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Adamu AA, Jalo RI, Muhammad ID, Essoh TA, Ndwandwe D, Wiysonge CS. Sustainable financing for vaccination towards advancing universal health coverage in the WHO African region: The strategic role of national health insurance. Hum Vaccin Immunother 2024; 20:2320505. [PMID: 38414114 PMCID: PMC10903629 DOI: 10.1080/21645515.2024.2320505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/15/2024] [Indexed: 02/29/2024] Open
Abstract
There is a growing political interest in health reforms in Africa, and many countries are choosing national health insurance as their main financing mechanism for universal health coverage. Although vaccination is an essential health service that can influence progress toward universal health coverage, it is not often prioritized by these national health insurance systems. This paper highlights the potential gains of integrating vaccination into the package of health services that is provided through national health insurance and recommends practical policy actions that can enable countries to harness these benefits at population level.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D. Muhammad
- Department of Obstetrics and Gynecology, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Téné-Alima Essoh
- Agence de Médecine Préventive, Regional Office for Africa, Abidjan, Cote d’Ivoire
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Brazzaville, Congo
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Norton A, Sigfrid L, Antonio E, Bucher A, Ndwandwe D. Improving coherence of global research funding: Pandemic PACT. Lancet 2024:S0140-6736(24)00452-5. [PMID: 38518795 DOI: 10.1016/s0140-6736(24)00452-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Alice Norton
- Global Research Collaboration for Infectious Disease Preparedness Research and Policy Team, Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford OX3 7BN, UK.
| | - Louise Sigfrid
- Global Research Collaboration for Infectious Disease Preparedness Research and Policy Team, Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford OX3 7BN, UK
| | - Emilia Antonio
- Policy and Practice Research Group, Pandemic Sciences Institute, University of Oxford, Oxford, UK
| | - Adrian Bucher
- UK Collaborative on Development Research, London, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Informal health sector and routine immunization: making the case for harnessing the potentials of patent medicine vendors for the big catch-up to reduce zero-dose children in sub-Saharan Africa. Front Public Health 2024; 12:1353902. [PMID: 38515595 PMCID: PMC10956693 DOI: 10.3389/fpubh.2024.1353902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
The COVID-19 pandemic caused a surge in the number of unimmunized and under-immunized children in Africa. The majority of unimmunized (or zero-dose) children live in hard-to-reach rural areas, urban slums, and communities affected by conflict where health facilities are usually unavailable or difficult to access. In these settings, people mostly rely on the informal health sector for essential health services. Therefore, to reduce zero-dose children, it is critical to expand immunization services beyond health facilities to the informal health sector to meet the immunization needs of children in underserved places. In this perspective article, we propose a framework for the expansion of immunization services through the informal health sector as one of the pillars for the big catch-up plan to improve coverage and equity. In African countries like Nigeria, Ethiopia, Tanzania, and the Democratic Republic of Congo, patent medicine vendors serve as an important informal health sector provider group, and thus, they can be engaged to provide immunization services. A hub-and-spoke model can be used to integrate patent medicine vendors into the immunization system. A hub-and-spoke model is a framework for organization design where services that are provided by a central facility (hub) are complimented by secondary sites (spokes) to optimize access to care. Systems thinking approach should guide the design, implementation, and evaluation of this model.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organization Regional Office for Africa, Djoué, Brazzaville, Republic of Congo
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Adamu AA, Jalo RI, Ndwandwe D, Wiysonge CS. Assessing the Implementation Determinants of Pilot Malaria Vaccination Programs in Ghana, Kenya, and Malawi through a Complexity Lens: A Rapid Review Using a Consolidated Framework for Implementation Research. Vaccines (Basel) 2024; 12:111. [PMID: 38400095 PMCID: PMC10892876 DOI: 10.3390/vaccines12020111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
In 2019, national immunization programs in Ghana, Kenya, and Malawi commenced the implementation of RTS,S/AS01 vaccination in large-scale pilot schemes. Understanding the implementation context of this malaria vaccination in the pilot countries can provide useful insights for enhancing implementation outcomes in new countries. There has not yet been a proper synthesis of the implementation determinants of malaria vaccination programs. A rapid review was conducted to identify the implementation determinants of the pilot malaria vaccination programs in Ghana, Kenya, and Malawi, and describe the mechanism by which these determinants interact with each other. A literature search was conducted in November 2023 in PubMed and Google Scholar to identify those studies that described the factors affecting malaria vaccine implementation in Ghana, Kenya, and Malawi. Thirteen studies conducted between 2021 and 2023 were included. A total of 62 implementation determinants of malaria vaccination across all five domains of the consolidated framework for implementation research (CFIR) were identified. A causal loop diagram showed that these factors are interconnected and interrelated, identifying nine reinforcing loops and two balancing loops. As additional countries in Africa prepare for a malaria vaccine roll-out, it is pertinent to ensure that they have access to adequate information about the implementation context of countries that are already implementing malaria vaccination programs so that they understand the potential barriers and facilitators. This information can be used to inform context-specific systems enhancement to maximize implementation success. Going forward, primary implementation studies that incorporate the causal loop diagram should be integrated into the malaria vaccine implementation program to enable immunization program managers and other key stakeholders to identify and respond to emerging implementation barriers in a timely and systematic manner, to improve overall implementation performance.
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Affiliation(s)
- Abdu A. Adamu
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
| | - Rabiu I. Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, Bayero University Kano, inside Aminu Kano Teaching Hospital, along Zaria Road, Kano 700233, Nigeria;
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parrow Valley, Cape Town 7500, South Africa; (D.N.); (C.S.W.)
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa
- Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Djoue, Brazzaville BP 06, Congo
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Moagi I, Mabasa L, Maputle SM, Ndwandwe D, Raliphaswa NS, Netshikweta LM, Malwela T, Samie A. The impact of DNA methylation as a factor of Adverse Pregnancy and Birth Outcomes (APBOs): a systematic review protocol. Syst Rev 2024; 13:4. [PMID: 38167510 PMCID: PMC10759365 DOI: 10.1186/s13643-023-02416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Deoxyribonucleic acid (DNA) methylation is one of the epigenetic modifications that has gained a lot of interest as a factor influencing fetal programming and as a biomarker for adverse pregnancy and birth outcomes (APBOs). Epidemiological studies have demonstrated that DNA methylation can result in adverse pregnancy and birth outcomes (APBOs) including miscarriage, intrauterine growth restriction (IUGR), low birth weight (LBW), sepsis, and preterm birth (PTB), which may later result in diseases in adulthood. However, the mechanism by which DNA methylation influences these APBOs remains unclear. The systematic review will assess the association between global and gene-specific DNA methylation with adverse pregnancy outcomes. METHOD The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist will be followed when conducting this systematic review. To develop the search strategy the PI(E)COS (population, intervention/exposure, comparator/control, outcome, and study designs) framework will be followed. Thus far, the research team has retrieved 4721 from Cochrane Library, PubMed, Web of Sciences, and MEDLINE. Out of these, 584 studies have been screened for eligibility, and approximately 124 studies meet the inclusion criteria. Pending the search results identified from the grey literature. For identification of unpublished studies in journals indexed in electronic databases, Google Scholar will be used. I.M and A.S will separately extract data from the articles and screen them, if there are any disagreements between I.M and A.S, then the L.M will resolve them. The methodological quality and bias risk of the included studies will be evaluated using the Critical Appraisal Skill Programme CASP) checklist. [Formula: see text] and [Formula: see text] alpha = 0.10 statistic will be used for assessing statistical heterogeneity between studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach will be used to assess and grade the overall quality of extracted data. ETHICS AND DISSEMINATION Ethical approval is not required. The systematic review will assess available literature on possible associations between DNA methylation with adverse pregnancy and birth outcomes (APBOs) including LBW, IUGR, miscarriage, sepsis, and PTB. The findings could help guide future research assessing DNA methylation and other APBOs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRCRD42022370647.
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Affiliation(s)
- Innocent Moagi
- Faculty of Sciences, Engineering and Agriculture, Department of Biochemistry and Microbiology, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa.
| | - Lawrence Mabasa
- Biomedical Research and Innovation Platform (BRIP), South Africa Medical Research Council, Tygerberg, P.O Box 19070, Cape Town, 7505, South Africa
| | - Sonto Maria Maputle
- Faculty of Health Sciences, Department of Advanced Nursing Sciences, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South Africa Medical Research Council, Parow Valley, Cape Town, 7501, South Africa
| | - Ndidzulafhi Selina Raliphaswa
- Faculty of Health Sciences, Department of Advanced Nursing Sciences, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa
| | - Lizzy Mutshinyalo Netshikweta
- Faculty of Health Sciences, Department of Advanced Nursing Sciences, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa
| | - Thivhulawi Malwela
- Faculty of Health Sciences, Department of Advanced Nursing Sciences, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa
| | - Amidou Samie
- Faculty of Sciences, Engineering and Agriculture, Department of Biochemistry and Microbiology, University of Venda, Private Bag X5050, Thohoyandou, 0950, South Africa.
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Nnaji CA, Wiysonge CS, Cooper S, Mayeye A, Luphondo L, Mabuya T, Kalui N, Lesosky M, Ndwandwe D. Contextualising missed opportunities for children's vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa. Hum Vaccin Immunother 2023; 19:2162771. [PMID: 36601915 PMCID: PMC9980502 DOI: 10.1080/21645515.2022.2162771] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0-23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5-8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers' knowledge, attitude and behavior toward children's immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers' attitude, knowledge and capability to assess children's immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.
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Affiliation(s)
- Chukwudi A. Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Chukwudi A. Nnaji, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, 1 Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Charles S. Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,Division of Social & Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lucy Luphondo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Mabuya
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntomboxolo Kalui
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Ndwandwe D, Ndlovu M, Mayeye A, Luphondo N, Muvhulawa N, Ntamo Y, Dludla PV, Wiysonge CS. Trends in Vaccine Completeness in Children Aged 0-23 Months in Cape Town, South Africa. Vaccines (Basel) 2023; 11:1782. [PMID: 38140186 PMCID: PMC10747087 DOI: 10.3390/vaccines11121782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND We have previously determined that the occurrence of missed vaccination opportunities in children in Cape Town, South Africa, is shaped by both individual and contextual factors. These factors present valuable openings for enhancing quality and implementing broader strategies to enhance the delivery of routine Immunisation services. METHODS Here, we are further reporting regional-level data on the coverage and factors influencing vaccination completion within a similar study population, based on extensive data analysis from the 2016 South African Demographic and Health Survey. RESULTS AND DISCUSSION The study reveals commendable vaccination coverage for most vaccines within recommended schedules, with high rates of initial vaccinations at birth and during the primary vaccination schedule. However, there are notable areas for improvement, particularly in ensuring complete coverage for the second measles vaccine and the 18-month vaccine. Socio-demographic factors also play a role, with maternal education and caregiver awareness campaigns showing the potential to positively influence vaccination completeness. This study emphasises the importance of timely vaccinations during the early months of life and underscores the need for interventions to maintain coverage as children age. Specific sub-districts, such as Tygerberg, may require targeted efforts to enhance vaccination completeness. Additionally, assessing caregiver knowledge about child vaccination is deemed vital, as it can impact vaccination decisions and adherence. CONCLUSIONS The findings provide valuable insights for public health interventions in Cape Town, aimed at reducing the burden of vaccine-preventable diseases and ensuring the health of the region's youngest population.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Musawenkosi Ndlovu
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Nomahlubi Luphondo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Yonela Ntamo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
| | - Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa; (M.N.); (A.M.); (N.L.); (N.M.); (Y.N.); (P.V.D.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa, Empangeni 3886, South Africa
| | - Charles S. Wiysonge
- Vaccine Preventable Diseases Programme, Universal Health Coverage/Communicable and Non-Communicable Diseases Cluster, World Health Organization Regional Office for Africa, Brazzaville P.O. Box 06, Congo;
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Muvhulawa N, Mazibuko-Mbeje SE, Ndwandwe D, Silvestri S, Ziqubu K, Moetlediwa MT, Mthembu SXH, Marnewick JL, Van der Westhuizen FH, Nkambule BB, Basson AK, Tiano L, Dludla PV. Sarcopenia in a type 2 diabetic state: Reviewing literature on the pathological consequences of oxidative stress and inflammation beyond the neutralizing effect of intracellular antioxidants. Life Sci 2023; 332:122125. [PMID: 37769808 DOI: 10.1016/j.lfs.2023.122125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 10/03/2023]
Abstract
Sarcopenia remains one of the major pathological features of type 2 diabetes (T2D), especially in older individuals. This condition describes gradual loss of muscle mass, strength, and function that reduces the overall vitality and fitness, leading to increased hospitalizations and even fatalities to those affected. Preclinical evidence indicates that dysregulated mitochondrial dynamics, together with impaired activity of the NADPH oxidase system, are the major sources of oxidative stress that drive skeletal muscle damage in T2D. While patients with T2D also display relatively higher levels of circulating inflammatory markers in the serum, including high sensitivity-C-reactive protein, interleukin-6, and tumor necrosis factor-α that are independently linked with the deterioration of muscle function and sarcopenia in T2D. In fact, beyond reporting on the pathological consequences of both oxidative stress and inflammation, the current review highlights the importance of strengthening intracellular antioxidant systems to preserve muscle mass, strength, and function in individuals with T2D.
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Affiliation(s)
- Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | | | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Sonia Silvestri
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona 60131, Italy
| | - Khanyisani Ziqubu
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Marakiya T Moetlediwa
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | | | - Jeanine L Marnewick
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Bellville 7535, South Africa
| | | | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Albertus K Basson
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Luca Tiano
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona 60131, Italy
| | - Phiwayinkosi V Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa.
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Mthembu SXH, Mazibuko-Mbeje SE, Moetlediwa MT, Muvhulawa N, Silvestri S, Orlando P, Nkambule BB, Muller CJF, Ndwandwe D, Basson AK, Tiano L, Dludla PV. Sulforaphane: A nutraceutical against diabetes-related complications. Pharmacol Res 2023; 196:106918. [PMID: 37703962 DOI: 10.1016/j.phrs.2023.106918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 09/15/2023]
Abstract
There is an increasing interest in the use of nutraceuticals and plant-derived bioactive compounds from foods for their potential health benefits. For example, as a major active ingredient found from cruciferous vegetables like broccoli, there has been growing interest in understanding the therapeutic effects of sulforaphane against diverse metabolic complications. The past decade has seen an extensive growth in literature reporting on the potential health benefits of sulforaphane to neutralize pathological consequences of oxidative stress and inflammation, which may be essential in protecting against diabetes-related complications. In fact, preclinical evidence summarized within this review supports an active role of sulforaphane in activating nuclear factor erythroid 2-related factor 2 or effectively modulating AMP-activated protein kinase to protect against diabetic complications, including diabetic cardiomyopathy, diabetic neuropathy, diabetic nephropathy, as well as other metabolic complications involving non-alcoholic fatty liver disease and skeletal muscle insulin resistance. With clinical evidence suggesting that foods rich in sulforaphane like broccoli can improve the metabolic status and lower cardiovascular disease risk by reducing biomarkers of oxidative stress and inflammation in patients with type 2 diabetes. This information remains essential in determining the therapeutic value of sulforaphane or its potential use as a nutraceutical to manage diabetes and its related complications. Finally, this review discusses essential information on the bioavailability profile of sulforaphane, while also covering information on the pathological consequences of oxidative stress and inflammation that drive the development and progression of diabetes.
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Affiliation(s)
- Sinenhlanhla X H Mthembu
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | | | - Marakiya T Moetlediwa
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa
| | - Ndivhuwo Muvhulawa
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Sonia Silvestri
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona 60131, Italy
| | - Patrick Orlando
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona 60131, Italy
| | - Bongani B Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Christo J F Muller
- Biomedical Research and Innovation Platform, South African Medical Research Council, Tygerberg 7505, South Africa; Centre for Cardiometabolic Research Africa (CARMA), Division of Medical Physiology, Stellenbosch University, Tygerberg 7505, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa
| | - Albertus K Basson
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa
| | - Luca Tiano
- Department of Life and Environmental Sciences, Polytechnic University of Marche, Ancona 60131, Italy
| | - Phiwayinkosi V Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa.
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Dludla PV, Cirilli I, Marcheggiani F, Silvestri S, Orlando P, Muvhulawa N, Moetlediwa MT, Nkambule BB, Mazibuko-Mbeje SE, Hlengwa N, Hanser S, Ndwandwe D, Marnewick JL, Basson AK, Tiano L. Bioactive Properties, Bioavailability Profiles, and Clinical Evidence of the Potential Benefits of Black Pepper ( Piper nigrum) and Red Pepper ( Capsicum annum) against Diverse Metabolic Complications. Molecules 2023; 28:6569. [PMID: 37764345 PMCID: PMC10534530 DOI: 10.3390/molecules28186569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
The consumption of food-derived products, including the regular intake of pepper, is increasingly evaluated for its potential benefits in protecting against diverse metabolic complications. The current study made use of prominent electronic databases including PubMed, Google Scholar, and Scopus to retrieve clinical evidence linking the intake of black and red pepper with the amelioration of metabolic complications. The findings summarize evidence supporting the beneficial effects of black pepper (Piper nigrum L.), including its active ingredient, piperine, in improving blood lipid profiles, including reducing circulating levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides in overweight and obese individuals. The intake of piperine was also linked with enhanced antioxidant and anti-inflammatory properties by increasing serum levels of superoxide dismutase while reducing those of malonaldehyde and C-reactive protein in individuals with metabolic syndrome. Evidence summarized in the current review also indicates that red pepper (Capsicum annum), together with its active ingredient, capsaicin, could promote energy expenditure, including limiting energy intake, which is likely to contribute to reduced fat mass in overweight and obese individuals. Emerging clinical evidence also indicates that pepper may be beneficial in alleviating complications linked with other chronic conditions, including osteoarthritis, oropharyngeal dysphagia, digestion, hemodialysis, and neuromuscular fatigue. Notably, the beneficial effects of pepper or its active ingredients appear to be more pronounced when used in combination with other bioactive compounds. The current review also covers essential information on the metabolism and bioavailability profiles of both pepper species and their main active ingredients, which are all necessary to understand their potential beneficial effects against metabolic diseases.
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Affiliation(s)
- Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; (N.M.); (D.N.)
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa; (N.H.); (A.K.B.)
| | - Ilenia Cirilli
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Fabio Marcheggiani
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Sonia Silvestri
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Patrick Orlando
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; (N.M.); (D.N.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Marakiya T. Moetlediwa
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Bongani B. Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa;
| | - Sithandiwe E. Mazibuko-Mbeje
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Nokulunga Hlengwa
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa; (N.H.); (A.K.B.)
| | - Sidney Hanser
- Department of Physiology and Environmental Health, University of Limpopo, Sovenga 0727, South Africa;
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg 7505, South Africa; (N.M.); (D.N.)
| | - Jeanine L. Marnewick
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Bellville 7535, South Africa;
| | - Albertus K. Basson
- Department of Biochemistry and Microbiology, University of Zululand, KwaDlangezwa 3886, South Africa; (N.H.); (A.K.B.)
| | - Luca Tiano
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
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11
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Dludla PV, Cirilli I, Marcheggiani F, Silvestri S, Orlando P, Muvhulawa N, Moetlediwa MT, Nkambule BB, Mazibuko-Mbeje SE, Hlengwa N, Hanser S, Ndwandwe D, Marnewick JL, Basson AK, Tiano L. Potential Benefits of Coffee Consumption on Improving Biomarkers of Oxidative Stress and Inflammation in Healthy Individuals and Those at Increased Risk of Cardiovascular Disease. Molecules 2023; 28:6440. [PMID: 37764216 PMCID: PMC10536804 DOI: 10.3390/molecules28186440] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Cardiovascular diseases (CVDs) are considered the predominant cause of death globally. An abnormal increase in biomarkers of oxidative stress and inflammation are consistently linked with the development and even progression of metabolic diseases, including enhanced CVD risk. Coffee is considered one of the most consumed beverages in the world, while reviewed evidence regarding its capacity to modulate biomarkers of oxidative stress and inflammation remains limited. The current study made use of prominent electronic databases, including PubMed, Google Scholar, and Scopus to retrieve information from randomized controlled trials reporting on any association between coffee consumption and modulation of biomarkers of oxidative stress and inflammation in healthy individuals or those at increased risk of developing CVD. In fact, summarized evidence indicates that coffee consumption, mainly due to its abundant antioxidant properties, can reduce biomarkers of oxidative stress and inflammation, which can be essential in alleviating the CVD risk in healthy individuals. However, more evidence suggests that regular/prolonged use or long term (>4 weeks) consumption of coffee appeared to be more beneficial in comparison with short-term intake (<4 weeks). These positive effects are also observed in individuals already presenting with increased CVD risk, although such evidence is very limited. The current analysis of data highlights the importance of understanding how coffee consumption can be beneficial in strengthening intracellular antioxidants to alleviate pathological features of oxidative stress and inflammation to reduce CVD risk within the general population. Also covered within the review is essential information on the metabolism and bioavailability profile of coffee, especially caffeine as one of its major bioactive compounds.
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Affiliation(s)
- Phiwayinkosi V. Dludla
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa; (N.M.); (D.N.)
- Department of Biochemistry and Microbiology, University of Zululand, Richards Bay 3886, South Africa; (N.H.); (A.K.B.)
| | - Ilenia Cirilli
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Fabio Marcheggiani
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Sonia Silvestri
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Patrick Orlando
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
| | - Ndivhuwo Muvhulawa
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa; (N.M.); (D.N.)
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Marakiya T. Moetlediwa
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Bongani B. Nkambule
- School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
| | - Sithandiwe E. Mazibuko-Mbeje
- Department of Biochemistry, North-West University, Mafikeng Campus, Mmabatho 2735, South Africa; (M.T.M.); (S.E.M.-M.)
| | - Nokulunga Hlengwa
- Department of Biochemistry and Microbiology, University of Zululand, Richards Bay 3886, South Africa; (N.H.); (A.K.B.)
| | - Sidney Hanser
- Department of Physiology and Environmental Health, University of Limpopo, Polokwane 0727, South Africa;
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town 7505, South Africa; (N.M.); (D.N.)
| | - Jeanine L. Marnewick
- Applied Microbial and Health Biotechnology Institute, Cape Peninsula University of Technology, Bellville 7535, South Africa;
| | - Albertus K. Basson
- Department of Biochemistry and Microbiology, University of Zululand, Richards Bay 3886, South Africa; (N.H.); (A.K.B.)
| | - Luca Tiano
- Department of Life and Environmental Sciences, Polytechnic University of Marche, 60131 Ancona, Italy; (I.C.); (F.M.); (S.S.); (P.O.); (L.T.)
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12
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Mathebula L, Malinga T, Mokgoro M, Ndwandwe D, Wiysonge CS, Gray G. Cholera vaccine clinical trials: A cross-sectional analysis of clinical trials registries. Hum Vaccin Immunother 2023; 19:2261168. [PMID: 37759348 PMCID: PMC10619520 DOI: 10.1080/21645515.2023.2261168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 09/17/2023] [Indexed: 09/29/2023] Open
Abstract
Cholera has been one of the world's biggest public health challenges for centuries. The presence of this disease brings into focus the social determinants of health in different parts of the world. Research and development efforts to find safe and effective Cholera vaccines are critical to decreasing the disease burden from Vibrio cholerae. We searched the International Clinical Trials Registry Platform (ICTRP) and Cochrane Central Register of Controlled Trials (CENTRAL) on 5 March 2023. We included all registered randomized trials studying Cholera vaccines. We used Microsoft Excel to perform a descriptive analysis of the source registry, geographic distribution, recruitment status, phase of trials, and type of trial sponsor and presented the findings using tables and graphs. The search of ICTRP yielded 84 trials, and 315 trials were identified from CENTRAL. Seventy-four trials were included in the analysis. Most of the trials (66%, n = 49) were registered in ClinicalTrials.gov, followed by Clinical Trials Registry - India (9%, n = 7) and the Cuban Public Registry of Clinical Trials (8%, n = 6). The geographical distribution of the trials indicates that 48% (n = 36) of the trials were conducted in Asia, followed by 23% (n = 17) in North America, 15% (n = 11) in Africa, and 11% (n = 8) in Europe. Results further indicate that 81% (n = 60) of trials have a recruitment status "Not recruiting," followed by 12% (n = 9) with a status "recruiting." With the recent surge in Cholera cases and the limited supply of Cholera vaccines, research indicates the need for Cholera vaccine trials to ensure the availability of vaccines, especially in populations affected.
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Affiliation(s)
- Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Mammekwa Mokgoro
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Vaccine-Preventable Diseases Programme, World Health Organisation Regional Office for Africa, Brazzaville, Congo
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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13
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Shelly CE, Logan C, Skorochod B, Wiyeh A, Ndwandwe D, Choko A, Valea I, Titanji BK. Creating a best practice template for participant communication plans in global health clinical studies. Trials 2023; 24:158. [PMID: 36864516 PMCID: PMC9983505 DOI: 10.1186/s13063-023-07185-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 02/18/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Clinical trial participants have a right to be informed throughout the entire process of human subject research. As part of this pillar of research ethics, participants and other stakeholders should be made aware of research findings after a trial has been completed. Though participants have both a right, and a desire to be informed of research outcomes, studies show that they rarely receive communication about study findings. Our aim was (1) to understand what, if any, role communication plans play in current global health clinical research protocols and (2) to use our findings to develop a communication plan template tailored to clinical research carried out in low-and-middle-income countries (LMIC) while minimizing colonial assumptions. While the template was drafted in the LMIC context, the principles are universally applicable and should be considered best practices for all global health clinical trials. METHODS We carried out a mixed-method study over a period of 6 months to understand the role of communication with study participants and other stakeholders in clinical trials. The semiquantitative analysis included mining publicly available clinical trial protocols for communication-related language. Qualitative interviews (n = 7) were used to gather knowledge and insight from clinical trial experts to inform the development of a communication plan template. RESULTS None of the 48 mined clinical trial protocols included a communication plan. Of the 48, 21% (n = 21) protocols included communication-related language, and 10% (n = 5) described plans to share trial results with participants. CONCLUSION The use of communication plans in global health clinical trials is lacking. To our knowledge, this is the first in-depth analysis of communication plans in clinical trials to date. We recommend that researchers utilize the developed communication plan template throughout the entire research process to ensure a human-centered approach to participant communication. This communication plan should apply to all phases of a research trial, with a particular emphasis on plans to share results in an accessible and engaging manner once the trial has been completed.
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Affiliation(s)
| | - Caroline Logan
- CollaborateUp Inc, 208 Noland Street, Falls Church, VA, USA
| | - Beth Skorochod
- CollaborateUp Inc, 208 Noland Street, Falls Church, VA, USA
| | - Alison Wiyeh
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Francie Van Zilj Drive, Parow Valley, Cape Town, South Africa
| | - Augustine Choko
- The Clinical Research Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital College of Medicine, Blantyre 3, Malawi, C, P.O. Box 30096, Chichiri, South Africa
| | - Boghuma K Titanji
- Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, USA
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14
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Abstract
Safe and efficacious COVID-19 vaccines exist, but their success against the disease depends on public willingness to receive them. Vaccine hesitancy is one major obstacle to the achievement of herd immunity. On 25 June 2021, about 2000 supporters of the Economic Freedom Fighters (EFF) (the third biggest political party in South Africa) marched to the offices of the national regulatory authority (NRA) supporting COVID-19 vaccination and demanding approval of two additional vaccines (Sputnik V and Sinovac) in South Africa. The march was led by EFF leader, Julius Malema. By then, only three COVID-19 vaccines had received emergency use authorization in the country-the Janssen, AstraZeneca and Pfizer-BioNtech vaccines. It is worth noting that NRAs should only approve a vaccine if they are satisfied that its benefits outweigh any potential risks and not through political pressure. Nevertheless, we believe that this march might have increased COVID-19 vaccine acceptance and uptake among EFF supporters. The endorsement of COVID-19 vaccines by Malema, an influential political figure in South Africa, probably convinced some vaccine hesitant South Africans that COVID-19 vaccination is important. Therefore, we suggest vaccine endorsement by influential individuals in South Africa as one of the strategies to increase COVID-19 vaccine uptake.
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Affiliation(s)
- Edison Johannes Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Edison Johannes Mavundza Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Ndwandwe D, Runeyi S, Mathebula L, Wiysonge C. Rotavirus vaccine clinical trials: a cross-sectional analysis of clinical trials registries. Trials 2022; 23:945. [PMCID: PMC9670083 DOI: 10.1186/s13063-022-06878-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/29/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Rotavirus is a primary infectious virus causing childhood diarrhoea and is associated with significant mortality in children. Three African countries (Nigeria, the Democratic Republic of Congo, and Angola) are among the five countries that account for 50% of all diarrheal-related deaths worldwide. This indicates that much needs to be done to reduce this burden. The World Health Organization International Clinical Trial Registry Platform (WHO ICTRP) is a global repository for primary registries reporting on clinical trials. This study aimed to identify and describe planned, ongoing, and completed rotavirus vaccine trials conducted globally.
Methods
We searched WHO-ICTRP on 17 June 2021 and conducted a cross-sectional analysis of rotavirus studies listed in the database. Data extraction included trial location, participant age, source of the trial record, trial phase, sponsor, and availability of results. We used the Microsoft Excel 365 package to generate descriptive summary statistics.
Results
We identified 242 rotavirus vaccine trials registered from 2004 to 2020. Most of these trials were registered retrospectively, with only 26% of the rotavirus vaccine trials reporting the availability of results in their registries. Most of the trials are studying children aged less than 5 years. The recruitment status for these trials is currently shown in the WHO-ICTRP as “not recruiting” for 80.17% of trials, “recruiting” for 11.57% of trials recruiting, and unknown for 6.61% of trials. The continents in which these rotavirus vaccine trials have recruitment sites in Asia (41%) and North America (20%), with the maximum number of trials in the clinical trial registries coming from India (21%) and the USA (11%) with most being sponsored by the pharmaceutical industry. Our analysis shows that only 26% of the rotavirus vaccine trials report the availability of results in their registries.
Conclusions
Mapping rotavirus vaccine clinical trial activity using data from the WHO ICTRP beneficial provides valuable information on planned, ongoing, or completed trials for researchers, funders, and healthcare decision-makers. Despite the high rotavirus disease burden in low- and middle-income countries, including Africa, there is minimal clinical trial activity related to the condition on the continent. The clinical trial registries as a valuable tool to share interim results of the trials.
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16
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Mathebula L, Runeyi S, Wiysonge C, Ndwandwe D. Clinical trial registration during COVID-19 and beyond in the African context: what have we learned? Trials 2022; 23:460. [PMID: 35668437 PMCID: PMC9167898 DOI: 10.1186/s13063-022-06412-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/18/2022] [Indexed: 11/28/2022] Open
Abstract
Since the outbreak of COVID-19, many lives have been impacted especially on the African continent which is already fighting the burden of multiple diseases of poverty. However, clinical research has offered hope for treatment and prevention options for this infectious disease. Despite many COVID-19 clinical trials conducted globally, three countries in Africa account for more than 80% of all trials from the continent registered trials in clinical trial registries. This indicates geographic disparity among COVID-19 research in Africa. From the perspective of clinical trial registration, transparency in clinical research and the availability of data became important for making informed decisions to manage the pandemic. Registries serve as a source of planned, ongoing, and completed trials while allowing efficient funding allocation for research that would not duplicate efforts. Additionally, research gaps can be identified, which provide opportunities for collaboration among researchers. Therefore, a critical lesson learnt during this pandemic is that clinical trial registration is important in facilitating the process of tracking changes made to protocols and minimizing publication bias, thereby promoting and advocating for clinical research transparency. Moreover, registration in a clinical trial registry is a condition for publication and allows for trial summary results to be publicly available. Adhering to the principle of results sharing is especially important for the rapidly growing clinical research activities racing to find evidence-based interventions to end the COVID-19 pandemic.
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Affiliation(s)
- Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa.
| | - Sinazo Runeyi
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa.,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7505, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, 7505, South Africa
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17
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Wiysonge CS, Ndwandwe D, Mathebula L, Goga A, Gray G. Randomised trials of COVID-19 vaccines in Africa – charting the path forward. S AFR J SCI 2022. [DOI: 10.17159/sajs.2022/13224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Vaccines have played a critical role in controlling disease outbreaks, hence the proliferation of the development and testing of multiple vaccine candidates during the COVID-19 pandemic. Randomised trials are gold standards for evaluating the safety and efficacy of pharmaceutical interventions such as COVID-19 vaccines. However, contextual differences may attenuate effects of COVID-19 vaccines. Thus, the need to conduct COVID-19 vaccine trials in all settings, including in Africa. We conducted a cross-sectional analysis of planned, ongoing, and completed COVID-19 vaccine trials in Africa. We searched the South African National Clinical Trials Register, Pan African Clinical Trials Registry, and International Clinical Trials Registry Platform (ICTRP) on 12 January and 30 April 2022; and complemented this with a search of ClinicalTrials.gov on 17 May 2022. We screened the search output and included randomised trials with at least one recruitment site in Africa. We identified only 108 eligible trials: 90 (83%) evaluating candidate COVID-19 vaccines, 11 (10%) assessing if existing vaccines could prevent SARS-CoV-2 infection, and 7 (7%) evaluating interventions for improving COVID-19 vaccination coverage. South Africa had the highest number of trials at 58 (54%). Beyond South Africa, countries with more than 10 trial sites include Kenya, Ghana, Egypt, Uganda, and Zimbabwe. Among the trials, 14 (13%) do not have principal investigators based in Africa, 39 (30%) are funded by industry, and 91 (84%) are funded by institutions based outside the host country. COVID-19 vaccine trials with recruitment sites in Africa represented only 7% of the 1453 COVID-19 vaccine trials in the ICTRP. The paucity of COVID-19 vaccine trials conducted on the African continent is a cause for concern. This has implications for the role that Africa may play in future pandemics.
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Affiliation(s)
- Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ameena Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Glenda Gray
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa
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18
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Merson L, Ndwandwe D, Malinga T, Paparella G, Oneil K, Karam G, Terry RF. Promotion of data sharing needs more than an emergency: An analysis of trends across clinical trials registered on the International Clinical Trials Registry Platform. Wellcome Open Res 2022; 7:101. [PMID: 35419494 PMCID: PMC8980676 DOI: 10.12688/wellcomeopenres.17700.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND: A growing body of evidence shows that sharing health research data with other researchers for secondary analyses can contribute to better health. This is especially important in the context of a public health emergency when stopping a pandemic depends on accelerating science. METHODS: We analysed the information on data sharing collected by the 18 clinical trial registries included in the WHO International Clinical Trials Registry Platform (ICTRP) to understand the reporting of data sharing plans and which studies were and were not planning to share data. Data on sponsor and funder organisations, country of recruitment, registry, and condition of study were standardised to compare the sharing of information and data across these facets. This represents the first ever comprehensive study of the complete data set contained in ICTRP. RESULTS: Across 132,545 studies registered between January 2019 and December 2020, 11.2% of studies stated that individual patient data (IPD) would be shared. Plans to share IPD varied across the 18 contributing registries– information on data sharing was missing in >95% of study records across 7/18 registries. In the 26,851 (20.3%) studies that were funded or sponsored by a commercial entity, intention to share IPD was similar to those that were not (11.5% vs 11.2%). Intention to share IPD was most common in studies recruiting across both high-income and low- or middle-income countries (21.4%) and in those recruiting in Sub-Saharan Africa (50.3%). Studies of COVID-19 had similar levels of data sharing to studies of other non-pandemic diseases in 2020 (13.7% vs 11.7%). CONCLUSIONS: Rates of planned IPD sharing vary between clinical trial registries and economic regions, and are similar whether commercial or non-commercial agencies are involved. Despite many calls to action, plans to share IPD have not increased significantly and remain below 14% for diseases causing public health emergencies.
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Affiliation(s)
- Laura Merson
- Infectious Diseases Data Observatory, University of Oxford, Oxford, OX3 7FZ, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, 7505, South Africa
| | - Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, 7505, South Africa
| | | | - Kwame Oneil
- Sierra Leone Ministry of Health and Sanitation, Freetown, Sierra Leone
| | | | - Robert F. Terry
- Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
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Ngandu NK, Mmotsa TM, Dassaye R, Thabetha A, Odendaal W, Langdown N, Ndwandwe D. Hospital acquired COVID-19 infections amongst patients before the rollout of COVID-19 vaccinations, a scoping review. BMC Infect Dis 2022; 22:140. [PMID: 35144556 PMCID: PMC8830001 DOI: 10.1186/s12879-022-07128-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/04/2022] [Indexed: 01/16/2023] Open
Abstract
Background Hospital settings are at increased risk of spreading Coronavirus Disease 2019 (COVID-19) infections, hence non-pharmaceutical prevention interventions (NPPIs) and prioritized vaccination of healthcare workers and resident patients are critical. The status of COVID-19 hospital acquired infections (HAIs) in low-income settings is unclear. We aimed to identify and summarize the existing evidence on COVID-19 HAIs amongst patients, prior to the rollout of vaccines in countries worldwide. Methods We conducted a scoping review of English peer-reviewed literature in PubMed, Web of Science and Scopus using a combination of selected search terms. Full texts articles presenting results on COVID-19 HAIs in hospitalised patients before the rollout of vaccines in countries worldwide were eligible. Data extracted from eligible articles included estimates of COVID-19 HAIs, country, and type of hospital setting, and was summarized narratively. Quality assessment of included articles was not possible. Results Literature searches generated a total of 5920 articles, and 45 were eligible for analysis. Eligible articles were from Europe, North America, Asia, and Brazil and none were from low-income countries. The proportion of COVID-19 HAIs ranged from 0% when strict NPPIs were applied, to 65% otherwise. The estimates of COVID-19 HAIs did not differ by country but were lower in studies conducted after implementation of NPPIs and in specialized hospital settings for operative surgery. Studies conducted before the implementation of NPPIs or in long-term care and psychiatric wards often reported high estimates of HAI. Although there was no clear trend in general wards, those situated in academic hospitals managed to reduce HAI rates under strict NPPI protocols. Operative surgery settings, unlike psychiatric settings, effectively prevented COVID-19 HAI using tailored NPPIs. Conclusion The available evidence shows a high risk of COVID-19 HAIs, the feasibility of preventing HAIs in different healthcare settings and the importance of appropriately tailored NPPIs. There were no data from low-income settings, therefore, it is unclear whether the reported NPPI approaches could be equally effective elsewhere. We recommend routine monitoring of COVID-19 HAIs in countries with low vaccination coverage, to identify and close gaps in NPPIs and understand gains made from vaccinating healthcare workers and hospitalized patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07128-5.
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Affiliation(s)
- Nobubelo K Ngandu
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Tshiamo M Mmotsa
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Reshmi Dassaye
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Alice Thabetha
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Willem Odendaal
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa.,Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Natasha Langdown
- Knowledge and Information Management Services, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane, South African Medical Research Council, Cape Town, South Africa
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20
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Mouako AL, Zunza M, Ndwandwe D, Uthman OA, Wiysonge CS. Health research publications by South African authors from 1996 to 2015: a bibliometric analysis. Pan Afr Med J 2022; 42:31. [PMID: 35910065 PMCID: PMC9288119 DOI: 10.11604/pamj.2022.42.31.28968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/20/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction research publications have a vital role in the scientific process, providing a strategic connection between the generation of new knowledge and its conversion into policy, practice, and positive health outcomes. There was a substantial increase in research funding in South Africa from the dawn of multi-party democracy in the mid-1990s to 2015. However, it is not known whether there was a corresponding increase in research publications from the country. Therefore, the objective of this bibliometric study was to assess trends and factors associated with health research publications from South Africa between 1996 and 2015. Methods in July 2016, we searched Scopus for health science articles published between 01 January 1996 and 31 December 2015 with at least one author affiliated to an institution based in South Africa. We sought annual data on national-level indicators from Statistics South Africa and World Bank data. We used Poisson regression to examine trends in publication outputs and negative binomial regression to explore national-level factors associated with a change in the number of publications over time. Results we identified 51,133 publications, with a mean of 2,557 publications per year. Four universities (University of Cape Town, University of the Witwatersrand, Stellenbosch University, and the University of Pretoria) contributed more than half of the publications. The top destination journals were the South African Medical Journal (14.57% of the articles), PLoS ONE (5.77%), South African Family Practice (4.68%), Journal of the South African Veterinary Association (2.48%), and The Lancet (2.37%). The annual number of publications increased five-fold from 1133 in 1996, with an upsurge after 2003, to 5820 in 2015. The average annual percentage growth in the number of publications rose from 3.31% in 1996-2000 to 13.63% in 2011-2015. Year of publication (incidence rate ratio 1.16, 95% confidence interval 1.14 to 1.18) and annual private expenditure on health (incidence rate ratio 1.08, 95% confidence interval 1.05 to 1.10) were independent predictors of publication output. Conclusion the number of health research publications from South Africa grew substantially between 1996 and 2015, with wide variation in output among universities. Private expenditure on health may be a proxy of health research funding, which probably explains its association with publication output in this study.
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Affiliation(s)
- Arlette Leufak Mouako
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Olalekan Abdulrahman Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Corresponding author: Charles Shey Wiysonge, Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
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Abstract
BACKGROUND Rotavirus is a common cause of diarrhoea, diarrhoea-related hospital admissions, and diarrhoea-related deaths worldwide. Rotavirus vaccines prequalified by the World Health Organization (WHO) include Rotarix (GlaxoSmithKline), RotaTeq (Merck), and, more recently, Rotasiil (Serum Institute of India Ltd.), and Rotavac (Bharat Biotech Ltd.). OBJECTIVES To evaluate rotavirus vaccines prequalified by the WHO for their efficacy and safety in children. SEARCH METHODS On 30 November 2020, we searched PubMed, the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (published in the Cochrane Library), Embase, LILACS, Science Citation Index Expanded, Social Sciences Citation Index, Conference Proceedings Citation Index-Science, Conference Proceedings Citation Index-Social Science & Humanities. We also searched the WHO ICTRP, ClinicalTrials.gov, clinical trial reports from manufacturers' websites, and reference lists of included studies, and relevant systematic reviews. SELECTION CRITERIA We selected randomized controlled trials (RCTs) conducted in children that compared rotavirus vaccines prequalified for use by the WHO with either placebo or no intervention. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and assessed risk of bias. One author extracted data and a second author cross-checked them. We combined dichotomous data using the risk ratio (RR) and 95% confidence interval (CI). We stratified the analyses by under-five country mortality rate and used GRADE to evaluate evidence certainty. MAIN RESULTS Sixty trials met the inclusion criteria and enrolled a total of 228,233 participants. Thirty-six trials (119,114 participants) assessed Rotarix, 15 trials RotaTeq (88,934 participants), five trials Rotasiil (11,753 participants), and four trials Rotavac (8432 participants). Rotarix Infants vaccinated and followed up for the first year of life In low-mortality countries, Rotarix prevented 93% of severe rotavirus diarrhoea cases (14,976 participants, 4 trials; high-certainty evidence), and 52% of severe all-cause diarrhoea cases (3874 participants, 1 trial; moderate-certainty evidence). In medium-mortality countries, Rotarix prevented 79% of severe rotavirus diarrhoea cases (31,671 participants, 4 trials; high-certainty evidence), and 36% of severe all-cause diarrhoea cases (26,479 participants, 2 trials; high-certainty evidence). In high-mortality countries, Rotarix prevented 58% of severe rotavirus diarrhoea cases (15,882 participants, 4 trials; high-certainty evidence), and 27% of severe all-cause diarrhoea cases (5639 participants, 2 trials; high-certainty evidence). Children vaccinated and followed up for two years In low-mortality countries, Rotarix prevented 90% of severe rotavirus diarrhoea cases (18,145 participants, 6 trials; high-certainty evidence), and 51% of severe all-cause diarrhoea episodes (6269 participants, 2 trials; moderate-certainty evidence). In medium-mortality countries, Rotarix prevented 77% of severe rotavirus diarrhoea cases (28,834 participants, 3 trials; high-certainty evidence), and 26% of severe all-cause diarrhoea cases (23,317 participants, 2 trials; moderate-certainty evidence). In high-mortality countries, Rotarix prevented 35% of severe rotavirus diarrhoea cases (13,768 participants, 2 trials; moderate-certainty evidence), and 17% of severe all-cause diarrhoea cases (2764 participants, 1 trial; high-certainty evidence). RotaTeq Infants vaccinated and followed up for the first year of life In low-mortality countries, RotaTeq prevented 97% of severe rotavirus diarrhoea cases (5442 participants, 2 trials; high-certainty evidence). In medium-mortality countries, RotaTeq prevented 79% of severe rotavirus diarrhoea cases (3863 participants, 1 trial; low-certainty evidence). In high-mortality countries, RotaTeq prevented 57% of severe rotavirus diarrhoea cases (6775 participants, 2 trials; high-certainty evidence), but there is probably little or no difference between vaccine and placebo for severe all-cause diarrhoea (1 trial, 4085 participants; moderate-certainty evidence). Children vaccinated and followed up for two years In low-mortality countries, RotaTeq prevented 96% of severe rotavirus diarrhoea cases (5442 participants, 2 trials; high-certainty evidence). In medium-mortality countries, RotaTeq prevented 79% of severe rotavirus diarrhoea cases (3863 participants, 1 trial; low-certainty evidence). In high-mortality countries, RotaTeq prevented 44% of severe rotavirus diarrhoea cases (6744 participants, 2 trials; high-certainty evidence), and 15% of severe all-cause diarrhoea cases (5977 participants, 2 trials; high-certainty evidence). We did not identify RotaTeq studies reporting on severe all-cause diarrhoea in low- or medium-mortality countries. Rotasiil Rotasiil has not been assessed in any RCT in countries with low or medium child mortality. Infants vaccinated and followed up for the first year of life In high-mortality countries, Rotasiil prevented 48% of severe rotavirus diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence), and resulted in little to no difference in severe all-cause diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence). Children vaccinated and followed up for two years In high-mortality countries, Rotasiil prevented 44% of severe rotavirus diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence), and resulted in little to no difference in severe all-cause diarrhoea cases (11,008 participants, 2 trials; high-certainty evidence). Rotavac Rotavac has not been assessed in any RCT in countries with low or medium child mortality. Infants vaccinated and followed up for the first year of life In high-mortality countries, Rotavac prevented 57% of severe rotavirus diarrhoea cases (6799 participants, 1 trial; moderate-certainty evidence), and 16% of severe all-cause diarrhoea cases (6799 participants, 1 trial; moderate-certainty evidence). Children vaccinated and followed up for two years In high-mortality countries, Rotavac prevented 54% of severe rotavirus diarrhoea cases (6541 participants, 1 trial; moderate-certainty evidence); no Rotavac studies have reported on severe all-cause diarrhoea at two-years follow-up. Safety No increased risk of serious adverse events (SAEs) was detected with Rotarix (103,714 participants, 31 trials; high-certainty evidence), RotaTeq (82,502 participants, 14 trials; moderate to high-certainty evidence), Rotasiil (11,646 participants, 3 trials; high-certainty evidence), or Rotavac (8210 participants, 3 trials; moderate-certainty evidence). Deaths were infrequent and the analysis had insufficient evidence to show an effect on all-cause mortality. Intussusception was rare. AUTHORS' CONCLUSIONS: Rotarix, RotaTeq, Rotasiil, and Rotavac prevent episodes of rotavirus diarrhoea. The relative effect estimate is smaller in high-mortality than in low-mortality countries, but more episodes are prevented in high-mortality settings as the baseline risk is higher. In high-mortality countries some results suggest lower efficacy in the second year. We found no increased risk of serious adverse events, including intussusception, from any of the prequalified rotavirus vaccines.
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Affiliation(s)
| | | | - Daniel Hungerford
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
| | | | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa
| | - Nigel Cunliffe
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
- NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, Liverpool, UK
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22
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Jaca A, Sishuba M, Jacobson Vann JC, Wiysonge CS, Ndwandwe D. Interventions to improve vaccination uptake among adults. Hippokratia 2021. [DOI: 10.1002/14651858.cd015057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anelisa Jaca
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
| | - Masibulele Sishuba
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
| | | | - Charles S Wiysonge
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa; South African Medical Research Council; Cape Town South Africa
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Abstract
COVID-19 is a pandemic of unprecedented proportions in recent human history. Less than 18 months since the onset of the pandemic, there are close to two hundred million confirmed cases and four million deaths worldwide. There have also been massive efforts geared towards finding safe and effective vaccines. By July 2021 there were 184 COVID-19 vaccine candidates in pre-clinical development, 105 in clinical development, and 18 vaccines approved for emergency use by at least one regulatory authority. These vaccines include whole virus live attenuated or inactivated, protein-based, viral vector, and nucleic acid vaccines. By mid-2021 three billion doses of COVID-19 vaccine have been administered around the world, mostly in high-income countries. COVID-19 vaccination provides hope for an end to the pandemic, if and only if there would be equal access and optimal uptake in all countries around the world.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Parow Valley, 7501, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Parow Valley, 7501, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925, Cape Town, South Africa
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Affiliation(s)
- Chukwudi A Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Hassan Mahomed
- Western Cape Provincial Department of Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Charles S Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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25
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Uthman OA, Ndwandwe D, Uthman MMB, Yaya S, Wiysonge CS. Multilevel Analysis of Individual and Contextual Factors Associated with Polio Non-Vaccination in Africa: Further Analyses to Enhance Policy and Opportunity to Save More Lives. Vaccines (Basel) 2021; 9:vaccines9070683. [PMID: 34206156 PMCID: PMC8310107 DOI: 10.3390/vaccines9070683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/10/2021] [Accepted: 06/12/2021] [Indexed: 01/22/2023] Open
Abstract
Background: Africa was certified polio-free in 2020 and to maintain the polio-free status, African countries need to attain and maintain optimal routine polio vaccination coverage. One indicator for optimal polio vaccination coverage is the prevalence of children who have received no polio vaccination through routine services. The objective of the study was to examine the individual-, neighbourhood-, and country-level factors associated with non-vaccination against polio in Africa. Methods: We applied multivariable multilevel logistic regression analyses on recent demographic and health survey data collected from 2010 onwards in Africa. We identified 64,867 children aged 12-23 months (Level 1) nested within 16,283 neighbourhoods (Level 2) from 32 countries (Level 3). Results: The prevalence of non-vaccination for polio ranged from 2.19% in Egypt to 32.74% in Guinea. We found the following factors to be independent predictors of the increased odds of non-vaccination for polio: being a male child, born to mother with no formal education, living in poorer households; being from a polygamous family, living in neighbourhoods with high maternal illiteracy, high unemployment rate, and low access to media. Conclusions: We found that both individual and contextual factors are associated with non-vaccination for Polio.
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Affiliation(s)
- Olalekan A. Uthman
- Warwick Centre for Global Health, Division of Health Sciences, University of Warwick Medical School, Coventry CV4 7AL, UK
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
- Correspondence:
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
| | - Muhammed M. B. Uthman
- Department of Epidemiology & Community Health, College of Health Sciences, University of Ilorin, Ilorin 240211, Nigeria;
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada;
- The George Institute for Global Health, Imperial College London, London SW7 2AZ, UK
| | - Charles S. Wiysonge
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town 7505, South Africa;
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Cape Town 7501, South Africa;
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
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Adetokunboh O, Iwu-Jaja CJ, Nnaji CA, Ndwandwe D. Missed opportunities for vaccination in Africa. Curr Opin Immunol 2021; 71:55-61. [PMID: 34087523 DOI: 10.1016/j.coi.2021.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this review is to assess the extent of missed opportunities for vaccination (MOV) in Africa, determine the associated factors, and provide recommendations that countries could adopt in reducing MOV. Two databases were searched for multinational studies and systematic reviews reporting MOV and involving African countries. A total of 288 records were identified and 12 studies included for synthesis. The prevalence ranged from 47.0% to 62.1%, with a weighted mean of 27.3%. This review highlighted caregiver utilization, health service delivery, and healthcare worker' factors associated with MOV. Understanding the extent of MOV in Africa presents an opportunity for multiple approaches to resolve the differential factors that contribute to MOV, and to bridge the gap in vaccination coverage in the continent.
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Affiliation(s)
- Olatunji Adetokunboh
- Department of Science and Innovation-National Research Foundation (DSI-NRF), Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa; Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
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27
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Hohlfeld ASJ, Mathebula L, Pienaar ED, Abrams A, Lutje V, Ndwandwe D, Kredo T. Tuberculosis treatment intervention trials in Africa: A cross-sectional bibliographic study and spatial analysis. PLoS One 2021; 16:e0248621. [PMID: 33739989 PMCID: PMC7978376 DOI: 10.1371/journal.pone.0248621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 03/02/2021] [Indexed: 11/18/2022] Open
Abstract
Background Mycobacterium Tuberculosis (TB) poses a substantial burden in sub-Saharan Africa and is the leading cause of death amongst infectious diseases. Randomised controlled trials (RCTs) are regarded as the gold standard for evaluating the effectiveness of interventions. We aimed to describe published TB treatment trials conducted in Africa. Methods This is a cross-sectional study of published TB trials conducted in at least one African country. In November 2019, we searched three databases using the validated Africa search filter and Cochrane’s sensitive trial string. Published RCTs conducted in at least one African country were included for analysis. Records were screened for eligibility. Co-reviewers assisted with duplicate data extraction. Extracted data included: the country where studies were conducted, publication dates, ethics statement, trial registration number, participant’s age range. We used Cochrane’s Risk of Bias criteria to assess methodological quality. Results We identified 10,495 records; 175 trials were eligible for inclusion. RCTs were published between 1952 and 2019. The median sample size was 206 participants (interquartile range: 73–657). Most trials were conducted in South Africa (n = 83) and were drug therapy trials (n = 130). First authors were from 30 countries globally. South Africa had the most first authors (n = 55); followed by the United States of America (USA) (n = 28) and Great Britain (n = 14) with fewer other African countries contributing to the first author tally. Children under 13 years of age eligible to participate in the trials made up 17/175 trials (9.71%). International governments (n = 29) were the most prevalent funders. Ninety-four trials provided CONSORT flow diagrams. Methodological quality such as allocation concealment and blinding were poorly reported or unclear in most trials. Conclusions By mapping African TB trials, we were able to identify potential research gaps. Many of the global north’s researchers were found to be the lead authors in these African trials. Few trials tested behavioural interventions compared to drugs, and far fewer tested interventions on children compared to adults to improve TB outcomes. Lastly, funders and researchers should ensure better methodological quality reporting of trials.
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Affiliation(s)
- Ameer S. J. Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- * E-mail:
| | - Lindi Mathebula
- Communicable Disease Control, Department of Health, Western Cape, Cape Town, South Africa
| | - Elizabeth D. Pienaar
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Amber Abrams
- Future Water Institute, University of Cape Town, Cape Town, South Africa
| | - Vittoria Lutje
- Cochrane Infectious Diseases Group, Liverpool, United Kingdom
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, Cape Town, South Africa
- Clinical Pharmacology Division, Department of Medicine, Stellenbosch University, Cape Town, South Africa
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Wiysonge CS, Ndwandwe D, Ryan J, Jaca A, Batouré O, Anya BPM, Cooper S. Vaccine hesitancy in the era of COVID-19: could lessons from the past help in divining the future? Hum Vaccin Immunother 2021; 18:1-3. [PMID: 33684019 PMCID: PMC8920215 DOI: 10.1080/21645515.2021.1893062] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Vaccine hesitancy, which embodies the unwillingness to receive vaccines when vaccination services are available and accessible, is one of the greatest threats to global health. Although vaccine hesitancy has existed among a small percentage of people for centuries, its harmful effects are likely to be more pronounced during the COVID-19 pandemic than ever before. COVID-19 vaccine hesitancy will pose substantial risks for both people who delay or refuse to be vaccinated and the wider community. It will make communities unable to reach thresholds of coverage necessary for herd immunity against COVID-19, thus unnecessarily perpetuating the pandemic and resulting in untold suffering and deaths. Vaccine hesitancy is pervasive, misinformed, contagious, and is not limited to COVID-19 vaccination. Our work shows that vaccine hesitancy is a complex and dynamic social process that reflects multiple webs of influence, meaning, and logic. People’s vaccination views and practices usually comprise an ongoing engagement that is contingent on unfolding personal and social circumstances, which can potentially change over time. Therefore, as COVID-19 vaccination rolls out globally, scientists and decision-makers need to investigate the scale and determinants of vaccine hesitancy in each setting; so that tailored and targeted strategies can be developed to address it.
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Affiliation(s)
- Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Jill Ryan
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | | | | | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, South Africa
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Malinga T, Wiysonge CS, Ndwandwe D, Okeibunor JC, Talisuna AO. A scoping review of the impact of long-distance truck drivers on the spread of COVID-19 infection. Pan Afr Med J 2021; 38:27. [PMID: 33777295 PMCID: PMC7955595 DOI: 10.11604/pamj.2021.38.27.26691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction long-distance truck drivers have been identified as a high-risk group for coronavirus disease (COVID-19) infection. Thus, the aim of this scoping review is to map out the existing evidence on the impact of long-distance truck drivers on the spread of COVID-19 and measures that countries can implement to mitigate this route of spread in the African region. Methods we searched the PubMed database and the website of the World Health Organization (WHO) in March 2020 for eligible studies. Results the search strategy identified 669 citations, of which six met the inclusion criteria. The most frequently reported interventions were maintaining hand hygiene, social distance, testing truck drivers, regulation of trade and transport e.g. only trucks with the food, medical supplies, fuels, agricultural supplies will be allowed to operate in interstate operations and regulating and controlling trucks carrying essential goods and services e.g. truck drivers are required to declare their final destination and are urged to stop only at designated points. Two studies from the African region reported about border closures and entry and exit screening, two studies from the US reported about the threat for public safety and risks and mitigation plans and 2 guidelines reported about harmonisation and facilitation of cross border in the context of the COVID-19 outbreak. Conclusion this review highlights the countries response to mitigate the impact of the pandemic by implementing measures to facilitate safe cross-border trade and adopting regional harmonization of trucking regulations.
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Affiliation(s)
- Thobile Malinga
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Department of Global Health, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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Ndwandwe D, Mathebula L, Adetokunboh O, Kamadjeu R, Wiysonge CS. Cochrane corner: universal screening for SARS-CoV-2 infection. Pan Afr Med J 2020; 37:48. [PMID: 33552376 DOI: 10.11604/pamj.supp.2020.37.48.26881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/16/2020] [Indexed: 02/06/2023] Open
Abstract
Introduction coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most people infected with SARS-CoV-2 have mild disease with non-specific symptoms, although a few becoming critically ill with septic shock and multiple organ failure. There is an unknown proportion of infected individuals who remain asymptomatic and infectious. Universal screening for COVID-19 infections to detect individuals who are infected before they present clinically could therefore be an important measure to contain the spread of the disease. We highlight a Cochrane rapid review which assessed the effectiveness and accuracy of universal screening for COVID-19 infection. Methods the authors of the Cochrane review searched multiple electronic databases to identify studies reporting on the effectiveness of universal screening and reporting on screening test accuracy. Eligible participants for the review included people who had not sought care for potential COVID-19 symptoms. Results the authors included 22 publications, with none of them conducted in Africa. Two modelling studies reported on the beneficial and negative effects of screening; and 20 studies (cohort and modelling) reported data on the accuracy of screening tests. The included studies had wide variability in the baseline prevalence of COVID-19 infection as well as study settings and methods. All cohort studies compared screening strategies to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. The rapid review suggests that there is low certainty of evidence that screening at travel hubs may slow the importation of infected cases. Furthermore, the review highlights the uncertainty and variation in the accuracy of screening. Conclusion given the low accuracy of the tests included in this review, a high proportion of COVID-19 infected individuals may be missed and go on to infect others. In addition, some healthy individuals may be falsely identified as positive, requiring confirmatory testing and potentially leading to the unnecessary isolation of these individuals.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Communicable Disease Control, Department of Health, Western Cape, South Africa
| | - Olatunji Adetokunboh
- Department of Science and Innovation-National Research Foundation (DSI-NRF) Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Raoul Kamadjeu
- UNICEF Program Division, Public Health Emergencies Team, New York, USA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Ndwandwe D, Ngcobo NJ, Adamu AA, Nnaji C, Mashunye T, Leufak AM, Cooper S, Uthman OA, Wiysonge CS. Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis. JMIR Res Protoc 2020; 9:e16672. [PMID: 32985990 PMCID: PMC7551109 DOI: 10.2196/16672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/04/2020] [Accepted: 04/21/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Vaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination. OBJECTIVE This study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa. METHODS The 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa. RESULTS Ethical review submission is planned for October 2020. Data collection is expected to be underway in January 2021. CONCLUSIONS The extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/16672.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntombenhle J Ngcobo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Abdu A Adamu
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Chukwudi Nnaji
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thandiwe Mashunye
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Arlette M Leufak
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Olalekan A Uthman
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, University of Warwick Medical School, Coventry, United Kingdom
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Ndwandwe D, Mathebula L, Kamadjeu R, Wiysonge CS. Cochrane corner: rapid point-of-care antigen and molecular-based tests for the diagnosis of COVID-19 infection. Pan Afr Med J 2020; 37:10. [PMID: 33294111 DOI: 10.11604/pamj.supp.2020.37.10.25982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/14/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction the COVID-19 pandemic, which results from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents important diagnostic challenges. Diagnostic strategies available to identify or rule out current infection, or to identify people in need of care escalation, or to test for past infection and immune response have become available, to reduce household and community transmission. We highlight a Cochrane review, published in September 2020, on the assessment of diagnostic accuracy of point-of-care antigen and molecular-based tests to determine current SARS-CoV-2 infection. Methods the authors of the Cochrane review searched multiple electronic databases for studies, which assessed SARS-CoV-2 infection with a diagnostic test. Eligible participants for the review included people with suspected current SARS-CoV-2 infection, known to have, or not to have COVID-19 infection, or where tests were used to screen for infection. Results the authors included 18 studies of point-of-care tests conducted in various parts of the world, with none from Africa. The review shows that there is considerable variability in sensitivity and specificity of the antigen tests. The review also shows that molecular tests had less variability in sensitivity and specificity. Conclusion the review suggests that the current evidence is not strong enough to determine the usefulness of point-of-care tests in all settings. However, the benefits are likely to be more noticeable in countries, like Africa where community transmission is high. An impact evaluation would be warranted when rapid point-of-care tests are implemented in African countries.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Communicable Disease Control, Department of Health, Western Cape, South Africa
| | - Raoul Kamadjeu
- UNICEF Program Division, Public Health Emergencies Team, New York, USA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.,Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ndwandwe D, Nnaji CA, Mashunye T, Uthman OA, Wiysonge CS. Incomplete vaccination and associated factors among children aged 12-23 months in South Africa: an analysis of the South African demographic and health survey 2016. Hum Vaccin Immunother 2020; 17:247-254. [PMID: 32703070 PMCID: PMC7872074 DOI: 10.1080/21645515.2020.1791509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain under-vaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12–23 months in South Africa. Methods The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12–23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette–Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI). Results About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42–6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27–5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30–5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47–0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31–6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03–5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35–7.15) provinces were maintained in both magnitude and direction. Conclusions There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that promote broader health service utilization, such as ANC attendance, can help improve the awareness and uptake of routine childhood vaccination. It is also imperative to take into consideration the provincial disparities in childhood vaccination completeness, in planning and implementing interventions to improve vaccination coverage in the country.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Thandiwe Mashunye
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School , Coventry, UK.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
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Ndwandwe D, Dube K, Mathebula L, Wiysonge CS. Description of vaccine clinical trials in Africa: a narrative review. Hum Vaccin Immunother 2020; 16:972-980. [PMID: 31730397 PMCID: PMC7227700 DOI: 10.1080/21645515.2019.1693720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 09/26/2019] [Accepted: 10/12/2019] [Indexed: 01/10/2023] Open
Abstract
Clinical research is important in establishing the effects of health-care interventions. Vaccine clinical trials are to examine the effectiveness and safety of vaccines for the prevention of diseases. Africa has a high burden of infectious diseases such as malaria, tuberculosis, HIV/AIDS, and Ebola virus disease. Here we report a database surveillance study of vaccine-related clinical trials conducted in Africa. An objective is to address and profile vaccine clinical trials conducted in Africa. Data were extracted from the WHO International Clinical Trials Registry Platform on 22 July 2018 and updated on 05 September 2019. We found that 61% of the 377 clinical trials were registered prospectively and 35% registered retrospectively. About 72% of the trials were single-country studies and within the country, most trials (86%) were single-center studies. The proportion of trials involving multiple African countries was 11% and that of trials involving countries outside of Africa was 16%. The biggest funder of the vaccine trials (34%) was industry, followed by governments (25%) and universities (21%). The most studied diseases were malaria (20%), HIV/AIDS (15%), tuberculosis (7%), and Ebola virus disease (6%). Most of the vaccine trials were conducted in adults (42%). The trials ranged from phase I to phase IV, with most of the trials being in phase I (18%) and phase III (18%). The conduct of vaccine clinical trials in Africa seeks to address the disease epidemics faced by the continent. There is a need for more investments from governmental bodies toward vaccine research in Africa. Further, African country collaborations are needed in efforts to find African solutions to the current infectious disease threats faced by the continent.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Kopano Dube
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
- Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
Introduction the COVID-19 pandemic, which results from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), presents important diagnostic challenges. Diagnostic strategies available to identify or rule out current infection, or to identify people in need of care escalation, or to test for past infection and immune response have become available, to reduce household and community transmission. We highlight a Cochrane review, published in September 2020, on the assessment of diagnostic accuracy of point-of-care antigen and molecular-based tests to determine current SARS-CoV-2 infection. Methods the authors of the Cochrane review searched multiple electronic databases for studies, which assessed SARS-CoV-2 infection with a diagnostic test. Eligible participants for the review included people with suspected current SARS-CoV-2 infection, known to have, or not to have COVID-19 infection, or where tests were used to screen for infection. Results the authors included 18 studies of point-of-care tests conducted in various parts of the world, with none from Africa. The review shows that there is considerable variability in sensitivity and specificity of the antigen tests. The review also shows that molecular tests had less variability in sensitivity and specificity. Conclusion the review suggests that the current evidence is not strong enough to determine the usefulness of point-of-care tests in all settings. However, the benefits are likely to be more noticeable in countries, like Africa where community transmission is high. An impact evaluation would be warranted when rapid point-of-care tests are implemented in African countries.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Corresponding author: Duduzile Ndwandwe, Cochrane South Africa, South African Medical Research Council, Francie van Zilj Drive, Parow Valley 7501, South Africa.
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Communicable Disease Control, Department of Health, Western Cape, South Africa
| | - Raoul Kamadjeu
- UNICEF Program Division, Public Health Emergencies Team, New York, USA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Abstract
Introduction coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most people infected with SARS-CoV-2 have mild disease with non-specific symptoms, although a few becoming critically ill with septic shock and multiple organ failure. There is an unknown proportion of infected individuals who remain asymptomatic and infectious. Universal screening for COVID-19 infections to detect individuals who are infected before they present clinically could therefore be an important measure to contain the spread of the disease. We highlight a Cochrane rapid review which assessed the effectiveness and accuracy of universal screening for COVID-19 infection. Methods the authors of the Cochrane review searched multiple electronic databases to identify studies reporting on the effectiveness of universal screening and reporting on screening test accuracy. Eligible participants for the review included people who had not sought care for potential COVID-19 symptoms. Results the authors included 22 publications, with none of them conducted in Africa. Two modelling studies reported on the beneficial and negative effects of screening; and 20 studies (cohort and modelling) reported data on the accuracy of screening tests. The included studies had wide variability in the baseline prevalence of COVID-19 infection as well as study settings and methods. All cohort studies compared screening strategies to reverse transcriptase-polymerase chain reaction (RT-PCR) as the gold standard. The rapid review suggests that there is low certainty of evidence that screening at travel hubs may slow the importation of infected cases. Furthermore, the review highlights the uncertainty and variation in the accuracy of screening. Conclusion given the low accuracy of the tests included in this review, a high proportion of COVID-19 infected individuals may be missed and go on to infect others. In addition, some healthy individuals may be falsely identified as positive, requiring confirmatory testing and potentially leading to the unnecessary isolation of these individuals.
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Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Corresponding author: Duduzile Ndwandwe, Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Lindi Mathebula
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Communicable Disease Control, Department of Health, Western Cape, South Africa
| | - Olatunji Adetokunboh
- Department of Science and Innovation-National Research Foundation (DSI-NRF) Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Raoul Kamadjeu
- UNICEF Program Division, Public Health Emergencies Team, New York, USA
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Wiyeh AB, Cooper S, Jaca A, Mavundza E, Ndwandwe D, Wiysonge CS. Social media and HPV vaccination: Unsolicited public comments on a Facebook post by the Western Cape Department of Health provide insights into determinants of vaccine hesitancy in South Africa. Vaccine 2019; 37:6317-6323. [PMID: 31521412 DOI: 10.1016/j.vaccine.2019.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 08/20/2019] [Accepted: 09/07/2019] [Indexed: 01/09/2023]
Abstract
On the 4 February 2019, the Western Cape Department of Health's Facebook page announced the implementation of a school-based vaccination campaign aimed to administer the first doses of human papillomavirus (HPV) vaccine in public schools to Grade 4 girls who are nine years old. This announcement was met with a flurry of social media responses posted on the campaign's Facebook page. This study identifies determinants of vaccine hesitancy amongst responses provided by social media users to this post. On 8 March 2019, we conducted a qualitative study including all 157 comments to the Facebook post. The post had 659 'emotion' reactions: 574 "likes", 62 "loves", 21 "angry faces", 2 "laughs", 2 "wows" and 1 "sad face". An overwhelming majority (636/659 i.e. 97%) of reactions were favourable to the HPV vaccination campaign. Out of the 157 comments, we judged 52 (33%) of them to be 'hesitant', suggesting that people with negative reactions though few in number, were more likely to be vocal deniers. Concern around the safety of HPV vaccines including effects on reproductive health was the most common theme identified. Other emerging themes included: risk of cervical cancer perceived as being low, issues around consent, concerns that girls are being used for research, questionable vaccine effectiveness, use of the school-based strategy for the campaign, risk-benefits calculations of HPV vaccination and constraints such as stock-outs. Knowing someone who had been affected or being at risk of cervical cancer, having knowledge about the causes of cervical cancer, confidence in the effectiveness and safety of the vaccine, knowing the vaccine was being used in high income settings, and having strong recommendations from the World Health Organisation and key actors seemed to increase the willingness to accept the vaccine. The magnitude and causes of HPV vaccine hesitancy need to be investigated to ensure the success of this programme.
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Affiliation(s)
- Alison B Wiyeh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Anelisa Jaca
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Edison Mavundza
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa; Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Adetokunboh OO, Ndwandwe D, Awotiwon A, Uthman OA, Wiysonge CS. Vaccination among HIV-infected, HIV-exposed uninfected and HIV-uninfected children: a systematic review and meta-analysis of evidence related to vaccine efficacy and effectiveness. Hum Vaccin Immunother 2019; 15:2578-2589. [PMID: 30945967 PMCID: PMC6930074 DOI: 10.1080/21645515.2019.1599677] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/05/2019] [Accepted: 03/16/2019] [Indexed: 01/04/2023] Open
Abstract
Evidence-based approaches were used in making recommendations for vaccination against vaccine-preventable diseases for HIV-infected and HIV-exposed individuals but with limited substantiation. We conducted a systematic review and meta-analysis with randomized-controlled trials (RCTs), cohort and case-control studies that have efficacy and effectiveness of vaccines in HIV-infected and HIV-exposed children as outcomes. Web of Science, Cochrane Library, PubMed and Scopus databases were searched for articles. Efficacy of 9-valent pneumococcal conjugate vaccine (PCV9) against total vaccine serotype invasive pneumococcal disease was 32% in HIV-infected children and 78% among HIV-uninfected children. Vaccine effectiveness of Bacillus Calmette-Guérin vaccine in preventing tuberculosis in HIV-infected children was zero compared to 59% protection in HIV-unexposed children. Likewise, HIV-uninfected children have better protection against invasive Haemophilus influenzae type b disease than the HIV-infected children. Effectiveness studies of rotavirus vaccines show that HIV-exposed uninfected children have similar protection against rotavirus gastroenteritis compared to the non-exposed children. Children who are severely immunosuppressed are poorly protected against invasive pneumococcal diseases. HIV-infected children tend to have lesser vaccine protection against vaccine-preventable diseases when compared to unexposed children. HIV-infected children who are immunocompetent are more likely to have better vaccine protection against vaccine-preventable diseases than those who are immunosuppressed. The overall quality of the observational studies was very low with very little confidence in the effect estimate. The overall quality of evidence for the RCT outcomes was mainly high. This study reveals a dearth of efficacy and effectiveness studies among HIV-infected and exposed children.
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Affiliation(s)
- Olatunji O. Adetokunboh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Olalekan A. Uthman
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Warwick Medical School - Population Evidence and Technologies, University of Warwick, Coventry, UK
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Adetokunboh OO, Awotiwon A, Ndwandwe D, Uthman OA, Wiysonge CS. The burden of vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa: a systematic review and meta-analysis. Hum Vaccin Immunother 2019; 15:2590-2605. [PMID: 30945963 PMCID: PMC6930054 DOI: 10.1080/21645515.2019.1599676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 03/05/2019] [Accepted: 03/18/2019] [Indexed: 12/27/2022] Open
Abstract
There are knowledge gaps regarding evidence-based research on the burden of vaccine-preventable diseases among human immunodeficiency virus (HIV)-infected and HIV-exposed children aged <18 years in sub-Saharan Africa. It is therefore essential to determine the trend and burden of vaccine-preventable diseases. We completed a systematic review and meta-analysis to identify the incidence, prevalence and case-fatality rates (CFR) attributed to various vaccine-preventable diseases among HIV-infected and HIV-exposed children in sub-Saharan Africa. The trends in the prevalence of vaccine-preventable diseases among HIV-infected and HIV-exposed children were also determined. Nine studies on tuberculosis (TB) were pooled to give an overall incidence rate estimate of 60 (95% confidence interval [CI] 30-70) per 1,000 child-years. The incidence of pneumococcal infections varied between 109-1509 per 100,000 while pertussis was between 2.9 and 3.7 per 1000 child-year. Twenty-two TB prevalence studies reported an estimated prevalence of 16%. Fifteen prevalence studies on hepatitis B infection were pooled together with an estimated prevalence of 5%. The pooled prevalence for pneumococcal infections was 2% while rotavirus diarrhoea reported a prevalence of 13%. Twenty-nine studies on TB were pooled to give an overall CFR estimate of 17% while pneumococcal infections in HIV-infected and exposed children were pooled together with a resultant rate of 15%. Some of the vaccine-preventable diseases still have high incidences, prevalence and CFR among HIV-infected and HIV-exposed children. There is also a dearth of research data on the burden of several vaccine-preventable diseases among HIV-infected and exposed children and a need for more studies in this area.
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Affiliation(s)
- Olatunji O. Adetokunboh
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ajibola Awotiwon
- Knowledge Translation Unit, University of Cape Town Lung Institute, Cape Town, South Africa
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Olalekan A. Uthman
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Warwick Medical School - Population Evidence and Technologies, University of Warwick, Coventry, UK
| | - Charles S. Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Adamu AA, Uthman OA, Sambala EZ, Ndwandwe D, Wiyeh AB, Olukade T, Bishwajit G, Yaya S, Okwo-Bele JM, Wiysonge CS. Rural-urban disparities in missed opportunities for vaccination in sub-Saharan Africa: a multi-country decomposition analyses. Hum Vaccin Immunother 2019; 15:1191-1198. [PMID: 30779684 DOI: 10.1080/21645515.2019.1575163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In this study, we aimed to explore the rural-urban disparities in the magnitude and determinants of missed opportunities for vaccination (MOV) in sub-Saharan Africa. METHODS This was a cross-sectional study using nationally representative household surveys conducted between 2007 and 2017 in 35 countries across sub-Saharan Africa. The risk difference in MOV between rural or urban dwellers were calculated. Logistic regression method was used to investigate the urban-rural disparities in multivariable analyses. Then Blinder-Oaxaca method was used to decompose differences in MOV between rural and urban dwellers. RESULTS The median number of children aged 12 to 23 months was 2113 (Min: 370, Max: 5896). There was wide variation in the the magnitude of MOV among children in rural and urban areas across the 35 countries. The magnitude of MOV in rural areas varied from 18.0% (95% CI 14.7 to 21.4) in the Gambia to 85.2% (81.2 to 88.9) in Gabon. Out of the 35 countries included in this analysis, pro-rural inequality was observed in 16 countries (i.e. MOV is prevalent among children living in rural areas) and pro-urban inequality in five countries (i.e. MOV is prevalent among children living in urban areas). The contributions of the compositional 'explained' and structural 'unexplained' components varied across the countries. However, household wealth index was the most frequently identified factor. CONCLUSIONS Variation exists in the level of missed opportunities for vaccination between rural and urban areas, with widespread pro-rural inequalities across Africa. Although several factors account for these rural-urban disparities in various countries, household wealth was the most common.
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Affiliation(s)
- Abdu A Adamu
- a Division of Epidemiology and Biostatistics , Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Olalekan A Uthman
- b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,c Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences , University of Warwick Medical School , Coventry , UK
| | - Evanson Z Sambala
- a Division of Epidemiology and Biostatistics , Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Duduzile Ndwandwe
- a Division of Epidemiology and Biostatistics , Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Alison B Wiyeh
- a Division of Epidemiology and Biostatistics , Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Tawa Olukade
- d Department of Research and Development , Center for Evidence-Based Global Health , Cape Town , Nigeria
| | - Ghose Bishwajit
- e School of International Development and Global Studies , University of Ottawa , Cape town , Canada
| | - Sanni Yaya
- e School of International Development and Global Studies , University of Ottawa , Cape town , Canada
| | | | - Charles S Wiysonge
- a Division of Epidemiology and Biostatistics , Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,g School of Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
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Uthman OA, Sambala EZ, Adamu AA, Ndwandwe D, Wiyeh AB, Olukade T, Bishwajit G, Yaya S, Okwo-Bele JM, Wiysonge CS. Does it really matter where you live? A multilevel analysis of factors associated with missed opportunities for vaccination in sub-Saharan Africa. Hum Vaccin Immunother 2018; 14:2397-2404. [PMID: 30059645 PMCID: PMC6284478 DOI: 10.1080/21645515.2018.1504524] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
There is an urgent need to examine the magnitude and factors responsible for missed opportunities for vaccination, to rapidly achieve national immunization targets. The objective of the study was to examine the influence of individual, neighbourhood and country level socioeconomic position on missed opportunities for vaccination (MOV) in Sub-Saharan Africa. We used multilevel logistic regression analysis on Demographic and Health Survey data collected between 2007 and 2016 in sub-Saharan Africa. We analysed data on 43,637 children aged 12 to 23 months (Level 1) nested within 15,122 neighbourhoods (Level 2) from 35 countries (Level 3). After adjustment for individual-, neighbourhood- and country-level factors, the following appeared as significant risk factors for increased odds of MOV: high birth order, high number of under-five children in the house, poorest household, lack of maternal education, lack of media access, and living in poorer neighbourhood. According to the intra-country and intra-neighbourhood correlation coefficient, 18.4% and 37.4% of the variance in odds of MOV could be attributed to the country and neighbourhood level factors, respectively; and if a child moved to another country or neighbourhood with a higher probability of MOV, the median increase in their odds of MOV would be 2.47 and 2.56 fold respectively. This study has revealed that the risk of missed opportunities for vaccination in sub-Saharan Africa is influenced by not only individual factors but also by compositional factors such as family’s financial capacity, place of birth and upbringing.
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Affiliation(s)
- Olalekan A Uthman
- a Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences , University of Warwick Medical School , Coventry , UK.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Evanson Z Sambala
- c Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Abdu A Adamu
- b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,c Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Duduzile Ndwandwe
- c Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Alison B Wiyeh
- c Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa
| | - Tawa Olukade
- d Research and Development , Center for Evidence-Based Global Health , Nigeria
| | - Ghose Bishwajit
- e School of International Development and Global Studies, University of Ottawa , Canada
| | - Sanni Yaya
- e School of International Development and Global Studies, University of Ottawa , Canada
| | | | - Charles S Wiysonge
- b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,c Cochrane South Africa, South African Medical Research Council , Tygerberg , South Africa.,g School of Public Health and Family Medicine, Faculty of Health Sciences , University of Cape Town , Cape Town , South Africa
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Ndwandwe D, Uthman OA, Adamu AA, Sambala EZ, Wiyeh AB, Olukade T, Bishwajit G, Yaya S, Okwo-Bele JM, Wiysonge CS. Decomposing the gap in missed opportunities for vaccination between poor and non-poor in sub-Saharan Africa: A Multicountry Analyses. Hum Vaccin Immunother 2018; 14:2358-2364. [PMID: 29688133 PMCID: PMC6284496 DOI: 10.1080/21645515.2018.1467685] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Understanding the gaps in missed opportunities for vaccination (MOV) in sub-Saharan Africa would inform interventions for improving immunisation coverage to achieving universal childhood immunisation. We aimed to conduct a multicountry analyses to decompose the gap in MOV between poor and non-poor in SSA. We used cross-sectional data from 35 Demographic and Health Surveys in SSA conducted between 2007 and 2016. Descriptive statistics used to understand the gap in MOV between the urban poor and non-poor, and across the selected covariates. Out of the 35 countries included in this analysis, 19 countries showed pro-poor inequality, 5 showed pro-non-poor inequality and remaining 11 countries showed no statistically significant inequality. Among the countries with statistically significant pro-illiterate inequality, the risk difference ranged from 4.2% in DR Congo to 20.1% in Kenya. Important factors responsible for the inequality varied across countries. In Madagascar, the largest contributors to inequality in MOV were media access, number of under-five children, and maternal education. However, in Liberia media access narrowed inequality in MOV between poor and non-poor households. The findings indicate that in most SSA countries, children belonging to poor households are most likely to have MOV and that socio-economic inequality in is determined not only by health system functions, but also by factors beyond the scope of health authorities and care delivery system. The findings suggest the need for addressing social determinants of health.
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Affiliation(s)
- Duduzile Ndwandwe
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Olalekan A Uthman
- b Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School , Coventry , United Kingdom.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Abdu A Adamu
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa
| | - Evanson Z Sambala
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Alison B Wiyeh
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Tawa Olukade
- d Department of Research and Development , Center for Evidence Based Global Health , Minna , Nigeria
| | - Ghose Bishwajit
- e School of International Development and Global Studies, University of Ottawa , Ontario , Canada
| | - Sanni Yaya
- e School of International Development and Global Studies, University of Ottawa , Ontario , Canada
| | | | - Charles S Wiysonge
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,c Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.,g Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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Sambala EZ, Uthman OA, Adamu AA, Ndwandwe D, Wiyeh AB, Olukade T, Bishwajit G, Yaya S, Okwo-Bele JM, Wiysonge CS. Mind the Gap: What explains the education-related inequality in missed opportunities for vaccination in sub-Saharan Africa? Compositional and structural characteristics. Hum Vaccin Immunother 2018; 14:2365-2372. [PMID: 29630441 PMCID: PMC6284484 DOI: 10.1080/21645515.2018.1460985] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Missed opportunities for vaccination (MOV) is an important barrier hindering full immunisation coverage among eligible children. Though factors responsible for MOV are well documented in literature, little attention has been paid to the role of inequalities. The aim of this study is to examine the association between structural or compositional factors and education inequalities in MOV. Blinder-Oaxaca decomposition technique was used to explain the factors contributing to the average gap in missed opportunities for vaccination between uneducated and educated mothers in sub-Saharan Africa using DHS survey data from 35 sub Saharan African countries collected between 2007 and 2016. The sample contained 69,657 children aged 12 to 23 months. We observed a wide variation and inter-country differences in the prevalence of missed opportunity for vaccination across populations and geographical locations. Our results show that the prevalence of MOV in Zimbabwe among uneducated and educated mothers was 9% and 21% respectively while in Gabon corresponding numbers were 85% and 89% respectively. In 15 countries, MOV was significantly prevalent among children born to uneducated mothers (pro-illiterate inequality) while in 5 countries MOV was significantly prevalent among educated mothers (pro-educated inequality). Our results suggest that education-related inequalities in missed opportunities for vaccination are explained by compositional and structural characteristics; and that neighbourhood socio-economic status was the most important contributor to education-related inequalities across countries followed by either the presence of under-five children, media access or household wealth index. The results showed that differential effects such as neighbourhood socio-economic status, presence of under-five children, media access and household wealth index, primarily explained education-related inequality in MOV. Interventions to reduce gaps in education-related inequality in MOV should focus on social determinants of health.
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Affiliation(s)
- Evanson Z Sambala
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Olalekan A Uthman
- b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa.,c Warwick-Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick Medical School , Coventry , United Kingdom
| | - Abdu A Adamu
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa
| | - Duduzile Ndwandwe
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Alison B Wiyeh
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa
| | - Tawa Olukade
- d Center for Evidence Based Global Health, Department of Research and Development , Minna , Nigeria
| | - Ghose Bishwajit
- e School of International Development and Global Studies, University of Ottawa , Ottawa , Ontario , Canada
| | - Sanni Yaya
- e School of International Development and Global Studies, University of Ottawa , Ottawa , Ontario , Canada
| | | | - Charles S Wiysonge
- a Cochrane South Africa, South African Medical Research Council , Cape Town , South Africa.,b Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health , Faculty of Medicine and Health Sciences, Stellenbosch University , Cape Town , South Africa.,g Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town , Cape Town , South Africa
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Jagesur L, Maharaj R, Haridutt A, Abbai N, Ndwandwe D, Ramjee G. Introduction of a Novel Monitoring Tool to Reduce Specimen Archive Errors. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5485.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lakshmi Jagesur
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Rashika Maharaj
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Avika Haridutt
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Nathlee Abbai
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Duduzile Ndwandwe
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
| | - Gita Ramjee
- Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
- London School of Hygiene & Tropical Medicine, Epidemiology and Population Health, London, United Kingdom
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Affiliation(s)
- Valerie Mizrahi
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Digby Warner
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
| | - Duduzile Ndwandwe
- Centre of Excellence for Biomedical TB ResearchUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Garth Abrahams
- Institute of Infectious Disease and Molecular MedicineUniversity of Cape TownCape TownSouth Africa
- Tuberculosis Research SectionLaboratory of CLinical Infectious DiseasesNIAIDBethesdaMD
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