceptable, but the study participants expressed concerns about the taste, smell, and side effects associated with amodiaquine and praziquantel in the combination package. Reluctance to accept the medications was also observed among children aged 10 to 14 years due to peer influence and gender-sensitive cultural beliefs. Addressing concerns about the taste and smell of amodiaquine and praziquantel is needed to optimize the uptake of the integrated treatment program. Also, culturally appropriate strategies need to be put in place to cater for the inclusion of children aged 10 to 14 years in this approach.
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Affiliation(s)
- Muhammed O. Afolabi
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aminata Diaw
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | | | | | - Adams Diédhiou
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Amadou Seck
- Service de Parasitologie et Mycologie, Université de Thies, Thies, Senegal
| | - Baba Camara
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Diatou Niang
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Isaac A. Manga
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Ibrahima Mbaye
- Hospital Administration, Saraya Health Centre, Saraya, Senegal
| | - Ndèye Mareme Sougou
- Faculté de Medecine Pharmacie d’Odonto-Stomatologie, Université Cheikh Anta Diop, Dakar, Senegal
| | - Doudou Sow
- Service de Parasitologie et Mycologie, Université Gaston Berger de Saint-Louis, Saint-Louis, Senegal
| | - Brian Greenwood
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Amponsah-Dacosta E, Blose N, Nkwinika VV, Chepkurui V. Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services? Front Public Health 2022; 10:799984. [PMID: 35174123 PMCID: PMC8841655 DOI: 10.3389/fpubh.2022.799984] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 01/07/2022] [Indexed: 12/17/2022] Open
Abstract
Compared to other regions of the world, sub-Saharan Africa has made limited progress in the implementation and performance of nationwide human papillomavirus (HPV) vaccination programmes. Without urgent intervention, this will serve to undermine cervical cancer elimination efforts in this region. The primary intent of this narrative review is to highlight the programmatic successes and challenges of the school-based HPV vaccination programme in South Africa since its inception in 2014, with the aim of contributing to the evidence base needed to accelerate implementation and improve programme performance in other sub-Saharan African countries. As of 2020, the proportion of adolescent girls aged 15 years who had received at least one dose of the HPV vaccine at any time between ages 9–14 years was 75%, while 61% had completed the full recommended two-dose schedule. This gives some indication of the reach of the South African HPV vaccination programme over the past 6 years. Despite this, vaccine coverage and dose completion rates have persistently followed a downward trend, slowing progress toward attaining global elimination targets. There is evidence suggesting that declining public demand for the HPV vaccine may be a result of weakening social mobilization over time, inadequate reminder and tracking systems, and vaccine hesitancy. Another concern is the disproportionate burden of HPV and HIV co-infections among adolescent girls and young women in South Africa, which predisposes them to early development of invasive cervical cancer. Moving forward, national policy makers and implementers will have to explore reforms to current age eligibility criteria and vaccine dose schedules, as well as implement strategies to support vaccine uptake among populations like out-of-school girls, girls attending private schools, and HIV positive young women. Additional opportunities to strengthen the South African HPV vaccination programme can be achieved by scaling up the co-delivery of other adolescent health services such as comprehensive sexual and reproductive health and rights education, deworming, and health screening. This calls for reinforcing implementation of the integrated school health policy and leveraging existing adolescent health programmes and initiatives in South Africa. Ultimately, establishing tailored, adolescent-centered, integrated health programmes will require guidance from further operational research.
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Affiliation(s)
- Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- *Correspondence: Edina Amponsah-Dacosta ;
| | - Ntombifuthi Blose
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Varsetile Varster Nkwinika
- Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Virological Pathology, South African Vaccination and Immunisation Centre (SAVIC), Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Viola Chepkurui
- Vaccines for Africa Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Faculty of Health Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Bigio J, MacLean E, Vasquez NA, Huria L, Kohli M, Gore G, Hannay E, Pai M, Adam P. Most common reasons for primary care visits in low- and middle-income countries: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000196. [PMID: 36962326 PMCID: PMC10022248 DOI: 10.1371/journal.pgph.0000196] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022]
Abstract
With the Covid-19 pandemic and the introduction of the WHO's Essential Diagnostics List (EDL), increasing global attention is focused on the crucial role of diagnostics in achieving universal health coverage. To create national EDLs and to aid health system planning, it is vital to understand the most common conditions with which people present at primary care health facilities. We undertook a systematic review of the most common reasons for primary care visits in low- and middle-income countries. Six databases were searched for articles published between January 2009 and December 2019, with the search updated on MEDLINE to January 2021. Data on the most common patient reasons for encounter (RFEs) and provider diagnoses were collected. 17 of 22,279 screened articles were included. Most studies used unvalidated diagnostic classification systems or presented provider diagnosis data grouped by organ system, rather than presenting specific diagnoses. No studies included data from low-income countries. Only four studies (from Brazil, India, Nigeria and South Africa) using the ICPC-2 classification system contained RFE and provider diagnosis data and could be pooled. The top five RFEs from the four studies were headache, fever, back or low back symptom, cough and pain general/multiple sites. The top five diagnoses were uncomplicated hypertension, upper respiratory tract infection, type 2 diabetes, malaria and health maintenance/prevention. No psychological symptoms were among the top 10 pooled RFEs. There was more variation in top diagnoses between studies than top RFEs, showing the importance of creating location-specific lists of essential diagnostics for primary care. Future studies should aim to sample primary care facilities from across their country of study and use ICPC-3 to report both patient RFEs and provider diagnoses.
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Affiliation(s)
- Jacob Bigio
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Emily MacLean
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Nathaly Aguilera Vasquez
- Research Institute of the McGill University Health Centre, Montreal, Canada
- McGill International TB Centre, Montreal, Canada
| | - Lavanya Huria
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Mikashmi Kohli
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, Canada
| | - Emma Hannay
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
| | - Madhukar Pai
- McGill International TB Centre, Montreal, Canada
- Dept of Epidemiology and Biostatistics, McGill University, Montreal, Canada
- Manipal Academy of Higher Education, Manipal University, Manipal, India
| | - Pierrick Adam
- Infectious Diseases Programs Control Unit, Ministry of Health, Tahiti, French Polynesia
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Simms V, Bernays S, Chibanda D, Chinoda S, Mutsinze A, Beji‐Chauke R, Mugurungi O, Apollo T, Sithole D, Verhey R, Weiss HA, Willis N. Risk factors for HIV virological non-suppression among adolescents with common mental disorder symptoms in Zimbabwe: a cross-sectional study. J Int AIDS Soc 2021; 24:e25773. [PMID: 34402199 PMCID: PMC8368838 DOI: 10.1002/jia2.25773] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 06/10/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Adolescents are at increased risk of HIV virological non-suppression compared to adults and younger children. Common mental disorders such as anxiety and depression are a barrier to adherence and virological suppression. The aim of this study was to identify factors associated with virological non-suppression among adolescents living with HIV (ALWH) in Zimbabwe who had symptoms of common mental disorders. METHODS We utilized baseline data from a cluster-randomized controlled trial of a problem-solving therapy intervention to improve mental health and HIV viral suppression of ALWH. Sixty clinics within 10 districts were randomized 1:1 to either the intervention or control arm, with the aim to recruit 14 adolescents aged 10 to 19 per clinic. Adolescents were eligible if they scored ≥7 on the Shona Symptom Questionnaire measuring symptoms of common mental disorders. Multivariable mixed-effects logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with non-suppression, defined as viral load ≥1000 copies/mL. RESULTS Between 2 January and 21 March 2019 the trial enrolled 842 participants aged 10 to 19 years (55.5% female, 58.8% aged <16). Most participants (N = 613) were taking an NNRTI-based ART regimen (13 PI-based, 216 unknown) and median duration on ART was six years (IQR three to nine years, 240 unknown). Of the 833 with viral load data 292 (35.1%) were non-suppressed. Virological non-suppression was independently associated with male sex (adjusted OR (aOR) = 1.43, 95% CI 1.04 to 1.97), and with not knowing one's own HIV status (aOR = 1.77, 95% CI 1.08 to 2.88), or knowing one's status but not disclosing it to anyone (aOR = 1.99, 95% CI 1.36 to 2.93), compared to adolescents who knew their status and had disclosed it to someone. CONCLUSIONS ALWH with symptoms of common mental disorders have high prevalence of virological non-suppression in Zimbabwe, especially if they do not know their status or have not disclosed it. In general adolescents should be informed of their HIV status, with encouragement on the beneficial health and social effects of viral suppression, to incentivise adherence. Efforts to strengthen the operationalization of disclosure guidelines for adolescents should now be prioritized.
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Affiliation(s)
- Victoria Simms
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
| | - Sarah Bernays
- London School of Hygiene & Tropical MedicineLondonUK
| | - Dixon Chibanda
- London School of Hygiene & Tropical MedicineLondonUK
- Friendship BenchHarareZimbabwe
- Department of PsychiatryUniversity of Zimbabwe College of Health SciencesHarareZimbabwe
| | | | | | | | - Owen Mugurungi
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Tsitsi Apollo
- AIDS & TB UnitMinistry of Health and Child CareHarareZimbabwe
| | - Dorcas Sithole
- Mental Health ServicesMinistry of Health and Child CareHarareZimbabwe
| | | | - Helen A Weiss
- MRC International Statistics and Epidemiology GroupLondon School of Hygiene & Tropical MedicineLondonUK
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