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Althabe F, Chomba E, Tshefu AK, Banda E, Belizán M, Bergel E, Berrueta M, Bertrand J, Bose C, Cafferata ML, Carlo WA, Ciganda A, Donnay F, García Elorrio E, Gibbons L, Klein K, Liljestrand J, Lusamba PD, Mavila AK, Mazzoni A, Nkamba DM, Mwanakalanga FH, Mwapule Tembo A, Mwenechanya M, Pyne-Mercier L, Spira C, Wetshikoy JD, Xiong X, Buekens P. A multifaceted intervention to improve syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cluster randomised controlled trial. Lancet Glob Health 2019; 7:e655-e663. [PMID: 30910531 PMCID: PMC6465956 DOI: 10.1016/s2214-109x(19)30075-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 12/19/2018] [Accepted: 01/16/2019] [Indexed: 11/11/2022]
Abstract
Background Despite international recommendations, coverage of syphilis testing in pregnant women and treatment of those found seropositive remains limited in sub-Saharan Africa. We assessed whether combining the provision of supplies with a behavioural intervention was more effective than providing supplies only, to improve syphilis screening and treatment during antenatal care. Methods In this 18-month, cluster randomised controlled trial, we randomly assigned (1:1) 26 urban antenatal care clinics in Kinshasa, Democratic Republic of the Congo, and Lusaka, Zambia, to receive a behavioural intervention (opinion leader selection, academic detailing visits, reminders, audits and feedback, and supportive supervision) plus supplies for syphilis testing and treatment (intervention group) or to receive supplies only (control group). The primary outcomes were proportion of pregnant women who had syphilis screening out of the total who attended the clinic; and the proportion of women who had treatment with benzathine benzylpenicillin out of those who tested positive for syphilis at their first antenatal care visit. This trial is registered at ClinicalTrials.gov, number NCT02353117. Findings The 18-month study period was Feb 1, 2016, to July 14, 2017. 18 357 women were enrolled at the 13 intervention clinics and 17 679 women were enrolled at the 13 control clinics at their first antenatal care visit. Syphilis screening was done in a median of 99·9% (IQR 99·0–100·0) of women in the intervention clinics and 93·8% (85·0–98·9) in the control clinics (absolute difference 6·1% [95% CI 1·1–14·1]; p=0·00092). Syphilis treatment at the first visit was done in a median of 100% (IQR 99·7–100·0) of seropositive women in intervention clinics and 43·2% (2·6–83·2) of seropositive women in control clinics (absolute difference 56·8% [12·8–99·0]; p=0·0028). Interpretation A behavioural intervention, together with the provision of supplies, can lead to more than 95% of women being screened and treated for syphilis. The sole provision of supplies is sufficient to reach such levels of screening coverage but is not sufficient to ensure high levels of treatment. Funding Bill & Melinda Gates Foundation.
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Affiliation(s)
- Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Elwyn Chomba
- University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Ernest Banda
- University Teaching Hospital of Lusaka, Lusaka, Zambia
| | - María Belizán
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
| | - Jane Bertrand
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | - Carl Bose
- University of North Carolina (UNC) School of Medicine, UNC Hospitals, Chapel Hill, NC, USA
| | | | - Waldemar A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Alvaro Ciganda
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - France Donnay
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | | | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Karen Klein
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | | - Paul D Lusamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Arlette K Mavila
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Agustina Mazzoni
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Dalau M Nkamba
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | | | | | - Cintia Spira
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Jean D Wetshikoy
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, Los Angeles, CA, USA
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Berrueta M, Cafferata ML, Mwenechanya M, Nkamba Mukadi D, Althabe F, Bergel E, Gibbons L, Ciganda A, Klein K, Mwapule Tembo A, Habulembe Mwanakalanga F, Banda E, Mavila Kilonga A, Lusamba Dikassa P, Xiong X, Chomba E, Tshefu AK, Buekens P. Syphilis screening and treatment in pregnant women in Kinshasa, Democratic Republic of the Congo and in Lusaka, Zambia: a cross-sectional study. Gates Open Res 2017; 1:13. [PMID: 29355227 PMCID: PMC5764227 DOI: 10.12688/gatesopenres.12768.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Congenital syphilis is associated with perinatal deaths, preterm births and congenital malformations. Low rates of syphilis screening during pregnancy and treatment of those found seropositive have been reported in the Democratic Republic of the Congo (DRC) and Zambia. We report the rates on antenatal syphilis screening, the seroprevalence of syphilis infection, and the frequency of antibiotic treatment in pregnant women screened positive for syphilis during their attendance at antenatal care (ANC) clinics in Kinshasa, DRC and Lusaka, Zambia. Methods: Women attending their first ANC were enrolled consecutively during a 9-month period in 16 and 13 ANC clinics in Kinshasa and Lusaka respectively, in the context of the baseline period of a cluster trial. Study personnel collected data on women’s characteristics, the syphilis screening practices, the test results, and the frequency of treatment, that were done under routine ANC conditions and registered in the clinic records. Results: 4,153 women in Kinshasa and 18,097 women in Lusaka were enrolled. The frequency of screening at the first visit was 59.7% (n= 2,479) in Kinshasa, and 27.8% (n=5,025) in Lusaka. Screening test availability varied. In the periods in which tests were available the screening rates were 92.8% in Kinshasa and 52.0% in Lusaka. The frequency of women screened seropositive was 0.4% (n=10) in Kinshasa and 2.2% (n=109) in Lusaka. Respectively, 10% (n=1) and 11.9% (n= 13) among seropositive women received treatment at the first visit. Conclusions: The results of the study show that screening for syphilis in pregnancy is not universal even when supplies are available. Our ongoing trial will evaluate the impact of a behavioral intervention on changing health providers’ practices to increase screening and treatment rates when supplies are available.
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Affiliation(s)
- Mabel Berrueta
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Maria Luisa Cafferata
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Musaku Mwenechanya
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Dalau Nkamba Mukadi
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Eduardo Bergel
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Alvaro Ciganda
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Karen Klein
- Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires, 1414 CABA, Argentina
| | - Abigail Mwapule Tembo
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | | | - Ernest Banda
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Arlette Mavila Kilonga
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Paul Lusamba Dikassa
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
| | - Elwyn Chomba
- University Teaching Hospital of Lusaka, Private Bag RW1X Ridgeway, Nationalist Road, Lusaka, Zambia
| | - Antoinette K Tshefu
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Congo, Democratic Republic
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, 6823 St Charles Ave, New Orleans, LA 70118, USA
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Jary HR, Kachidiku J, Banda H, Kapanga M, Doyle JV, Banda E, Fox C, Gordon SB, Mortimer K. Feasibility of conducting a randomised controlled trial of a cookstove intervention in rural Malawi. Int J Tuberc Lung Dis 2014; 18:240-7. [PMID: 24429320 PMCID: PMC4436815 DOI: 10.5588/ijtld.13.0485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND: Exposure to household air pollution (HAP) causes 4 million deaths annually, and strategies to reduce HAP exposure are urgently required. OBJECTIVE: To evaluate the acceptability and feasibility of conducting a trial of a cookstove intervention in rural Malawi. DESIGN: Non-smoking women were randomised to continuing to use an open fire (control) or to using a wood-burning clay cookstove (intervention). Symptom burden, oxygen saturation and exhaled carbon monoxide (eCO) were assessed at baseline and 7-day follow-up. A subset of women underwent HAP exposure monitoring. Of 51 women recruited, 50 (98%) completed the main study. The methodology was acceptable to participants. Headache, back pain and cough were the most commonly reported symptoms at baseline and follow-up. Median eCO was within normal limits, but with a difference of 0.5 parts per million (ppm) in median change of eCO from baseline to follow-up seen between the two groups (P ∙ 0.035). The peak ambient CO concentration detected was 150 ppm. This study suggests that a large cookstove intervention trial in Malawi would be feasible with careful community sensitisation. Monitoring exposure to HAP is challenging, and further studies evaluating potential biomarkers of exposure, including eCO, should be undertaken.
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Affiliation(s)
- H R Jary
- Liverpool School of Tropical Medicine, Liverpool, UK; University of Liverpool, Liverpool, UK
| | | | - H Banda
- Concern Universal, Blantyre, Malawi
| | | | | | - E Banda
- Clioma Ltd, Lilongwe, Malawi
| | - C Fox
- Clioma Ltd, Lilongwe, Malawi
| | - S B Gordon
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
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Subías L, Zaballos JP, Banda E, Fontal-Cazalla F, Nieves-Aldrey JL. Ácaros oribátidos (Acari: Oribatei) del Parque Nacional de la isla de Coiba, Panamá. ACTA ACUST UNITED AC 2014. [DOI: 10.15517/rbt.v52i1.14755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Glynn J, Kayuni N, Banda E, Parrott F, Floyd S, Tanton C, Hemmings J, Molesworth A, Crampin A, French N. O2-S3.02 Assessing the validity of sexual behaviour reports in a whole population survey in rural Malawi. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.80] [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] [Indexed: 11/03/2022]
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Banda E, Damitz M, Williams R, Persky V, Turyk M, Chisum G, Godbolt B, Lesley V. Exposure to Home Environmental Triggers Within Three Different Age Groups and Asthma Hospitalizations. J Allergy Clin Immunol 2009. [DOI: 10.1016/j.jaci.2009.01.030] [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] [Indexed: 11/28/2022]
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Abstract
Urine reagent strips have been used to test cerebrospinal fluid (CSF) in areas where laboratory facilities are unavailable. Protein, glucose and leukocyte esterase patches have been shown to be useful in this context. We propose that the nitrite patch also has a contribution to make: it could provide clinically useful information, at no extra cost. We tested CSF samples from 200 children with suspected meningitis. In a pragmatic approach chosen to reflect the clinical dilemma of whether or not to use parenteral antibiotics, the final laboratory diagnosis was dichotomized into either 'bacterial meningitis' or 'not bacterial meningitis'. These diagnostic categories were compared with nitrite patch results, which were either positive or negative. Nitrite patch testing of all CSF, clear CSF and bloody CSF gave positive likelihood ratios of 49, 'infinity' and 5.8, respectively.
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Affiliation(s)
- C Maclennan
- Department of Paediatrics, College of Medicine, Box 360, Blantyre, Malawi
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Subías L, Zaballos JP, Banda E, Fontal-Cazalla F, Nieves-Aldrey JL. [Oribatid acari (Acari: Oribatei) from Coiba Island National Park, Panamá]. REV BIOL TROP 2004; 52:85-95. [PMID: 17357403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Abstract
Taking part of the Program for The Inventory of Flora and Fauna of Coiba Island National Park (Panama), a first list of oribatid mites (Acari: Oribatei) is presented. Materials studied come from several soil samplings, including humus and fallen leaves, done in Coiba Island in July 1998. 134 species were identified from a total amount of 1053 individuals collected. Almost all the identified species are new records for Panama as well as eigth species that represent first records for the Neotropical Region. A new name is given: Aeroppia mariehammerae n. nom. for Aeroppia sp. and a new combination is proposed: Protoribates antillensis (Mahunka, 1985) n. comb. (Xylobates).
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Banda E, Albert-Beltran J, Torné M, Fernàndez M. Regional Geothermal Gradients and Lithospheric Structure in Spain. Exploration of the Deep Continental Crust 1991. [DOI: 10.1007/978-3-642-75582-8_8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fernàndez M, Banda E. Geothermal anomalies in the Valles-Penedes Graben Master Fault: Convection through the Horst as a possible mechanism. ACTA ACUST UNITED AC 1990. [DOI: 10.1029/jb095ib04p04887] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Banda E. Nursing in the Zambia Flying Doctor Service. Zambia Nurse (1978) 1985; 13:11-2. [PMID: 3854942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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