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Sylvetsky AC, Hughes SA, Kuttamperoor JT, Moore HR, Murphy J, Sacheck J, Smith ER. Mothers' Experiences During the 2022 Infant Formula Shortage in Washington D.C. Matern Child Health J 2024; 28:873-886. [PMID: 38147276 PMCID: PMC11001681 DOI: 10.1007/s10995-023-03860-9] [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] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION An unprecedented shortage of infant formula occurred in the United States (U.S.) in 2022 and posed widespread challenges to infant feeding nationwide. The purpose of this study is to investigate mothers' experiences during the 2022 infant formula shortage and its perceived impacts on infants' diet and health. METHODS Mothers (n = 45) of infants under 8 months old from Washington D.C. were invited to participate in a virtual study meeting during the summer of 2022. Mothers completed surveys regarding their demographics, infants' anthropometrics, infant feeding practices, information they have received about infant feeding, and knowledge about infant feeding practices. They then participated in a qualitative interview about their experiences during the infant formula shortage. RESULTS Overarching themes were: the shortage (1) had adverse impacts on mothers' mental and emotional health; (2) had significant financial and intangible costs; (3) led to changes in infant feeding practices; (4) social and family networks were helpful in navigating the shortage; and (5) mothers felt fortunate to have resources to breastfeed and/or obtain formula. DISCUSSION The infant formula shortage adversely impacted mothers' mental and emotional health, and was costly, in terms of financial and intangible costs. Findings demonstrate the need to develop clinical and policy approaches to support mothers in feeding their infants and provide education about safe infant feeding practices.
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Affiliation(s)
- Allison C Sylvetsky
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA.
| | - Sarah A Hughes
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Janae T Kuttamperoor
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Hailey R Moore
- Division of Psychology, Children's National Hospital, 111 Michigan Ave NW, Washington, D.C., 20010, USA
| | - Jeanne Murphy
- School of Nursing, The George Washington University, 1919 Pennsylvania Ave. NW, Washington, D.C., 20006, USA
| | - Jennifer Sacheck
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
| | - Emily R Smith
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue NW, Washington, D.C., 20052, USA
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Gwanika Y, Rice HE, Metcalf M, Espinoza P, Kajoka HD, Rice HE, Staton C, Mmbaga BT, Majaliwa E, Smith ER, Cotache-Condor C. Impact of the COVID-19 pandemic in childhood and adolescent cancer care in northern Tanzania: a cross-sectional study. BMC Cancer 2024; 24:457. [PMID: 38609910 PMCID: PMC11010397 DOI: 10.1186/s12885-024-12168-y] [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: 12/08/2023] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
INTRODUCTION The SARS-CoV-2 (COVID-19) pandemic has strained healthcare systems and presented unique challenges for children requiring cancer care, particularly in low- and middle-income countries. This study aimed to assess the impact of the COVID-19 pandemic on access to cancer care for children and adolescents in Northern Tanzania. METHODS In this cross-sectional study, we assessed the demographic and clinical characteristics of 547 pediatric and adolescent cancer patients (ages 0-19 years old) between 2016 and 2022 using the population-based Kilimanjaro Cancer Registry (KCR). We categorized data into pre-COVID-19 (2016-2019) and COVID-19 (2020-2022) eras, and performed descriptive analyses of diagnostic, treatment, and demographic information. A secondary analysis was conducted on a subset of 167 patients with stage of diagnosis at presentation. RESULTS Overall admissions nearly doubled during the pandemic (n = 190 versus 357). The variety of diagnoses attended at KCMC increased during the pandemic, with only five groups of diseases reported in 2016 to twelve groups of diseases in 2021. Most patients were diagnosed at a late stage (stage III or IV) across eras, with the proportion of under-five years old patients increasing late-diagnoses from 29.4% (before the pandemic), 52.8% (during the pandemic), when compared to the overall cohort. Around 95% of children in this age category reported late-stage diagnosis during the pandemic. Six out of the twelve cancer site groups also reported an increase in late-stage diagnosis. During the pandemic, the proportion of children receiving surgery increased from 15.8 to 30.8% (p < 0.001). CONCLUSION Childhood and adolescent cancer care changed in Northern Tanzania during the COVID-19 pandemic, with increased late-stage diagnoses presentations among younger patients and the increased use of surgical therapies in the context of a growing practice. Understanding the impact of the COVID-19 pandemic on pediatric and adolescent cancer care can help us better adapt healthcare systems and interventions to the emerging needs of children and adolescents with cancer in the midst of a health crisis.
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Affiliation(s)
- Yotham Gwanika
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Hannah E Rice
- Duke Primary Care, Population Health, Duke University, Durham, NC, USA
| | | | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Happiness D Kajoka
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Blandina T Mmbaga
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
- Kilimanjaro Christian Medical University College, Moshi, Tanzania.
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA
- Duke Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
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Zadey S, Smith ER, Staton CA, Fitzgerald TN, Vissoci JRN. Population-level surgical rates and unmet need in India: a retrospective analysis of districts and states from 2011 to 2019. Int J Surg 2024; 110:1884-1887. [PMID: 38181119 PMCID: PMC10942208 DOI: 10.1097/js9.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR)
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Department of Surgery, Duke University School of Medicine
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Department of Surgery, Duke University School of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine A. Staton
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Tamara N. Fitzgerald
- Department of Surgery, Duke University School of Medicine
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Joao Ricardo Nickenig Vissoci
- Department of Emergency Medicine, Duke University Medical Center
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Levitan B, Hadler SC, Hurst W, Izurieta HS, Smith ER, Baker NL, Bauchau V, Chandler R, Chen RT, Craig D, King J, Pitisuttithum P, Strauss W, Tomczyk S, Zafack J, Kochhar S. The Brighton collaboration standardized module for vaccine benefit-risk assessment. Vaccine 2024; 42:972-986. [PMID: 38135642 DOI: 10.1016/j.vaccine.2023.09.039] [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: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 12/24/2023]
Abstract
Vaccine Benefit-Risk (B-R) assessment consists of evaluating the benefits and risks of a vaccine and making a judgment whether the expected key benefits outweigh the potential key risks associated with its expected use. B-R supports regulatory and public health decision-making throughout the vaccine's lifecycle. In August 2021, the Brighton Collaboration's Benefit-Risk Assessment of VAccines by TechnolOgy (BRAVATO) Benefit-Risk Assessment Module working group was established to develop a standard module to support the planning, conduct and evaluation of structured B-R assessments for vaccines from different platforms, based on data from clinical trials, post-marketing studies and real-world evidence. It enables sharing of relevant information via value trees, effects tables and graphical depictions of B-R trade-offs. It is intended to support vaccine developers, funders, regulators and policy makers in high-, middle- or low-income countries to help inform decision-making and facilitate transparent communication concerning development, licensure, deployment and other lifecycle decisions.
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Affiliation(s)
| | | | | | - Hector S Izurieta
- Center for Biologics Evaluation and Research, Food and Drug Administration, USA
| | | | | | | | | | | | - Danielle Craig
- Coalition of Epidemic Preparedness Innovations, London, UK
| | | | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Thailand
| | | | - Sylvie Tomczyk
- Independent Pharmacovigilance Consultant, Cambridge, MA, USA
| | - Joseline Zafack
- Centre for Immunization Programs, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Sonali Kochhar
- University of Washington, Seattle, USA; Global Healthcare Consulting, India.
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Farooq F, Smith ER, Pan Q, Glass Baumann S, Akelo V, Jehan F, Kasaro M, Nisar I, Ouma G, Vwalika B, Spelke MB, Price JT, Hoodbhoy Z. Comparison of Masimo Total Hemoglobin SpHb® continuous non-invasive hemoglobin monitoring device with laboratory complete blood count measurement using venous sample: Protocol for an observational substudy of the Pregnancy Risk and Infant Surveillance and Measurement Alliance Maternal and Newborn Health (PRISMA MNH) study. Gates Open Res 2024; 7:50. [PMID: 37868333 PMCID: PMC10587393 DOI: 10.12688/gatesopenres.14499.1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 10/24/2023] Open
Abstract
Background The Masimo Total Hemoglobin SpHb® is a continuous and non-invasive handheld device to measure hemoglobin levels. Previous research has found that SpHb is able to accurately detect hemoglobin levels in adult patients with a similar degree of bias and standard deviation to point-of-care invasive method measurements. Generally, limited clinical evidence, lack of validation of Masimo at higher than and lower than hemoglobin threshold values, and scientific consensus supporting the use of Masimo for accurate hemoglobin testing for the diagnosis of anemia during pregnancy calls for further research. Methods and analysis The proposed prospective cohort will be nested within the ongoing Pregnancy Risk and Infant Surveillance and Measurement Alliance (PRISMA) Maternal and Newborn Health (MNH) study. Three study sites (located in Zambia, Kenya, and Pakistan) will participate and collect hemoglobin data at five time points (<20 weeks, 20 weeks, 28 weeks, 36 weeks' gestation, and six weeks postpartum). We will measure hemoglobin using a venous blood sample via hematology auto-analyzer complete blood count (gold standard) and the non-invasive device. The primary objective is to assess agreement between Masimo total hemoglobin and complete blood count and on a continuous scale using Intraclass Correlation Coefficient and Bland-Altman Analysis. The second objective is to assess agreement between the two measures on a binary scale using Positive Percentage Agreement and Negative Percentage Agreement, Cohen's Kappa, and McNemar Test. On an ordinal scale, agreement will be measured using Weighted Cohen's Kappa and Harrel's Concordance Index. Lastly, we will assess factors that might affect the accuracy of Masimo total hemoglobin using linear mixed models. Conclusions The primary aim of this study is to assess the validity of the non-invasive Masimo device compared to the gold standard method of invasive hemoglobin measurements during pregnancy and postpartum periods for the diagnosis of anemia.
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Affiliation(s)
- Fouzia Farooq
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Qing Pan
- Department of Statistics, Columbian College of Arts & Sciences, George Washington University, Washington, DC, 20052, USA
| | - Sasha Glass Baumann
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA
| | - Victor Akelo
- Centers for Disease Controls and Prevention - Kenya, Kisumu, Kenya
| | - Fyezah Jehan
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
| | - Margaret Kasaro
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Imran Nisar
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
| | - Gregory Ouma
- Centre for Global Health Research (CGHR), Kenya Medical Research Institute, Kisumu, Kenya
| | | | - M. Bridget Spelke
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, NC 27599, USA
| | - Joan T. Price
- UNC Global Projects Zambia, Lusaka, Zambia
- School of Medicine, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Zahra Hoodbhoy
- Aga Khan University Hospital, Karachi, Karachi, Sindh, Pakistan
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Smith ER, Espinoza P, Metcalf M, Ogbuoji O, Cotache-Condor C, Rice HE, Shrime MG. Modeling the global impact of reducing out-of-pocket costs for children's surgical care. PLOS Glob Public Health 2024; 4:e0002872. [PMID: 38277421 PMCID: PMC10817198 DOI: 10.1371/journal.pgph.0002872] [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] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/09/2024] [Indexed: 01/28/2024]
Abstract
Over 1.7 billion children lack access to surgical care, mostly in low- and middle-income countries (LMICs), with substantial risks of catastrophic health expenditures (CHE) and impoverishment. Increasing interest in reducing out-of-pocket (OOP) expenditures as a tool to reduce the rate of poverty is growing. However, the impact of reducing OOP expenditures on CHE remains poorly understood. The purpose of this study was to estimate the global impact of reducing OOP expenditures for pediatric surgical care on the risk of CHE within and between countries. Our goal was to estimate the impact of reducing OOP expenditures for surgical care in children for 149 countries by modeling the risk of CHE under various scale-up scenarios using publicly available World Bank data. Scenarios included reducing OOP expenditures from baseline levels to paying 70%, 50%, 30%, and 10% of OOP expenditures. We also compared the impact of these reductions across income quintiles (poorest, poor, middle, rich, richest) and differences by country income level (low-income, lower-middle-income, upper-middle-income, and high-income countries).Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal. The risk of CHE due to a surgical procedure for children was highest in low-income countries. An unexpected observation was that upper-middle income countries were at higher risk for CHE than LMICs. The most vulnerable regions were Africa and Latin America. Across all countries, the poorest quintile had the greatest risk for CHE. Increasing interest in financial protection programs to reduce OOP expenditures is growing in many areas of global health. Reducing OOP expenditures benefited people from all countries and income quintiles, although the benefits were not equal across countries, wealth groups, or even by wealth groups within countries. Understanding these complexities is critical to develop appropriate policies to minimize the risks of poverty.
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Affiliation(s)
- Emily R. Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Pamela Espinoza
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Madeline Metcalf
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Duke Center for Policy Impact in Global Health, Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Population Health, Duke School of Medicine, Durham, North Carolina, United States of America
| | - Cesia Cotache-Condor
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Henry E. Rice
- Duke Center for Global Surgery and Health Equity, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
| | - Mark G. Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Mercy Ships, Tyler, Texas, United States of America
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Rahnavard A, Chatterjee R, Wen H, Gaylord C, Mugusi S, Klatt KC, Smith ER. Molecular epidemiology of pregnancy using omics data: advances, success stories, and challenges. J Transl Med 2024; 22:106. [PMID: 38279125 PMCID: PMC10821542 DOI: 10.1186/s12967-024-04876-7] [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] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 12/26/2023] [Indexed: 01/28/2024] Open
Abstract
Multi-omics approaches have been successfully applied to investigate pregnancy and health outcomes at a molecular and genetic level in several studies. As omics technologies advance, research areas are open to study further. Here we discuss overall trends and examples of successfully using omics technologies and techniques (e.g., genomics, proteomics, metabolomics, and metagenomics) to investigate the molecular epidemiology of pregnancy. In addition, we outline omics applications and study characteristics of pregnancy for understanding fundamental biology, causal health, and physiological relationships, risk and prediction modeling, diagnostics, and correlations.
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Affiliation(s)
- Ali Rahnavard
- Computational Biology Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
| | - Ranojoy Chatterjee
- Computational Biology Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Hui Wen
- Computational Biology Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Clark Gaylord
- Computational Biology Institute, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA
| | - Sabina Mugusi
- Department of Clinical Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kevin C Klatt
- Nutritional Sciences & Toxicology, University of California, Berkeley, CA, 94720, USA
| | - Emily R Smith
- Department of Global Health, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
- Department of Exercise and Nutrition Sciences, The Milken Institute School of Public Health, The George Washington University, Washington, DC, 20052, USA.
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns by fine stratum of gestational age and birthweight for 230 679 live births in nine low- and middle-income countries, 2000-2017. BJOG 2024. [PMID: 38228570 DOI: 10.1111/1471-0528.17743] [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: 07/31/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE To describe the mortality risks by fine strata of gestational age and birthweight among 230 679 live births in nine low- and middle-income countries (LMICs) from 2000 to 2017. DESIGN Descriptive multi-country secondary data analysis. SETTING Nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Liveborn infants from 15 population-based cohorts. METHODS Subnational, population-based studies with high-quality birth outcome data were invited to join the Vulnerable Newborn Measurement Collaboration. All studies included birthweight, gestational age measured by ultrasound or last menstrual period, infant sex and neonatal survival. We defined adequate birthweight as 2500-3999 g (reference category), macrosomia as ≥4000 g, moderate low as 1500-2499 g and very low birthweight as <1500 g. We analysed fine strata classifications of preterm, term and post-term: ≥42+0 , 39+0 -41+6 (reference category), 37+0 -38+6 , 34+0 -36+6 ,34+0 -36+6 ,32+0 -33+6 , 30+0 -31+6 , 28+0 -29+6 and less than 28 weeks. MAIN OUTCOME MEASURES Median and interquartile ranges by study for neonatal mortality rates (NMR) and relative risks (RR). We also performed meta-analysis for the relative mortality risks with 95% confidence intervals (CIs) by the fine categories, stratified by regional study setting (sub-Saharan Africa and Southern Asia) and study-level NMR (≤25 versus >25 neonatal deaths per 1000 live births). RESULTS We found a dose-response relationship between lower gestational ages and birthweights with increasing neonatal mortality risks. The highest NMR and RR were among preterm babies born at <28 weeks (median NMR 359.2 per 1000 live births; RR 18.0, 95% CI 8.6-37.6) and very low birthweight (462.8 per 1000 live births; RR 43.4, 95% CI 29.5-63.9). We found no statistically significant neonatal mortality risk for macrosomia (RR 1.1, 95% CI 0.6-3.0) but a statistically significant risk for all preterm babies, post-term babies (RR 1.3, 95% CI 1.1-1.5) and babies born at 370 -386 weeks (RR 1.2, 95% CI 1.0-1.4). There were no statistically significant differences by region or underlying neonatal mortality. CONCLUSIONS In addition to tracking vulnerable newborn types, monitoring finer categories of birthweight and gestational age will allow for better understanding of the predictors, interventions and health outcomes for vulnerable newborns. It is imperative that all newborns from live births and stillbirths have an accurate recorded weight and gestational age to track maternal and neonatal health and optimise prevention and care of vulnerable newborns.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology-Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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9
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Zimmerman A, Monteiro W, Nickenig Vissoci JR, Smith ER, Rocha T, Sachett J, Wen FH, Staton C, Gerardo CJ, Ogbuoji O. Scaling up antivenom for snakebite envenoming in the Brazilian Amazon: a cost-effectiveness analysis. Lancet Reg Health Am 2024; 29:100651. [PMID: 38124996 PMCID: PMC10733094 DOI: 10.1016/j.lana.2023.100651] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
Background Snakebite envenoming (SBE) affects nearly three million people yearly, causing up to 180,000 deaths and 400,000 cases of permanent disability. Brazil's state of Amazonas is a global hotspot for SBE, with one of the highest annual incidence rates per 100,000 people, worldwide. Despite this burden, snake antivenom remains inaccessible to a large proportion of SBE victims in Amazonas. This study estimates the costs, and health and economic benefits of scaling up antivenom to community health centers (CHCs) and hospitals in the state. Methods We built a decision tree model to simulate three different antivenom scale-up scenarios: (1) scale up to 95% of hospitals, (2) scale up to 95% of CHCs, and (3) scale up to 95% of hospitals and 95% of CHCs. We consider each scenario with and without a 10% increase in demand for antivenom among SBE victims. For each scenario, we model the treatment costs averted, deaths averted, and disability-adjusted life years (DALYs) averted from a societal, health system, and patient perspective relative to the status quo and over a time horizon of one year. For each scenario and perspective, we also calculate the incremental cost per DALY averted and per death averted. We use a willingness to pay threshold equal to the 2022 gross domestic product (GDP) per capita of Brazil. Findings Scaling up antivenom to 95% of hospitals averts up to 2022 DALYs, costs up to USD $460 per DALY averted from a health system perspective, but results in net economic benefits up to USD $4.42 million from a societal perspective. Scaling up antivenom to 95% of CHCs averts up to 3179 DALYs, costs up to USD $308 per DALY averted from a health system perspective, but results in net economic benefits up to USD $7.35 million from a societal perspective. Scaling up antivenom to 95% of hospitals and CHCs averts up to 3922 DALYs, costs up to USD $328 per DALY averted from a health system perspective, but results in net economic benefits up to USD $8.98 million from a societal perspective. Interpretation All three antivenom scale up scenarios - scale up to 95% of hospitals, scale up to 95% of CHCs, and scale up to 95% of hospitals and 95% of CHCs - avert a substantial proportion of the SBE burden in Amazonas and are cost-saving from a societal perspective and cost-effective from a health system perspective. Funding W.M. and J.S. were funded by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq productivity scholarships). W.M. was funded by Fundação de Amparo à Pesquisa do Estado do Amazonas (PRÓ-ESTADO, call n. 011/2021-PCGP/FAPEAM, call n. 010/2021-CT&I ÁREAS PRIORITÁRIAS, call n. 003/2022-PRODOC/FAPEAM, POSGRAD/FAPEAM) and by the Ministry of Health, Brazil (Proposal No. 733781/19-035). Research reported in this publication was supported by the Fogarty International Center of the National Institutes of Health under Award Number R21TW011944. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Affiliation(s)
- Armand Zimmerman
- Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Wuelton Monteiro
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Diretoria de Ensino e Pesquisa, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Joao Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Emily R. Smith
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Thiago Rocha
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Jacqueline Sachett
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, Brazil
- Programa de Pós-Graduação em Enfermagem, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Fan Hui Wen
- Instituto Butantan, São Paulo, São Paulo, Brazil
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Charles J. Gerardo
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Emergency Medicine, Duke University School of Medicine, Duke University, Durham, NC, United States
| | - Osondu Ogbuoji
- Duke Global Health Institute, Duke University, Durham, NC, United States
- Department of Population Health Sciences, Duke University School of Medicine, Duke University, Durham, NC, United States
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10
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Wilkinson B, Patel KS, Smith K, Walker R, Wang C, Greene AM, Smith G, Smith ER, Gurwith M, Chen RT. A Brighton Collaboration standardized template with key considerations for a benefit/risk assessment for the Novavax COVID-19 Vaccine (NVX-CoV2373), a recombinant spike protein vaccine with Matrix-M adjuvant to prevent disease caused by SARS-CoV-2 viruses. Vaccine 2023; 41:6762-6773. [PMID: 37739888 DOI: 10.1016/j.vaccine.2023.07.040] [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] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 09/24/2023]
Abstract
Novavax, a global vaccine company, began evaluating NVX-CoV2373 in human studies in May 2020 and the pivotal placebo-controlled phase 3 studies started in November 2020; five clinical studies provided adult and adolescent clinical data for over 31,000 participants who were administered NVX-CoV2373. This extensive data has demonstrated a well-tolerated response to NVX-CoV2373 and high vaccine efficacy against mild, moderate, or severe COVID-19 using a two-dose series (Dunkle et al., 2022) [1], (Heath et al., 2021) [2], (Keech et al., 2020) [3], (Mallory et al., 2022) [4]. The most common adverse events seen after administration with NVX-CoV2373 were injection site tenderness, injection site pain, fatigue, myalgia, headache, malaise, arthralgia, nausea, or vomiting. In addition, immunogenicity against variants of interest (VOI) and variants of concern (VOC) was established with high titers of ACE2 receptor-inhibiting and neutralizing antibodies in these studies (EMA, 2022) [5], (FDA, 2023) [6]. Further studies on correlates of protection determined that titers of anti-Spike IgG and neutralizing antibodies correlated with efficacy against symptomatic COVID-19 established in clinical trials (p < 0.001 for recombinant protein vaccine and p = 0.005 for mRNA vaccines for IgG levels) (Fong et al., 2022) [7]. Administration of a booster dose of the recombinant protein vaccine approximately 6 months following the primary two-dose series resulted in substantial increases in humoral antibodies against both the prototype strain and all evaluated variants, similar to or higher than the antibody levels observed in phase 3 studies that were associated with high vaccine efficacy (Dunkle et al., 2022) [1], (Mallory et al., 2022) [4]. These findings, together with the well tolerated safety profile, support use of the recombinant protein vaccine as primary series and booster regimens.
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Affiliation(s)
| | | | | | | | | | | | | | - Emily R Smith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA.
| | - Marc Gurwith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Robert T Chen
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
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11
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Minchin J, Harris GH, Baumann S, Smith ER. Exclusion of pregnant people from emergency vaccine clinical trials: A systematic review of clinical trial protocols and reporting from 2009 to 2019. Vaccine 2023; 41:5159-5181. [PMID: 37442686 DOI: 10.1016/j.vaccine.2023.06.073] [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: 10/28/2022] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Existing ethics guidance and regulatory requirements emphasize the need for pregnancy-specific safety and efficacy data during the development of vaccines in health emergencies. Our objective was to conduct a systematic review of vaccine clinical trials during active epidemic periods. METHODS We searched for Phase II and Phase III vaccine clinical trials initiated during the H1N1 influenza, Middle East Respiratory Syndrome Coronavirus (MERS-CoV), Zika, and Ebola virus disease (EVD) outbreaks from 2009 to 2019. Data were extracted from clinical trial protocols identified in the following registries: ClinicalTrials.gov, Pan African Clinical Trial Registry (PACTR), and all primary registries indicated by the World Health Organization's International Clinical Trials Registry Platform (ICTRP). Published studies from registered clinical trials were located through PubMed. Data was extracted on eligibility criteria and pregnancy outcomes. Data from this study is available in the Center for Open Science Data Repository: https://osf.io/nfk2p/?view_only=47deb3b206724af9b46c9c0c0083a267. RESULTS We identified 96 vaccine clinical trial protocols and included 84 in analysis. 5 records were excluded in screening for irrelevant abstracts, 7 were excluded in full-text assessment (1 for a therapeutic drug trial, 3 for enrolling elderly adults only, 3 for enrolling children/adolescents only). There were no eligible trials for MERS-CoV or Zika virus vaccines. Overall, 8 protocols explicitly included pregnant people; of these, 3 were completed trials with published results. Incidental pregnancies and outcomes of pregnant participants were reported in 2 studies, 10 studies reported serious adverse events related to pregnancy without mentioning total incidental pregnancies. A total of 411 recorded pregnancy outcomes were reported, with 293 from the 3 pregnancy-eligible studies with results. 71 serious adverse events pertaining to pregnancy were reported from all clinical trials with results. CONCLUSION Pregnant people are underrepresented in vaccine clinical trials conducted during outbreaks, resulting in underreporting of pregnancy-related outcomes and a lack of protection for pregnant people and neonates from infectious diseases.
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Affiliation(s)
- Jamie Minchin
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Gavin H Harris
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington D.C., USA.
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12
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Talayero MJ, Robbins CR, Smith ER, Santos-Burgoa C. The association between lead exposure and crime: A systematic review. PLOS Glob Public Health 2023; 3:e0002177. [PMID: 37527230 PMCID: PMC10393136 DOI: 10.1371/journal.pgph.0002177] [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] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
Prior research has demonstrated an association between lead exposure and criminal behavior at the population-level, however studies exploring the effect of lead exposure on criminal behavior at the individual-level have not been reviewed systematically. The intent of this study is to complete a systematic review of all studies assessing individual-level exposures to lead and the outcomes of crime and antisocial behavior traits. We included peer reviewed studies that were published prior to August 2022 and were classified as cohort, cross-sectional, or case-control. Studies measuring the outcomes of crime, delinquency, violence, or aggression were included. The following databases were searched using a standardized search strategy: ProQuest Environmental Science Database, PubMed, ToxNet and the Public Affairs Information Service (PAIS). Seventeen manuscripts met our inclusion criteria. Blood lead was measured in 12 studies, bone lead in 3 studies, and dentine lead levels in 2 studies. This systematic review identified a wide range of diverse outcomes between exposure to lead at multiple windows of development and later delinquent, criminal and antisocial behavior. A review of all potential confounding variables included within each study was made, with inclusion of relevant confounders into the risk of bias tool. There is limited data at the individual level on the effects of prenatal, childhood, and adolescent lead exposure and later criminal behavior and more evidence is necessary to evaluate the magnitude of the associations seen in this review. Our review, in conjunction with the available biological evidence, suggests that an excess risk for criminal behavior in adulthood exists when an individual is exposed to lead in utero or in the early years of childhood. The authors report no conflict of interest and no funding source. Clinical trial registration: PROSPERO ID: CRD42021268379.
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Affiliation(s)
- Maria Jose Talayero
- Department of Environmental and Occupational Health, The George Washington University, Washington, DC, United States of America
| | - C Rebecca Robbins
- Department of Environmental and Occupational Health, The George Washington University, Washington, DC, United States of America
| | - Emily R Smith
- Department of Global Health, The George Washington University, Washington, DC, United States of America
| | - Carlos Santos-Burgoa
- Department of Global Health, The George Washington University, Washington, DC, United States of America
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13
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Shetty R, Zadey S, Jindal A, Iyer H, Dubey S, Jesudian G, Smith ER, Staton CA, Fitzgerald TN, Vissoci JRN. Prioritization of surgical, obstetric, trauma, and anesthesia care in India over seven decades: A systematic analysis of policy documents. PLOS Glob Public Health 2023; 3:e0002084. [PMID: 37523346 PMCID: PMC10389714 DOI: 10.1371/journal.pgph.0002084] [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] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
Improving access to surgical care in India requires policy-level prioritization of surgical, obstetric, trauma, and anesthesia (SOTA) care. We quantified SOTA care prioritization in the last seven decades by analyzing India's national policy and programmatic documents. Forty documents of national importance over seven decades (1946-2017) were screened for a set of 52 surgical and 6 non-surgical keywords. The number of mentions per keyword was used as a proxy for surgical prioritization. For thematic analysis, surgical mentions were further classified into five domains: Infrastructure, Workforce, Service Delivery, Financing, and Information Management. The total number of mentions was 4681 for the surgical keywords and 2322 for non-surgical. The number of mentions per keyword was 90.02 for surgical keywords and 387 for non-surgical. The older committee reports showed relatively higher SOTA care prioritization compared to the years after 2010. Among the domains, Service Delivery (897) had the maximum number of mentions followed by Infrastructure (545), Workforce (516), Financing (98), and Information Management (40). National Health Policy 2017, the most recent high-level policy, grossly neglected SOTA care. SOTA care is inadequately prioritized in Indian national health policies, especially in the documents after 2010. Concerted efforts are necessary to improve the focus on financing and information management. Prioritization can be improved through a stand-alone national plan for SOTA care along with integration into existing policies.
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Affiliation(s)
- Ritika Shetty
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Terna Medical College and Hospital, Navi Mumbai, Maharashtra, India
| | - Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, India
| | - Anushka Jindal
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- King's College Hospital, Denmark Hill, London, United Kingdom
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
- Department of Surgery, Khurshitji Beharamji Bhabha Municipal General Hospital, Mumbai, Maharashtra, India
| | - Sweta Dubey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, India
| | - Gnanaraj Jesudian
- Department of EIE, Karunya University, Coimbatore, Tamil Nadu, India
- Association of Rural Surgeons of India/International Federation of Rural Surgeons-Rural Surgery Research and Training Center, Shanthi Bhavan Medical Center, Jharkhand, India
| | - Emily R Smith
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Catherine A Staton
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Tamara N Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, United States of America
- Global Emergency Medicine Innovation and Implementation (GEMINI) Research Center, Duke University, Durham, North Carolina, United States of America
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America
- Duke Global Health Institute, Durham, North Carolina, United States of America
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14
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Abubakari SW, Workneh F, Asante KP, Hemler EC, Madzorera I, Wang D, Ismail A, Assefa N, Azemraw T, Lankoande B, Nuhu AR, Chukwu A, Mapendo F, Millogo O, Olufemi AA, Okpara D, Boudo V, Mwanyika-Sando M, Berhane Y, Baernighausen T, Oduola A, Vuai S, Sie A, Soura A, Killewo J, Tajudeen R, Fawzi WW, Smith ER. Determinants of COVID-19 vaccine readiness and hesitancy among adults in sub-Saharan Africa. PLOS Glob Public Health 2023; 3:e0000713. [PMID: 37450441 PMCID: PMC10348558 DOI: 10.1371/journal.pgph.0000713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 02/08/2023] [Indexed: 07/18/2023]
Abstract
There is very limited data on the extent and determinants of COVID-19 vaccine hesitancy among adults living in sub-Saharan Africa since the global roll-out of vaccines began in 2021. This multi-country survey sought to investigate COVID-19 vaccine hesitancy and other predictors of readiness to get vaccinated. We conducted surveys among adults residing in nine urban and rural areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania in late 2021. Log binomial regression models were used to identify prevalence and factors associated with vaccine hesitancy and beliefs around COVID-19 misinformation. We completed a total of 2,833 interviews. Among all respondents, 9% had never heard of a COVID-19 vaccine, 12% had been vaccinated, and 20% knew someone else who had been vaccinated. The prevalence of vaccine hesitancy varied by country (Ethiopia 29%, Burkina Faso 33%, Nigeria 34%, Ghana 42%, Tanzania 65%), but not by rural or urban context. People who did not think the vaccine was safe or effective, or who were unsure about it, were more likely to be vaccine hesitant. Those who reported they did not have a trusted source of information about the vaccine (aPR: 1.25, 95% CI: 1.18,1.31) and those who thought the vaccine would not be made available to them within the year were more likely to be vaccine hesitant. Women were more likely to be vaccine hesitant (aPR: 1.31, 95% CI: 1.19,1.43) and believe COVID-19 falsehoods (aPR: 1.05, 95% CI: 1.02,1.08). The most commonly believed falsehoods were that the vaccine was developed too fast and that there was not enough information about whether the vaccine was effective or not. Educational campaigns targeted at misinformation and tailored to suit each country are recommended to build trust in COVID-19 vaccines and reduce hesitancy.
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Affiliation(s)
- Sulemana Watara Abubakari
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Firehiwot Workneh
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Kwaku Poku Asante
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Elena C. Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Dongqing Wang
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Temesgen Azemraw
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Bruno Lankoande
- Institut Superieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abdul Razak Nuhu
- Research and Development Division, Kintampo Health Research Centre, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | - Adedokun A. Olufemi
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Daniel Okpara
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | | | | | - Yemane Berhane
- Department of Epidemiology and Biostatistics, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Abdramane Soura
- Institut Superieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raji Tajudeen
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
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15
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Zadey S, Iyer H, Nayan A, Shetty R, Sonal S, Smith ER, Staton CA, Fitzgerald TN, Nickenig Vissoci JR. Evaluating the status of the Lancet Commission on Global Surgery indicators for India. Lancet Reg Health Southeast Asia 2023; 13:100178. [PMID: 37383563 PMCID: PMC10306037 DOI: 10.1016/j.lansea.2023.100178] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/03/2023] [Accepted: 03/02/2023] [Indexed: 06/30/2023]
Abstract
For universal surgical, obstetric, trauma, and anesthesia care by 2030, the Lancet Commission on Global Surgery (LCoGS) suggested tracking six indicators. We reviewed academic and policy literature to investigate the current state of LCoGS indicators in India. There was limited primary data for access to timely essential surgery, risk of impoverishing and catastrophic health expenditures due to surgery, though some modeled estimates are present. Surgical specialist workforce estimates are heterogeneous across different levels of care, urban and rural areas, and diverse health sectors. Surgical volumes differ widely across demographic, socio-economic, and geographic cohorts. Perioperative mortality rates vary across procedures, diagnoses, and follow-up time periods. Available data suggest India falls short of achieving global targets. This review highlights the evidence gap for India's surgical care planning. India needs a systematic subnational mapping of indicators and adaptation of targets as per the country's health needs for equitable and sustainable planning.
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Affiliation(s)
- Siddhesh Zadey
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
- Dr. D.Y. Patil Medical College, Hospital, and Research Centre, Pune, Maharashtra, 411018, India
| | - Himanshu Iyer
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
| | - Anveshi Nayan
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, 400012, India
| | - Ritika Shetty
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Terna Medical College and Hospital, Navi Mumbai, Maharashtra, 400706, India
| | - Swati Sonal
- Association for Socially Applicable Research (ASAR), Pune, Maharashtra, 411007, India
- Division of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Department of Surgery, Harvard Medical School, Boston, MA, 02114, USA
| | - Emily R. Smith
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
| | - Catherine A. Staton
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
| | - Tamara N. Fitzgerald
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
| | - Joao Ricardo Nickenig Vissoci
- Department of Surgery, Duke University School of Medicine, Durham, NC, 27707, USA
- Global Emergency Medicine Innovation and Implementation Research Center, Duke University, Durham, NC, 27710, USA
- Duke Global Health Institute, Durham, NC, 27710, USA
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, 27707, USA
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Majaliwa E, Smith ER, Cotache-Condor C, Rice H, Gwanika Y, Canick J, Chao N, Schroeder K, Rice HE, Staton C, Mmbaga BT. Childhood and Adolescent Cancer Care at a Tertiary Hospital in Northern Tanzania: A Retrospective Study. JCO Glob Oncol 2023; 9:e2200263. [PMID: 37384861 PMCID: PMC10497254 DOI: 10.1200/go.22.00263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 07/01/2023] Open
Abstract
PURPOSE Over 400,000 children are diagnosed with cancer around the world each year, with over 80% of these children residing in low- and middle-income countries. This study aims to summarize the epidemiology and care patterns of newly diagnosed childhood cancer patients in Northern Tanzania. METHODS Data from all children and adolescents (age 0-19 years) with newly diagnosed cancers were collected from the Kilimanjaro Cancer Registry located at the Kilimanjaro Christian Medical Centre. Descriptive and inferential analyses were used to compare the demographic and clinical characteristics of the participants over time, stage, and status at last contact. Statistical significance was set at P < .05. Secondary descriptive analysis was conducted on a subset sample with available staging data. RESULTS A total of 417 patients were diagnosed with cancer between 2016 and 2021. There was an increase in the rate of patients with newly diagnosed pediatric cancer each year, particularly among children under age 5 years and 10 years. Leukemias and lymphomas were the leading diagnoses and accounted for 183 (43.8%) of all patients. Over 75% of patients were diagnosed at stage III or above. From a subset analysis of patients with available staging data (n = 101), chemotherapy was the most common treatment (87.1%), compared with radiotherapy and surgery. CONCLUSION There is a significant burden of children with cancer in Tanzania. Our study fills crucial gaps in the literature related to the large burden of disease and survival for children with cancer in the Kilimanjaro region. Furthermore, our results can be used to understand the regional needs and guide research and strategic interventions to improve childhood cancer survival in Northern Tanzania.
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Affiliation(s)
- Esther Majaliwa
- Pediatric Hematology and Oncology Services, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Emily R. Smith
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Hannah Rice
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yotham Gwanika
- Kilimanjaro Cancer Registry, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Julia Canick
- Duke Global Health Institute, Duke University, Durham, NC
| | - Nelson Chao
- Department of Medicine, Duke University Medical Center, Durham, NC
| | - Kristin Schroeder
- Department of Oncology, Bugando Medical Centre, Mwanza, Tanzania
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Henry E. Rice
- Duke Global Health Institute, Duke University, Durham, NC
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Catherine Staton
- Department of Emergency Medicine, Duke University Medical Center, Durham, NC
- Duke Global Health Institute, Duke University, Durham, NC
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Ciulei MA, Smith ER, Perumal N, Jakazi CS, Sudfeld CR, Gernand AD. Nutritious Supplemental Foods for Pregnant Women from Food Insecure Settings: Types, Nutritional Composition, and Relationships to Health Outcomes. Curr Dev Nutr 2023; 7:100094. [PMID: 37250388 PMCID: PMC10209485 DOI: 10.1016/j.cdnut.2023.100094] [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: 02/22/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
There is growing evidence that the provision of nutritious supplemental foods to undernourished pregnant women can improve maternal and infant outcomes. However, comparing and synthesizing the evidence base is complicated by differences in interventions and products and the use of ambiguous terminology. We aimed to define 2 common types of nutritious supplemental foods used in pregnancy, balanced energy-protein (BEP) supplements and lipid-based nutrient supplements (LNS), and to review the evidence supporting each via a narrative review of systematic reviews and meta-analyses (SRMAs). Information about the nutritional composition of the food supplements and their effects on maternal and infant outcomes was abstracted. Five SRMAs (n = 20 trials) evaluated the effect of BEP compared with no BEP/control (comparison group commonly received iron and folic acid [IFA]). BEP foods/products ranged in calories (118-1017 kcals), protein (3-50 g), fat (6-57 g), and micronutrient content. Overall, maternal BEP improved birth weight and reduced the risk of stillbirth and small for gestational age when compared with no BEP/control in pregnancy. Three SRMAs (n = 5 trials) evaluated the effect of LNS compared with IFA or multiple micronutrients (MMNs). The LNS interventions comprised small- and large-quantity LNS that ranged in calories (118-746 kcals), protein (3-21 g), fat (10-53 g), and micronutrient content. LNS compared with IFA increased pregnancy duration, birth weight, and birth length and reduced the risk of small for gestational age and infant stunting; however, no beneficial effect of LNS was identified when compared with MMN. Despite heterogeneity in the nutritional composition of BEP supplements, the evidence suggests that in nutritionally at-risk populations, these products may improve birth outcomes in pregnant women. The evidence is limited but promising when LNS is compared with IFA in improving maternal and infant outcomes. Overall, BEP, compared with MMN or LNS, are key areas that have not been studied and deserve attention.
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Affiliation(s)
- Mihaela A. Ciulei
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
| | - Emily R. Smith
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Exercise and Nutrition Sciences, George Washington University Milken Institute School of Public Health, Washington, DC, United States
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Nandita Perumal
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
| | - Chioniso S. Jakazi
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States
| | - Christopher R. Sudfeld
- Department of Global Health and Population, Harvard School of Public Health, Boston, MA, United States
- Department of Nutrition, Harvard School of Public Health, Boston, MA, United States
| | - Alison D. Gernand
- Department of Nutritional Sciences, the Pennsylvania State University, University Park, PA, United States
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18
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Hazel EA, Erchick DJ, Katz J, Lee ACC, Diaz M, Wu LSF, West KP, Shamim AA, Christian P, Ali H, Baqui AH, Saha SK, Ahmed S, Roy AD, Silveira MF, Buffarini R, Shapiro R, Zash R, Kolsteren P, Lachat C, Huybregts L, Roberfroid D, Zhu Z, Zeng L, Gebreyesus SH, Tesfamariam K, Adu-Afarwuah S, Dewey KG, Gyaase S, Poku-Asante K, Boamah Kaali E, Jack D, Ravilla T, Tielsch J, Taneja S, Chowdhury R, Ashorn P, Maleta K, Ashorn U, Mangani C, Mullany LC, Khatry SK, Ramokolo V, Zembe-Mkabile W, Fawzi WW, Wang D, Schmiegelow C, Minja D, Msemo OA, Lusingu JPA, Smith ER, Masanja H, Mongkolchati A, Keentupthai P, Kakuru A, Kajubi R, Semrau K, Hamer DH, Manasyan A, Pry JM, Chasekwa B, Humphrey J, Black RE. Neonatal mortality risk of vulnerable newborns: A descriptive analysis of subnational, population-based birth cohorts for 238 203 live births in low- and middle-income settings from 2000 to 2017. BJOG 2023. [PMID: 37156238 DOI: 10.1111/1471-0528.17518] [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: 01/10/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low- and middle-income countries (LMICs). DESIGN Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. SETTING Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. POPULATION Live birth neonates. METHODS We categorically defined five vulnerable newborn types based on size (large- or appropriate- or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. MAIN OUTCOME MEASURES Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. RESULTS There were 238 203 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.6, interquartile range [IQR] 2.0-2.9), PT + LGA (median RR 7.3, IQR 2.3-10.4), PT + AGA (median RR 6.0, IQR 4.4-13.2) and PT + SGA (median RR 10.4, IQR 8.6-13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. CONCLUSIONS Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.
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Affiliation(s)
- Elizabeth A Hazel
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel J Erchick
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanne Katz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Anne C C Lee
- Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Diaz
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lee S F Wu
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Keith P West
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Parul Christian
- Department of International Health, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasmot Ali
- JiVitA Maternal and Child Health Research Project, Rangpur, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | | | | | - Mariângela F Silveira
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Romina Buffarini
- Post-Graduate Program in Epidemiology - Federal University of Pelotas, Pelotas, Brazil
| | - Roger Shapiro
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rebecca Zash
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Patrick Kolsteren
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Carl Lachat
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
| | - Lieven Huybregts
- Department of Food Technology, Safety and Health, Ghent University, Ghent, Belgium
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, District of Columbia, USA
| | - Dominique Roberfroid
- Namur University, Namur, Belgium
- Belgian Health Care Knowledge Centre, Brussels, Belgium
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
| | - Seifu H Gebreyesus
- Department of Nutrition and Dietetics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Kokeb Tesfamariam
- Department of Food Technology, Safety, and Health, Faculty of Bioscience Engineering, Ghent University, Ghent, Belgium
| | - Seth Adu-Afarwuah
- Department of Nutrition and Food Science, University of Ghana, Accra, Ghana
| | - Kathryn G Dewey
- Department of Nutrition, Institute for Global Nutrition, University of California, Davis, California, USA
| | | | | | - Ellen Boamah Kaali
- Kintampo Health Research Centre, Kintampo, Ghana
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Darby Jack
- Columbia University's Mailman School of Public Health, New York, New York, USA
| | | | - James Tielsch
- George Washington University Milken Institute School of Public Health, Washington, District of Columbia, USA
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Ranadip Chowdhury
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Per Ashorn
- Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Kenneth Maleta
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Charles Mangani
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Luke C Mullany
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Vundli Ramokolo
- HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Gertrude H Sergievsky Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Wanga Zembe-Mkabile
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- South African Research Chair in Social Policy at College Graduate of Studies, University of South Africa, Pretoria, South Africa
| | - Wafaie W Fawzi
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, Virginia, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel Minja
- National Institute of Medical Research, Tanga, Tanzania
| | | | | | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
| | | | | | - Paniya Keentupthai
- College of Medicine and Public Health, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | - Abel Kakuru
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Richard Kajubi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Katherine Semrau
- Ariadne Labs, Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Albert Manasyan
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jake M Pry
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia
| | - Bernard Chasekwa
- Zvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe
| | - Jean Humphrey
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Robert E Black
- International Health Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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19
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Smith ER, Kapoor P, Concepcion T, Ramirez T, Mohamed M, Dahir S, Cotache-Condor C, Adan Ismail E, Rice HE, Shrime MG. Does reducing out-of-pocket costs for children's surgical care protect families from poverty in Somaliland? A cross-sectional, national, economic evaluation modelling study. BMJ Open 2023; 13:e069572. [PMID: 37130683 PMCID: PMC10163539 DOI: 10.1136/bmjopen-2022-069572] [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] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES An estimated 1.7 billion children around the world do not have access to safe, affordable and timely surgical care, with the financing through out-of-pocket (OOP) expenses being one of the main barriers to care. Our study modelled the impact of reducing OOP costs related to surgical care for children in Somaliland on the risk of catastrophic expenditures and impoverishment. DESIGN AND SETTING This cross-sectional nationwide economic evaluation modelled several different approaches to reduction of paediatric OOP surgical costs in Somaliland. PARTICIPANTS AND OUTCOME MEASURES A surgical record review of all procedures on children up to 15 years old was conducted at 15 surgically capable hospitals. We modelled two rates of OOP cost reduction (reduction of OOP proportion from 70% to 50% and from 70% to 30% reduction in OOP costs) across five wealth quintiles (poorest, poor, neutral, rich, richest) and two geographical areas (urban and rural). The outcome measures of the study are catastrophic expenditures and risk of impoverishment due to surgery. We followed the Consolidated Health Economic Evaluation Reporting Standards. RESULTS We found that the risk of catastrophic and impoverishing expenditures related to OOP expenditures for paediatric surgery is high across Somaliland, but most notable in the rural areas and among the poorest quintiles. Reducing OOP expenses for surgical care to 30% would protect families in the richest wealth quintiles while minimally affecting the risk of catastrophic expenditure and impoverishment for those in the lowest wealth quintiles, particularly those in rural areas. CONCLUSION Our models suggest that the poorest communities in Somaliland lack protection against the risk of catastrophic health expenditure and impoverishment, even if OOP payments are reduced to 30% of surgical costs. A comprehensive financial protection in addition to reduction of OOP costs is required to prevent risk of impoverishment in these communities.
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Affiliation(s)
- Emily R Smith
- Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Pranav Kapoor
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - Tessa Concepcion
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Treasure Ramirez
- Department of Economics, Hanmaker School of Business, Baylor University, Waco, Texas, USA
| | - Mubarak Mohamed
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Shukri Dahir
- Department of Surgery, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Edna Adan Ismail
- Founder and Director, Edna Adan University Hospital, Hargeisa, Somaliland
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mark G Shrime
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Mercy Ships, Tyler, Texas, USA
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20
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Rahman MR, Shen L, Ewen JP, Collard B, Heyes DM, Dini D, Smith ER. Non-equilibrium molecular simulations of thin film rupture. J Chem Phys 2023; 158:2882242. [PMID: 37093990 DOI: 10.1063/5.0149974] [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] [Received: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/26/2023] Open
Abstract
The retraction of thin films, as described by the Taylor-Culick (TC) theory, is subject to widespread debate, particularly for films at the nanoscale. We use non-equilibrium molecular dynamics simulations to explore the validity of the assumptions used in continuum models by tracking the evolution of holes in a film. By deriving a new mathematical form for the surface shape and considering a locally varying surface tension at the front of the retracting film, we reconcile the original theory with our simulation to recover a corrected TC speed valid at the nanoscale.
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Affiliation(s)
- Muhammad Rizwanur Rahman
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Li Shen
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - James P Ewen
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Benjamin Collard
- Department of Materials Science, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - D M Heyes
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - Daniele Dini
- Department of Mechanical Engineering, Imperial College London, South Kensington Campus, London SW7 2AZ, United Kingdom
| | - E R Smith
- Department of Mechanical and Aerospace Engineering, Brunel University London, Uxbridge UB8 3PH, United Kingdom
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21
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Wang D, Adedokun OA, Millogo O, Madzorera I, Hemler EC, Workneh F, Mapendo F, Lankoande B, Ismail A, Chukwu A, Assefa N, Abubakari SW, Lyatuu I, Okpara D, Abdullahi YY, Zabre P, Vuai S, Soura AB, Smith ER, Sie A, Oduola AMJ, Killewo J, Berhane Y, Baernighausen T, Asante KP, Raji T, Mwanyika-Sando M, Fawzi WW. The Continued Impacts of the COVID-19 Pandemic on Education and Mental Health Among Sub-Saharan African Adolescents. J Adolesc Health 2023; 72:535-543. [PMID: 36635187 PMCID: PMC9701646 DOI: 10.1016/j.jadohealth.2022.11.012] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the potential factors that may exacerbate these adverse impacts. METHODS A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected information on adolescents' sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of education and mental health outcomes. RESULTS Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence interval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41). DISCUSSION The COVID-19 pandemic presents continued challenges to adolescents' education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemic.
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Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia.
| | | | | | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Elena C Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Isaac Lyatuu
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Daniel Okpara
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | | | - Pascal Zabre
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C.; Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Tajudeen Raji
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
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22
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Cotache-Condor C, Rice HE, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Delays in cancer care for children in low-income and middle-income countries: development of a composite vulnerability index. Lancet Glob Health 2023; 11:e505-e515. [PMID: 36925171 PMCID: PMC10938288 DOI: 10.1016/s2214-109x(23)00053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/28/2022] [Accepted: 01/20/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Early access to diagnosis and care is essential to improve rates of survival from childhood cancer, particularly in low-income and middle-income countries (LMICs). Composite indices are increasingly used to compare country performance in many health fields. We aimed to develop a composite vulnerability index of risk of mortality associated with delays in care for childhood cancer in LMICs, and to compare the vulnerability index scores across countries. METHODS The composite vulnerability index was built in ten steps. A previous systematic review of determinants of delays in cancer care for children guided data selection. We collected exposure variables (determinants of delays in care) and outcome variables (childhood cancer-related mortality) from several large datasets. Data were analysed with regression models to identify determinants of delays in care that contribute to childhood cancer mortality. Significant indicators were aggregated into domains according to the socio-ecological model. We used geospatial tools to summarise and compare the composite vulnerability index scores across countries. FINDINGS We found that life expectancy, maternal education, fertility rate, availability of pathology services, bone marrow transplantation capacity, availability of treatment services (chemotherapy, radiotherapy, or surgery), number of pharmacists per 10 000 population, country income level, and out-of-pocket health expenditure were significantly associated with cancer mortality for children in LMICs. The highest levels of vulnerability were found in sub-Saharan Africa. INTERPRETATION Our composite vulnerability index can potentially serve as a valuable policy decision tool to help monitor country performance and guide interventions to reduce delays in care for children with cancer in LMICs. FUNDING None. TRANSLATIONS For the Chinese, Portuguese, Arabic, Spanish and Swahili translations of the abstract see Supplementary Materials section.
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Affiliation(s)
- Cesia Cotache-Condor
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | | | - Kristin Schroeder
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, NC, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, NC, USA; Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, NC, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA; Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, NC, USA; Center for Global Surgery and Health Equity, Duke University, Durham, NC, USA; Department of Emergency Medicine, Duke School of Medicine, Duke University, Durham, NC, USA.
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23
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Ademuyiwa AO, Nwomeh BC, Poenaru D, Seyi-Olajide JO, Ademuyiwa IY, Odugbemi TO, Abazie O, Ladipo-Ajayi OA, Bankole O, Elebute OA, Okusanya B, Alakaloko FM, Alabi EO, Makanjuola A, Gupta S, Tran T, Onwuka A A, Smith ER, Pius R, Harrison E, Bode CO. Picture Cards Versus Physical Examination: A Proof-of-Concept Study to Improve the SOSAS Survey Tool. J Surg Res 2023; 284:186-192. [PMID: 36580879 DOI: 10.1016/j.jss.2022.11.069] [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] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 11/17/2022] [Accepted: 11/24/2022] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The Surgeons OverSeas Assessment of Surgical Needs (SOSAS) survey tool is used to determine the unmet surgical needs in the community and has been validated in several countries. A major weakness is the absence of an objective assessment to verify patient-reported surgically treatable conditions. The goal of this study was to determine whether a picture portfolio, a tool previously shown to improve parental recognition of their child's congenital deformity, could improve the accuracy of the SOSAS tool by how it compares with physical examination. This study focused on children as many surgical conditions in them require prompt treatment but are often not promptly diagnosed. METHODS We conducted a descriptive cross-sectional community-based study to determine the prevalence of congenital and acquired surgical conditions among children and adults in a mixed rural-urban area of Lagos, Southwest Nigeria. The picture portfolio was administered only to children and the surgical conditions to be assessed were predetermined using an e-Delphi process among pediatric surgeons. The modified The Surgeons OverSeas Assessment of Surgical Needs-Nigeria Survey Tool (SOSAS-NST) was administered to household members to collect other relevant data. Data were analyzed using the REDCap analytic tool. RESULTS Eight hundred and fifty-six households were surveyed. There were 1984 adults (49.5%) and 2027 children (50.5%). Thirty-six children met the predetermined criteria for the picture portfolio-hydrocephalus (n = 1); lymphatic malformation (n = 1); umbilical hernia (n = 14); Hydrocele (n = 5); inguinal hernia (n = 10) and undescended testes (n = 5). The picture portfolio predicted all correctly except a case of undescended testis that was mistaken for a hernia. The sensitivity of the picture portfolio was therefore 35/36 or 97.2%. CONCLUSIONS The SOSAS-NST has improved on the original SOSAS tool and within the limits of the small numbers, the picture portfolio has a high accuracy in predicting diagnosis in children in lieu of physical examination.
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Affiliation(s)
- Adesoji O Ademuyiwa
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
| | | | - Dan Poenaru
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Justina O Seyi-Olajide
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iyabo Y Ademuyiwa
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tinuola O Odugbemi
- Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ogechi Abazie
- Department of Nursing, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Oluwaseun A Ladipo-Ajayi
- Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olufemi Bankole
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olumide A Elebute
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Babasola Okusanya
- Dept of Obstetrics and Gynaecology, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Lagos, Nigeria
| | - Felix M Alakaloko
- Department of Pediatric Surgery, McGill University Health Centre, Montreal, Canada
| | - Eyitayo O Alabi
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ayomide Makanjuola
- Department of Orthopaedics and Trauma, Lagos University Teaching Hospital, Lagos, Nigeria; General Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Shailvi Gupta
- Adams Cowley Shock Trauma Centre and University of Maryland Medical System, Baltimore, Maryland
| | - Tu Tran
- University of Minnesota, Minnesota
| | | | - Emily R Smith
- Department of Surgery, Duke University, Duke Global Health Institute, Durham, North Carolina
| | - Riinu Pius
- Department of Surgery, University of Edinburgh, UK
| | | | - Christopher O Bode
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria; Paediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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24
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Gomes F, Askari S, Black RE, Christian P, Dewey KG, Mwangi MN, Rana Z, Reed S, Shankar AH, Smith ER, Tumilowicz A. Antenatal multiple micronutrient supplements versus iron‐folic acid supplements and birth outcomes: Analysis by gestational age assessment method. Maternal & Child Nutrition 2023:e13509. [DOI: 10.1111/mcn.13509] [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] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/01/2023] [Accepted: 03/08/2023] [Indexed: 04/04/2023]
Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences New York City New York USA
- NOVA Medical School Universidade NOVA de Lisboa Lisboa Portugal
| | | | - Robert E. Black
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Kathryn G. Dewey
- Department of Nutrition University of California, Davis Davis California USA
| | | | - Ziaul Rana
- The New York Academy of Sciences New York City New York USA
| | - Sarah Reed
- The Bill & Melinda Gates Foundation Seattle Washington USA
| | - Anuraj H. Shankar
- Nuffield Department of Medicine University of Oxford Oxford UK
- Summit Institute for Development Mataram Indonesia
| | - Emily R. Smith
- Milken Institute School of Public Health The George Washington University Washington District of Columbia USA
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25
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Estephan L, Liu LTC, Lien CE, Smith ER, Gurwith M, Chen RT. A Brighton Collaboration standardized template with key considerations for a benefit/risk assessment for the Medigen COVID-19 protein vaccine. Vaccine 2023; 41:2615-2629. [PMID: 36925422 PMCID: PMC9981522 DOI: 10.1016/j.vaccine.2023.02.083] [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: 02/17/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023]
Abstract
The Brighton Collaboration Benefit-Risk Assessment of VAccines by TechnolOgy (BRAVATO) Working Group has prepared standardized templates to describe the key considerations for the benefit-risk assessment of several vaccine platform technologies, including protein subunit vaccines. This article uses the BRAVATO template to review the features of the MVC-COV1901 vaccine, a recombinant protein subunit vaccine based on the stabilized pre-fusion SARS-CoV-2 spike protein S-2P, adjuvanted with CpG 1018 and aluminum hydroxide, manufactured by Medigen Vaccine Biologics Corporation in Taiwan. MVC-COV1901 vaccine is indicated for active immunization to prevent COVID-19 caused by SARS-CoV-2 in individuals 12 years of age and older. The template offers details on basic vaccine information, target pathogen and population, characteristics of antigen and adjuvant, preclinical data, human safety and efficacy data, and overall benefit-risk assessment. The clinical development program began in September 2020 and based on demonstration of favorable safety and immunogenicity profiles in 11 clinical trials in over 5,000 participants, it has been approved for emergency use based on immunobridging results for adults in Taiwan, Estwatini, Somaliland, and Paraguay. The main clinical trials include placebo-controlled phase 2 studies in healthy adults (CT-COV-21), adolescents (CT-COV-22), and elderly population (CT-COV-23) as well as 3 immunobridging phase 3 trials (CT-COV-31, CT-COV-32, and CT-COV-34) in which MVC-COV1901 was compared to AZD1222. There are also clinical trials studying MVC-COV1901 as homologous and heterologous boosters (CT-COV-24 and CT-COV-25). The totality of evidence based on ∼3 million vaccinees to date includes a mostly clean safety profile, with adverse events mostly being mild and self-limiting in both clinical development and post-marketing experience, proven immunogenic response, and real-world effectiveness data. The immunogenic profile demonstrates that MVC-COV1901 induces high levels of neutralizing and binding antibodies against SARS-CoV-2. There is a dose-dependent response and a significant correlation between binding and neutralizing antibody activity. Antigen-specific T-cell responses, particularly a Th1-biased immune response characterized by high levels of interferon gamma and IL-2 cytokines, have also been observed. Coupled with this, MVC-COV1901 has favorable thermostability and better safety profiles when compared to other authorized vaccines from different platforms, which make it potentially a good candidate for vaccine supply chains in global markets.
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Affiliation(s)
| | | | - Chia En Lien
- Medigen Vaccine Biologics Corp., Taipei, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Emily R Smith
- Brighton Collaboration, A Program of the Task Force for Global Health, Decatur, GA, USA.
| | - Marc Gurwith
- Brighton Collaboration, A Program of the Task Force for Global Health, Decatur, GA, USA
| | - Robert T Chen
- Brighton Collaboration, A Program of the Task Force for Global Health, Decatur, GA, USA
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26
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Cotache-Condor C, Kantety V, Grimm A, Williamson J, Landrum KR, Schroeder K, Staton C, Majaliwa E, Tang S, Rice HE, Smith ER. Determinants of delayed childhood cancer care in low- and middle-income countries: A systematic review. Pediatr Blood Cancer 2023; 70:e30175. [PMID: 36579761 DOI: 10.1002/pbc.30175] [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: 05/24/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/30/2022]
Abstract
Early access to care is essential to improve survival rates for childhood cancer. This study evaluates the determinants of delays in childhood cancer care in low- and middle-income countries (LMICs) through a systematic review of the literature. We proposed a novel Three-Delay framework specific to childhood cancer in LMICs by summarizing 43 determinants and 24 risk factors of delayed cancer care from 95 studies. Traditional medicine, household income, lack of transportation, rural population, parental education, and travel distance influenced most domains of our framework. Our novel framework can be used as a policy tool toward improving cancer care and outcomes for children in LMICs.
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Affiliation(s)
| | - Vinootna Kantety
- Department of Public Health, Baylor University, Waco, Texas, USA
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama, USA
| | | | - Kelsey R Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Catherine Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Shenglan Tang
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Pediatric Surgery, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Division of Emergency Medicine, Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina, USA
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27
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Smith ER, Oakley E, Grandner GW, Rukundo G, Farooq F, Ferguson K, Baumann S, Adams Waldorf KM, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Bevilacqua E, Bracero N, Brandt JS, Broutet N, Carrillo J, Conry J, Cosmi E, Crispi F, Crovetto F, Del Mar Gil M, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Fernandez Buhigas I, Flaherman V, Gale C, Godwin CL, Gottlieb S, Gratacós E, He S, Hernandez O, Jones S, Joshi S, Kalafat E, Khagayi S, Knight M, Kotloff KL, Lanzone A, Laurita Longo V, Le Doare K, Lees C, Litman E, Lokken EM, Madhi SA, Magee LA, Martinez-Portilla RJ, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Sahota D, Sakowicz A, Sanin-Blair J, Stephansson O, Temmerman M, Thorson A, Thwin SS, Tippett Barr BA, Tolosa JE, Tug N, Valencia-Prado M, Visentin S, von Dadelszen P, Whitehead C, Wood M, Yang H, Zavala R, Tielsch JM. Clinical risk factors of adverse outcomes among women with COVID-19 in the pregnancy and postpartum period: a sequential, prospective meta-analysis. Am J Obstet Gynecol 2023; 228:161-177. [PMID: 36027953 PMCID: PMC9398561 DOI: 10.1016/j.ajog.2022.08.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE This sequential, prospective meta-analysis sought to identify risk factors among pregnant and postpartum women with COVID-19 for adverse outcomes related to disease severity, maternal morbidities, neonatal mortality and morbidity, and adverse birth outcomes. DATA SOURCES We prospectively invited study investigators to join the sequential, prospective meta-analysis via professional research networks beginning in March 2020. STUDY ELIGIBILITY CRITERIA Eligible studies included those recruiting at least 25 consecutive cases of COVID-19 in pregnancy within a defined catchment area. METHODS We included individual patient data from 21 participating studies. Data quality was assessed, and harmonized variables for risk factors and outcomes were constructed. Duplicate cases were removed. Pooled estimates for the absolute and relative risk of adverse outcomes comparing those with and without each risk factor were generated using a 2-stage meta-analysis. RESULTS We collected data from 33 countries and territories, including 21,977 cases of SARS-CoV-2 infection in pregnancy or postpartum. We found that women with comorbidities (preexisting diabetes mellitus, hypertension, cardiovascular disease) vs those without were at higher risk for COVID-19 severity and adverse pregnancy outcomes (fetal death, preterm birth, low birthweight). Participants with COVID-19 and HIV were 1.74 times (95% confidence interval, 1.12-2.71) more likely to be admitted to the intensive care unit. Pregnant women who were underweight before pregnancy were at higher risk of intensive care unit admission (relative risk, 5.53; 95% confidence interval, 2.27-13.44), ventilation (relative risk, 9.36; 95% confidence interval, 3.87-22.63), and pregnancy-related death (relative risk, 14.10; 95% confidence interval, 2.83-70.36). Prepregnancy obesity was also a risk factor for severe COVID-19 outcomes including intensive care unit admission (relative risk, 1.81; 95% confidence interval, 1.26-2.60), ventilation (relative risk, 2.05; 95% confidence interval, 1.20-3.51), any critical care (relative risk, 1.89; 95% confidence interval, 1.28-2.77), and pneumonia (relative risk, 1.66; 95% confidence interval, 1.18-2.33). Anemic pregnant women with COVID-19 also had increased risk of intensive care unit admission (relative risk, 1.63; 95% confidence interval, 1.25-2.11) and death (relative risk, 2.36; 95% confidence interval, 1.15-4.81). CONCLUSION We found that pregnant women with comorbidities including diabetes mellitus, hypertension, and cardiovascular disease were at increased risk for severe COVID-19-related outcomes, maternal morbidities, and adverse birth outcomes. We also identified several less commonly known risk factors, including HIV infection, prepregnancy underweight, and anemia. Although pregnant women are already considered a high-risk population, special priority for prevention and treatment should be given to pregnant women with these additional risk factors.
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Affiliation(s)
- Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC.
| | - Erin Oakley
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Gargi Wable Grandner
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Gordon Rukundo
- PeriCOVID (PREPARE)-Uganda Team, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Fouzia Farooq
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Kacey Ferguson
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Sasha Baumann
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Kristina Maria Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA
| | - Yalda Afshar
- Division of Maternal-Fetal Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Mia Ahlberg
- Division of Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Victor Akelo
- Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Grace Aldrovandi
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA
| | - Elisa Bevilacqua
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Nabal Bracero
- Department of Obstetrics and Gynecology, University of Puerto Rico School of Medicine, San Juan, PR; Puerto Rico Obstetrics and Gynecology (PROGyn)
| | - Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Natalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jorge Carrillo
- Departamento de Obstetricia y Ginecologia, Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Jeanne Conry
- International Federation of Gynecology and Obstetrics, London, United Kingdom
| | - Erich Cosmi
- Department of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy
| | - Fatima Crispi
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Francesca Crovetto
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Maria Del Mar Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain; School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Camille Delgado-López
- Surveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, PR
| | - Hema Divakar
- Asian Research & Training Institute for Skill Transfer, Bengaluru, India
| | - Amanda J Driscoll
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD
| | - Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Département Femme-Mère-Enfant, Lausanne University Hospital, Lausanne, Switzerland
| | - Irene Fernandez Buhigas
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain; School of Medicine, Universidad Francisco de Vitoria, Madrid, Spain
| | - Valerie Flaherman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Christopher Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Christine L Godwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Eduard Gratacós
- BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu Barcelona and Hospital Clínic de Barcelona, Universitat de Barcelona, and Center for Biomedical Research on Rare Diseases, Barcelona, Spain
| | - Siran He
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Olivia Hernandez
- Gynecology and Obstetrics, Félix Bulnes Hospital and RedSalud Clinic, Santiago, Chile
| | - Stephanie Jones
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheetal Joshi
- Asian Research & Training Institute for Skill Transfer, Bengaluru, India
| | - Erkan Kalafat
- Department of Obstetrics and Gynecology, School of Medicine, Koç University, Istanbul, Turkey
| | - Sammy Khagayi
- Kenya Medical Research Institute-Centre for Global Health Research, Kisumu, Kenya
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Karen L Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, MD
| | - Antonio Lanzone
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Laurita Longo
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University of Sacred Heart, Rome, Italy
| | - Kirsty Le Doare
- PeriCOVID (PREPARE)-Uganda Team, Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda; Medical Research Council /Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda; Paediatric Infectious Disease Research Group, St George's University of London, London, United Kingdom
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom
| | - Ethan Litman
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Erica M Lokken
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA; Department of Global Health, University of Washington, Seattle, WA
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Laura A Magee
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Institute of Women and Children's Health, King's College Hospital, London, United Kingdom
| | | | - Torri D Metz
- Division of Maternal-Fetal Medicine, The University of Utah Health, Salt Lake City, UT
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Deborah Money
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
| | - Sakita Moungmaithong
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, United Kingdom; George Institute for Global Health, London, United Kingdom
| | - Jean B Nachega
- Department of Epidemiology and Center for Global Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA; Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit and Department of Science and Technology/National Research Foundation, South African Research Chair Initiative in Vaccine Preventable Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland; Service of Pharmacy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong
| | - Daniel Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
| | - Lesley Regan
- International Federation of Gynecology and Obstetrics, Imperial College London, London, United Kingdom
| | - Daljit Sahota
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong
| | - Allie Sakowicz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jose Sanin-Blair
- Maternal-Fetal Unit, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Olof Stephansson
- Division of Division of Clinical Epidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Beth A Tippett Barr
- Centers for Disease Control and Prevention, Kisumu, Kenya; Nyanja Health Research Institute, Salima, Malawi
| | - Jorge E Tolosa
- Maternal-Fetal Unit, Universidad Pontificia Bolivariana, Medellín, Colombia; Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Oregon Health & Science University, Portland, OR; Department of Obstetrics and Gynecology, Maternal Fetal Medicine, St. Luke's University Health Network, Bethlehem, PA
| | - Niyazi Tug
- Department of Obstetrics and Gynecology, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Miguel Valencia-Prado
- Division of Children with Special Medical Needs, Puerto Rico Department of Health, San Juan, PR
| | - Silvia Visentin
- Department of Women's and Children's Health, Obstetrics and Gynecology Clinic, University of Padua, Padua, Italy
| | - Peter von Dadelszen
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, United Kingdom; Global Health Institute, King's College London, London, United Kingdom
| | - Clare Whitehead
- Department of Maternal Fetal Medicine, University of Melbourne, Royal Women's Hospital, Melbourne, Australia
| | - Mollie Wood
- Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Huixia Yang
- Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, China
| | - Rebecca Zavala
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - James M Tielsch
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC
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Smith ER, Oakley E, Grandner GW, Ferguson K, Farooq F, Afshar Y, Ahlberg M, Ahmadzia H, Akelo V, Aldrovandi G, Tippett Barr BA, Bevilacqua E, Brandt JS, Broutet N, Fernández Buhigas I, Carrillo J, Clifton R, Conry J, Cosmi E, Crispi F, Crovetto F, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Flaherman VJ, Gale C, Gil MM, Gottlieb SL, Gratacós E, Hernandez O, Jones S, Kalafat E, Khagayi S, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Madhi SA, Magee LA, Martinez-Portilla RJ, McClure EM, Metz TD, Miller ES, Money D, Moungmaithong S, Mullins E, Nachega JB, Nunes MC, Onyango D, Panchaud A, Poon LC, Raiten D, Regan L, Rukundo G, Sahota D, Sakowicz A, Sanin-Blair J, Söderling J, Stephansson O, Temmerman M, Thorson A, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Adams Waldorf K, Whitehead C, Yassa M, Tielsch JM. Adverse maternal, fetal, and newborn outcomes among pregnant women with SARS-CoV-2 infection: an individual participant data meta-analysis. BMJ Glob Health 2023; 8:e009495. [PMID: 36646475 PMCID: PMC9895919 DOI: 10.1136/bmjgh-2022-009495] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/24/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Despite a growing body of research on the risks of SARS-CoV-2 infection during pregnancy, there is continued controversy given heterogeneity in the quality and design of published studies. METHODS We screened ongoing studies in our sequential, prospective meta-analysis. We pooled individual participant data to estimate the absolute and relative risk (RR) of adverse outcomes among pregnant women with SARS-CoV-2 infection, compared with confirmed negative pregnancies. We evaluated the risk of bias using a modified Newcastle-Ottawa Scale. RESULTS We screened 137 studies and included 12 studies in 12 countries involving 13 136 pregnant women.Pregnant women with SARS-CoV-2 infection-as compared with uninfected pregnant women-were at significantly increased risk of maternal mortality (10 studies; n=1490; RR 7.68, 95% CI 1.70 to 34.61); admission to intensive care unit (8 studies; n=6660; RR 3.81, 95% CI 2.03 to 7.17); receiving mechanical ventilation (7 studies; n=4887; RR 15.23, 95% CI 4.32 to 53.71); receiving any critical care (7 studies; n=4735; RR 5.48, 95% CI 2.57 to 11.72); and being diagnosed with pneumonia (6 studies; n=4573; RR 23.46, 95% CI 3.03 to 181.39) and thromboembolic disease (8 studies; n=5146; RR 5.50, 95% CI 1.12 to 27.12).Neonates born to women with SARS-CoV-2 infection were more likely to be admitted to a neonatal care unit after birth (7 studies; n=7637; RR 1.86, 95% CI 1.12 to 3.08); be born preterm (7 studies; n=6233; RR 1.71, 95% CI 1.28 to 2.29) or moderately preterm (7 studies; n=6071; RR 2.92, 95% CI 1.88 to 4.54); and to be born low birth weight (12 studies; n=11 930; RR 1.19, 95% CI 1.02 to 1.40). Infection was not linked to stillbirth. Studies were generally at low or moderate risk of bias. CONCLUSIONS This analysis indicates that SARS-CoV-2 infection at any time during pregnancy increases the risk of maternal death, severe maternal morbidities and neonatal morbidity, but not stillbirth or intrauterine growth restriction. As more data become available, we will update these findings per the published protocol.
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Affiliation(s)
- Emily R Smith
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Erin Oakley
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Gargi Wable Grandner
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Kacey Ferguson
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Fouzia Farooq
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yalda Afshar
- Division of Maternal Fetal Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Mia Ahlberg
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Victor Akelo
- Office of the Director, US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Grace Aldrovandi
- Department of Pediatrics, University of California Los Angeles, Los Angeles, California, USA
| | - Beth A Tippett Barr
- Office of the Director, US Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Elisa Bevilacqua
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Justin S Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Nathalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | | | - Jorge Carrillo
- Departamento de Obstetricia y Ginecologia, Universidad del Desarrollo Facultad de Medicina Clinica Alemana, Santiago, Chile
| | - Rebecca Clifton
- The Biostatistics Center, The George Washington University Milken Institute School of Public Health, Rockville, Maryland, USA
| | - Jeanne Conry
- International Federation of Gynecology and Obstetrics, London, UK
| | - Erich Cosmi
- Department of Women's and Children's Health, University of Padua, Padova, Italy
| | - Fatima Crispi
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Francesca Crovetto
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Camille Delgado-López
- Surveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Hema Divakar
- Asian Research and Training Institute for Skill Transfer (ARTIST), Bengaluru, India
| | - Amanda J Driscoll
- Center for Vaccine Development, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Guillaume Favre
- Materno-Fetal and Obstetrics Research Unit, Department ‘Femme-Mère-Enfant’, Lausanne University Hospital, Lausanne, Switzerland
| | - Valerie J Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London Faculty of Medicine, London, UK
| | - Maria M Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Sami L Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Eduard Gratacós
- Department of Maternal-Fetal Medicine, BCNatal, Barcelona Center for Maternal-Fetal and Neonatal Medicine, Hospital Sant Joan de Déu and Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Olivia Hernandez
- Gynecology and Obstetrics, Felix Bulnes Hospital and RedSalud Clinic, Santiago, Chile
| | - Stephanie Jones
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Erkan Kalafat
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Istanbul, Turkey
| | - Sammy Khagayi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Marian Knight
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Karen Kotloff
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Antonio Lanzone
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Roma, Italy
| | - Kirsty Le Doare
- Uganda Virus Institute and the London School of Hygiene & Tropical Medicine, Entebbe, Uganda,Pediatric Infectious Diseases Research Group, St George's University of London, London, UK
| | - Christoph Lees
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Ethan Litman
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Erica M Lokken
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Valentina Laurita Longo
- Institute of Obstetrics and Gynecology Clinic, Catholic University of Sacred Heart, Rome, Italy
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Laura A Magee
- Department of Women and Children’s Health, School of Life Course and Population Sciences, King's College London, London, UK
| | | | | | - Tori D Metz
- Departments of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake, Utah, USA
| | - Emily S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Deborah Money
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sakita Moungmaithong
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Edward Mullins
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jean B Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Marta C Nunes
- South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | | | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Liona C Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Daniel Raiten
- Pediatric Growth and Nutrition Branch, National Institute of Health, Bethesda, Maryland, USA
| | - Lesley Regan
- International Federation of Gynecology and Obstetrics, London, UK
| | - Gordon Rukundo
- Uganda Virus Institute and the London School of Hygiene & Tropical Medicine, Entebbe, Uganda
| | - Daljit Sahota
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Allie Sakowicz
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jose Sanin-Blair
- Universidad Pontificia Bolivariana, Medellin, Antioquia, Colombia
| | - Jonas Söderling
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Olof Stephansson
- Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Jorge E Tolosa
- Department of Obstetrics and Gynecology, St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Miguel Valencia-Prado
- Children with Special Medical Needs Division, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Silvia Visentin
- Department of Women's and Children's Health, University of Padua, Padova, Italy
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - Kristina Adams Waldorf
- Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington, USA
| | - Clare Whitehead
- Department of Maternal-Fetal Medicine, The Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Jim M Tielsch
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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29
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Beck TP, Tupetz A, Farias AS, Silva-Neto A, Rocha T, Smith ER, Murta F, Dourado FS, Cardoso D, Ramos TA, Sachett A, Pinto TS, Pucca MB, Sampaio V, Ramos F, Vissoci JN, Sachett J, Wen FH, Staton CA, Gerardo CJ, Monteiro W. Mapping of clinical management resources for snakebites and other animal envenomings in the Brazilian Amazon. Toxicon X 2022; 16:100137. [PMID: 36160931 PMCID: PMC9489497 DOI: 10.1016/j.toxcx.2022.100137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Snakebite envenomings (SBEs) and other envenomings triggered by venomous animals (VAEs) represent a significant disease burden in Brazil, with 29,152 SBEs reported in 2021 alone with nearly half of those occurring in the remote Brazilian Amazon. In 2021, Brazil recorded 240,294 envenomings from snakes, scorpions, spiders, and caterpillars. Therefore, there is an unequal distribution of SBEs with high morbidity and mortality in the Brazilian Amazon. The severity of SBEs increases when patients require more than 6 h to access antivenom treatment, a common issue for the rural and indigenous populations. Understanding currently available resources and practices in Amazon remote areas of Brazil can serve to inform future interventions and guide health care policies. This study aims to develop a resource map of existing healthcare resources for the Brazilian Amazon's clinical management of VAEs with emphasis in SBEs, which will aid future strategic interventions. Data collection included a literature review, secondary data collected by government departments and organizational records, GIS mapping activities, and expert input. Our framework was guided by the three levels of healthcare service ecosystem analysis (macro, meso, and micro). Our resource map lays out a comprehensive overview of antivenom access, the distribution landscape, differences in patient transportation, and barriers to access healthcare that face populations in the Brazilian Amazon. In Brazil, there are financial, cultural, and logistical barriers to access antivenom. Despite antivenom manufacturing on a national scale, antivenom treatment is limited in rural areas. Indigenous and riverine populations are the most vulnerable to being deprived of proper treatment. We present a framework guided by the macro, meso, and micro levels of healthcare service. Antivenom treatment decentralization should be a priority of the health system in the Brazilian Amazon.
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Affiliation(s)
- Timothy P. Beck
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Anna Tupetz
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Altair Seabra Farias
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Alexandre Silva-Neto
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Rocha
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Emily R. Smith
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Felipe Murta
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | | | - Deugles Cardoso
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - Tatyana A. Ramos
- Zoonosis Department, Fundação de Vigilância Em Saúde Dra. Rosemary Costa Pinto, Manaus, Brazil
| | - André Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Thiago Serrão Pinto
- School of Pharmaceutical Sciences, Universidade Federal Do Amazonas, Manaus, Brazil
| | | | - Vanderson Sampaio
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
| | - Flavia Ramos
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - João Nickenig Vissoci
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Jacqueline Sachett
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Department of Teaching and Research, Fundação Alfredo da Matta, Manaus, Brazil
| | - Fan Hui Wen
- Butantan Institute, São Paulo, São Paulo, Brazil
| | - Catherine A. Staton
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Charles J. Gerardo
- Department of Emergency Medicine, Department of Surgery, Durham, NC, 27710, USA
- Duke Global Health Institute, Duke University, Durham, NC, 27710, USA
| | - Wuelton Monteiro
- School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil
- Department of Teaching and Research, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazil
- Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil
- Corresponding author. School of Health Sciences, Universidade Do Estado Do Amazonas, Manaus, Brazil.
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30
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Smith ER, Curtin WM, Yeagle KP, Carkaci-Salli N, Ural SH. Mesenchymal Stem Cell Identification After Delayed Cord Clamping. Reprod Sci 2022; 30:1565-1571. [PMID: 36443591 DOI: 10.1007/s43032-022-01129-0] [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: 06/22/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022]
Abstract
We sought to determine the feasibility of identifying and quantifying mesenchymal stem cells (MSCs) from umbilical cord blood (UCB) after delayed cord clamping in preterm and term births. We obtained 3 mL of UCB at various gestational ages after delayed cord clamping. UCB separated by density gradient centrifugation within 4 h of delivery was passed through magnetic bead micro-columns to exclude the CD34 + cell population. The samples were incubated with fluorescent-tagged mesenchymal cell marker antibodies CD 29, CD44, CD73, CD105, and hematopoietic cell marker CD45. The cell populations were analyzed by flow cytometry. Viable cells were assessed with 7-aminoactinomycin-D. The results were expressed in median (minimum to maximum) MSCs and compared between preterm and term samples. A total of 12 UCB samples (32-40 weeks) were obtained, 10 of which demonstrated MSCs, accounting for 0.0174% (0-14.7%) of the viable UCB mononuclear cells. MSCs comprised 0.148% (0.0006-1.59%) and 0.116% (0-14.7%) of the viable UCB mononuclear cells in the term (n = 5), 38.4 ± 1.3 weeks, and preterm (n = 7) samples, 34.6 ± 1.1, respectively, p = 0.17. There was an overall median of 96 (0-39,574) MSCs. There was no difference in the median numbers of MSCs identified between term and preterm UCB samples, 3384 (23-6042) and 36 (0-39,574), respectively, p = 0.12. Mesenchymal stem cells were identified and quantified in 5 of 7 preterm and all 5 term UCB 3-mL samples obtained after delayed cord clamping.
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Affiliation(s)
- Emily R Smith
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Penn State College of Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
- Current Affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - William M Curtin
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Penn State College of Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA.
- Department of Pathology and Laboratory Medicine, Penn State Health, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
| | - Kevin P Yeagle
- Department of Obstetrics, Penn State College of Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Serdar H Ural
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Penn State College of Medicine, Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
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Zadey S, Sonal S, Iyer H, Baxy H, Smith ER, Staton CA, Fitzgerald TN, Nickenig Vissoci JR. Roadblocks and solutions to planning surgical care for a billion Indians. BMJ Glob Health 2022; 7:bmjgh-2022-010292. [DOI: 10.1136/bmjgh-2022-010292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
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Wang D, Chukwu A, Mwanyika-Sando M, Abubakari SW, Assefa N, Madzorera I, Hemler EC, Ismail A, Lankoande B, Mapendo F, Millogo O, Workneh F, Azemraw T, Febir LG, James C, Tinkasimile A, Asante KP, Baernighausen T, Berhane Y, Killewo J, Oduola AMJ, Sie A, Smith ER, Soura AB, Raji T, Vuai S, Fawzi WW. COVID-19 vaccine hesitancy and its determinants among sub-Saharan African adolescents. PLOS Glob Public Health 2022; 2:e0000611. [PMID: 36962540 PMCID: PMC10022111 DOI: 10.1371/journal.pgph.0000611] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
COVID-19 vaccine hesitancy among adolescents poses a challenge to the global effort to control the pandemic. This multi-country survey aimed to assess the prevalence and determinants of COVID-19 vaccine hesitancy among adolescents in sub-Saharan Africa between July and December 2021. The survey was conducted using computer-assisted telephone interviewing among adolescents in five sub-Saharan African countries, Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. A rural area and an urban area were included in each country (except Ghana, which only had a rural area), with approximately 300 adolescents in each area and 2662 in total. Sociodemographic characteristics and perceptions and attitudes on COVID-19 vaccines were measured. Vaccine hesitancy was defined as definitely not getting vaccinated or being undecided on whether to get vaccinated if a COVID-19 vaccine were available. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations between potential determinants and COVID-19 vaccine hesitancy. The percentage of COVID-19 vaccine hesitancy was 14% in rural Kersa, 23% in rural Ibadan, 31% in rural Nouna, 32% in urban Ouagadougou, 37% in urban Addis Ababa, 48% in rural Kintampo, 65% in urban Lagos, 76% in urban Dar es Salaam, and 88% in rural Dodoma. Perceived low necessity, concerns about vaccine safety, and concerns about vaccine effectiveness were the leading reasons for hesitancy. Healthcare workers, parents or family members, and schoolteachers had the greatest impacts on vaccine willingness. Perceived lack of safety (aPR: 3.52; 95% CI: 3.00, 4.13) and lack of effectiveness (aPR: 3.46; 95% CI: 2.97, 4.03) were associated with greater vaccine hesitancy. The prevalence of COVID-19 vaccine hesitancy among adolescents is alarmingly high across the five sub-Saharan African countries, especially in Tanzania. COVID-19 vaccination campaigns among sub-Saharan African adolescents should address their concerns and misconceptions about vaccine safety and effectiveness.
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Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | | | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Elena C. Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | | | | | - Temesgen Azemraw
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Christabel James
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | | | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo North Municipality, Bono East Region, Ghana
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoade M. J. Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Emily R. Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Tajudeen Raji
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Landrum KR, Hall BJ, Smith ER, Flores W, Lou-Meda R, Rice HE. Challenges with pediatric surgical financing and universal health coverage in Guatemala: A qualitative analysis. PLOS Glob Public Health 2022; 2:e0000220. [PMID: 36962482 PMCID: PMC10021280 DOI: 10.1371/journal.pgph.0000220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 08/21/2022] [Indexed: 06/18/2023]
Abstract
The financing of surgical care for children in low- and middle-income countries (LMICs) remains challenging and may restrict adherence to universal health coverage (UHC) frameworks. Our aims were to describe Guatemala's national pediatric surgical financing structure, to identify financing challenges, and to develop recommendations to improve the financing of surgical care for children. We conducted a qualitative study of the financing of surgical care for children in Guatemala's public health system with key informant interviews (n = 20) with experts in the medical, financial, and political health sectors. We used this data to generate recommendations to improve surgical care financing for children. We identified several systemic challenges to the financing of surgical care for children, including passive purchasing structures, complex political contexts, health system fragmentation, widespread use of informal fees for surgical services, and lack of earmarked funding for surgical care. Patient and provider challenges include lack of provider input in non-personnel funding decisions, and patients functioning as both financing agents and beneficiaries in the same financing stream. Key recommendations include reducing health finance system fragmentation through resource pooling, increasing earmarked funding for surgical care with quantifiable outcome measures, engagement with clinical providers in non-personnel budgetary decision-making, and use of innovative financing instruments such as resource pooling. Surgical financing for children in Guatemala requires substantial remodeling to increase access to timely, affordable, and safe surgical care and improve alignment with Guatemala's UHC scheme.
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Affiliation(s)
- Kelsey R. Landrum
- Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Bria J. Hall
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Emily R. Smith
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, United States of America
| | - Walter Flores
- Centro De Estudios Para La Equidad y Gobernanza En Los Sistema De Salud, Guatemala City, Guatemala
| | - Randall Lou-Meda
- Department of Pediatrics, Roosevelt Hospital, Guatemala City, Guatemala
| | - Henry E. Rice
- Duke Global Health Institute, Durham, North Carolina, United States of America
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, United States of America
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Leav B, Straus W, White P, Leav A, Gaines T, Maggiacomo G, Kim D, Smith ER, Gurwith M, Chen RT. A Brighton Collaboration standardized template with key considerations for a benefit/risk assessment for the Moderna COVID-19 Vaccine (mRNA-1273). Vaccine 2022; 40:5275-5293. [PMID: 35753841 PMCID: PMC9181264 DOI: 10.1016/j.vaccine.2022.06.005] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 06/02/2022] [Indexed: 11/01/2022]
Abstract
The Brighton Collaboration Benefit-Risk Assessment of VAccines by TechnolOgy (BRAVATO) Working Group has prepared standardized templates to describe the key considerations for the benefit-risk assessment of several vaccine platform technologies, including nucleic acid (RNA and DNA) vaccines. This paper uses the BRAVATO template to review the features of a vaccine employing a proprietary mRNA vaccine platform to develop Moderna COVID-19 Vaccine (mRNA-1273); a highly effective vaccine to prevent coronavirus disease 2019 (Covid-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In response to the pandemic the first in human studies began in March 2020 and the pivotal, placebo-controlled phase 3 efficacy study in over 30,000 adults began in July 2020. Based on demonstration of efficacy and safety at the time of interim analysis in November 2020 and at the time of trial unblinding in March 2021, the mRNA-1273 received Emergency Use Authorization in December 2020 and full FDA approval in January 2022.
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Affiliation(s)
| | | | | | | | | | | | - Denny Kim
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Emily R Smith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA.
| | - Marc Gurwith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Robert T Chen
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
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Folegatti PM, Jenkin D, Morris S, Gilbert S, Kim D, Robertson JS, Smith ER, Martin E, Gurwith M, Chen RT. Vaccines based on the replication-deficient simian adenoviral vector ChAdOx1: Standardized template with key considerations for a risk/benefit assessment. Vaccine 2022; 40:5248-5262. [PMID: 35715352 PMCID: PMC9194875 DOI: 10.1016/j.vaccine.2022.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Received: 01/19/2022] [Revised: 05/10/2022] [Accepted: 06/02/2022] [Indexed: 02/07/2023]
Abstract
Replication-deficient adenoviral vectors have been under investigation as a platform technology for vaccine development for several years and have recently been successfully deployed as an effective COVID-19 counter measure. A replication-deficient adenoviral vector based on the simian adenovirus type Y25 and named ChAdOx1 has been evaluated in several clinical trials since 2012. The Brighton Collaboration Benefit-Risk Assessment of VAccines by TechnolOgy (BRAVATO) was formed to evaluate the safety and other key features of new platform technology vaccines. This manuscript reviews key features of the ChAdOx1-vectored vaccines. The simian adenovirus Y25 was chosen as a strategy to circumvent pre-existing immunity to common human adenovirus serotypes which could impair immune responses induced by adenoviral vectored vaccines. Deletion of the E1 gene renders the ChAdOx1 vector replication incompetent and further genetic engineering of the E3 and E4 genes allows for increased insertional capability and optimizes vaccine manufacturing processes. ChAdOx1 vectored vaccines can be manufactured in E1 complementing cell lines at scale and are thermostable. The first ChAdOx1 vectored vaccines approved for human use, against SARS-CoV-2, received emergency use authorization in the UK on 30th December 2020, and is now approved in more than 180 countries. Safety data were compiled from phase I-III clinical trials of ChAdOx1 vectored vaccines expressing different antigens (influenza, tuberculosis, malaria, meningococcal B, prostate cancer, MERS-CoV, Chikungunya, Zika and SARS-CoV-2), conducted by the University of Oxford, as well as post marketing surveillance data for the COVID-19 Oxford-AstraZeneca vaccine. Overall, ChAdOx1 vectored vaccines have been well tolerated. Very rarely, thrombosis with thrombocytopenia syndrome (TTS), capillary leak syndrome (CLS), immune thrombocytopenia (ITP), and Guillain-Barre syndrome (GBS) have been reported following mass administration of the COVID-19 Oxford-AstraZeneca vaccine. The benefits of this COVID-19 vaccination have outweighed the risks of serious adverse events in most settings, especially with mitigation of risks when possible. Extensive immunogenicity clinical evaluation of ChAdOx1 vectored vaccines reveal strong, durable humoral and cellular immune responses to date; studies to refine the COVID-19 protection (e.g., via homologous/heterologous booster, fractional dose) are also underway. New prophylactic and therapeutic vaccines based on the ChAdOx1 vector are currently undergoing pre-clinical and clinical assessment, including vaccines against viral hemorrhagic fevers, Nipah virus, HIV, Hepatitis B, amongst others.
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Affiliation(s)
| | | | | | | | - Denny Kim
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - James S. Robertson
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Emily R. Smith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA,Corresponding author
| | - Emalee Martin
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Marc Gurwith
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
| | - Robert T. Chen
- Brighton Collaboration, a program of the Task Force for Global Health, Decatur, GA, USA
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Yang WC, Fogel A, Lauria ME, Ferguson K, Smith ER. Fast Feed Advancement for Preterm and Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188645. [PMID: 35921676 DOI: 10.1542/peds.2022-057092g] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Fast feed advancement may reduce hospital stay and infection but may increase adverse outcomes in preterm and low birth weight infants. The objective of this study was to assess effects of fast feed advancement (≥30 ml/kg per day) compared with slow feed advancement (<30 ml/kg per day) in preterm and low birth weight infants. METHODS Data sources include Medline, Scopus, Web of Science, CINAHL, and Index Medicus through June 30, 2021. Randomized trials were selected. Primary outcomes were mortality, morbidity, growth, and neurodevelopment. Data were extracted and pooled using random-effects models. The Cochrane Risk of Bias 2 tool was used. RESULTS A total of 12 RCTs with 4291 participants were included. At discharge, there was moderate certainty evidence that fast advancement likely slightly reduces the risk of: mortality (relative risk [RR] 0.93, 95% confidence interval [95% CI] 0.73 to 1.18, I2 = 18%, 11 trials, 4132 participants); necrotizing enterocolitis (RR 0.89, 95% CI 0.68 to 1.15, I2 = 0%, 12 trials, 4291 participants); sepsis (RR 0.92, 95% CI 0.83 to 1.03, I2 = 0%, 9 trials, 3648 participants); and feed intolerance (RR 0.92, 95% CI 0.77 to 1.10, I2 = 0%, 8 trials, 1114 participants). Fast feed advancement may also reduce the risk of apnea (RR 0.72, 95% CI 0.47 to 1.12, I2 = 0%, low certainty, 2 trials, 153 participants). Fast feed advancement decreases time to regain birth weight (mean difference [MD] -3.69 days, 95% CI -4.44 to -2.95, I2 = 70%, high certainty, 6 trials, 993 participants,) and likely reduces the duration of hospitalization (MD -3.08 days, 95% CI -4.34 to -1.81, I2 = 77%, moderate certainty, 7 trials, 3864 participants). Limitations include heterogeneity between studies and small sample sizes. CONCLUSIONS Fast feed advancement reduces time to regain birth weight and likely reduces the length of hospital stay; it also likely reduces the risk of neonatal morbidity and mortality slightly. However, it may increase the risk of neurodevelopmental disability slightly. More studies are needed to understand the long-term effects of fast feed advancement.
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Affiliation(s)
- Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | | | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia.,ICF, Rockville, Maryland
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
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Talej M, Smith ER, Lauria ME, Chitale R, Ferguson K, He S. Responsive Feeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188648. [PMID: 35921679 DOI: 10.1542/peds.2022-057092f] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Responsive feeding may improve health outcomes in preterm and low birth weight (LBW) infants. Our objective was to assess effects of responsive compared with scheduled feeding in preterm and LBW infants. METHODS Data sources include PubMed, Scopus, Web of Science, CINAHL, LILACS, and MEDICUS. Randomized trials were screened. Primary outcomes were mortality, morbidity, growth, neurodevelopment. Secondary outcomes were feed intolerance and duration of hospitalization. Data were extracted and pooled with random-effects models. RESULTS Eleven eligible studies were identified, and data from 8 randomized control trials with 455 participants were pooled in the meta-analyses. At discharge, the mean difference in body weight between the intervention (responsive feeding) and comparison (scheduled feeding) was -2.80 g per day (95% CI -3.39 to -2.22, I2 = 0%, low certainty evidence, 4 trials, 213 participants); -0.99 g/kg per day (95% CI -2.45 to 0.46, I2 = 74%, very low certainty evidence, 5 trials, 372 participants); -22.21 g (95% CI -130.63 to 86.21, I2 = 41%, low certainty evidence, 3 trials, 183 participants). The mean difference in duration of hospitalization was -1.42 days (95% CI -5.43 to 2.59, I2 = 88%, very low certainty evidence, 5 trials, 342 participants). There were no trials assessing other growth outcomes (eg, length and head circumference) mortality, morbidity or neurodevelopment. Limitations include a high risk of bias, heterogeneity, and small sample size in included studies. CONCLUSIONS Overall, responsive feeding may decrease in-hospital weight gain. Although the evidence is very uncertain, responsive feeding may slightly decrease the duration of hospitalization. Evidence was insufficient to understand the effects of responsive compared with scheduled feeding on mortality, morbidity, linear growth, and neurodevelopmental outcomes in preterm and LBW infants.
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Affiliation(s)
- Megan Talej
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia.,ICF International, Rockville, Maryland
| | - Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, the George Washington University, Washington, District of Columbia
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Yang WC, Lauria ME, Fogel A, Ferguson K, Smith ER. Duration of Exclusive Breastfeeding for Preterm or Low Birth Weight Infants: A Systematic Review and Meta-analysis. Pediatrics 2022; 150:188638. [PMID: 35921669 DOI: 10.1542/peds.2022-057092h] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cessation of exclusive breastfeeding (EBF) with early introduction of complementary food provides additional calories for catch-up growth but may also increase the risk of adverse outcomes. The objective of this study was to assess effects of exclusive breastfeeding for less than 6 months compared with 6 months in preterm and low birth weight infants. METHODS Data sources include Medline, Scopus, Web of Science, CINAHL, and Index Medicus through June 30, 2021. Study selection includes randomized trials and observational studies. Primary outcomes were mortality, morbidity, growth, and neurodevelopment. Data were extracted and pooled using random-effects models. The Cochrane Risk of Bias 2 tool was used to assess the risk of bias of included studies. RESULTS A total of 2 studies of 307 preterm or low birth weight infants were included. None of the study results could be pooled. Both studies compared EBF for 4 months to 6 months. Growth was similar between the 4-month and 6-month EBF groups for the following outcomes: weight-for-age z-score at corrected age 12 months (mean [standard deviation], 4-month group: -1.7 [1.1], 6-month group: -1.8 [1.2], 1 study, 188 participants, low certainty evidence), absolute weight gain (gram) from 16 to 26 weeks of age (4-month group: 1004 [366], 6-month group: 1017 [350], 1 study, 119 participants, very low certainty evidence), and linear growth gain (cm) from 16 to 26 weeks of age (4-month group: 4.3 [0.9], 6-month group: 4.5 [1.2], 1 study, 119 participants, very low certainty evidence). There were no apparent differences in reported morbidity symptoms. No difference in the timing to achieve motor development milestones between the 2 groups was found (1 study; 119 participants, very low certainty evidence). A limited number of studies prevented data pooling. CONCLUSIONS The evidence is very uncertain about the effect of exclusive breastfeeding for less than 6 months for preterm and low birth weight infants. Further studies are warranted to better answer this question.
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Affiliation(s)
- Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - Molly E Lauria
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia.,ICF, Rockville, Maryland
| | | | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, District of Columbia
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Bruell S, Nicholls KM, Hewitson TD, Talbot AS, Holt SG, Smith ER, Ruderman I. Reduced hip bone mineral density is associated with high levels of calciprotein particles in patients with Fabry disease. Osteoporos Int 2022; 33:1783-1794. [PMID: 35575807 PMCID: PMC9499881 DOI: 10.1007/s00198-022-06420-z] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 05/03/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED Calciprotein particles (CPP) are nanoscale mineralo-protein aggregates that help stabilize excess mineral in the circulation. We examined the relationship between CPP and bone mineral density in Fabry disease patients. We found an inverse correlation with total hip and femoral neck density, but none with lumbar spine. PURPOSE Calciprotein particles (CPP) are colloidal mineral-protein complexes made up primarily of the circulating glycoprotein fetuin-A, calcium, and phosphate. They form in extracellular fluid and facilitate the stabilization, transport, and clearance of excess minerals from the circulation. While most are monomers, they also exist in larger primary (CPP-I) and secondary (CPP-II) form, both of which are reported to be raised in pathological states. This study sought to investigate CPP levels in the serum of patients with Fabry disease, an X-linked systemic lysosomal storage disorder that is associated with generalized inflammation and low bone mineral density (BMD). METHODS We compared serum CPP-I and CPP-II levels in 59 patients with Fabry disease (37 female) with levels in an age-matched healthy adult cohort (n=28) and evaluated their association with BMD and biochemical data obtained from routine clinical review. RESULTS CPP-I and CPP-II levels were higher in male Fabry disease patients than female sufferers as well as their corresponding sex- and age-matched controls. CPP-II levels were inversely correlated with BMD at the total hip and femoral neck, but not the lumbar spine. Regression analyses revealed that these associations were independent of common determinants of BMD, but at the femoral neck, a significant association was only found in female patients. CONCLUSION Low hip BMD was associated with high CPP-II in patients with Fabry disease, but further work is needed to investigate the relevance of sex-related differences and to establish whether CPP measurement may aid assessment of bone disease in this setting.
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Affiliation(s)
- S Bruell
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
| | - K M Nicholls
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - T D Hewitson
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia
| | - A S Talbot
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
| | - S G Holt
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia
- SEHA Kidney Care, Abu Dhabi Health Services Company, Abu Dhabi, United Arab Emirates
- Khalifa University, Abu Dhabi, United Arab Emirates
| | - E R Smith
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia.
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia.
- Kincaid-Smith Renal Laboratories, Department of Nephrology, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, 3052, Australia.
| | - I Ruderman
- Department of Nephrology, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine (RMH), University of Melbourne, Parkville, Australia
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Chitale R, Ferguson K, Talej M, Yang WC, He S, Edmond KM, Smith ER. Early Enteral Feeding for Preterm or Low Birth Weight Infants: a Systematic Review and Meta-analysis. Pediatrics 2022; 150:188642. [PMID: 35921673 DOI: 10.1542/peds.2022-057092e] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Early enteral feeding has been associated with adverse outcomes such as necrotizing enterocolitis in preterm and low birth weight infants. OBJECTIVES To assess effects of early enteral feeding initiation within the first days after birth compared to delayed initiation. DATA SOURCES Medline, Scopus, Web of Science, CINAHL from inception to June 30, 2021. STUDY SELECTION Randomized trials (RCTs) were included. Primary outcomes were mortality, morbidity, growth, neurodevelopment, feed intolerance, and duration of hospitalization. DATA EXTRACTION Data were extracted and pooled with random-effects models. RESULTS We included 14 randomized controlled trials with 1505 participants in our primary analysis comparing early (<72 hours) to delayed (≥72 hours) enteral feeding initiation. Early initiation likely decreased mortality at discharge and 28 days (1292 participants, 12 trials, relative risk 0.69, 95% confidence interval [95% CI] 0.48-0.99, moderate certainty evidence) and duration of hospitalization (1100 participants, 10 trials, mean difference -3.20 days, 95%CI -5.74 to -0.66, moderate certainty evidence). The intervention may also decrease sepsis and weight at discharge. Based on low certainty evidence, early feeding may have little to no effect on necrotizing enterocolitis, feed intolerance, and days to regain birth weight. The evidence is very uncertain regarding the effect of initiation time on intraventricular hemorrhage, length, and head circumference at discharge. CONCLUSIONS Enteral feeding within 72 hours after birth likely reduces the risk of mortality and length of hospital stay, may reduce the risk of sepsis, and may reduce weight at discharge.
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Affiliation(s)
- Ramaa Chitale
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Kacey Ferguson
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Megan Talej
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Wen-Chien Yang
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Siran He
- The George Washington University, Milken Institute School of Public Health, Washington, DC
| | - Karen M Edmond
- World Health Organization, Department of Maternal, Child, Adolescent Health and Aging, Geneva, Switzerland
| | - Emily R Smith
- The George Washington University, Milken Institute School of Public Health, Washington, DC
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Vigliotti VS, Concepcion T, Mohamed M, Dahir S, Ismail EA, Poenaru D, Rice HE, Smith ER. Modeling the Scale-up of Surgical Services for Children with Surgically Treatable Congenital Conditions in Somaliland. World J Surg 2022; 46:2489-2497. [PMID: 35838776 DOI: 10.1007/s00268-022-06651-5] [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] [Accepted: 06/12/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Congenital conditions comprise a significant portion of the global burden of surgical conditions in children. In Somaliland, over 250,000 children do not receive required surgical care annually, although the estimated costs and benefits of scale-up of children's surgical services to address this disease burden is not known. METHODS We developed a Markov model using a decision tree template to project the costs and benefits of scale-up of surgical care for children across Somaliland. We used a proxy set of congenital anomalies across Somaliland to estimate scale-up costs using three different scale-up rates. The cost-effectiveness ratio and net societal monetary benefit were estimated using these models, supported by disability weights in existing literature. RESULTS Overall, we found that scale-up of surgical services at an aggressive rate (22.5%) over a 10-year time horizon is cost effective. Although the scale-up of surgical care for most conditions in the proxy set was cost effective, scale-up of hydrocephalus and spina bifida are not as cost effective as other conditions. CONCLUSIONS Our analysis concludes that it is cost effective to scale-up surgical services for congenital anomalies for children in Somaliland.
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Affiliation(s)
| | | | | | - Shugri Dahir
- Edna Adan University Hospital, Hargeisa, Somaliland
| | | | | | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, NC, USA. .,Duke Department of Surgery, Duke University School of Medicine, Durham, USA.
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Smith ER, Oakley E, He S, Zavala R, Ferguson K, Miller L, Grandner GW, Abejirinde IOO, Afshar Y, Ahmadzia H, Aldrovandi G, Akelo V, Tippett Barr BA, Bevilacqua E, Brandt JS, Broutet N, Fernández Buhigas I, Carrillo J, Clifton R, Conry J, Cosmi E, Delgado-López C, Divakar H, Driscoll AJ, Favre G, Flaherman V, Gale C, Gil MM, Godwin C, Gottlieb S, Hernandez Bellolio O, Kara E, Khagayi S, Kim CR, Knight M, Kotloff K, Lanzone A, Le Doare K, Lees C, Litman E, Lokken EM, Laurita Longo V, Magee LA, Martinez-Portilla RJ, McClure E, Metz TD, Money D, Mullins E, Nachega JB, Panchaud A, Playle R, Poon LC, Raiten D, Regan L, Rukundo G, Sanin-Blair J, Temmerman M, Thorson A, Thwin S, Tolosa JE, Townson J, Valencia-Prado M, Visentin S, von Dadelszen P, Adams Waldorf K, Whitehead C, Yang H, Thorlund K, Tielsch JM. Protocol for a sequential, prospective meta-analysis to describe coronavirus disease 2019 (COVID-19) in the pregnancy and postpartum periods. PLoS One 2022; 17:e0270150. [PMID: 35709239 PMCID: PMC9202913 DOI: 10.1371/journal.pone.0270150] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022] Open
Abstract
We urgently need answers to basic epidemiological questions regarding SARS-CoV-2 infection in pregnant and postpartum women and its effect on their newborns. While many national registries, health facilities, and research groups are collecting relevant data, we need a collaborative and methodologically rigorous approach to better combine these data and address knowledge gaps, especially those related to rare outcomes. We propose that using a sequential, prospective meta-analysis (PMA) is the best approach to generate data for policy- and practice-oriented guidelines. As the pandemic evolves, additional studies identified retrospectively by the steering committee or through living systematic reviews will be invited to participate in this PMA. Investigators can contribute to the PMA by either submitting individual patient data or running standardized code to generate aggregate data estimates. For the primary analysis, we will pool data using two-stage meta-analysis methods. The meta-analyses will be updated as additional data accrue in each contributing study and as additional studies meet study-specific time or data accrual thresholds for sharing. At the time of publication, investigators of 25 studies, including more than 76,000 pregnancies, in 41 countries had agreed to share data for this analysis. Among the included studies, 12 have a contemporaneous comparison group of pregnancies without COVID-19, and four studies include a comparison group of non-pregnant women of reproductive age with COVID-19. Protocols and updates will be maintained publicly. Results will be shared with key stakeholders, including the World Health Organization (WHO) Maternal, Newborn, Child, and Adolescent Health (MNCAH) Research Working Group. Data contributors will share results with local stakeholders. Scientific publications will be published in open-access journals on an ongoing basis.
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Affiliation(s)
- Emily R. Smith
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Erin Oakley
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Siran He
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Rebecca Zavala
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Kacey Ferguson
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Lior Miller
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | - Gargi Wable Grandner
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
| | | | - Yalda Afshar
- Division of Maternal Fetal Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Homa Ahmadzia
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Grace Aldrovandi
- Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Victor Akelo
- US Centers for Disease Control and Prevention, Kisumu, Kenya
| | | | - Elisa Bevilacqua
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Justin S. Brandt
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States of America
| | - Natalie Broutet
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Irene Fernández Buhigas
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Jorge Carrillo
- Departmento de Obstetricia y Ginecologia, Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Rebecca Clifton
- Biostatistics Center, The George Washington University, Washington, DC, United States of America
| | - Jeanne Conry
- OBGYN, The International Federation of Gynecology and Obstetrics, London, United Kingdom
| | - Erich Cosmi
- Department of Woman’s and Child’s Health, Obstetrics and Gynecologic Clinic, University of Padua, Padua, Italy
| | - Camille Delgado-López
- Surveillance for Emerging Threats to Mothers and Babies, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Hema Divakar
- Asian Research and Training Institute for Skill Transfer (ARTIST), Bengaluru, India
| | - Amanda J. Driscoll
- Center for Vaccine Development and Global Health, University of Maryland, School of Medicine, Baltimore, MD, United States of America
| | - Guillaume Favre
- Materno-fetal and Obstetrics Research Unit, Department “Femme-Mère-Enfant”, University Hospital, Lausanne, Switzerland
| | - Valerie Flaherman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, United States of America
| | - Christopher Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Maria M. Gil
- Department of Obstetrics and Gynecology, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
- School of Medicine, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | - Christine Godwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Global Health Research, FHI 360, Durham, NC, United States of America
| | - Sami Gottlieb
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Edna Kara
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sammy Khagayi
- Kenya Medical Research Institute-Center for Global Health Research, Kisumu, Kenya
| | - Caron Rahn Kim
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland, School of Medicine, Baltimore, MD, United States of America
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Antonio Lanzone
- Department of Women and Child Health, Women Health Area, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Catholic University of Sacred Hearth, Rome, Italy
| | - Kirsty Le Doare
- Medical Research Council /Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Pediatric Infectious Diseases Research Group, St. George’s University of London, of London, United Kingdom
| | - Christoph Lees
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Ethan Litman
- Division of Maternal-Fetal Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C., United States of America
| | - Erica M. Lokken
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Washington, DC, United States of America
- Department of Global Health, School of Public Health, University of Washington, Washington, DC, United States of America
| | | | - Laura A. Magee
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Institute of Women and Children’s Health, King’s College Hospital, London, United Kingdom
| | - Raigam Jafet Martinez-Portilla
- Clinical Research Division, National Institute of Perinatology, Mexico City, Mexico
- ABC Medical Center, Fetal Surgery Clinic, Mexico City, Mexico
| | - Elizabeth McClure
- Division of Statistics and Epidemiology, RTI International, Chapel Hill, NC, United States of America
| | - Torri D. Metz
- University of Utah Health, Salt Lake City, UT, United States of America
| | - Deborah Money
- Department of Obstetrics and Gynecology, The University of British Columbia, Vancouver, Canada
| | - Edward Mullins
- Department of Metabolism, Digestion, and Reproduction, Imperial College London, of London, United Kingdom
| | - Jean B. Nachega
- Department of Epidemiology and Center for Global Health, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, United States of America
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Alice Panchaud
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Service of Pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Rebecca Playle
- Center for Trials Research, Cardiff University, Wales, United Kingdom
| | - Liona C. Poon
- Department of Obstetrics and Gynecology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Daniel Raiten
- Pediatric Growth and Nutrition Branch, National Institute of Health, Bethesda, MD, United States of America
| | - Lesley Regan
- Federation International Federation Gynaecology & Obstetrics, Imperial College London, London, United Kingdom
| | - Gordon Rukundo
- PeriCovid (PREPARE)–Uganda Team, Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Jose Sanin-Blair
- Maternal Fetal Unit, Universidad Pontificia Bolivariana, RECOGEST Study, Medellín, Colombia
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Anna Thorson
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soe Thwin
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Jorge E. Tolosa
- Maternal Fetal Unit, Universidad Pontificia Bolivariana, RECOGEST Study, Medellín, Colombia
- Department of Obstetrics and Gynecology, Maternal Fetal Medicine, Oregon Health and Science University, Portland, OR, United States of America
- St. Luke’s University Health Network, Department of Obstetrics & Gynecology, Maternal Fetal Medicine, Bethlehem, PA, United States of America
| | - Julia Townson
- Center for Trials Research, Cardiff University, Wales, United Kingdom
| | - Miguel Valencia-Prado
- Children with Special Medical Needs Division, Puerto Rico Department of Health, San Juan, Puerto Rico
| | - Silvia Visentin
- Department of Woman’s and Child’s Health, Obstetrics and Gynecologic Clinic, University of Padua, Padua, Italy
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, King’s College London, London, United Kingdom
- Global Health Institute, King’s College London, London, United Kingdom
| | - Kristina Adams Waldorf
- Department of Obstetrics and Gynecology, School of Medicine, University of Washington, Washington, DC, United States of America
- Department of Global Health, School of Public Health, University of Washington, Washington, DC, United States of America
| | - Clare Whitehead
- Department of Maternal Fetal Medicine, University of Melbourne, Royal Women’s Hospital, Parkville, VIC, Australia
| | - Huixia Yang
- Health Science Center, Peking University, Beijing, China
| | - Kristian Thorlund
- Department of Health Research Methods Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - James M. Tielsch
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, United States of America
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Quinn MK, Edmond KM, Fawzi WW, Hurt L, Kirkwood BR, Masanja H, Muhihi AJ, Newton S, Noor RA, Williams PL, Sudfeld CR, Smith ER. Non-specific effects of BCG and DTP vaccination on infant mortality: An analysis of birth cohorts in Ghana and Tanzania. Vaccine 2022; 40:3737-3745. [PMID: 35618557 PMCID: PMC9194613 DOI: 10.1016/j.vaccine.2022.04.082] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Vaccines may induce non-specific effects on survival and health outcomes, in addition to protection against targeted pathogens or disease. Observational evidence suggests that infant Baccillus Calmette-Guérin (BCG) vaccination may provide non-specific survival benefits, while diphtheria-tetanus-pertussis (DTP) vaccination may increase the risk of mortality. Non-specific vaccine effects have been hypothesized to modify the effect of neonatal vitamin A supplementation (NVAS) on mortality. METHODS 22,955 newborns in Ghana and 31,999 newborns in Tanzania were enrolled in two parallel, randomized, double-blind, placebo-controlled trials of neonatal vitamin A supplementation from 2010 to 2014 and followed until 1-year of age. Cox proportional hazard models were used to estimate associations of BCG and DTP vaccination with infant survival. RESULTS BCG vaccination was associated with a decreased risk of infant mortality after controlling for confounders in both countries (Ghana adjusted hazard ratio (aHR): 0.51, 95% CI: 0.38-0.68; Tanzania aHR: 0.08, 95% CI: 0.07-0.10). Receiving a DTP vaccination was associated with a decreased risk of death (Ghana aHR: 0.39, 95% CI: 0.26-0.59; Tanzania aHR: 0.19, 95% CI: 0.16-0.22). There was no evidence of interaction between BCG or DTP vaccination status and infant sex or NVAS. CONCLUSION We demonstrated that BCG and DTP vaccination were associated with decreased risk of infant mortality in Ghana and Tanzania with no evidence of interaction between DTP or BCG vaccination, NVAS, and infant sex. Our study supports global recommendations on BCG and DTP vaccination and programmatic efforts to ensure all children have access to timely vaccination. CLINICAL TRIALS REGISTRATION Ghana (Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000582055) and Tanzania (ANZCTR: ACTRN12610000636055).
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Affiliation(s)
- M K Quinn
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Karen M Edmond
- Department of Women and Children's Health, Kings College London, United Kingdom
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Betty R Kirkwood
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Sam Newton
- Kwame Nkrumah University of Science and Technology, Kumasi, Ashanti, Ghana; Kintampo Health Research Centre, Kintampo, Ghana
| | - Ramadhani A Noor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Emily R Smith
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA; Department of Exercise and Nutrition Sciences, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
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44
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Nachega JB, Sam-Agudu NA, Machekano RN, Rosenthal PJ, Schell S, de Waard L, Bekker A, Gachuno OW, Kinuthia J, Mwongeli N, Budhram S, Vannevel V, Somapillay P, Prozesky HW, Taljaard J, Parker A, Agyare E, Opoku AB, Makarfi AU, Abdullahi AM, Adirieje C, Ishoso DK, Pipo MT, Tshilanda MB, Bongo-Pasi Nswe C, Ditekemena J, Sigwadhi LN, Nyasulu PS, Hermans MP, Sekikubo M, Musoke P, Nsereko C, Agbeno EK, Yeboah MY, Umar LW, Ntakwinja M, Mukwege DM, Birindwa EK, Mushamuka SZ, Smith ER, Mills EJ, Otshudiema JO, Mbala-Kingebeni P, Tamfum JJM, Zumla A, Tsegaye A, Mteta A, Sewankambo NK, Suleman F, Adejumo P, Anderson JR, Noormahomed EV, Deckelbaum RJ, Stringer JSA, Mukalay A, Taha TE, Fowler MG, Wasserheit JN, Masekela R, Mellors JW, Siedner MJ, Myer L, Kengne AP, Yotebieng M, Mofenson LM, Langenegger E. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Pregnancy in Sub-Saharan Africa: A 6-Country Retrospective Cohort Analysis. Clin Infect Dis 2022; 75:1950-1961. [PMID: 36130257 PMCID: PMC9214158 DOI: 10.1093/cid/ciac294] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 02/05/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice. METHODS We conducted a 6-country retrospective cohort study among hospitalized women of childbearing age between 1 March 2020 and 31 March 2021. Exposures were (1) pregnancy and (2) a positive SARS-CoV-2 RT-PCR test. The primary outcome for both analyses was intensive care unit (ICU) admission. Secondary outcomes included supplemental oxygen requirement, mechanical ventilation, adverse birth outcomes, and in-hospital mortality. We used log-binomial regression to estimate the effect between pregnancy and SARS-CoV-2 infection. Factors associated with mortality were evaluated using competing-risk proportional subdistribution hazards models. RESULTS Our analyses included 1315 hospitalized women: 510 pregnant women with SARS-CoV-2, 403 nonpregnant women with SARS-CoV-2, and 402 pregnant women without SARS-CoV-2 infection. Among women with SARS-CoV-2 infection, pregnancy was associated with increased risk for ICU admission (adjusted risk ratio [aRR]: 2.38; 95% CI: 1.42-4.01), oxygen supplementation (aRR: 1.86; 95% CI: 1.44-2.42), and hazard of in-hospital death (adjusted sub-hazard ratio [aSHR]: 2.00; 95% CI: 1.08-3.70). Among pregnant women, SARS-CoV-2 infection increased the risk of ICU admission (aRR: 2.0; 95% CI: 1.20-3.35), oxygen supplementation (aRR: 1.57; 95% CI: 1.17-2.11), and hazard of in-hospital death (aSHR: 5.03; 95% CI: 1.79-14.13). CONCLUSIONS Among hospitalized women in SSA, both SARS-CoV-2 infection and pregnancy independently increased risks of ICU admission, oxygen supplementation, and death. These data support international recommendations to prioritize COVID-19 vaccination among pregnant women.
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Affiliation(s)
- Jean B Nachega
- Correspondence: J. B. Nachega, University of Pittsburgh School of Public Health, Department of Epidemiology, Infectious Diseases and Microbiology and Center for Global Health 130 DeSoto Street, A532 Crabtree Hall, Pittsburgh, PA 15261 ()
| | | | - Rhoderick N Machekano
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Philip J Rosenthal
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Sonja Schell
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liesl de Waard
- Department of Obstetrics and Gynecology, Tygerberg Teaching Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health; Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Onesmus W Gachuno
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya
| | - John Kinuthia
- Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya,Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Nancy Mwongeli
- Department of Research, Department of Reproductive Health, Kenyatta National Hospital, Nairobi, Kenya
| | - Samantha Budhram
- Department of Obstetrics and Gynecology, University of KwaZulu Natal, Durban, South Africa
| | - Valerie Vannevel
- Department of Obstetrics and Gynecology, Kalafong Hospital, University of Pretoria, Pretoria, South Africa
| | - Priya Somapillay
- Maternal Foetal Medicine; Steve Biko Hospital, University of Pretoria, Pretoria, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Elizabeth Agyare
- Department of Microbiology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Akwasi Baafuor Opoku
- Department of Obstetrics and Gynaecology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aminatu Umar Makarfi
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Asara M Abdullahi
- Department of Medicine, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chibueze Adirieje
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | - Marc B Tshilanda
- Monkole Hospital Center, Kinshasa, Democratic Republic of the Congo
| | - Christian Bongo-Pasi Nswe
- Department of Public Health, Centre Interdisciplinaire de Recherche en Ethnopharmacologie, Faculty of Medicine, Université Notre-Dame du Kasayi, Kananga, Democratic Republic of the Congo,Faculty of Public Health, Université Moderne de Kinkole, Kinshasa, Democratic Republic of the Congo
| | - John Ditekemena
- University of Kinshasa School of Medicine, Kinshasa, Democratic Republic of the Congo
| | - Lovemore Nyasha Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Michel P Hermans
- Department of Endocrinology and Nutrition, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Musa Sekikubo
- Department of Obstetrics and Gynaecology, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Philippa Musoke
- Department of Paediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Christopher Nsereko
- Department of Medicine, Entebbe Regional Reference Hospital, Entebbe, Uganda
| | - Evans K Agbeno
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Michael Yaw Yeboah
- Department of Obstetrics and Gynaecology, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal W Umar
- Department of Pediatrics, College of Health Sciences, Ahmadu Bello University and Ahmadu Bello Teaching Hospital, Zaria, Nigeria
| | - Mukanire Ntakwinja
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Denis M Mukwege
- Gynaecology and General Surgery, Panzi General Referral Hospital, Bukavu, and Université Evangelique en Afrique (UEA), Bukavu, Democratic Republic of the Congo
| | - Etienne Kajibwami Birindwa
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Serge Zigabe Mushamuka
- Hôpital Provincial Général de Référence de Bukavu and Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Edward J Mills
- Department of Health Research Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - John Otokoye Otshudiema
- Epidemiological Surveillance Team, COVID-19 Response, Health Emergencies Program, World Health Organization, Kinshasa, Democratic Republic of the Congo
| | - Placide Mbala-Kingebeni
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Jean-Jacques Muyembe Tamfum
- Department of Medical Microbiology and Virology, Faculty of Medicine, University of Kinshasa, National Institute of Biomedical Research, Kinshasa, Democratic Republic of the Congo
| | - Alimuddin Zumla
- Division of Infection and Immunity, Department of Infection, Centre for Clinical Microbiology, University College London, London, United Kingdom,National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London, United Kingdom
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alfred Mteta
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
| | - Nelson K Sewankambo
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Prisca Adejumo
- Department of Nursing, University of Ibadan, Ibadan, Nigeria
| | - Jean R Anderson
- Department of Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard J Deckelbaum
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Jeffrey S A Stringer
- Department of Obstetrics and Gynecology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, USA
| | - Abdon Mukalay
- Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Taha E Taha
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mary Glenn Fowler
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judith N Wasserheit
- Departments of Global Health and Medicine, Schools of Medicine and Public Health, University of Washington, Seattle, Washington, USA
| | - Refiloe Masekela
- Department of Pediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - John W Mellors
- Department of Medicine, Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Mark J Siedner
- Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts, USA,Mbarara University of Science and Technology, Mbarara, Uganda
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Andre-Pascal Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, New York, USA
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Geurden T, Smith ER, Vercruysse J, Yazwinski T, Rehbein S, Nielsen MK. Reflections and future directions for continued development and refinement of guidelines for anthelmintic efficacy studies. Vet Parasitol 2022; 307-308:109741. [PMID: 35667202 DOI: 10.1016/j.vetpar.2022.109741] [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: 11/25/2021] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/19/2022]
Abstract
This reflection paper complements the WAAVP (World Association for the Advancement of Veterinary Parasitology) general anthelmintic efficacy guideline, which outlines the general principles of anthelmintic efficacy evaluation across all animal host species. It provides background to the recommendations made in the WAAVP general anthelmintic efficacy guideline, with insights into the discussions leading to specific recommendations in the general guideline or the absence thereof. Furthermore, this paper discusses recent technological advancements with potential value to the evaluation of anthelmintic efficacy that may be considered for future versions of the general or species-specific guidelines if supported by sufficient levels of evidence. Finally, it also identifies potential research questions, such as the statistical approach for comparing worm counts between groups of animals.
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Affiliation(s)
| | - Emily R Smith
- Center for Veterinary Medicine, USA Food and Drug Administration, Rockville, USA
| | - Jozef Vercruysse
- Faculty of Veterinary Medicine, University of Gent, Salisburylaan 133, B-9820 Merelbeke, Belgium
| | - Tom Yazwinski
- Department of Animal Science, University of Arkansas, Fayetteville, AR, USA
| | - Steffen Rehbein
- Boehringer Ingelheim Vetmedica GmbH, Kathrinenhof Research Center, Rohrdorf, Germany
| | - Martin K Nielsen
- M.H. Gluck Equine Research Center, Department of Veterinary Science, University of Kentucky, Lexington, KY, USA
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Cotache-Condor C, Grimm A, Williamson J, Kantety V, Landrum K, Schroeder K, Staton CA, Majaliwa E, Rice HE, Smith ER. Factors contributing to delayed childhood cancer care in low- and middle-income countries: A systematic review protocol. Pediatr Blood Cancer 2022; 69:e29646. [PMID: 35253351 DOI: 10.1002/pbc.29646] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Significant disparities exist for timely access to cancer care for children, with the highest disparities in low- and middle-income countries (LMICs). This study aims to conduct a systematic review that identifies the factors contributing to delayed care of childhood cancers in LMICs. METHODS We will conduct a systematic review with search strings compliant with the PICO framework: (1) the Population-children (aged 0-18 years) from LMICs; (2) the Exposure-factors contributing to timely childhood cancer care; (3) the Outcome-delays in childhood cancer care. DISCUSSION Our study is an essential step to guide strategic interventions to assess the myriad of factors that prevent children from accessing timely cancer care in LMICs. The results will be submitted for publication in a peer-reviewed journal and shared with institutions related to the field.
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Affiliation(s)
| | - Andie Grimm
- Birmingham's Institute for Cancer Outcomes and Survivorship, University of Alabama, Birmingham, Alabama
| | | | | | - Kelsey Landrum
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Kristin Schroeder
- Division of Pediatric Oncology, Department of Pediatrics, Duke University, Durham, North Carolina.,Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Catherine A Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Esther Majaliwa
- Division of Pediatric Oncology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Henry E Rice
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
| | - Emily R Smith
- Duke Global Health Institute, Duke University, Durham, North Carolina.,Department of Surgery, Duke School of Medicine, Duke University, Durham, North Carolina
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Gomes F, Agustina R, Black RE, Christian P, Dewey KG, Kraemer K, Shankar AH, Smith ER, Thorne-Lyman A, Tumilowicz A, Bourassa MW. Multiple micronutrient supplements versus iron-folic acid supplements and maternal anemia outcomes: an iron dose analysis. Ann N Y Acad Sci 2022; 1512:114-125. [PMID: 35218047 PMCID: PMC9306935 DOI: 10.1111/nyas.14756] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/01/2021] [Indexed: 11/26/2022]
Abstract
Antenatal multiple micronutrient supplements (MMS) are more effective than iron and folic acid (IFA) supplements in reducing adverse pregnancy outcomes. Questions remain, however, about the ability of MMS to prevent anemia as effectively as IFA, especially at a lower dose of daily iron and in areas of high anemia prevalence. Analyzing data from 11 trials from a recent Cochrane review, we compared MMS to IFA, delivering either 30 or 60 mg of iron, in sustaining hemoglobin and preventing third trimester anemia and iron deficiency anemia (IDA), accounting for daily iron dose, total supplemental iron intake, and baseline prevalence of anemia. There were no differences between MMS and IFA in third trimester hemoglobin concentration or risks of anemia or IDA by iron dose or total supplemental iron consumed. MMS providing 30 mg of iron was comparable to IFA with 60 mg of iron: mean hemoglobin difference of −0.26 g/L (95% CI: −1.41 to 0.89), risk ratios of 0.99 (95% CI: 0.92–1.07) for anemia, and 1.31 (95% CI: 0.66–2.60) for IDA. Baseline prevalence of anemia did not explain heterogeneity in findings. Compared to IFA, MMS results in comparable hemoglobin concentration and protection against anemia during pregnancy, independently of iron dose.
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Affiliation(s)
- Filomena Gomes
- The New York Academy of Sciences, New York, New York.,NOVA Medical School, Lisbon, Portugal
| | - Rina Agustina
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia - Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.,Human Nutrition Research Centre, Indonesian Medical Education and Research Institute, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Robert E Black
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Parul Christian
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Klaus Kraemer
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Sight and Life Foundation, Basel, Switzerland
| | - Anuraj H Shankar
- University of Oxford, Oxford, UK.,Summit Institute for Development, Mataram, Indonesia
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Haber NA, Clarke-Deelder E, Feller A, Smith ER, Salomon JA, MacCormack-Gelles B, Stone EM, Bolster-Foucault C, Daw JR, Hatfield LA, Fry CE, Boyer CB, Ben-Michael E, Joyce CM, Linas BS, Schmid I, Au EH, Wieten SE, Jarrett B, Axfors C, Nguyen VT, Griffin BA, Bilinski A, Stuart EA. Problems with evidence assessment in COVID-19 health policy impact evaluation: a systematic review of study design and evidence strength. BMJ Open 2022; 12:e053820. [PMID: 35017250 PMCID: PMC8753111 DOI: 10.1136/bmjopen-2021-053820] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Assessing the impact of COVID-19 policy is critical for informing future policies. However, there are concerns about the overall strength of COVID-19 impact evaluation studies given the circumstances for evaluation and concerns about the publication environment. METHODS We included studies that were primarily designed to estimate the quantitative impact of one or more implemented COVID-19 policies on direct SARS-CoV-2 and COVID-19 outcomes. After searching PubMed for peer-reviewed articles published on 26 November 2020 or earlier and screening, all studies were reviewed by three reviewers first independently and then to consensus. The review tool was based on previously developed and released review guidance for COVID-19 policy impact evaluation. RESULTS After 102 articles were identified as potentially meeting inclusion criteria, we identified 36 published articles that evaluated the quantitative impact of COVID-19 policies on direct COVID-19 outcomes. Nine studies were set aside because the study design was considered inappropriate for COVID-19 policy impact evaluation (n=8 pre/post; n=1 cross-sectional), and 27 articles were given a full consensus assessment. 20/27 met criteria for graphical display of data, 5/27 for functional form, 19/27 for timing between policy implementation and impact, and only 3/27 for concurrent changes to the outcomes. Only 4/27 were rated as overall appropriate. Including the 9 studies set aside, reviewers found that only four of the 36 identified published and peer-reviewed health policy impact evaluation studies passed a set of key design checks for identifying the causal impact of policies on COVID-19 outcomes. DISCUSSION The reviewed literature directly evaluating the impact of COVID-19 policies largely failed to meet key design criteria for inference of sufficient rigour to be actionable by policy-makers. More reliable evidence review is needed to both identify and produce policy-actionable evidence, alongside the recognition that actionable evidence is often unlikely to be feasible.
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Affiliation(s)
- Noah A Haber
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Emma Clarke-Deelder
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Avi Feller
- Department of Statistics, Goldman School of Public Policy, University of California Berkeley, Berkeley, California, USA
| | - Emily R Smith
- Department of Global Health, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA
| | - Joshua A Salomon
- Department of Health Policy, Stanford University, Stanford, CA, USA
| | - Benjamin MacCormack-Gelles
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Clara Bolster-Foucault
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Jamie R Daw
- Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Laura Anne Hatfield
- Department of Biostatistics, Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie E Fry
- Department of Health Policy, Vanderbilt University, Nashville, Tennessee, USA
| | - Christopher B Boyer
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Eli Ben-Michael
- Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Caroline M Joyce
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Québec, Canada
| | - Beth S Linas
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Applied Public Health and Research, RTI International, Washington, DC, USA
| | - Ian Schmid
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Eric H Au
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah E Wieten
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Brooke Jarrett
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cathrine Axfors
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | - Van Thu Nguyen
- Meta Research Innovation Center at Stanford University (METRICS), Stanford University, Stanford, California, USA
| | | | - Alyssa Bilinski
- Interfaculty Initiative in Health Policy, Harvard University Graduate School of Arts and Sciences, Cambridge, Massachusetts, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Axfors C, Janiaud P, Schmitt AM, Van't Hooft J, Smith ER, Haber NA, Abayomi A, Abduljalil M, Abdulrahman A, Acosta-Ampudia Y, Aguilar-Guisado M, Al-Beidh F, Alejandria MM, Alfonso RN, Ali M, AlQahtani M, AlZamrooni A, Anaya JM, Ang MAC, Aomar IF, Argumanis LE, Averyanov A, Baklaushev VP, Balionis O, Benfield T, Berry S, Birocco N, Bonifacio LB, Bowen AC, Bown A, Cabello-Gutierrez C, Camacho B, Camacho-Ortiz A, Campbell-Lee S, Cao DH, Cardesa A, Carnate JM, Castillo GJJ, Cavallo R, Chowdhury FR, Chowdhury FUH, Ciccone G, Cingolani A, Climacosa FMM, Compernolle V, Cortez CFN, Costa Neto A, D'Antico S, Daly J, Danielle F, Davis JS, De Rosa FG, Denholm JT, Denkinger CM, Desmecht D, Díaz-Coronado JC, Díaz Ponce-Medrano JA, Donneau AF, Dumagay TE, Dunachie S, Dungog CC, Erinoso O, Escasa IMS, Estcourt LJ, Evans A, Evasan ALM, Fareli CJ, Fernandez-Sanchez V, Galassi C, Gallo JE, Garcia PJ, Garcia PL, Garcia JA, Garigliany M, Garza-Gonzalez E, Gauiran DTV, Gaviria García PA, Giron-Gonzalez JA, Gómez-Almaguer D, Gordon AC, Gothot A, Grass Guaqueta JS, Green C, Grimaldi D, Hammond NE, Harvala H, Heralde FM, Herrick J, Higgins AM, Hills TE, Hines J, Holm K, Hoque A, Hoste E, Ignacio JM, Ivanov AV, Janssen M, Jennings JH, Jha V, King RAN, Kjeldsen-Kragh J, Klenerman P, Kotecha A, Krapp F, Labanca L, Laing E, Landin-Olsson M, Laterre PF, Lim LL, Lim J, Ljungquist O, Llaca-Díaz JM, López-Robles C, López-Cárdenas S, Lopez-Plaza I, Lucero JAC, Lundgren M, Macías J, Maganito SC, Malundo AFG, Manrique RD, Manzini PM, Marcos M, Marquez I, Martínez-Marcos FJ, Mata AM, McArthur CJ, McQuilten ZK, McVerry BJ, Menon DK, Meyfroidt G, Mirasol MAL, Misset B, Molton JS, Mondragon AV, Monsalve DM, Moradi Choghakabodi P, Morpeth SC, Mouncey PR, Moutschen M, Müller-Tidow C, Murphy E, Najdovski T, Nichol AD, Nielsen H, Novak RM, O'Sullivan MVN, Olalla J, Osibogun A, Osikomaiya B, Oyonarte S, Pardo-Oviedo JM, Patel MC, Paterson DL, Peña-Perez CA, Perez-Calatayud AA, Pérez-Alba E, Perkina A, Perry N, Pouladzadeh M, Poyato I, Price DJ, Quero AKH, Rahman MM, Rahman MS, Ramesh M, Ramírez-Santana C, Rasmussen M, Rees MA, Rego E, Roberts JA, Roberts DJ, Rodríguez Y, Rodríguez-Baño J, Rogers BA, Rojas M, Romero A, Rowan KM, Saccona F, Safdarian M, Santos MCM, Sasadeusz J, Scozzari G, Shankar-Hari M, Sharma G, Snelling T, Soto A, Tagayuna PY, Tang A, Tatem G, Teofili L, Tong SYC, Turgeon AF, Veloso JD, Venkatesh B, Ventura-Enriquez Y, Webb SA, Wiese L, Wikén C, Wood EM, Yusubalieva GM, Zacharowski K, Zarychanski R, Khanna N, Moher D, Goodman SN, Ioannidis JPA, Hemkens LG. Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials. BMC Infect Dis 2021; 21:1170. [PMID: 34800996 PMCID: PMC8605464 DOI: 10.1186/s12879-021-06829-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, https://doi.org/10.17605/OSF.IO/GEHFX ). METHODS In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. RESULTS A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. CONCLUSIONS Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.
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Affiliation(s)
- Cathrine Axfors
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Department for Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Perrine Janiaud
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland
| | - Andreas M Schmitt
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland
- Department of Medical Oncology, University of Basel, Basel, Switzerland
| | - Janneke Van't Hooft
- Amsterdam University Medical Center, Amsterdam University, Amsterdam, The Netherlands
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, USA
| | - Noah A Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
| | | | - Manal Abduljalil
- Internal Medicine, Bahrain Defence Force Hospital, Riffa, Bahrain
| | - Abdulkarim Abdulrahman
- Medical Team, National Task Force for Combating the Coronavirus (COVID19), Riffa, Bahrain
- Mohammed Bin Khalifa Cardiac Centre, Awali, Bahrain
| | - Yeny Acosta-Ampudia
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Manuela Aguilar-Guisado
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Farah Al-Beidh
- Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
| | - Marissa M Alejandria
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rachelle N Alfonso
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Mohammad Ali
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Manaf AlQahtani
- Medical Team, National Task Force for Combating the Coronavirus (COVID19), Riffa, Bahrain
- Microbiology, Infectious Diseases, Bahrain Defence Force Hospital, Riffa, Bahrain
- Microbiology, Royal College of Surgeons in Ireland-Medical University in Bahrain, Riffa, Bahrain
| | - Alaa AlZamrooni
- Internal Medicine, Salmaniya Medical Complex, Manama, Bahrain
| | - Juan-Manuel Anaya
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Mark Angelo C Ang
- Department of Laboratories, Division of Blood Bank, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Ismael F Aomar
- Department of Internal Medicine, Hospital Universitario San Cecilio, Granada, Spain
| | - Luis E Argumanis
- Banco de Sangre, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Alexander Averyanov
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Fundamental Medicine Department, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Vladimir P Baklaushev
- Fundamental Medicine Department, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
- Cell Culture Laboratory, Biomedical Research, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Olga Balionis
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Laboratory of Personalized Medicine, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Thomas Benfield
- Center for Research and Disruption of Infectious Diseases, Department of Infectious Diseases, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Nadia Birocco
- Department of Oncology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Lynn B Bonifacio
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Asha C Bowen
- Menzies School of Health Research, Casuarina, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Australia
| | - Abbie Bown
- Rare and Imported Pathogens Laboratory, Public Health England, Porton Down, UK
| | - Carlos Cabello-Gutierrez
- Department Research in Virology and Mycology, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Bernardo Camacho
- Instituto Distrital de Ciencia Biotecnología e Investigación en Salud (IDCBIS), Bogotá, Colombia
| | - Adrian Camacho-Ortiz
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | | | - Damon H Cao
- Department of Medicine, Division of Nephrology, Henry Ford Hospital, Detroit, USA
| | - Ana Cardesa
- Clinical Department, Red Andaluza de Diseño y Traslacion de Terapias Avanzadas, Sevilla, Spain
| | - Jose M Carnate
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - German Jr J Castillo
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rossana Cavallo
- Department of Laboratory Medicine, Unit of Microbiology and Virology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Fazle R Chowdhury
- Internal Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | | | - Giovannino Ciccone
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonella Cingolani
- Infectious Disease, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Veerle Compernolle
- Blood Services, Belgian Red Cross-Flanders, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Carlo Francisco N Cortez
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Abel Costa Neto
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Sergio D'Antico
- Department of Laboratory Medicine, Unit of Transfusion Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - James Daly
- Australian Red Cross Lifeblood, Melbourne, Australia
| | - Franca Danielle
- Department of Laboratory Medicine, Blood Bank, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Unit of Infective Diseases, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Justin T Denholm
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Claudia M Denkinger
- Center of Infectious Diseases, Division of Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | | | - Teresita E Dumagay
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Susanna Dunachie
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Cecile C Dungog
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | | | - Ivy Mae S Escasa
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Lise J Estcourt
- Clinical, Research and Development, NHS Blood and Transplant, Oxford, UK
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
| | - Amy Evans
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Agnes L M Evasan
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Christian J Fareli
- CENETEC (National Center for Health Technology Excellence), Mexico City, Mexico
| | | | - Claudia Galassi
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Patricia J Garcia
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia L Garcia
- Servicio de Hemoterapia y Banco de Sangre, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Jesus A Garcia
- Department of Haematology, Centro Transfusional Tejidos y Celulas de Granada, Granada, Spain
| | | | - Elvira Garza-Gonzalez
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Deonne Thaddeus V Gauiran
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Paula A Gaviria García
- Instituto Distrital de Ciencia Biotecnología e Investigación en Salud (IDCBIS), Bogotá, Colombia
| | | | | | - Anthony C Gordon
- Surgery and Cancer, Anaesthetics, Pain Medicine and Intensive Care, Imperial College London, London, UK
- Intensive Care, Imperial College Healthcare NHS Trust, London, UK
| | - André Gothot
- Immunohematology, Liège University Hospital, Liège, Belgium
| | | | - Cameron Green
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David Grimaldi
- Intensive Care Medicine, Cliniques Universitaires de Bruxelles-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Naomi E Hammond
- The George Institute for Global Health, Sydney and New Delhi, Sydney, Australia
| | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, London, UK
| | - Francisco M Heralde
- Department of Biochemistry and Molecular Biology, University of the Philippines, Manila, Philippines
| | - Jesica Herrick
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - Alisa M Higgins
- ANZIC-RC, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas E Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
- Auckland City Hospital, Auckland, New Zealand
| | - Jennifer Hines
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Karin Holm
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Ashraful Hoque
- Blood Transfusion, Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
| | - Eric Hoste
- Intensive Care Medicine, Gand University Hospital, Gent, Belgium
| | - Jose M Ignacio
- Department of Neumology and Pulmonology, Hospital Quiron de Marbella, Málaga, Spain
| | - Alexander V Ivanov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology of the Russian Academy of Sciences, Moscow, Russian Federation
| | - Maike Janssen
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Jeffrey H Jennings
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Vivekanand Jha
- The George Institute for Global Health, Sydney and New Delhi, New Delhi, India
- School of Public Health, Imperial College, London, UK
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Ruby Anne N King
- Department of Biochemistry and Molecular Biology, University of the Philippines, Manila, Philippines
| | - Jens Kjeldsen-Kragh
- Clinical Immunology and Transfusion Medicine, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | - Paul Klenerman
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Aditya Kotecha
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Fiorella Krapp
- Facultad de Medicina, Instituto de Medicina Tropical Alexander Von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Luciana Labanca
- Department of Laboratory Medicine, Blood Bank, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Emma Laing
- Clinical Trials Unit, NHS Blood and Transplant, Cambridge, UK
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Skåne University Hospital, Lund, Sweden
| | | | | | - Jodor Lim
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Oskar Ljungquist
- Clinical Sciences, Clinical Infection Medicine, Lund University, Malmo, Sweden
| | - Jorge M Llaca-Díaz
- Department of Clinical Pathology, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Concepción López-Robles
- Department of Infectious Diseases, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Salvador López-Cárdenas
- Department of Infectious Diseases, Hospital Universitario de Jerez de La Frontera, Jerez de la Frontera, Spain
| | - Ileana Lopez-Plaza
- Division of Transfusion Medicine, Department of Pathology, Henry Ford Hospital, Detroit, USA
| | - Josephine Anne C Lucero
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Maria Lundgren
- Clinical Immunology and Transfusion Medicine, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | - Juan Macías
- Department of Infectious Diseases, Hospital Universitario de Valme, Sevilla, Spain
| | - Sandy C Maganito
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Anna Flor G Malundo
- Department of Medicine, Division of Infectious Diseases, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Rubén D Manrique
- Epidemiology and Biostatistics Research Group, Universidad CES, Medellín, Colombia
| | - Paola M Manzini
- Department of Laboratory Medicine, Unit of Transfusion Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Miguel Marcos
- Department of Internal Medicine, Hospital Quiron de Malaga, Málaga, Spain
| | - Ignacio Marquez
- Department of Infectious Diseases, Hospital Regional Universitario de Malaga, Málaga, Spain
| | | | - Ana M Mata
- Department of Internal Medicine, Hospital San Juan de Dios del Aljarafe, Bormujos, Spain
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand
| | - Zoe K McQuilten
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Monash Health, Melbourne, Australia
| | - Bryan J McVerry
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - David K Menon
- University Division of Anaesthesia, Addenbrooke's Hospital Cambridge, University of Cambridge, Cambridge, UK
| | - Geert Meyfroidt
- Intensive Care Medicine, Leuven University Hospital, Leuven, Belgium
| | - Ma Angelina L Mirasol
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Benoît Misset
- Intensive Care Medicine, Liège University Hospital, Liège, Belgium
| | | | - Alric V Mondragon
- Department of Medicine, Division of Allergy and Immunology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Diana M Monsalve
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Parastoo Moradi Choghakabodi
- Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Thalassemia and Hemoglobinopathy Research Center, Health Research Institute, Ahvaz, Iran
| | | | - Paul R Mouncey
- Clinical Trials Unit, Intensive Care National Audit and Research Centre, London, UK
| | - Michel Moutschen
- Intensive Care Medicine, Liège University Hospital, Liège, Belgium
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology and Rheumatology, Internal Medicine V, University Hospital Heidelberg, Heidelberg, Germany
| | - Erin Murphy
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | | | - Alistair D Nichol
- School of Medicine and Medical Sciences, University College Dublin-Clinical Research Centre, University College Dublin, Dublin, Ireland
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Intensive Care Medicine, Alfred Health, Melbourne, Australia
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Richard M Novak
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - Matthew V N O'Sullivan
- Institute of Clinical Pathology and Medical Research, NSW Health Pathology, Westmead, Australia
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julian Olalla
- Department of Internal Medicine, Hospital Costa del Sol, Málaga, Spain
| | - Akin Osibogun
- College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Salvador Oyonarte
- Department of Infectious Diseases, Centro Transfusional Tejidos y Celulas de Sevilla, Sevilla, Spain
| | - Juan M Pardo-Oviedo
- Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
| | - Mahesh C Patel
- Medicine, Division of Infectious Diseases, Immunology, and International Medicine, University of Illinois at Chicago, Chicago, USA
| | - David L Paterson
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | | | - Eduardo Pérez-Alba
- Department of Infectious Diseases, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Anastasia Perkina
- Pulmonary Division, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
- Laboratory of Personalized Medicine, Pulmonology Scientific and Research Institute under Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Naomi Perry
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Mandana Pouladzadeh
- Emergency Medicine Department, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Inmaculada Poyato
- Department of Internal Medicine, Hospital Universitario Torrecardenas, Almería, Spain
| | - David J Price
- Doherty Department, University of Melbourne, Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Anne Kristine H Quero
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Md M Rahman
- Internal Medicine, Dhaka Medical College, Dhaka, Bangladesh
| | - Md S Rahman
- Pharmacology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
| | - Mayur Ramesh
- Department of Internal Medicine, Division of Infectious Diseases, Henry Ford Hospital, Detroit, USA
| | | | - Magnus Rasmussen
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Megan A Rees
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Royal Melbourne Hospital, Melbourne Health, Melbourne, Australia
| | - Eduardo Rego
- Instituto D'Or de Pesquisa e Ensino (IDOR), São Paulo, Brazil
| | - Jason A Roberts
- Hospital Universitario Mayor Méderi, Universidad del Rosario, Bogotá, Colombia
- Departments of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - David J Roberts
- Radcliffe Department of Medicine and BRC Haematology Theme, University of Oxford, Oxford, UK
- Clinical and Research and Development, NHS Blood and Transplant, Oxford, UK
| | - Yhojan Rodríguez
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
- Clinica del Occidente, Bogotá, Colombia
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Department of Medicine, University of Sevilla-IBiS, Sevilla, Spain
| | - Benjamin A Rogers
- Monash University, Melbourne, Australia
- Monash Health, Melbourne, Australia
| | - Manuel Rojas
- Center for Autoimmune Diseases Research (CREA), Universidad del Rosario, Bogotá, Colombia
| | - Alberto Romero
- Department of Infectious Diseases, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Kathryn M Rowan
- Intensive Care National Audit and Research Centre (ICNARC), London, UK
| | - Fabio Saccona
- Department of Quality and Safety in Health Care, Unit of Clinical Epidemiology, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mehdi Safdarian
- Nanotechnology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maria Clariza M Santos
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Joe Sasadeusz
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Australia
- Doherty Department, University of Melbourne, The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Gitana Scozzari
- Department of Medical Hospital Direction, Unit of Medical Direction, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Manu Shankar-Hari
- St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
- School of Immunology and Microbial Sciences, Kings College London, London, UK
| | - Gorav Sharma
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Thomas Snelling
- Menzies School of Health Research, Casuarina, Australia
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Australia
- Sydney School of Public Health, University of Sydney, Camperdown, Australia
- Sydney Children's Hospital Network, Westmead, Australia
| | - Alonso Soto
- Facultad de Medicina Humana, Instituto de Investigación en Ciencias Biomédicas (INICIB), Universidad Ricardo Palma, Lima, Peru
- Department of Internal Medicine, Hospital Nacional Hipolito Unanue, Lima, Peru
| | - Pedrito Y Tagayuna
- Department of Laboratories, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Amy Tang
- Public Health Sciences, Henry Ford Hospital, Detroit, USA
| | - Geneva Tatem
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Henry Ford Hospital, Detroit, USA
| | - Luciana Teofili
- Transfusion Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Quebec City, QC, Canada
| | - Januario D Veloso
- Department of Medicine, Division of Hematology, University of the Philippines-Philippine General Hospital, Manila, Philippines
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, Sydney and New Delhi, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
- Wesley and Princess Alexandra Hospitals, University of Queensland, Brisbane, Australia
| | | | - Steve A Webb
- School of Medicine and Medical Sciences, University College Dublin-Clinical Research Centre, University College Dublin, Dublin, Ireland
- St John of God Hospital, Subiaco, Subiaco, Australia
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Christian Wikén
- Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - Erica M Wood
- Department of Clinical Haematology, Monash Health, Melbourne, Australia
| | - Gaukhar M Yusubalieva
- Cell Culture Laboratory, Biomedical Research, Federal Scientific and Clinical Center of Specialized Medical Care and Medical Technologies of the Federal Medical and Biological Agency, Moscow, Russian Federation
| | - Kai Zacharowski
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Ryan Zarychanski
- Department of Internal Medicine, Critical Care and Hematology/Medical Oncology, University of Manitoba, Winnipeg, Canada
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Hygiene and Infection Biology Laboratory, University Hospital Basel and University of Basel, Basel, Switzerland
| | - David Moher
- Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Steven N Goodman
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Stanford University School of Medicine, Stanford, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
| | - John P A Ioannidis
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, USA
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, USA
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, USA
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany
| | - Lars G Hemkens
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, USA.
- Department of Clinical Research, University Hospital Basel, University of Basel, Spitalstrasse 12, 4031, Basel, Switzerland.
- Meta-Research Innovation Center Berlin (METRIC-B), Berlin Institute of Health, Berlin, Germany.
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Haber NA, Wieten SE, Smith ER, Nunan D. Much ado about something: a response to "COVID-19: underpowered randomised trials, or no randomised trials?". Trials 2021; 22:780. [PMID: 34743755 PMCID: PMC8572532 DOI: 10.1186/s13063-021-05755-y] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Non-pharmaceutical interventions (NPI) for infectious diseases such as COVID-19 are particularly challenging given the complexities of what is both practical and ethical to randomize. We are often faced with the difficult decision between having weak trials or not having a trial at all. In a recent article, Dr. Atle Fretheim argues that statistically underpowered studies are still valuable, particularly in conjunction with other similar studies in meta-analysis in the context of the DANMASK-19 trial, asking "Surely, some trial evidence must be better than no trial evidence?" However, informative trials are not always feasible, and feasible trials are not always informative. In some cases, even a well-conducted but weakly designed and/or underpowered trial such as DANMASK-19 may be uninformative or worse, both individually and in a body of literature. Meta-analysis, for example, can only resolve issues of statistical power if there is a reasonable expectation of compatible well-designed trials. Uninformative designs may also invite misinformation. Here, we make the case that-when considering informativeness, ethics, and opportunity costs in addition to statistical power-"nothing" is often the better choice.
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Affiliation(s)
- Noah A Haber
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Rd Palo Alto, Stanford, CA, 94305, USA.
| | - Sarah E Wieten
- Meta-Research Innovation Center at Stanford (METRICS), Stanford University, 1265 Welch Rd Palo Alto, Stanford, CA, 94305, USA
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, USA
| | - David Nunan
- Centre for Evidence Based Medicine, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
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