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Schnure MC, Kasaie P, Dowdy DW, Genberg BL, Kendall EA, Fojo AT. Forecasting the effect of HIV-targeted interventions on the age distribution of people with HIV in Kenya. AIDS 2024; 38:1375-1385. [PMID: 38537051 PMCID: PMC11211060 DOI: 10.1097/qad.0000000000003895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/27/2024] [Accepted: 03/21/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVES To provide accurate forecasts of the age distribution of people with HIV (PWH) in Kenya from 2025 to 2040. DESIGN Development of a compartmental model of HIV in Kenya, calibrated to historical estimates of HIV epidemiology. METHODS We forecasted changes in population size and age distribution of new HIV infections and PWH under the status quo and under scale-up of HIV services. RESULTS Without scale-up, new HIV infections were forecasted to fall from 34 000 (28 000-41 000) in 2,025 to 29 000 (15 000-57 000) in 2,040; the percentage of new infections occurring among persons over 30 increased from 33% (20-50%) to 40% (24-62%). The median age of PWH increased from 39 years (38-40) in 2025 to 43 years (39-46) in 2040, and the percentage of PWH over age 50 increased from 26% (23-29%) to 34% (26-43%). Under the full intervention scenario, new infections were forecasted to fall to 6,000 (3,000-12 000) in 2,040. The percentage of new infections occurring in people over age 30 increased to 52% (34-71%) in 2,040, and there was an additional shift in the age structure of PWH [forecasted median age of 46 (43-48) and 40% (33-47%) over age 50]. CONCLUSION PWH in Kenya are forecasted to age over the next 15 years; improvements to the HIV care continuum are expected to contribute to the growing proportion of older PWH.
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Affiliation(s)
| | - Parastu Kasaie
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David W. Dowdy
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Becky L. Genberg
- The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Acharya A, Chowdhury HR, Ihyauddin Z, Mahesh PKB, Adair T. Cardiovascular disease mortality based on verbal autopsy in low- and middle-income countries: a systematic review. Bull World Health Organ 2023; 101:571-586. [PMID: 37638359 PMCID: PMC10452938 DOI: 10.2471/blt.23.289802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To conduct a systematic review of verbal autopsy studies in low- and middle-income countries to estimate the fraction of deaths due to cardiovascular disease. Method We searched MEDLINE®, Embase® and Scopus databases for verbal autopsy studies in low- and middle-income countries that reported deaths from cardiovascular disease. Two reviewers screened the studies, extracted data and assessed study quality. We calculated cause-specific mortality fractions for cardiovascular disease for each study, both overall and according to age, sex, geographical location and type of cardiovascular disease. Findings We identified 42 studies for inclusion in the review. Overall, the cardiovascular disease cause-specific mortality fractions for people aged 15 years and above was 22.9%. This fraction was generally higher for males (24.7%) than females (20.9%), but the pattern varied across World Health Organization regions. The highest cardiovascular disease mortality fraction was reported in the Western Pacific Region (26.3%), followed by the South-East Asia Region (24.1%) and the African Region (12.7%). The cardiovascular disease mortality fraction was higher in urban than rural populations in all regions, except the South-East Asia Region. The mortality fraction for ischaemic heart disease (12.3%) was higher than that for stroke (8.7%). Overall, 69.4% of cardiovascular disease deaths were reported in people aged 65 years and above. Conclusion The burden of cardiovascular disease deaths outside health-care settings in low- and middle-income countries is substantial. Increasing coverage of verbal autopsies in these countries could help fill gaps in cardiovascular disease mortality data and improve monitoring of national, regional and global health goals.
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Affiliation(s)
- Ajay Acharya
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | | | - Zulfikar Ihyauddin
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Pasyodun Koralage Buddhika Mahesh
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
| | - Tim Adair
- The Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Level 5, 333 Exhibition St, Melbourne, Victoria, 3000 VIC, Australia
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Mohamed SF, Macharia T, Asiki G, Gill P. A socio-ecological framework examination of drivers of blood pressure control among patients with comorbidities and on treatment in two Nairobi slums; a qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001625. [PMID: 36963082 PMCID: PMC10021823 DOI: 10.1371/journal.pgph.0001625] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/31/2023] [Indexed: 03/12/2023]
Abstract
Despite the known and effective treatments to control blood pressure, there is limited information on why there are high uncontrolled hypertension rates in urban slum settings. The aim of this paper is to explore the views of treated people with uncontrolled hypertension and other key stakeholders on the facilitators and barriers to blood pressure control among people with comorbid conditions in two Nairobi slums. The study was conducted in two Nairobi slums namely, Korogocho and Viwandani. This study used a qualitative methodology using interviews and focus group discussions. Barriers and facilitators to blood pressure control were explored using the Social Ecological Model (SEM) framework. A total of 57 participants were interviewed for this study. There were 31 in-depth interviews and two focus group discussions among participants with uncontrolled hypertension and with comorbidities. Additionally, 16 key informant interviews were conducted with healthcare providers and decision/policymakers. All interviews were audio-recorded, transcribed verbatim and analysed thematically. This study identified barriers and facilitators to blood pressure control among patients with uncontrolled hypertension at the patient/individual level, family and community level, health system level and at the policy level. High cost of hypertension medicines, the constant unavailability of medicines at the health facilities, unsupportive family and environment, poor medicines supply chain management, availability and use of guidelines were among the barriers reported. The results show that uncontrolled hypertension is a major public health issue in slums of Nairobi and they highlight barriers to blood pressure control at different levels of the socio-ecological model. These findings can be used to design holistic interventions to improve blood pressure control by addressing factors operating at multiple levels of the socio-ecological framework.
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Affiliation(s)
- Shukri F Mohamed
- Division of Health Sciences and the NIHR Global Health Research Unit on Improving Health in Slums, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Global Health and Population, Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) and the NIHR Global Health Research Unit on Improving Health in Slums, University of Warwick, Coventry, United Kingdom
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4
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Wadende P, Francis O, Musuva R, Mogo E, Turner-Moss E, Were V, Obonyo C, Foley L. Foodscapes, finance, and faith: Multi-sectoral stakeholder perspectives on the local population health and wellbeing in an urbanizing area in Kenya. Front Public Health 2022; 10:913851. [PMID: 36505008 PMCID: PMC9731138 DOI: 10.3389/fpubh.2022.913851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/28/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Rapid urbanization (growth of cities) can upset the local population's health and wellbeing by creating obesogenic environments which increase the burden of non-communicable diseases (NCDs). It is important to understand how stakeholders perceive the impact of urbanizing interventions (such as the construction of a new hypermarket) on the health and wellbeing of local populations. Because low- and middle-income countries (LMICs) lack the reliable infrastructure to mitigate the effects of obesogenic environments, so engaging stakeholders who influence dietary habits is one population-level strategy for reducing the burden of NCDs caused by newly built developments. Methods We conducted key informant interviews with 36 stakeholders (25 regulatory and 11 local community stakeholders) from Kisumu and Homa Bay Counties of Western Kenya in June 2019. We collected stakeholders' perspectives on the impacts of a new Mall and supermarket in Kisumu, and existing supermarkets in Homa Bay on the health and wellbeing of local populations. Results Through thematic discourse analysis, we noted that some stakeholders thought supermarkets enabled access to unhealthy food items despite these outlets being also reliable food sources for discerning shoppers. Others linked the changing physical environment to both an increase in pollution and different types of diseases. Stakeholders were unsure if the pricing and convenience of supermarkets would stop local populations from buying from their usual small-scale food vendors. The key finding of this study was that engaging relevant stakeholders as part of population health impact assessments of new developments in cities are important as it directs focus on health equity and prevention in instances of resource constraints. The findings highlight, also, that community members have a strong awareness of the potential for interventions that would improve the health and wellbeing of local populations.
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Affiliation(s)
- Pamela Wadende
- School of Education and Human Resource Development, Kisii University, Kisii, Kenya,*Correspondence: Pamela Wadende
| | - Oliver Francis
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Rosemary Musuva
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ebele Mogo
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Eleanor Turner-Moss
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
| | - Vincent Were
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Charles Obonyo
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Louise Foley
- MRC Epidemiology Unit, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge, Cambridge, United Kingdom
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Waruiru W, Oramisi V, Sila A, Onyango D, Waruru A, Mwangome MN, Young PW, Muuo S, Nyagah LM, Ollongo J, Ngugi C, Rutherford GW. All-cause and cause-specific mortality rates for Kisumu County: a comparison with Kenya, low-and middle-income countries. BMC Public Health 2022; 22:1828. [PMID: 36167543 PMCID: PMC9516838 DOI: 10.1186/s12889-022-14141-5] [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: 04/26/2021] [Accepted: 08/25/2022] [Indexed: 11/14/2022] Open
Abstract
Background Understanding the magnitude and causes of mortality at national and sub-national levels for countries is critical in facilitating evidence-based prioritization of public health response. We provide comparable cause of death data from Kisumu County, a high HIV and malaria-endemic county in Kenya, and compared them with Kenya and low-and-middle income countries (LMICs). Methods We analyzed data from a mortuary-based study at two of the largest hospital mortuaries in Kisumu. Mortality data through 2019 for Kenya and all LMICs were downloaded from the Global Health Data Exchange. We provided age-standardized rates for comparisons of all-cause and cause-specific mortality rates, and distribution of deaths by demographics and Global Burden of Disease (GBD) classifications. Results The all-cause age-standardized mortality rate (SMR) was significantly higher in Kisumu compared to Kenya and LMICs (1118 vs. 659 vs. 547 per 100,000 population, respectively). Among women, the all-cause SMR in Kisumu was almost twice that of Kenya and double the LMICs rate (1150 vs. 606 vs. 518 per 100,000 population respectively). Among men, the all-cause SMR in Kisumu was approximately one and a half times higher than in Kenya and nearly double that of LMICs (1089 vs. 713 vs. 574 per 100,000 population). In Kisumu and LMICs non-communicable diseases accounted for most (48.0 and 58.1% respectively) deaths, while in Kenya infectious diseases accounted for the majority (49.9%) of deaths. From age 10, mortality rates increased with age across all geographies. The age-specific mortality rate among those under 1 in Kisumu was nearly twice that of Kenya and LMICs (6058 vs. 3157 and 3485 per 100,000 population, respectively). Mortality from injuries among men was at least one and half times that of women in all geographies. Conclusion There is a notable difference in the patterns of mortality rates across the three geographical areas. The double burden of mortality from GBD Group I and Group II diseases with high infant mortality in Kisumu can guide prioritization of public health interventions in the county. This study demonstrates the importance of establishing reliable vital registry systems at sub-national levels as the mortality dynamics and trends are not homogeneous.
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Affiliation(s)
- Wanjiru Waruiru
- Institute for Global Health Sciences, University of California, San-Francisco, USA.
| | - Violet Oramisi
- Ministry of Health, National AIDS and STI Control Program (NASCOP), Nairobi, Kenya
| | - Alex Sila
- United Nations Poulation Fund, Vientiane, Laos
| | | | - Anthony Waruru
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB, Nairobi, Kenya
| | - Mary N Mwangome
- Global Programs for Research and Training (GPRT), Nairobi, Kenya
| | - Peter W Young
- US Centers for Disease Control and Prevention (CDC), Division of Global HIV & TB, Nairobi, Kenya
| | - Sheru Muuo
- Global Programs for Research and Training (GPRT), Nairobi, Kenya
| | - Lilly M Nyagah
- Ministry of Health, Office of Director General, Nairobi, Kenya
| | - John Ollongo
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Catherine Ngugi
- Ministry of Health, National AIDS and STI Control Program (NASCOP), Nairobi, Kenya
| | - George W Rutherford
- Institute for Global Health Sciences, University of California, San-Francisco, USA
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Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, Singini GC, Kgarosi K, Mchunu N, Nevhungoni P, Silinda P, Ekwomadu T, Maposa I. Mapping Evidence on the Burden of Breast, Cervical, and Prostate Cancers in Sub-Saharan Africa: A Scoping Review. Front Public Health 2022; 10:908302. [PMID: 35784211 PMCID: PMC9246362 DOI: 10.3389/fpubh.2022.908302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/24/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCancer remains a major public health problem, especially in Sub-Saharan Africa (SSA) where the provision of health care is poor. This scoping review mapped evidence in the literature regarding the burden of cervical, breast and prostate cancers in SSA.MethodsWe conducted this scoping review using the Arksey and O'Malley framework, with five steps: identifying the research question; searching for relevant studies; selecting studies; charting the data; and collating, summarizing, and reporting the data. We performed all the steps independently and resolved disagreements through discussion. We used Endnote software to manage references and the Rayyan software to screen studies.ResultsWe found 138 studies that met our inclusion criteria from 2,751 studies identified through the electronic databases. The majority were retrospective studies of mostly registries and patient files (n = 77, 55.8%), followed by cross-sectional studies (n = 51, 36.9%). We included studies published from 1990 to 2021, with a sharp increase from 2010 to 2021. The quality of studies was overall satisfactory. Most studies were done in South Africa (n = 20) and Nigeria (n = 17). The majority were on cervical cancer (n = 93, 67.4%), followed by breast cancer (67, 48.6%) and the least were on prostate cancer (48, 34.8%). Concerning the burden of cancer, most reported prevalence and incidence. We also found a few studies investigating mortality, disability-adjusted life years (DALYs), and years of life lost (YLL).ConclusionsWe found many retrospective record review cross-sectional studies, mainly in South Africa and Nigeria, reporting the prevalence and incidence of cervical, breast and prostate cancer in SSA. There were a few systematic and scoping reviews. There is a scarcity of cervical, breast and prostate cancer burden studies in several SSA countries. The findings in this study can inform policy on improving the public health systems and therefore reduce cancer incidence and mortality in SSA.
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Affiliation(s)
- Alfred Musekiwa
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- *Correspondence: Alfred Musekiwa
| | - Maureen Moyo
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mohanad Mohammed
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Zvifadzo Matsena-Zingoni
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Jesca Mercy Batidzirai
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | | | - Kabelo Kgarosi
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nobuhle Mchunu
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Durban, South Africa
| | - Portia Nevhungoni
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Patricia Silinda
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Theodora Ekwomadu
- Department of Biological Sciences, Faculty of Natural and Agricultural Sciences, North-West University, Mmabatho, South Africa
| | - Innocent Maposa
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Yokobori Y, Matsuura J, Sugiura Y, Mutemba C, Julius P, Himwaze C, Nyahoda M, Mwango C, Kazhumbula L, Yuasa M, Munkombwe B, Mucheleng'anga L. Comparison of the Causes of Death Identified Using Automated Verbal Autopsy and Complete Autopsy among Brought-in-Dead Cases at a Tertiary Hospital in Sub-Sahara Africa. Appl Clin Inform 2022; 13:583-591. [PMID: 35705183 PMCID: PMC9200488 DOI: 10.1055/s-0042-1749118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Over one-third of deaths recorded at health facilities in Zambia are brought in dead (BID) and the causes of death (CODs) are not fully analyzed. The use of automated verbal autopsy (VA) has reportedly determined the CODs of more BID cases than the death notification form issued by the hospital. However, the validity of automated VA is yet to be fully investigated. OBJECTIVES To compare the CODs identified by automated VA with those by complete autopsy to examine the validity of a VA tool. METHODS The study site was the tertiary hospital in the capital city of Zambia. From September 2019 to January 2020, all BID cases aged 13 years and older brought to the hospital during the daytime on weekdays were enrolled in this study. External COD cases were excluded. The deceased's relatives were interviewed using the 2016 World Health Organization VA questionnaire. The data were analyzed using InterVA, an automated VA tool, to determine the CODs, which were compared with the results of complete autopsies. RESULTS A total of 63 cases were included. The CODs of 50 BID cases were determined by both InterVA and complete autopsies. The positive predictive value of InterVA was 22%. InterVA determined the CODs correctly in 100% cases of maternal CODs, 27.5% cases of noncommunicable disease CODs, and 5.3% cases of communicable disease CODs. Using the three broader disease groups, 56.0% cases were classified in the same groups by both methods. CONCLUSION While the positive predictive value was low, more than half of the cases were categorized into the same broader categories. However, there are several limitations in this study, including small sample size. More research is required to investigate the factors leading to discrepancies between the CODs determined by both methods to optimize the use of automated VA in Zambia.
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Affiliation(s)
- Yuta Yokobori
- National Center for Global Health and Medicine, Shinjuku-ku, Japan,Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan,Address for correspondence Yuta Yokobori, MD, MPH, MSc 1-21-1, Toyama, Shinjuku-ku, TokyoJapan
| | - Jun Matsuura
- National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Yasuo Sugiura
- National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Charles Mutemba
- Ministry of Health, Lusaka, Zambia,Adult Hospital, University Teaching Hospital, Lusaka, Zambia
| | - Peter Julius
- Ministry of Health, Lusaka, Zambia,Department of Pathology and Microbiology, School of Medicine, The University of Zambia, Lusaka, Zambia
| | - Cordelia Himwaze
- Ministry of Health, Lusaka, Zambia,Department of Pathology and Microbiology, School of Medicine, The University of Zambia, Lusaka, Zambia
| | - Martin Nyahoda
- Department of National Registration of Home Passport & Citizenship, Ministry Affairs, Lusaka, Zambia
| | - Chomba Mwango
- Bloomberg Data for Health Initiative, Lusaka, Zambia
| | | | - Motoyuki Yuasa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Brian Munkombwe
- National Center for Health Statistics, Center for Disease Control and Prevention, Atlanta, United States
| | - Luchenga Mucheleng'anga
- Office of the State Forensic Pathologist, Ministry of Home Affairs and Internal Security, Lusaka, Zambia
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Waruru A, Onyango D, Nyagah L, Sila A, Waruiru W, Sava S, Oele E, Nyakeriga E, Muuo SW, Kiboye J, Musingila PK, van der Sande MAB, Massawa T, Rogena EA, DeCock KM, Young PW. Leading causes of death and high mortality rates in an HIV endemic setting (Kisumu county, Kenya, 2019). PLoS One 2022; 17:e0261162. [PMID: 35051186 PMCID: PMC8775329 DOI: 10.1371/journal.pone.0261162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 11/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry. METHODS Medical experts trained in COD certification examined medical charts and ascertained causes of death for 456 decedents admitted to the mortuaries from April 16 through July 12, 2019. Decedents with unknown HIV status or who had tested HIV-negative >90 days before the date of death were tested for HIV. We calculated annualized all-cause and cause-specific mortality rates grouped according to global burden of disease (GBD) categories and separately for deaths due to HIV/AIDS and expressed estimated deaths per 100,000 population. We compared notified to ascertained UCOD using Cohen's Kappa (κ) and assessed for the independence of proportions using Pearson's chi-squared test. FINDINGS The four leading UCOD were HIV/AIDS (102/442 [23.1%]), hypertensive disease (41/442 [9.3%]), other cardiovascular diseases (23/442 [5.2%]), and cancer (20/442 [4.5%]). The all-cause mortality rate was 1,086/100,000 population. The highest cause-specific mortality was in GBD category II (noncommunicable diseases; 516/100,000), followed by GBD I (communicable, perinatal, maternal, and nutritional; 513/100,000), and III (injuries; 56/100,000). The HIV/AIDS mortality rate was 251/100,000 population. The proportion of deaths due to GBD II causes was higher among females (51.9%) than male decedents (42.1%; p = 0.039). Conversely, more men/boys (8.6%) than women/girls (2.1%) died of GBD III causes (p = 0.002). Most of the records with available recorded and ascertained UCOD (n = 236), 167 (70.8%) had incorrectly recorded UCOD, and agreement between notified and ascertained UCOD was poor (29.2%; κ = 0.26). CONCLUSIONS Mortality from infectious diseases, especially HIV/AIDS, is high in Kisumu County, but there is a shift toward higher mortality from noncommunicable diseases, possibly reflecting an epidemiologic transition and improving HIV outcomes. The epidemiologic transition suggests the need for increased focus on controlling noncommunicable conditions despite the high communicable disease burden. The weak agreement between notified and ascertained UCOD could lead to substantial inaccuracies in mortality statistics, which wholly depend on death notifications.
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Affiliation(s)
- Anthony Waruru
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Dickens Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | - Lilly Nyagah
- Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
| | - Alex Sila
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Solomon Sava
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | | | | | - Sheru W. Muuo
- Global Programs for Research and Training, Nairobi, Kenya
| | | | - Paul K. Musingila
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marianne A. B. van der Sande
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Julius Global Health, Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, Netherlands
| | | | - Emily A. Rogena
- Department of Human Pathology, School of Medicine, College of Health Sciences, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Kevin M. DeCock
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Peter W. Young
- Division of Global HIV and TB, US Centers for Disease Control and Prevention, Nairobi, Kenya
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9
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/11.15002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. Methods This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. Results We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. Conclusions There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Social Work, University of Nigeria, Nsukka, Nigeria.,Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing - African Network, Nigeria (www.erpaan.org).,Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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10
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Kalu ME, Ojembe BU, Akinrolie O, Okoh AC, Adandom II, Nwankwo HC, Ajulo MS, Omeje CA, Okeke CO, Uduonu EM, Ezulike JC, Anieto EM, Emofe D, Nwachukwu EC, Ibekaku MC, Obi PC. Setting priorities for ageing research in Africa: A systematic mapping review of 512 studies from sub-Saharan Africa. J Glob Health 2021; 11:15002. [PMID: 34327003 PMCID: PMC8284542 DOI: 10.7189/jogh.11.15002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND In 2040, the older population's growth rate in sub-Saharan Africa (SSA) will be faster than those experienced by developed nations since 1950. In preparation for this growth, the National Institute on Aging commissioned the National Academies' Committee on Population to organize a workshop on advancing aging research in Africa. This meeting provided a platform for discussing some areas requiring improvement in aging research in SSA regions. We believed that conducting a systematic review of peer-reviewed articles to set priorities for aging research in SSA is warranted. Therefore, this article is the first in a Four-Part series that summaries the types and trends of peer-reviewed studies in SSA. METHODS This systematic mapping review followed the Search-Appraisal-Synthesis-Analysis Framework. We systematically searched multiple databases from inception till February 2021 and included peer-reviewed articles conducted with/for older adults residing in SSA. Conventional content analysis was employed to categorize studies into subject-related areas. RESULTS We included 512 studies (quantitative = 426, qualitative = 71 and mixed-method = 15). Studies were conducted in 32 countries. Quantitative studies included were observational studies: cross-sectional (n = 250, 59%), longitudinal (n = 126, 30%), and case-control (n = 12, 3%); and experimental studies: pre-post design (n = 4, 1%), randomized control trial (RCT, n = 12, 3%); and not reported (n = 21, 5%). Fifteen qualitative studies did not state their study design; where stated, study design ranged from descriptive (n = 14, 20%), ethnography (n = 12, 17%), grounded theory (n = 7, 10%), narrative (n = 5, 7%), phenomenology (n = 10, 14%), interpretative exploratory (n = 4, 6%), case studies (n = 4, 6%). Of the 15 mixed-method studies, seven did not state their mixed-method design. Where stated, design includes concurrent (n = 1), convergent (n = 1), cross-sectional (n = 3), informative (n = 1), sequential exploratory (n = 1) and retrospective (n = 2). Studies were classified into 30 (for quantitative studies) and seven (for qualitative and mixed-method) subject-related areas. HIV/AIDs-related and non-communicable diseases-related studies were the most predominant subject-related areas. No studies explored the transdisciplinary co-production of interventions. CONCLUSIONS There are glaring gaps in ageing research in SSA, especially mixed-methods and RCTs. A large number of studies focused on HIV/AIDs and non-communicable disease-related studies. National and international funding agencies should set up priority funding competitions for transdisciplinary collaborations in ageing research.
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Affiliation(s)
- Michael E Kalu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- School of Rehabilitation Science, McMaster University, Hamilton Ontario Canada
| | - Blessing U Ojembe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health, Ageing & Society, McMaster University, Hamilton Ontario Canada
| | - Olayinka Akinrolie
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Applied Health Science Program, University of Manitoba, Winnipeg, Canada
| | - Augustine C Okoh
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Israel I Adandom
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Cedacrest Hospitals, Abuja, Nigeria
| | - Henrietta C Nwankwo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Faculty of Health Science, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Michael S Ajulo
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
| | - Chidinma A Omeje
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Chukwuebuka O Okeke
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ekezie M Uduonu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Medical Rehabilitation, College of Medicine, University of Nigeria, Nigeria
| | - Juliet C Ezulike
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Ebuka M Anieto
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa
| | - Diameta Emofe
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Humanity Hospital Effurun, Delta State, Nigeria
| | - Ernest C Nwachukwu
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Department, Enugu State University of Science and Technology Teaching Hospital-Parklane, Enugu, Nigeria
| | - Michael C Ibekaku
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Department of Physiotherapy, University of Benin Teaching Hospital, Benin city, Nigeria
| | - Perpetual C Obi
- Emerging Researchers & Professionals in Ageing – African Network, Nigeria (www.erpaan.org)
- Physiotherapy Unit, Peak Wellness Centre, Abuja, Nigeria
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11
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Ng G, Raskin E, Wirtz VJ, Banks KP, Laing RO, Kiragu ZW, Rockers PC, Onyango MA. Coping with access barriers to non-communicable disease medicines: qualitative patient interviews in eight counties in Kenya. BMC Health Serv Res 2021; 21:417. [PMID: 33941177 PMCID: PMC8094552 DOI: 10.1186/s12913-021-06433-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is rich literature on barriers to medicines access for the treatment of non-communicable diseases (NCDs) in high-income countries. Less is known about low- and middle-income countries, in particular the differences in coping with medicines access barrier by household wealth and disease. The aim of this study was to compare the coping mechanisms of patients with the lack of availability and affordability of cardio-vascular diseases, diabetes and asthma medicines in Kenya. Methods This qualitative study was part of a larger mixed methods evaluation study conducted in eight counties of Kenya from 2016 to 2019. Forty-nine patient interviews at study end line explored their NCD journey, perceptions of availability, stockouts and affordability of NCD medicines, their enrollment in health insurance, and their relationship with the private chemists. Transcribed interviews were coded using Nvivo software. A two-step thematic approach was used, first conducting a priority coding which was followed by coding emerging and divergent themes. Results Overall, we found that patients across all disease types and wealth level faced frequent medicine stock-outs at health facilities. In the absence of NCD medicines at health facilities, patients coped by purchasing medicines from local chemists, switching health facilities, requesting a different prescription, admitting oneself to an inpatient facility, establishing connections with local staff to receive notifications of medicine stock, stocking up on medicines, utilizing social capital to retrieve medicines from larger cities and obtaining funds from a network of friends and family. Categorizing by disease revealed patterns in coping choices that were based on the course of the disease, severity of the symptoms and the direct and indirect costs incurred as a result of stockouts of NCD medicines. Categorizing by wealth highlight differences in households’ capacity to cope with the unavailability and unaffordability of NCD medicines. Conclusions The type of coping strategies to access barriers differ by NCD and wealth group. Although Kenya has made important strides to address NCD medicines access challenges, prioritizing enrollment of low wealth households in county health insurance programs and ensuring continuous availability of essential NCD medicines at public health facilities close to the patient homes could improve access.
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Affiliation(s)
- Gloria Ng
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Elizabeth Raskin
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA.
| | - Kathleen P Banks
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Richard O Laing
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA.,School of Public Health, Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - Zana W Kiragu
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
| | - Monica A Onyango
- Department of Global Health, Boston University School of Public Health, Crosstown, 3rd floor, 801 Massachusetts Avenue, MA, 02118, Boston, USA
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12
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Kasaie P, Weir B, Schnure M, Dun C, Pennington J, Teng Y, Wamai R, Mutai K, Dowdy D, Beyrer C. Integrated screening and treatment services for HIV, hypertension and diabetes in Kenya: assessing the epidemiological impact and cost-effectiveness from a national and regional perspective. J Int AIDS Soc 2021; 23 Suppl 1:e25499. [PMID: 32562353 PMCID: PMC7305418 DOI: 10.1002/jia2.25499] [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: 09/27/2019] [Revised: 02/28/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION As people with HIV age, prevention and management of other communicable and non-communicable diseases (NCDs) will become increasingly important. Integration of screening and treatment for HIV and NCDs is a promising approach for addressing the dual burden of these diseases. The aim of this study was to assess the epidemiological impact and cost-effectiveness of a community-wide integrated programme for screening and treatment of HIV, hypertension and diabetes in Kenya. METHODS Coupling a microsimulation of cardiovascular diseases (CVDs) with a population-based model of HIV dynamics (the Spectrum), we created a hybrid HIV/CVD model. Interventions were modelled from year 2019 (baseline) to 2023, and population was followed to 2033. Analyses were carried at a national level and for three selected regions (Nairobi, Coast and Central). RESULTS At a national level, the model projected 7.62 million individuals living with untreated hypertension, 692,000 with untreated diabetes and 592,000 individuals in need of ART in year 2018. Improving ART coverage from 68% at baseline to 88% in 2033 reduced HIV incidence by an estimated 64%. Providing NCD treatment to 50% of diagnosed cases from 2019 to 2023 and maintaining them on treatment afterwards could avert 116,000 CVD events and 43,600 CVD deaths in Kenya over the next 15 years. At a regional level, the estimated impact of expanded HIV services was highest in Nairobi region (averting 42,100 HIV infections compared to baseline) while Central region experienced the highest impact of expanded NCD treatment (with a reduction of 22,200 CVD events). The integrated HIV/NCD intervention could avert 7.76 million disability-adjusted-life-years (DALYs) over 15 years at an estimated cost of $6.68 billion ($445.27 million per year), or $860.30 per DALY averted. At a cost-effectiveness threshold of $2,010 per DALY averted, the probability of cost-effectiveness was 0.92, ranging from 0.71 in Central to 0.92 in Nairobi region. CONCLUSIONS Integrated screening and treatment of HIV and NCDs can be a cost-effective and impactful approach to save lives of people with HIV in Kenya, although important variation exists at the regional level. Containing the substantial costs required for scale-up will be critical for management of HIV and NCDs on a national scale.
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Affiliation(s)
- Parastu Kasaie
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brian Weir
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Schnure
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chen Dun
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeff Pennington
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yu Teng
- Avenir Health, Glastonbury, CT, USA
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, Integrated Initiative for Global Health, Northeastern University, Boston, MA, USA
| | | | - David Dowdy
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Chris Beyrer
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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13
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Oruko K, Maixenchs M, Phillips-Howard P, Ondire M, Akelo C, Sanz A, Ordi J, Menéndez C, Bassat Q, Odhiambo FO, Munguambe K. Conceptual frameworks for understanding the acceptability and feasibility of the minimally invasive autopsy to determine cause of death: Findings from the CADMIA Study in western Kenya. PLoS One 2020; 15:e0242574. [PMID: 33315918 PMCID: PMC7735626 DOI: 10.1371/journal.pone.0242574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/04/2020] [Indexed: 11/17/2022] Open
Abstract
Establishing the cause of death (CoD) is critical to better understanding health and prioritizing health investments, however the use of full post-mortem examination is rare in most low and middle-income counties for multiple reasons. The use of minimally invasive autopsy (MIA) approaches, such as needle biopsies, presents an alternate means to assess CoD. In order to understand the feasibility and acceptability of MIA among communities in western Kenya, we conducted focus groups and in-depth interviews with next-of-kin of recently deceased persons, community leaders and health care workers in Siaya and Kisumu counties. Results suggest two conceptual framework can be drawn, one with facilitating factors for acceptance of MIA due to the ability to satisfy immediate needs related to interest in learning CoD or protecting social status and honoring the deceased), and one framework covering barriers to acceptance of MIA, for reasons relating to the failure to serve an existing need, and/or the exacerbation of an already difficult time.
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Affiliation(s)
- Kelvin Oruko
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.,Kenya Medical Training College, Nairobi, Kenya
| | - Maria Maixenchs
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | | | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akelo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Ariadna Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Pathology, Hospital Clinic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
| | - Frank O Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Khatia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Faculty of Medicine, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
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Asiki G, Wanjohi MN, Barnes A, Bash K, Muthuri S, Amugsi D, Doughman D, Kimani E, Vandevijvere S, Holdsworth M. Benchmarking food environment policies for the prevention of diet-related non-communicable diseases in Kenya: National expert panel's assessment and priority recommendations. PLoS One 2020; 15:e0236699. [PMID: 32760079 PMCID: PMC7410300 DOI: 10.1371/journal.pone.0236699] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/12/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Unhealthy food environments drive the increase of diet-related non-communicable diseases (NCDs). Objective We aimed to examine healthy food environment policies in Kenya and identify priorities for future action. Methods Using the Healthy Food Environment Policy Index (Food-EPI) we collected evidence on the extent of government action to create healthy food environments across 13 policy and infrastructure support domains and 43 related good practice indicators between 2017 and 2018. A panel of 15 national experts rated the extent of government action on each indicator compared to the policy development cycle and international best practice respectively. Based on gaps found, actions to improve food environments in Kenya were identified and prioritized. Results In the policy development cycle, 16/43 (37%) of good practice policy indicators were judged to be in ‘implementation’ phase, including: food composition targets, packaged foods’ ingredient lists/nutrient declarations; systems regulating health claims; restrictions on marketing breast milk substitutes; and school nutrition policies. Infrastructure support actions in ‘implementation’ phase included: food-based dietary guidelines; strong political support to reduce NCDs; comprehensive NCD action plan; transparency in developing food policies; and surveys monitoring nutritional status. Half (22/43) of the indicators were judged to be ‘in development’. Compared to international best practice, the Kenyan Government was judged to be performing relatively well (‘medium’ implementation) in one policy (restrictions on marketing breast milk substitutes) and three infrastructure support areas (political leadership; comprehensive implementation plan; and ensuring all food policies are sensitive to nutrition). Implementation for 36 (83.7%) indicators were rated as ‘low’ or ‘very little’. Taking into account importance and feasibility, seven actions within the areas of leadership, food composition, labelling, promotion, prices and health-in-all-policies were prioritized. Conclusion This baseline assessment is important in creating awareness to address gaps in food environment policy. Regular monitoring using Food-EPI may contribute to addressing the burden of diet-related NCDs in Kenya.
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Affiliation(s)
- Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Solna, Sweden
- * E-mail:
| | | | - Amy Barnes
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Kristin Bash
- Public Health, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
| | - Stella Muthuri
- African Population and Health Research Center, Nairobi, Kenya
| | - Dickson Amugsi
- African Population and Health Research Center, Nairobi, Kenya
| | | | | | | | - Michelle Holdsworth
- French National Research Institute for Sustainable Development (IRD), NUTRIPASS Unit: IRD-Univ Montpellier-SupAgro, Montpellier, France
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15
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Osetinsky B, Hontelez JAC, Lurie MN, McGarvey ST, Bloomfield GS, Pastakia SD, Wamai R, Bärnighausen T, de Vlas SJ, Galárraga O. Epidemiological And Health Systems Implications Of Evolving HIV And Hypertension In South Africa And Kenya. Health Aff (Millwood) 2019; 38:1173-1181. [PMID: 31260360 PMCID: PMC7983613 DOI: 10.1377/hlthaff.2018.05287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Health systems in sub-Saharan Africa are facing an ongoing HIV epidemic and increasing burden of noncommunicable disease. With the focus shifting to the development of comprehensive primary health care and chronic disease treatment, multidisease modeling is integral to estimating future health care needs. We extended an established agent-based model of HIV transmission to include hypertension in two rural settings: KwaZulu-Natal, South Africa, and western Kenya. We estimated that from 2018 to 2028 hypertension prevalence would increase from 40 percent to 46 percent in KwaZulu-Natal and from 29 percent to 35 percent in western Kenya, while HIV prevalence is stabilizing and predicted to decrease. As the health system burden in sub-Saharan Africa is changing, innovative chronic disease treatment and the broadening of successful programs, such as integrated HIV and noncommunicable disease care, are necessary to reach universal health care coverage.
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Affiliation(s)
- Brianna Osetinsky
- Brianna Osetinsky is a PhD candidate in the Department of Health Services, Policy, and Practice, Brown University School of Public Health, in Providence, Rhode Island
| | - Jan A C Hontelez
- Jan A. C. Hontelez is an assistant professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam, in the Netherlands, and at the Heidelberg Institute of Global Health, Heidelberg University, in Germany
| | - Mark N Lurie
- Mark N. Lurie is an associate professor in the Department of Epidemiology, Brown University School of Public Health
| | - Stephen T McGarvey
- Stephen T. McGarvey is director of the International Health Institute and a professor in the Department of Epidemiology, both at the Brown University School of Public Health
| | - Gerald S Bloomfield
- Gerald S. Bloomfield is an associate professor in the Department of Medicine and Global Health, Duke University School of Medicine, in Durham, North Carolina
| | - Sonak D Pastakia
- Sonak D. Pastakia is a professor of pharmacy practice with the Purdue Kenya Partnership, Purdue University College of Pharmacy, in Eldoret, Kenya
| | - Richard Wamai
- Richard Wamai is an associate professor in the Department of Cultures, Societies, and Global Studies, Northeastern University, in Boston, Massachusetts
| | - Till Bärnighausen
- Till Bärnighausen is the Alexander von Humboldt University Professor and director of the Heidelberg Institute of Global Health, Heidelberg University. He is also senior faculty at the Africa Health Research Institute, in Somkhele, South Africa, and an adjunct professor of global health at the Harvard T. H. Chan School of Public Health, in Boston
| | - Sake J de Vlas
- Sake J. de Vlas is a professor in the Department of Public Health at Erasmus MC, Erasmus University Rotterdam
| | - Omar Galárraga
- Omar Galárraga ( ) is an associate professor in the Department of Health Services, Policy, and Practice, Brown University School of Public Health
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Wekesah FM, Kyobutungi C, Grobbee DE, Klipstein-Grobusch K. Understanding of and perceptions towards cardiovascular diseases and their risk factors: a qualitative study among residents of urban informal settings in Nairobi. BMJ Open 2019; 9:e026852. [PMID: 31209088 PMCID: PMC6588962 DOI: 10.1136/bmjopen-2018-026852] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES The study explored the understanding of and perception towards cardiovascular disease (CVD) and risk factors, and how they influence prevention and development of the conditions, care-seeking and adhering to treatment. SETTING Informal settlements of Nairobi. PARTICIPANTS Nine focus group discussions consisting of between six and eight purposively sampled participants were conducted among healthy individuals aged 20 years or older. A total of 65 participants (41 female) were involved. RESULTS Poverty, ignorance and illiteracy promoted behaviours like smoking, (harmful) alcohol consumption, physical inactivity and unhealthy diet, implicated in the development of obesity, diabetes and hypertension. Some respondents could not see the link between behavioural risk factors with diabetes, hypertension and stroke and heart attacks. Contaminated food items consumed by the residents and familial inheritance were factors that caused CVD, whereas emotional stress from constant worry was linked to hypertension, stroke and heart attacks. Few and inadequately equipped public health facilities were hindrances to treatment seeking and adherence to treatment for CVD conditions. Lack of medication in public health facilities was considered to be the single most important barrier to adherence to treatment next to lack of family support among older patients. CONCLUSION Interventions to prevent and manage CVD in low-resource and urban poor settings should consider perceptions and understanding of risk factors for CVD, and the interrelationships among them while accounting for cultural and contextual issues for example, stigma and disregard for conventional medicine. Programmes should be informed by locally generated evidence on awareness and opportunities for CVD care, coupled with effective risk communication through healthcare providers. Screening for and treatment of CVD must address perceptions such as prohibitive cost of healthcare. Finally, social determinants of disease and health, mainly poverty and illiteracy, which are implicated in addressing CVD in low-resource settings, should be addressed.
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Affiliation(s)
- Frederick Murunga Wekesah
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Catherine Kyobutungi
- Health and Systems for Health, African Population and Health Research Center, Nairobi, Kenya
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of theWitwatersrand, Johannesburg, South Africa
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Mohamed SF, Mutua MK, Wamai R, Wekesah F, Haregu T, Juma P, Nyanjau L, Kyobutungi C, Ogola E. Prevalence, awareness, treatment and control of hypertension and their determinants: results from a national survey in Kenya. BMC Public Health 2018; 18:1219. [PMID: 30400858 PMCID: PMC6219055 DOI: 10.1186/s12889-018-6052-y] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypertension is the most important risk factor for cardiovascular diseases and the leading cause of death worldwide. Despite growing evidence that the prevalence of hypertension is rising in sub-Saharan Africa, national data on hypertension that can guide programming are missing for many countries. In this study, we estimated the prevalence of hypertension, awareness, treatment, and control. We further examined the factors associated with hypertension and awareness. METHOD We used data from the 2015 Kenya STEPs survey, a national cross-sectional household survey targeting randomly selected people aged 18-69 years. Demographic and behavioral characteristics as well as physical measurements were collected using the World Health Organization's STEPs Survey methodology. Descriptive statistics were used to estimate the prevalence, awareness, treatment and control of hypertension. Multiple logistic regression models were used to identify the determinants of hypertension and awareness. RESULTS The study surveyed 4485 participants. The overall age-standardized prevalence for hypertension was 24.5% (95% confidence interval (CI) 22.6% to 26.6%). Among individuals with hypertension, only 15.6% (95% CI 12.4% to 18.9%) were aware of their elevated blood pressure. Among those aware only 26.9%; (95% CI 17.1% to 36.4%) were on treatment and 51.7%; (95% CI 33.5% to 69.9%) among those on treatment had achieved blood pressure control. Factors associated with hypertension were older age (p < 0.001), higher body mass index (BMI) (p < 0.001) and harmful use of alcohol (p < 0.001). Similarly, factors associated with awareness were older age (p = 0.013) and being male (p < 0.001). CONCLUSION This study provides the first nationally-representative estimates for hypertension in Kenya. Prevalence among adults is high, with unacceptably low levels of awareness, treatment and control. The results also reveal that men are less aware of their hypertension status hence special attention should focus on this group.
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Affiliation(s)
- Shukri F. Mohamed
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin K. Mutua
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Richard Wamai
- Department of Cultures, Societies and Global Studies, North Eastern University, Massachusetts, USA
| | - Frederick Wekesah
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Tilahun Haregu
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Pamela Juma
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Loise Nyanjau
- Division of Non Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Catherine Kyobutungi
- Health and Systems for Health Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Elijah Ogola
- Clinical Medicine, University of Nairobi, Nairobi, Kenya
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Wamai RG, Kengne AP, Levitt N. Non-communicable diseases surveillance: overview of magnitude and determinants in Kenya from STEPwise approach survey of 2015. BMC Public Health 2018; 18:1224. [PMID: 30400841 PMCID: PMC6218983 DOI: 10.1186/s12889-018-6051-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Richard G Wamai
- Integrated Initiative for Global Health, Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA USA
| | - Andre Pascal Kengne
- Non Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town, Western Cape South Africa
| | - Naomi Levitt
- Diabetic Medicine and Endocrinology, University of Cape Town, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Chronic Disease Initiative for Africa (CDIA), University of Capetown, J47/86 Old Main Building Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
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Ng’ang’a A, Nyangasi M, Nkonge NG, Gathitu E, Kibachio J, Gichangi P, Wamai RG, Kyobutungi C. Predictors of cervical cancer screening among Kenyan women: results of a nested case-control study in a nationally representative survey. BMC Public Health 2018; 18:1221. [PMID: 30400916 PMCID: PMC6219012 DOI: 10.1186/s12889-018-6054-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cervical cancer is a major public health concern in Kenya. It is the leading cause of cancer morbidity and mortality among women. Although screening is an effective prevention method, uptake is low among eligible women. Little is known about predictors of cervical cancer screening uptake. This study explored relationship between uptake of cervical cancer screening, socio-demographic, behavioral and biological risk factors. METHODS Nested case-control study within STEPS survey, a population-based cross-sectional household survey conducted between April and June 2015.Cases were women who had undergone cervical cancer screening and controls were unscreened women. Study participants were women eligible for cervical cancer screening (30-49 years). Variables included socio-demographic; behavioral risk factors such as physical activity, tobacco and alcohol use diet and biological factors like diabetes and hypertension. Outcome of interest was cervical cancer screening. Data analysis was done using STATA version 14. Logistic regression model was used to assess relationship between cervical cancer screening and socio-demographic, behavioral and biological risk factors. RESULTS Of 1180 women interviewed, 16.4% (n = 194) had been screened for cervical cancer. Of unscreened women (n = 986), 67.9% were aware of cervical cancer screening. Higher screening rates were observed in more educated women (25.2%), highest income quintile (29.6%) and living in urban areas (23%) than in women with no formal education (3.2%), poorest (3.6%) and living in rural areas (13.8%). Younger women (35-39) and those with low High-density lipoprotein (HDL) were less likely to be screened [OR = 0.56; 95% CI = (0.34, 0.93); p-value = 0.025] and [OR = 0.51; 95% CI = (0.29, 0.91); p = value 0.023] respectively. Self-employed women, those in the fourth wealth quintile, binge drinkers, high sugar consumption and insufficient physical activity were more likely to be screened [OR 2.55 (1.12, 5.81) p value 0.026], [OR 3.56 (1.37, 9.28) p value 0.009], [OR 5.94 (1.52, 23.15) p value 0.010], [OR 2.99 (1.51, 5.89) p value 0.002] and [OR 2.79 (1.37, 5.68) p value 0.005] respectively. CONCLUSION Uptake of cervical cancer screening is low despite high awareness. Strategies to improve cervical cancer screening in Kenya should be implemented with messages targeting persons with both risky and non-risky lifestyles especially younger women with no formal education living in rural areas.
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Affiliation(s)
- Anne Ng’ang’a
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Mary Nyangasi
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nancy G Nkonge
- Division of Pharmacy, Kenyatta National Hospital, Nairobi, Kenya
| | - Eunice Gathitu
- NCD Division National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Division of Non Communicable Diseases, Ministry of Health, Nairobi, Kenya
- The Institute of Global Health, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland
| | - Peter Gichangi
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard G Wamai
- Department of Cultures, Societies and Global Studies, North Eastern University, Massachusetts, USA
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Mannik J, Figol A, Churchill V, Aw J, Francis S, Karino E, Chesire JK, Opot D, Ochieng B, Hawkes MT. Community-based screening for cardiovascular risk using a novel mHealth tool in rural Kenya. JOURNAL OF INNOVATION IN HEALTH INFORMATICS 2018; 25:176-182. [PMID: 30398461 DOI: 10.14236/jhi.v25i3.1012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/03/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND An increasing burden of cardiovascular disease (CVD) in low-resource settings demands innovative public health approaches. OBJECTIVES To design and test a novel mHealth tool for use by community health workers (CHWs) to identify individuals at high CVD risk who would benefit from education and/or pharmacologic interventions. METHODS We designed and implemented a novel two-way mobile phone application, "AFYACHAT," to rapidly screen for CVD risk in rural Kenya. AFYACHAT collects and stores SMS text message data entered by a CHW on a subject's age, sex, smoking, diabetes, and systolic blood pressure, and returns as SMS text message the category of 10-year CVD risk: "GREEN" (<10% 10 year risk of cardiovascular event), "YELLOW" (10 to <20%), "orange"(20 to <30%), or "RED" (≥30%). CHWs were equipped and trained to use an automated blood pressure device and the mHealth tool. RESULTS Five CHWs screened 2,865 subjects in remote rural communities in Kenya over a 22 month period (2015-17). The median age of subjects was 50 (IQR 43 to 60) and 1581 (55%) were female. Point prevalence of hypertension (systolic blood pressure>140mmHg), diabetes, and tobacco use were 23%, 3.2%, and 22%, respectively. Overall, the 10-year risk of CVD among patients was <10% in 2778 (97%) patients, 10 to <20% in 65 (2.3%), 20 to <30% in 12 (0.4%), and ≥30% in 10 (0.2%). CONCLUSION We have developed a mHealth tool that can be used by CHWs to screen for CVD risk factors, demonstrating proof-of-concept in rural Kenya.
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Abstract
OBJECTIVE FFQ are often used to estimate food and nutrient intakes to rank individuals by their level of intake. We evaluated the relative validity of a semi-quantitative FFQ created for use in Tanzania by comparing it with two 24 h diet recalls. DESIGN We measured relative validity of the FFQ with deattenuated energy-adjusted rank correlations for nutrients, deattenuated rank correlations for food groups, and performed a cross-classification analysis of energy-adjusted nutrient quartiles using percentage of agreement and Bland-Altman analysis. SETTING Interviews were conducted in 2014 in participants' homes in Ukonga, Dar es Salaam, Tanzania. SUBJECTS We surveyed 317 adults aged 40 years or older from the general public. RESULTS Deattenuated energy-adjusted rank correlation coefficients of nutrients ranged from -0·03 for riboflavin to 0·41 for percentage of energy from carbohydrates, with a median correlation of 0·21. Coefficients for food groups ranged from 0·00 for root vegetables to 0·51 for alcohol, with a median of 0·35. Relative to the average of the two 24 h diet recalls, the FFQ overestimated energy intake and intakes of all nutrients and food groups, other than tea, with ratios among nutrients ranging from 1·34 for SFA to 7·08 for vitamin A; and among food groups from 0·92 for tea to 9·00 for fruit. The percentage of participants classified into the same nutrient intake quartile ranged from 23 % for SFA to 32 % for both niacin and pantothenic acid, with a median of 28 %. CONCLUSIONS The FFQ performed moderately well in urban Tanzanian adults.
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Joshi R, Faruqui N, Nagarajan SR, Rampatige R, Martiniuk A, Gouda H. Reporting of ethics in peer-reviewed verbal autopsy studies: a systematic review. Int J Epidemiol 2018; 47:255-279. [PMID: 29092034 DOI: 10.1093/ije/dyx216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Verbal autopsy (VA) is a method that determines the cause of death by interviewing a relative of the deceased about the events occurring before the death, in regions where medical certification of cause of death is incomplete. This paper aims to review the ethical standards reported in peer-reviewed VA studies. Methods A systematic review of Medline and Ovid was conducted by two independent researchers. Data were extracted and analysed for articles based on three key areas: Institutional Review Board (IRB) clearance and consenting process; data collection and management procedures, including: time between death and interview; training and education of interviewer, confidentiality of data and data security; and declarations of funding and conflict of interest. Results The review identified 802 articles, of which 288 were included. The review found that 48% all the studies reported having IRB clearance or obtaining consent of participants. The interviewer training and education levels were reported in 62% and 21% of the articles, respectively. Confidentiality of data was reported for 14% of all studies, 18% did not report the type of respondent interviewed and 51% reported time between death and the interview for the VA. Data security was reported in 8% of all studies. Funding was declared in 63% of all studies and conflict of interest in 42%. Reporting of all these variables increased over time. Conclusions The results of this systematic review show that although there has been an increase in ethical reporting for VA studies, there still remains a large gap in reporting.
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Affiliation(s)
- Rohina Joshi
- George Institute for Global Health
- University of New South Wales
- University of Sydney, Sydney, NSW, Australia
| | - Neha Faruqui
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | | | | | - Alex Martiniuk
- George Institute for Global Health
- University of Sydney, Sydney, NSW, Australia
| | - Hebe Gouda
- School of Public Health
- Queensland Centre for Mental Health Research, University of Queensland, Brisbane, QLD, Australia
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Sommer M, Phillips-Howard PA, Mahon T, Zients S, Jones M, Caruso BA. Beyond menstrual hygiene: addressing vaginal bleeding throughout the life course in low and middle-income countries. BMJ Glob Health 2017; 2:e000405. [PMID: 29225941 PMCID: PMC5717954 DOI: 10.1136/bmjgh-2017-000405] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/15/2017] [Accepted: 06/17/2017] [Indexed: 11/16/2022] Open
Abstract
Girls and women experience numerous types of vaginal bleeding. These include healthy reproductive processes, such as menstruation and bleeding after childbirth, but also bleeding related to health conditions, such as fibroids or cancer. In most societies, the management of menstruation is handled covertly, something girls are often instructed about at menarche. The management of other vaginal bleeding is often similarly discreet, although behaviours are not well documented. In many societies, cultural taboos frequently hinder open discussion around vaginal bleeding, restricting information and early access to healthcare. Additionally, the limited availability of clean, accessible water and sanitation facilities in many low and middle-income countries augments the challenges girls and women face in conducting daily activities while managing vaginal bleeding, including participating in school or work, going to the market or fetching water. This paper aims to highlight the key vaginal bleeding experiences throughout a woman's life course and the intersection of these bleeding experiences with their access to adequate water and sanitation facilities, information and education sources, and supplies. The aim is to address the silence around girls and women's vaginal bleeding and their related social, physical and clinical management needs across the life course; and highlight critical gaps that require attention in research, practice and policy around this neglected topic of health and gender equality.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | | | | | - Sasha Zients
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Meredith Jones
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Bethany A Caruso
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Clinical and geographic patterns of rheumatic heart disease in outpatients attending cardiology clinic in western Kenya. Int J Cardiol 2016; 223:228-235. [PMID: 27541662 DOI: 10.1016/j.ijcard.2016.08.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Rheumatic heart disease (RHD) remains a leading cause of cardiovascular mortality in sub-Saharan Africa. Identifying high risk populations and geographic patterns of disease is crucial to developing RHD prevention and screening strategies in endemic areas. OBJECTIVES To identify clinical and geographical trends in RHD throughout western Kenya METHODS: We conducted a retrospective chart review of all patients <50years old attending adult cardiology clinic at a national referral hospital in western Kenya. Demographic information, residential location and cardiac history were collected. We mapped the spatial distribution of cardiac disease rates and analyzed the effect of distance from the hospital on RHD status. RESULTS Two-thirds (64%) of cardiology clinic patients <50years old (n=906) had RHD. RHD patients were younger (26 vs. 33years, p<0.001) and more often female (69% vs. 59%, p=0.001) than non-RHD patients. Global clustering of disease rates existed within 200km of the hospital with significant clustering of the RHD and non-RHD rate difference surrounding the hospital (Moran's I: 0.3, p=0.001). There was an interaction between ethnicity and distance from the hospital such that the odds of RHD decreased with further distance for Nilotes, but the odds of RHD increased with further distance for non-Nilotes CONCLUSION: Most adult cardiology patients treated at a national referral hospital in western Kenya have RHD. Young people and females are commonly affected. Ethnicity and distance to the hospital interdependently affect the odds of RHD. Future studies in this area should consider the impact of ethnic predisposition to RHD.
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