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Imam ZO, Nabwera HM, Tongo OO, Andang’o PEA, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Mwangome MK, Umoru DD, Akindolire AE, Otieno W, Olwala M, Nalwa GM, Talbert AW, Abubakar I, Embleton ND, Allen SJ. Time to full enteral feeds in hospitalised preterm and very low birth weight infants in Nigeria and Kenya. PLoS One 2024; 19:e0277847. [PMID: 38457475 PMCID: PMC10923414 DOI: 10.1371/journal.pone.0277847] [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: 11/02/2022] [Accepted: 01/18/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Preterm (born < 37 weeks' gestation) and very low birthweight (VLBW; <1.5kg) infants are at the greatest risk of morbidity and mortality within the first 28 days of life. Establishing full enteral feeds is a vital aspect of their clinical care. Evidence predominantly from high income countries shows that early and rapid advancement of feeds is safe and reduces length of hospital stay and adverse health outcomes. However, there are limited data on feeding practices and factors that influence the attainment of full enteral feeds among these vulnerable infants in sub-Saharan Africa. AIM To identify factors that influence the time to full enteral feeds, defined as tolerance of 120ml/kg/day, in hospitalised preterm and VLBW infants in neonatal units in two sub-Saharan African countries. METHODS Demographic and clinical variables were collected for newborns admitted to 7 neonatal units in Nigeria and Kenya over 6-months. Multiple linear regression analysis was conducted to identify factors independently associated with time to full enteral feeds. RESULTS Of the 2280 newborn infants admitted, 484 were preterm and VLBW. Overall, 222/484 (45.8%) infants died with over half of the deaths (136/222; 61.7%) occurring before the first feed. The median (inter-quartile range) time to first feed was 46 (27, 72) hours of life and time to full enteral feeds (tFEF) was 8 (4.5,12) days with marked variation between neonatal units. Independent predictors of tFEF were time to first feed (unstandardised coefficient B 1.69; 95% CI 1.11 to 2.26; p value <0.001), gestational age (1.77; 0.72 to 2.81; <0.001), the occurrence of respiratory distress (-1.89; -3.50 to -0.79; <0.002) and necrotising enterocolitis (4.31; 1.00 to 7.62; <0.011). CONCLUSION The use of standardised feeding guidelines may decrease variations in clinical practice, shorten tFEF and thereby improve preterm and VLBW outcomes.
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Affiliation(s)
- Zainab O. Imam
- Massey Street Children’s Hospital, Lagos Island, Lagos, Nigeria
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
| | - Olukemi O. Tongo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | | | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Chinyere V. Ezeaka
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Beatrice N. Ezenwa
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Iretiola B. Fajolu
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Martha K. Mwangome
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Dominic D. Umoru
- Department of Paediatrics, Maitama District Hospital, Maitama, Abuja, Nigeria
| | | | - Walter Otieno
- Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Macrine Olwala
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Grace M. Nalwa
- Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W. Talbert
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ismaela Abubakar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Department of Paediatrics, Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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German EL, Nabwera HM, Robinson R, Shiham F, Liatsikos K, Parry CM, McNamara C, Kattera S, Carter K, Howard A, Pojar S, Hamilton J, Matope A, Read JM, Allen SJ, Hill H, Hawcutt DB, Urban BC, Collins AM, Ferreira DM, Nikolaou E. Participant perceptions and experiences of a novel community-based respiratory longitudinal sampling method in Liverpool, UK: A mixed methods feasibility study. PLoS One 2023; 18:e0294133. [PMID: 37943741 PMCID: PMC10635470 DOI: 10.1371/journal.pone.0294133] [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: 07/12/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
Longitudinal, community-based sampling is important for understanding prevalence and transmission of respiratory pathogens. Using a minimally invasive sampling method, the FAMILY Micro study monitored the oral, nasal and hand microbiota of families for 6 months. Here, we explore participant experiences and opinions. A mixed methods approach was utilised. A quantitative questionnaire was completed after every sampling timepoint to report levels of discomfort and pain, as well as time taken to collect samples. Participants were also invited to discuss their experiences in a qualitative structured exit interview. We received questionnaires from 36 families. Most adults and children >5y experienced no pain (94% and 70%) and little discomfort (73% and 47% no discomfort) regardless of sample type, whereas children ≤5y experienced variable levels of pain and discomfort (48% no pain but 14% hurts even more, whole lot or worst; 38% no discomfort but 33% moderate, severe, or extreme discomfort). The time taken for saliva and hand sampling decreased over the study. We conducted interviews with 24 families. Families found the sampling method straightforward, and adults and children >5y preferred nasal sampling using a synthetic absorptive matrix over nasopharyngeal swabs. It remained challenging for families to fit sampling into their busy schedules. Adequate fridge/freezer space and regular sample pick-ups were found to be important factors for feasibility. Messaging apps proved extremely effective for engaging with participants. Our findings provide key information to inform the design of future studies, specifically that self-sampling at home using minimally invasive procedures is feasible in a family context.
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Affiliation(s)
- Esther L. German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen M. Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ryan Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Farah Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kostas Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | | | | | | | - Katie Carter
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
| | - Ashleigh Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Sherin Pojar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Joshua Hamilton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Agnes Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jonathan M. Read
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Stephen J. Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniel B. Hawcutt
- Alder Hey Children’s Hospital, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Britta C. Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Andrea M. Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
| | - Daniela M. Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Elissavet Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ezenwa BN, Fajolu IB, Pius S, Ezeanosike OB, Iloh K, Umoru D, Tongo O, Abdulkadir I, Okolo AA, Nabwera HM, Oleolo-Ayodeji K, Daniel N, Abubakar I, Obu C, Onwe-Ogah E, Daniyan O, Adeke A, Nwegbu O, Bisumang JD, Hassan L, Abdullahi F, Mohammad A, Nasir U, Ezeaka VC, Allen S. Marked variability in institutional deliveries and neonatal outcomes during the COVID-19 lockdown in Nigeria. Trans R Soc Trop Med Hyg 2023; 117:780-787. [PMID: 37264932 DOI: 10.1093/trstmh/trad030] [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: 03/06/2023] [Revised: 04/05/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic and the interventions to mitigate its spread impacted access to healthcare, including hospital births and newborn care. This study evaluated the impact of COVID-19 lockdown measures on newborn service utilization in Nigeria. METHODS The records of women who delivered in hospitals and babies admitted to neonatal wards were retrospectively reviewed before (March 2019-February 2020) and during (March 2020-February 2021) the COVID-19 pandemic lockdown in selected facilities in Nigeria. RESULTS There was a nationwide reduction in institutional deliveries during the COVID-19 lockdown period in Nigeria, with 14 444 before and 11 723 during the lockdown-a decrease of 18.8%. The number of preterm admissions decreased during the lockdown period (30.6% during lockdown vs 32.6% pre-lockdown), but the percentage of outborn preterm admissions remained unchanged. Newborn admissions varied between zones with no consistent pattern. Although neonatal jaundice and prematurity remained the most common reasons for admission, severe perinatal asphyxia increased by nearly 50%. Neonatal mortality was significantly higher during the COVID-19 lockdown compared with pre-lockdown (110.6/1000 [11.1%] vs 91.4/1000 [9.1%], respectively; p=0.01). The odds of a newborn dying were about four times higher if delivered outside the facility during the lockdown (p<0.001). CONCLUSIONS The COVID-19 lockdown had markedly deleterious effects on healthcare seeking for deliveries and neonatal care that varied between zones with no consistent pattern.
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Affiliation(s)
- Beatrice N Ezenwa
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Simon Pius
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Obumneme B Ezeanosike
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Kenechukwu Iloh
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Dominic Umoru
- Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria
| | - Olukemi Tongo
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, College of Medical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Angela A Okolo
- Department of Paediatrics, Federal Medical Centre, Asaba, Delta State, Nigeria
| | - Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
| | | | - Nelson Daniel
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ismaela Abubakar
- Insilico Unit, Cancer Therapeutic, Institute of Cancer Research, Sutton, UK
| | - Chinwe Obu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Emeka Onwe-Ogah
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Olapeju Daniyan
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Azuka Adeke
- Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - Obinna Nwegbu
- Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria
| | - J D Bisumang
- Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Laila Hassan
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Fatimah Abdullahi
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Aisha Mohammad
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Usman Nasir
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Veronica Chinyere Ezeaka
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Paediatrics, Edwards Francis Small Teaching Hospital, Banjul, The Gambia
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4
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Nikolaou E, German EL, Howard A, Nabwera HM, Matope A, Robinson R, Shiham F, Liatsikos K, McNamara C, Kattera S, Carter K, Parry CM, Read JM, Allen SJ, Urban BC, Hawcutt DB, Hill H, Collins AM, Ferreira DM. Assessing the use of minimally invasive self-sampling at home for long-term monitoring of the microbiota within UK families. Sci Rep 2023; 13:18201. [PMID: 37875557 PMCID: PMC10598218 DOI: 10.1038/s41598-023-45574-6] [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: 06/09/2023] [Accepted: 10/21/2023] [Indexed: 10/26/2023] Open
Abstract
Monitoring the presence of commensal and pathogenic respiratory microorganisms is of critical global importance. However, community-based surveillance is difficult because nasopharyngeal swabs are uncomfortable and painful for a wide age range of participants. We designed a methodology for minimally invasive self-sampling at home and assessed its use for longitudinal monitoring of the oral, nasal and hand microbiota of adults and children within families. Healthy families with two adults and up to three children, living in and near Liverpool, United Kingdom, self-collected saliva, nasal lining fluid using synthetic absorptive matrices and hand swabs at home every two weeks for six months. Questionnaires were used to collect demographic and epidemiological data and assess feasibility and acceptability. Participants were invited to take part in an exit interview. Thirty-three families completed the study. Sampling using our approach was acceptable to 25/33 (76%) families, as sampling was fast (76%), easy (76%) and painless (60%). Saliva and hand sampling was acceptable to all participants of any age, whereas nasal sampling was accepted mostly by adults and children older than 5 years. Multi-niche self-sampling at home can be used by adults and children for longitudinal surveillance of respiratory microorganisms, providing key data for design of future studies.
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Affiliation(s)
- E Nikolaou
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, VIC, 3050, Australia.
- Microbiology and Immunology Department, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, VIC, Australia.
| | - E L German
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Howard
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - A Matope
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - R Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - F Shiham
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Liatsikos
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - C McNamara
- Alder Hey Children's Hospital, Liverpool, UK
| | - S Kattera
- Alder Hey Children's Hospital, Liverpool, UK
| | - K Carter
- Alder Hey Children's Hospital, Liverpool, UK
| | - C M Parry
- Alder Hey Children's Hospital, Liverpool, UK
| | - J M Read
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - S J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Edward Francis Small Teaching Hospital, Banjul, The Gambia
| | - B C Urban
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK
| | - D B Hawcutt
- Alder Hey Children's Hospital, Liverpool, UK
- University of Liverpool, Liverpool, UK
| | - H Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D M Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, OX3 7LE, UK.
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Wright JL, Achieng F, Tindi L, Patil M, Boga M, Kimani M, Barsosio HC, Juma D, Kiige L, Manu A, Kariuki S, Mathai M, Nabwera HM. Design and implementation of a community-based mother-to-mother peer support programme for the follow-up of low birthweight infants in rural western Kenya. Front Pediatr 2023; 11:1173238. [PMID: 37465422 PMCID: PMC10352086 DOI: 10.3389/fped.2023.1173238] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023] Open
Abstract
Background Globally, low birthweight (LBW) infants (<2,500 g) have the highest risk of mortality during the first year of life. Those who survive often have adverse health outcomes. Post-discharge outcomes of LBW infants in impoverished communities in Africa are largely unknown. This paper describes the design and implementation of a mother-to-mother peer training and mentoring programme for the follow-up of LBW infants in rural Kenya. Methods Key informant interviews were conducted with 10 mothers of neonates (infants <28 days) from two rural communities in western Kenya. These data informed the identification of key characteristics required for mother-to-mother peer supporters (peer mothers) following up LBW infants post discharge. Forty potential peer mothers were invited to attend a 5-day training programme that focused on three main themes: supportive care using appropriate communication, identification of severe illness, and recommended care strategies for LBW infants. Sixteen peer mothers were mentored to conduct seven community follow-up visits to each mother-LBW infant pair with fifteen completing all the visits over a 6-month period. A mixed methods approach was used to evaluate the implementation of the programme. Quantitative data of peer mother socio-demographic characteristics, recruitment, and retention was collected. Two post-training focus group discussions were conducted with the peer mothers to explore their experiences of the programme. Descriptive statistics were generated from the quantitative data and the qualitative data was analysed using a thematic framework. Results The median age of the peer mothers was 26 years (range 21-43). From March-August 2019, each peer mother conducted a median of 28 visits (range 7-77) with fourteen (88%) completing all their assigned follow-up visits. Post training, our interviews suggest that peer mothers felt empowered to promote appropriate infant feeding practices. They gave multiple examples of improved health seeking behaviours as a result of the peer mother training programme. Conclusion Our peer mother training programme equipped peer mothers with the knowledge and skills for the post-discharge follow-up of LBW infants in this rural community in Kenya. Community-based interventions for LBW infants, delivered by appropriately trained peer mothers, have the potential to address the current gaps in post-discharge care for these infants.
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Affiliation(s)
- Jemma L. Wright
- Department of Community Paediatrics, Countess of Chester Hospital, Chester, United Kingdom
| | | | - Linda Tindi
- Department of Maternal and Child Health, Homa Bay County Referral Hospital, Homa Bay, Kenya
| | - Manasi Patil
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Mwanamvua Boga
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mary Kimani
- Department of Nutrition, Action Against Hunger, Nairobi, Kenya
| | - Hellen C. Barsosio
- Department of Community Paediatrics, Countess of Chester Hospital, Chester, United Kingdom
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Dan Juma
- KEMRI-Center for Global Health Research, Kisumu, Kenya
| | - Laura Kiige
- Nutrition Unit, UNICEF-Kenya, Nairobi, Kenya
| | - Alexander Manu
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Simon Kariuki
- KEMRI-Center for Global Health Research, Kisumu, Kenya
| | - Matthews Mathai
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen M. Nabwera
- Department of Education, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Centre of Excellence for Women and Child Health, Aga Khan University, Nairobi, Kenya
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Kathembe J, Tapkigen J, Mwangome MK, Prentice AM, Nabwera HM. Stunting of Growth in Developing Countries. World Rev Nutr Diet 2023; 126:17-31. [PMID: 36948172 DOI: 10.1159/000527936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/04/2022] [Indexed: 03/24/2023]
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7
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Gribbin C, Achieng F, K’Oloo A, Barsosio HC, Kwobah E, Kariuki S, Nabwera HM. Exploring the influence of postnatal depression on neonatal care practices among mothers in Western Kenya: A qualitative study. Womens Health (Lond) 2023; 19:17455057231189547. [PMID: 37551659 PMCID: PMC10411280 DOI: 10.1177/17455057231189547] [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] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/23/2023] [Accepted: 07/05/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality. OBJECTIVES To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya. DESIGN A cross-sectional study. METHODS Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale. RESULTS Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to perceived insufficient breastmilk were a particular challenge for mothers with features of PND, who were more likely to introduce complementary feeds. Maternal health-seeking decisions were influenced by high financial cost, long waiting times and poor interactions with health care providers that induced stress and fear among mothers. Maternal caregiving capacity was influenced by her ability to juggle other household duties, which was difficult for mothers with features suggestive of PND. Support from friends and relatives positively impacted maternal mood and caregiving ability. CONCLUSION Mothers experienced many stress-inducing events in the perinatal period which potentially exacerbated features of PND in the immediate postnatal period. Women with features of PND were particularly vulnerable to these stressors that influenced infant caregiving practices. Addressing the socio-economic challenges and health system gaps that include scale up of compassionate and respectful care for women during pregnancy and childbirth, as well as early screening and intervention of PND, through enhanced referral pathways between health facilities and community support structures, could mitigate against the impact of PND on neonatal caregiving.
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Affiliation(s)
- Catherine Gribbin
- Liverpool School of Tropical Medicine, Liverpool, UK
- King’s Mill Hospital, Sutton-in-Ashfield, UK
| | - Florence Achieng
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Alloys K’Oloo
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Hellen C Barsosio
- Liverpool School of Tropical Medicine, Liverpool, UK
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Edith Kwobah
- Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Psychiatry, Moi University, Eldoret, Kenya
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Helen M Nabwera
- Liverpool School of Tropical Medicine, Liverpool, UK
- The Aga Khan University, Nairobi, Kenya
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8
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Staunton AP, Nabwera HM, Allen SJ, Tongo OO, Akindolire AE, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Umoru DD, Otieno W, Nalwa GM, Olwala M, Talbert AW, Andang'o PEA, Mwangome MK, Abubakar I, Embleton ND. Prospective observational study of the challenges in diagnosing common neonatal conditions in Nigeria and Kenya. BMJ Open 2022; 12:e064575. [PMID: 36600346 PMCID: PMC9730357 DOI: 10.1136/bmjopen-2022-064575] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/18/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Accurate and timely diagnosis of common neonatal conditions is crucial for reducing neonatal deaths. In low/middle-income countries with limited resources, there is sparse information on how neonatal diagnoses are made. The aim of this study was to describe the diagnostic criteria used for common conditions in neonatal units (NNUs) in Nigeria and Kenya. DESIGN Prospective observational study. Standard case report forms for suspected sepsis, respiratory disorders, birth asphyxia and abdominal conditions were co-developed by the Neonatal Nutrition Network (https://www.lstmed.ac.uk/nnu) collaborators. Clinicians completed forms for all admissions to their NNUs. Key data were displayed using heatmaps. SETTING Five NNUs in Nigeria and two in Kenya comprising the Neonatal Nutrition Network. PARTICIPANTS 2851 neonates, which included all neonates admitted to the seven NNUs over a 6-month period. RESULTS 1230 (43.1%) neonates had suspected sepsis, 874 (30.6%) respiratory conditions, 587 (20.6%) birth asphyxia and 71 (2.5%) abdominal conditions. For all conditions and across all NNUs, clinical criteria were used consistently with sparse use of laboratory and radiological criteria. CONCLUSION Our findings highlight the reliance on clinical criteria and extremely limited use of diagnostic technologies for common conditions in NNUs in sub-Saharan Africa. This has implications for the management of neonatal conditions which often have overlapping clinical features. Strategies for implementation of diagnostic pathways and investment in affordable and sustainable diagnostics are needed to improve care for these vulnerable infants.
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Affiliation(s)
- Aimee P Staunton
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Infectious Diseases, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Stephen J Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Olukemi O Tongo
- Institute of Child Health, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chinyere V Ezeaka
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Beatrice N Ezenwa
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B Fajolu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Paediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | - Zainab O Imam
- Department of Paediatrics, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Dominic D Umoru
- Department of Paediatrics, Maitama District Hospital, Abuja, Nigeria
| | - Walter Otieno
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Grace M Nalwa
- Department of Paediatrics and Child Health, Maseno University, Maseno, Kenya
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Macrine Olwala
- Department of Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W Talbert
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Martha K Mwangome
- Department of Clinical Research, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Ismaela Abubakar
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicholas D Embleton
- Department of Paediatrics, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, UK
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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9
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Nabwera HM, Mwangome MK, Prentice AM. Stunting of Growth in Developing Countries. World Rev Nutr Diet 2022; 125:14-27. [PMID: 35249019 DOI: 10.1159/000521775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/28/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Helen M Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Martha K Mwangome
- Kenya Medical Research Institute (KEMRI), Centre for Geographic Research Medicine-Coast (CGMRC), Kilifi, Kenya.,KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
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10
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Tongo OO, Olwala MA, Talbert AW, Nabwera HM, Akindolire AE, Otieno W, Nalwa GM, Andang'o PEA, Mwangome MK, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Umoru DD, Abubakar I, Embleton ND, Allen SJ. Enteral Feeding Practices for Very Preterm and Very Low Birth Weight Infants in Nigeria and Kenya. Front Pediatr 2022; 10:892209. [PMID: 35633964 PMCID: PMC9130927 DOI: 10.3389/fped.2022.892209] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Background Optimizing nutrition in very preterm (28-32 weeks gestation) and very low birth weight (VLBW; 1,000 g to <1,500 g) infants has potential to improve their survival, growth, and long-term health outcomes. Aim To assess feeding practices in Nigeria and Kenya for very preterm and VLBW newborn infants. Methods This was a cross-sectional study where convenience sampling was used. A standard questionnaire was sent to doctors working in neonatal units in Nigeria and Kenya. Results Of 50 respondents, 37 (74.0%) were from Nigeria and 13 (26.0%) from Kenya. All initiated enteral feeds with breastmilk, with 24 (48.0%) initiating within 24 h. Only 28 (56.0%) used written feeding guidelines. Starting volumes ranged between 10 and 80 ml/kg/day. Median volume advancement of feeds was 20 ml/kg/day (IQR 10-20) with infants reaching full feeds in 8 days (IQR 6-12). 26 (52.0%) of the units fed the infants 2 hourly. Breastmilk fortification was practiced in 7 (14.0%) units, while folate, iron, calcium, and phosphorus were prescribed in 42 (84.0%), 36 (72.0%), 22 (44.0%), 5 (10.0%) of these units, respectively. No unit had access to donor breastmilk, and only 18 (36.0%) had storage facilities for expressed breastmilk. Twelve (24.0%) used wet nurses whilst 30 (60.0%) used formula feeds. Conclusion Feeding practices for very preterm and VLBW infants vary widely within Nigeria and Kenya, likely because of lack of locally generated evidence. High quality research that informs the feeding of these infants in the context of limited human resources, technology, and consumables, is urgently needed.
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Affiliation(s)
- Olukemi O. Tongo
- College of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Macrine A. Olwala
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Alison W. Talbert
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- *Correspondence: Alison W. Talbert
| | - Helen M. Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children's Hospital NHS Trust, Liverpool, United Kingdom
| | | | - Walter Otieno
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
- Department of Nutrition and Health, Maseno University, Maseno, Kenya
| | - Grace M. Nalwa
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
- Department of Nutrition and Health, Maseno University, Maseno, Kenya
| | | | | | - Isa Abdulkadir
- Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Chinyere V. Ezeaka
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Beatrice N. Ezenwa
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Iretiola B. Fajolu
- College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Zainab O. Imam
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Ismaela Abubakar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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11
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Nabwera HM, Ekhaguere OA, Kirpalani H, Burgoine K, Ezeaka CV, Otieno W, Allen SJ, Embleton ND. Caffeine for the care of preterm infants in sub-Saharan Africa: a missed opportunity? BMJ Glob Health 2021; 6:bmjgh-2021-007682. [PMID: 34952857 PMCID: PMC8710870 DOI: 10.1136/bmjgh-2021-007682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 11/24/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Helen M Nabwera
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK .,Infectious Diseases, Alder Hey Children's Hospital, Liverpool, UK
| | - Osayame A Ekhaguere
- Neonatal-Perinatal Medicine, Indiana University Department of Pediatrics, Indianapolis, Indiana, USA
| | - Haresh Kirpalani
- Emeritus Department Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | | | - Walter Otieno
- Paediatrics, Maseno University, Maseno, Nyanza, Kenya.,Paediatrics, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya
| | - Stephen J Allen
- Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Gastroenterology, Alder Hey Children's Hospital, Liverpool, UK
| | - Nicholas D Embleton
- Neonatal Medicine, Newcastle University, Newcastle upon Tyne, UK.,Neonatology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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12
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Nabwera HM, Espinoza JL, Worwui A, Betts M, Okoi C, Sesay AK, Bancroft R, Agbla SC, Jarju S, Bradbury RS, Colley M, Jallow AT, Liu J, Houpt ER, Prentice AM, Antonio M, Bernstein RM, Dupont CL, Kwambana-Adams BA. Interactions between fecal gut microbiome, enteric pathogens, and energy regulating hormones among acutely malnourished rural Gambian children. EBioMedicine 2021; 73:103644. [PMID: 34695658 PMCID: PMC8550991 DOI: 10.1016/j.ebiom.2021.103644] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 07/26/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The specific roles that gut microbiota, known pathogens, and host energy-regulating hormones play in the pathogenesis of non-edematous severe acute malnutrition (marasmus SAM) and moderate acute malnutrition (MAM) during outpatient nutritional rehabilitation are yet to be explored. METHODS We applied an ensemble of sample-specific (intra- and inter-modality) association networks to gain deeper insights into the pathogenesis of acute malnutrition and its severity among children under 5 years of age in rural Gambia, where marasmus SAM is most prevalent. FINDINGS Children with marasmus SAM have distinct microbiome characteristics and biologically-relevant multimodal biomarkers not observed among children with moderate acute malnutrition. Marasmus SAM was characterized by lower microbial richness and biomass, significant enrichments in Enterobacteriaceae, altered interactions between specific Enterobacteriaceae and key energy regulating hormones and their receptors. INTERPRETATION Our findings suggest that marasmus SAM is characterized by the collapse of a complex system with nested interactions and key associations between the gut microbiome, enteric pathogens, and energy regulating hormones. Further exploration of these systems will help inform innovative preventive and therapeutic interventions. FUNDING The work was supported by the UK Medical Research Council (MRC; MC-A760-5QX00) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement; Bill and Melinda Gates Foundation (OPP 1066932) and the National Institute of Medical Research (NIMR), UK. This network analysis was supported by NIH U54GH009824 [CLD] and NSF OCE-1558453 [CLD].
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Affiliation(s)
- Helen M Nabwera
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Josh L Espinoza
- J. Craig Venture Institute, 4120 Capricorn Ln, La Jolla, CA 92037, USA; Applied Sciences, Durban University of Technology, Durban, South Africa
| | - Archibald Worwui
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Modupeh Betts
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom
| | - Catherine Okoi
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Abdul K Sesay
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Rowan Bancroft
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Schadrac C Agbla
- Department of Health Data Science, University of Liverpool, Liverpool, UK
| | - Sheikh Jarju
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | | | - Mariama Colley
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Amadou T Jallow
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Jie Liu
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Eric R Houpt
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, Virginia, United States of America
| | - Andrew M Prentice
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia
| | - Martin Antonio
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, Banjul, PO Box 273, The Gambia; Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Robin M Bernstein
- Growth and Development Lab, Department of Anthropology, University of Colorado, Boulder, CO, United States of America
| | | | - Brenda A Kwambana-Adams
- NIHR Global Health Research Unit on Mucosal Pathogens, Division of Infection and Immunity, University College London, London, United Kingdom.
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13
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James PT, Ali Z, Armitage AE, Bonell A, Cerami C, Drakesmith H, Jobe M, Jones KS, Liew Z, Moore SE, Morales-Berstein F, Nabwera HM, Nadjm B, Pasricha SR, Scheelbeek P, Silver MJ, Teh MR, Prentice AM. The Role of Nutrition in COVID-19 Susceptibility and Severity of Disease: A Systematic Review. J Nutr 2021; 151:1854-1878. [PMID: 33982105 PMCID: PMC8194602 DOI: 10.1093/jn/nxab059] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [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: 11/03/2020] [Revised: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Many nutrients have powerful immunomodulatory actions with the potential to alter susceptibility to coronavirus disease 2019 (COVID-19) infection, progression to symptoms, likelihood of severe disease, and survival. OBJECTIVE The aim was to review the latest evidence on how malnutrition across all its forms (under- and overnutrition and micronutrient status) may influence both susceptibility to, and progression of, COVID-19. METHODS We synthesized information on 13 nutrition-related components and their potential interactions with COVID-19: overweight, obesity, and diabetes; protein-energy malnutrition; anemia; vitamins A, C, D, and E; PUFAs; iron; selenium; zinc; antioxidants; and nutritional support. For each section we provide: 1) a landscape review of pertinent material; 2) a systematic search of the literature in PubMed and EMBASE databases, including a wide range of preprint servers; and 3) a screen of 6 clinical trial registries. All original research was considered, without restriction to study design, and included if it covered: 1) severe acute respiratory syndrome coronavirus (CoV) 2 (SARS-CoV-2), Middle East respiratory syndrome CoV (MERS-CoV), or SARS-CoV viruses and 2) disease susceptibility or 3) disease progression, and 4) the nutritional component of interest. Searches took place between 16 May and 11 August 2020. RESULTS Across the 13 searches, 2732 articles from PubMed and EMBASE, 4164 articles from the preprint servers, and 433 trials were returned. In the final narrative synthesis, we include 22 published articles, 38 preprint articles, and 79 trials. CONCLUSIONS Currently there is limited evidence that high-dose supplements of micronutrients will either prevent severe disease or speed up recovery. However, results of clinical trials are eagerly awaited. Given the known impacts of all forms of malnutrition on the immune system, public health strategies to reduce micronutrient deficiencies and undernutrition remain of critical importance. Furthermore, there is strong evidence that prevention of obesity and type 2 diabetes will reduce the risk of serious COVID-19 outcomes. This review is registered at PROSPERO as CRD42020186194.
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Affiliation(s)
- Philip T James
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zakari Ali
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Andrew E Armitage
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Ana Bonell
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Carla Cerami
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Hal Drakesmith
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Modou Jobe
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Kerry S Jones
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) Nutritional Biomarker Laboratory, MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Zara Liew
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sophie E Moore
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - Fernanda Morales-Berstein
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Behzad Nadjm
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
| | - Sant-Rayn Pasricha
- Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, Australia
| | - Pauline Scheelbeek
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Matt J Silver
- MRC Unit The Gambia at the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Megan R Teh
- MRC Human Immunology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Andrew M Prentice
- Medical Research Council (MRC) Unit The Gambia at the London School of Hygiene & Tropical Medicine, Fajara, The Gambia
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14
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Unsworth S, Barsosio HC, Achieng F, Juma D, Tindi L, Omiti F, Kariuki S, Nabwera HM. Caregiver experiences and healthcare worker perspectives of accessing healthcare for low-birthweight. Paediatr Int Child Health 2021; 41:145-153. [PMID: 33645452 DOI: 10.1080/20469047.2021.1881269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Low-birthweight (LBW) infants (<2500 g) are at greatest risk of mortality in the neonatal period, particularly in low- and middle-income countries. Timely access to quality healthcare averts adverse outcomes. AIM To explore caregiver experiences and healthcare provider perspectives of accessing healthcare for LBW infants in rural Kenya. METHODS This qualitative study was undertaken in Homa Bay County of in rural western Kenya in June 2019. In-depth interviews with eleven caregivers and four healthcare providers were conducted by a trained research assistant. All interviews were transcribed verbatim, and transcripts in the local languages were translated into English. A thematic framework was used to analyse the data. RESULTS At the community and individual level,community misconceptions about LBW infants, inadequate infant care practices after discharge, lack of maternal support networks, long distances from healthcare facilities and lack of financial support were key challenges. In addition, long hospital waiting times, healthcare worker strikes and the apparent inadequate knowledge and skills of healthcare providers were disincentives among caregivers. Among healthcare providers, health system deficiencies (staff shortages and inadequate resources for optimal assessment and treatment of LBW infants) and maternal illiteracy were key challenges. Education by staff during antenatal visits and community support groups were enablers. CONCLUSION Accessing healthcare for LBW infants in this community is fraught with challenges which have implications for their post-discharge outcome. There is an urgent need to develop and test strategies to address the barriers at the community and health system level to optimise outcome..
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Affiliation(s)
- Sarah Unsworth
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool UK
| | - Hellen C Barsosio
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florence Achieng
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Daniel Juma
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Linda Tindi
- Department of Maternal and Child Health, Homa Bay County Teaching and Referral Hospital, Homa Bay, Kenya
| | - Fred Omiti
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Simon Kariuki
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Helen M Nabwera
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool UK
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15
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Nabwera HM, Shah V, Neville R, Sosseh F, Saidykhan M, Faal F, Sonko B, Keita O, Schmidt WP, Torondel B. Menstrual hygiene management practices and associated health outcomes among school-going adolescents in rural Gambia. PLoS One 2021; 16:e0247554. [PMID: 33630924 PMCID: PMC7906402 DOI: 10.1371/journal.pone.0247554] [Citation(s) in RCA: 6] [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: 05/25/2020] [Accepted: 02/10/2021] [Indexed: 01/18/2023] Open
Abstract
Inadequate menstrual hygiene management (MHM) practices have been associated with adverse health outcomes. This study aimed to describe MHM practices among schoolgirls from rural Gambia and assess risk factors associated with urogenital infections and depressive symptoms. A cross-sectional study was conducted among adolescent schoolgirls in thirteen schools in rural Gambia. A questionnaire was used to collect information on socio-demographics, MHM practices and clinical symptoms of reproductive and urinary tract infections (UTIs). A modified Beck Depression Inventory-II was used to screen for depressive symptoms. Mid-stream urine samples were collected to assess for UTIs. Modified Poisson regression analysis was used to determine risk factors for symptoms of urogenital infections and depression among adolescent girls. Three hundred and fifty-eight girls were recruited. Although, 63% of the girls attended schools providing free disposable pads, reusable cloths/towels were the commonest absorbent materials used. Heavy menstrual bleeding was associated with depressive symptoms (adjusted prevalence ratio, aPR 1.4 [95% CI 1.0, 1.9]), while extreme menstrual pain (aPR 1.3 [95% CI 1.2, 1,4]), accessing sanitary pads in school (aPR 1.4 [95% CI 1.2, 1.5]) and less access to functional water source at school (aPR 1.4 [95% CI 1.3, 1.6]) were associated with UTI symptoms. Conversely, privacy in school toilets (aPR 0.6 [95% CI 0.5, 0.7]) was protective for UTI symptoms. Heavy menstrual bleeding (aPR 1.4 [95% CI 1.1, 2.0]) and taking <30 minutes to collect water at home were associated with RTI symptoms (aPR 1.2 [95% CI 1.0, 1.5]) while availability of soap in school toilets (aPR 0.6 [95% CI 0.5, 0.8] was protective for RTI symptoms. Interventions to ensure that schoolgirls have access to private sanitation facilities with water and soap both at school and at home could reduce UTI and RTI symptoms. More attention is also needed to support girls with heavy menstrual bleeding and pain symptoms.
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Affiliation(s)
- Helen M. Nabwera
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Rowena Neville
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Fatou Sosseh
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Mariama Saidykhan
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Fatou Faal
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Bakary Sonko
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, Banjul, The Gambia
| | - Omar Keita
- Regional Education Directorate Four, Ministry of Basic and Secondary Education, Mansakonko Lower River Region, The Gambia
| | - Wolf-Peter Schmidt
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Belen Torondel
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
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Nabwera HM, Wang D, Tongo OO, Andang’o PEA, Abdulkadir I, Ezeaka CV, Ezenwa BN, Fajolu IB, Imam ZO, Mwangome MK, Umoru DD, Akindolire AE, Otieno W, Nalwa GM, Talbert AW, Abubakar I, Embleton ND, Allen SJ. Burden of disease and risk factors for mortality amongst hospitalized newborns in Nigeria and Kenya. PLoS One 2021; 16:e0244109. [PMID: 33444346 PMCID: PMC7808658 DOI: 10.1371/journal.pone.0244109] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/13/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To describe the patient population, priority diseases and outcomes in newborns admitted <48 hours old to neonatal units in both Kenya and Nigeria. STUDY DESIGN In a network of seven secondary and tertiary level neonatal units in Nigeria and Kenya, we captured anonymised data on all admissions <48 hours of age over a 6-month period. RESULTS 2280 newborns were admitted. Mean birthweight was 2.3 kg (SD 0.9); 57.0% (1214/2128) infants were low birthweight (LBW; <2.5kg) and 22.6% (480/2128) were very LBW (VLBW; <1.5 kg). Median gestation was 36 weeks (interquartile range 32, 39) and 21.6% (483/2236) infants were very preterm (gestation <32 weeks). The most common morbidities were jaundice (987/2262, 43.6%), suspected sepsis (955/2280, 41.9%), respiratory conditions (817/2280, 35.8%) and birth asphyxia (547/2280, 24.0%). 18.7% (423/2262) newborns died; mortality was very high amongst VLBW (222/472, 47%) and very preterm infants (197/483, 40.8%). Factors independently associated with mortality were gestation <28 weeks (adjusted odds ratio 11.58; 95% confidence interval 4.73-28.39), VLBW (6.92; 4.06-11.79), congenital anomaly (4.93; 2.42-10.05), abdominal condition (2.86; 1.40-5.83), birth asphyxia (2.44; 1.52-3.92), respiratory condition (1.46; 1.08-2.28) and maternal antibiotics within 24 hours before or after birth (1.91; 1.28-2.85). Mortality was reduced if mothers received a partial (0.51; 0.28-0.93) or full treatment course (0.44; 0.21-0.92) of dexamethasone before preterm delivery. CONCLUSION Greater efforts are needed to address the very high burden of illnesses and mortality in hospitalized newborns in sub-Saharan Africa. Interventions need to address priority issues during pregnancy and delivery as well as in the newborn.
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Affiliation(s)
- Helen M. Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
- * E-mail:
| | - Dingmei Wang
- Children's Hospital of Fudan University, Minhang District, Shanghai, China
| | | | | | - Isa Abdulkadir
- Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | | | | | | | | | | | | | | | - Walter Otieno
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | - Grace M. Nalwa
- Maseno University, Maseno, Kenya
- Jaramogi Oginga Odinga Teaching and Referral Hospital, Jomo Kenyatta Highway Kaloleni Kisumu KE, Central, Kenya
| | | | - Ismaela Abubakar
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nicholas D. Embleton
- Newcastle University, Newcastle upon Tyne, United Kingdom
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, High Heaton, Newcastle upon Tyne, United Kingdom
| | - Stephen J. Allen
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Alder Hey Children’s Hospital NHS Trust, Liverpool, United Kingdom
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Nabwera HM, Mwangome MK, Prentice AM. Stunting of Growth in Developing Countries. World Rev Nutr Diet 2021; 123:14-27. [PMID: 34404053 DOI: 10.1159/000516450] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/17/2021] [Indexed: 03/23/2023]
Affiliation(s)
- Helen M Nabwera
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | | | - Andrew M Prentice
- MRC Unit, The Gambia at London School of Hygiene and Tropical Medicine, Banjul, Gambia
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Nabwera HM, Wright JL, Patil M, Dickinson F, Godia P, Maua J, Sammy MK, Naimoi BC, Warfa OH, Dewez JE, Murila F, Manu A, Smith H, Mathai M. 'Sometimes you are forced to play God…': a qualitative study of healthcare worker experiences of using continuous positive airway pressure in newborn care in Kenya. BMJ Open 2020; 10:e034668. [PMID: 32792424 PMCID: PMC7430418 DOI: 10.1136/bmjopen-2019-034668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE: To explore the experiences of using continuous positive airway pressure (CPAP) in newborn care among healthcare workers in Kenya, and to identify factors that would promote successful scale-up. DESIGN AND SETTING: A qualitative study using key informant interviews and focus group discussions, based at secondary and tertiary level hospitals in Kenya. PARTICIPANTS: Healthcare workers in the newborn units providing CPAP. PRIMARY AND SECONDARY OUTCOME MEASURE: Facilitators and barriers of CPAP use in newborn care in Kenya. RESULTS: 16 key informant interviews and 15 focus group discussions were conducted across 19 hospitals from September 2017 to February 2018. Main barriers reported were: (1) inadequate infrastructure to support the effective delivery of CPAP, (2) shortage of skilled staff rendering it difficult for the available staff to initiate or monitor infants on CPAP and (3) inadequate knowledge and training of staff that inhibited the safe care of infants on CPAP. Key facilitators reported were positive patient outcomes after CPAP use that increased staff confidence and partnership with caregivers in the management of newborns on CPAP. Healthcare workers in private/mission hospitals had more positive experiences of using CPAP in newborn care as the relevant support and infrastructure were available. CONCLUSION: CPAP use in newborn care is valued by healthcare workers in Kenya. However, we identified key challenges that threaten its safe use and sustainability. Further scale-up of CPAP in newborn care should ensure that staff members have ready access to optimal training on CPAP and that there are enough resources and infrastructure to support its use. ETHICS: This study was approved through the appropriate ethics committees in Kenya and the UK (see in text) with written informed consent for each participant.
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Affiliation(s)
- Helen M Nabwera
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jemma L Wright
- Paediatrics Department, Betsi Cadwaladr CHC, Wrexham, UK
| | - Manasi Patil
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Fiona Dickinson
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Pamela Godia
- International Public Health, Liverpool School of Tropical Medicine, Nairobi, Kenya
| | - Judith Maua
- International Public Health, Liverpool School of Tropical Medicine, Nairobi, Kenya
| | - Mercy K Sammy
- General Paediatrics, Gertrude's Garden Children's Hospital, Nairobi, Kenya
| | | | - Osman H Warfa
- Neonatal, Child and Adolescent Health, Kenya Ministry of Health, Nairobi, Kenya
| | - Juan Emmanuel Dewez
- Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Florence Murila
- Paediatrics and Child Health, University of Nairobi School of Medicine, Nairobi, Kenya
| | - Alexander Manu
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Smith
- Maternal and Newborn Health, International Health Consulting Services Ltd, Liverpool, UK
| | - Matthews Mathai
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Shah V, Nabwera HM, Sosseh F, Jallow Y, Comma E, Keita O, Torondel B. A rite of passage: a mixed methodology study about knowledge, perceptions and practices of menstrual hygiene management in rural Gambia. BMC Public Health 2019; 19:277. [PMID: 30845945 PMCID: PMC6407285 DOI: 10.1186/s12889-019-6599-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Appropriate menstrual hygiene management (MHM) is impeded by taboos and secrecy surrounding menstruation. Unhygienic menstrual practices and unpreparedness for managing menstruation has been associated with adverse health and social outcomes among adolescent girls. In The Gambia, there is limited data on menstrual practices among girls and women in rural communities and the sources of information about menstruation for the adolescents. This study aimed to explore knowledge, preparedness and practices of menstruation and its management among adolescents, mothers and teachers in rural Gambia. METHODS A mixed methods study was conducted in the rural Kiang West district of The Gambia. Twenty focus group discussions and thirteen in-depth interviews were conducted among mothers, adolescents and teachers to explore their views on menstruation, cultural beliefs, sources and level of knowledge on menstruation and MHM practices. In addition, a survey was done among 331 school girls to assess their knowledge, practices and attitudes of menstruation and its management. Inductive content analysis was used to analyse the qualitative data, and descriptive analysis and chi-squared tests were used to analyse quantitative data. RESULTS All participants had different levels of knowledge about menstruation. Knowledge score was higher among post-menarche girls compare with pre-menarche girls (p = 0.0001). All groups expressed difficulties, embarrassment and shame in relation to discussing menstruation. Two thirds of the surveyed girls reported having learnt about menstruation before menarche, however at menarche most felt unprepared. Teachers were the main source of information, but when asking for advice most girls preferred to ask their mothers. Mothers reported facing difficulties in discussing menstruation with their children and felt that boys did not need to be taught about it, however boys were very curious to know about. Most girls used reusable cloth unless they are given free pads from school. CONCLUSION Taboos, secrecy and embarrassment associated with discussing menstruation hinder adolescents from seeking advice from parents and teachers on appropriate MHM practices. Strategies to encourage positive social norms towards menstruation would help to promote more open discussions about it at the family, community and national level, which will support improvements in MHM in this and similar communities in low and middle income settings.
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Affiliation(s)
- Vishna Shah
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, The Gambia, P.O.Box 273, Banjul, The Gambia
| | - Helen M. Nabwera
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
| | - Fatou Sosseh
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, The Gambia, P.O.Box 273, Banjul, The Gambia
| | - Yamundao Jallow
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, The Gambia, P.O.Box 273, Banjul, The Gambia
| | - Ebrima Comma
- Nutrition Theme, MRCG Keneba, Medical Research Council Unit, The Gambia, P.O.Box 273, Banjul, The Gambia
| | - Omar Keita
- Regional Education Directorate Four, Ministry of Basic and Secondary Education, Mansakonko, Lower River Region, The Gambia
| | - Belen Torondel
- Environmental Health Group, Department of Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK
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20
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Husseini M, Darboe MK, Moore SE, Nabwera HM, Prentice AM. Thresholds of socio-economic and environmental conditions necessary to escape from childhood malnutrition: a natural experiment in rural Gambia. BMC Med 2018; 16:199. [PMID: 30382849 PMCID: PMC6211595 DOI: 10.1186/s12916-018-1179-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [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: 07/18/2018] [Accepted: 09/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood malnutrition remains highly prevalent in low-income countries, and a 40% reduction in under-5 year stunting is WHO's top Global Target 2025. Disappointingly, meta-analyses of intensive nutrition interventions reveal that they generally have low efficacy at improving growth. Unhygienic environments also contribute to growth failure, but large WASH Benefits and SHINE trials of improved water, sanitation and hygiene (WASH) recently reported no benefits to child growth. METHODS To explore the thresholds of socio-economic status (SES) and living standards associated with malnutrition, we exploited a natural experiment in which the location of our research centre within a remote rural village created a wide diversity of wealth, education and housing conditions within the same ecological setting and with free health services to all. A composite SES score was generated by grading occupation, education, income, water and sanitation, and housing and families were allocated to 5 groups (SES1 = highest). SES ranged from very poor subsistence-farming villagers to post graduate staff with overseas training. Nutritional status at 24 m was obtained from clinic records for 230 children and expressed relative to WHO Growth Standards. RESULTS Height-for-age (HAZ) and weight-for-age (WAZ) Z-scores were strongly predicted by SES group. HAZ varied from - 0.67 to - 2.23 (P < 0.001) and WAZ varied from - 0.90 to - 1.64 (P < 0.001), from SES1 to SES5, respectively. Weight-for-height (WHZ) showed no gradient. Children in SES1 showed greater dispersion so were further divided in a post hoc analysis. Children resident in Western housing on the research compound (SES1A) had HAZ = + 0.68 and WAZ = + 0.36. The residual gradient between those in SES1B and SES5 spanned only 0.65 Z-score for HAZ (- 1.58 to - 2.23) and was not significant for WAZ or WHZ. CONCLUSIONS The large difference in growth between children in SES1A living in Western-type housing and SES1B children living in the village, and the very shallow gradient between SES1B and SES5, implies a very high SES threshold before stunting and underweight will be eliminated. This may help to explain the lack of efficacy of the recent WASH interventions and points to the need for what is termed 'Transformative WASH'. Good quality housing, with piped water into the home, may be key to eliminating malnutrition.
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Affiliation(s)
- Mayya Husseini
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Regional Activity Centre for Sustainable Consumption and Production (SCP/RAC), Sant Pau Art Nouveau Site, Carrer Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Momodou K Darboe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
| | - Sophie E Moore
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia
- Department of Women and Children's Health, King's College London, 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Helen M Nabwera
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Andrew M Prentice
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Atlantic Boulevard, Fajara, Banjul, The Gambia.
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Hennig BJ, Unger SA, Dondeh BL, Hassan J, Hawkesworth S, Jarjou L, Jones KS, Moore SE, Nabwera HM, Ngum M, Prentice A, Sonko B, Prentice AM, Fulford AJ. Cohort Profile: The Kiang West Longitudinal Population Study (KWLPS)-a platform for integrated research and health care provision in rural Gambia. Int J Epidemiol 2018; 46:e13. [PMID: 26559544 PMCID: PMC5837564 DOI: 10.1093/ije/dyv206] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Affiliation(s)
- Branwen J Hennig
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Stefan A Unger
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,University of Edinburgh, Department of Child Life and Health, Edinburgh, UK
| | - Bai Lamin Dondeh
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Jahid Hassan
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Sophie Hawkesworth
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Landing Jarjou
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Kerry S Jones
- MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Sophie E Moore
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Helen M Nabwera
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Mohammed Ngum
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Ann Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, UK and
| | - Bakary Sonko
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia
| | - Andrew M Prentice
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony J Fulford
- MRC International Nutrition Group at MRC Unit The Gambia, Banjul, The Gambia.,MRC International Nutrition Group, London School of Hygiene & Tropical Medicine, London, UK
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22
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Nabwera HM, Moore SE, Mwangome MK, Molyneux SC, Darboe MK, Camara-Trawally N, Sonko B, Darboe A, Singhateh S, Fulford AJ, Prentice AM. The influence of maternal psychosocial circumstances and physical environment on the risk of severe wasting in rural Gambian infants: a mixed methods approach. BMC Public Health 2018; 18:109. [PMID: 29304780 PMCID: PMC5756408 DOI: 10.1186/s12889-017-4984-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 12/07/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe wasting affects 16 million under 5's and carries an immediate risk of death. Prevalence remains unacceptably high in sub-Saharan Africa and early infancy is a high-risk period. We aimed to explore risk factors for severe wasting in rural Gambian infants. METHODS We undertook a case-control study from November 2014 to June 2015, in rural Gambia. Cases had WHO standard weight-for-length z-scores (WLZ) < -3 on at least 1 occasion in infancy. Controls with a WLZ > -3 in the same interval, matched on age, gender, village size and distance from the clinic were selected. Standard questionnaires were used to assess maternal socioeconomic status, water sanitation and hygiene and maternal mental health. Conditional logistic regression using a multivariable model was used to determine the risk factors for severe wasting. Qualitative in depth interviews were conducted with mothers and fathers who were purposively sampled. A thematic framework was used to analyse the in-depth interviews. RESULTS Two hundred and eighty (77 cases and 203 controls) children were recruited. In-depth interviews were conducted with 16 mothers, 3 fathers and 4 research staff members. The mean age of introduction of complementary feeds was similar between cases and controls (5.2 [SD 1.2] vs 5.1 [SD 1.3] months). Increased odds of severe wasting were associated with increased frequency of complementary feeds (range 1-8) [adjusted OR 2.06 (95%: 1.17-3.62), p = 0.01]. Maternal adherence to the recommended infant care practices was influenced by her social support networks, most importantly her husband, by infant feeding difficulties and maternal psychosocial stressors that include death of a child or spouse, recurrent ill health of child and lack of autonomy in child spacing. CONCLUSION In rural Gambia, inappropriate infant feeding practices were associated with severe wasting in infants. Additionally, adverse psychosocial circumstances and infant feeding difficulties constrain mothers from practising the recommended child care practices. Interventions that promote maternal resilience through gender empowerment, prioritising maternal psychosocial support and encouraging the involvement of fathers in infant and child care promotion strategies, would help prevent severe wasting in these infants.
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Affiliation(s)
- Helen M Nabwera
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia. .,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK.
| | - Sophie E Moore
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Division of Women's Health, King's College London, 10th floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Martha K Mwangome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya
| | - Sassy C Molyneux
- Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O.Box 230-80108, Kilifi, Kenya.,University of Oxford, Nuffield Department of Medicine, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford, OX3 7BN, UK
| | - Momodou K Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | | | - Bakary Sonko
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Alhagie Darboe
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Seedy Singhateh
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia
| | - Anthony J Fulford
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
| | - Andrew M Prentice
- Medical Research Council Unit, The Gambia, P. O. Box 273, Banjul, The Gambia.,Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel street, London, WC1E 7HT, UK
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Nabwera HM, Jepkosgei J, Muraya KW, Hassan AS, Molyneux CS, Ali R, Prentice AM, Berkley JA, Mwangome MK. What influences feeding decisions for HIV-exposed infants in rural Kenya? Int Breastfeed J 2017; 12:31. [PMID: 28717383 PMCID: PMC5508793 DOI: 10.1186/s13006-017-0125-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 07/05/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya. METHODS We used a qualitative study design. Between March and August 2011, we conducted in-depth interviews (n = 9) and focus group discussions (n = 10) with purposively selected hospital and community respondents at Kilifi County Hospital, Kenya. These respondents had all experienced of infant feeding in the context of HIV. These interviews were informed by prior structured observations of health care worker interactions with carers during infant feeding counselling sessions. RESULTS Overall, women living with HIV found it difficult to adhere to the HIV infant feeding guidance. There were three dominant factors that influenced decision making processes: 1) Exclusive breastfeeding was not the cultural norm, therefore practising it raised questions within the family and community about a mother's parenting capabilities and HIV status. 2) Women living with HIV lacked autonomy in decision-making on infant feeding due to socio-cultural factors. 3) Non-disclosure of HIV status to close members due to the stigma. CONCLUSION Infant feeding decision-making by women living with HIV in rural Kenya is constrained by a lack of autonomy, stigma and poverty. There is an urgent need to address these challenges through scaling up psycho-social and gender empowerment strategies for women, and introducing initiatives that promote the integration of HIV infant feeding strategies into other child health services.
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Affiliation(s)
- Helen M. Nabwera
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Joyline Jepkosgei
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Kelly W. Muraya
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
| | - Amin S. Hassan
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Catherine S. Molyneux
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Rehema Ali
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
| | - Andrew M. Prentice
- MRC Unit, The Gambia, PO Box 273, Banjul, The Gambia
- MRC International Nutrition Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - James A. Berkley
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF UK
| | - Martha K. Mwangome
- KEMRI Centre for Geographic Medicine Research Coast, P.O. Box 230-80108, Kilifi, Kenya
- The Childhood Acute Illness & Nutrition (CHAIN) Network, PO Box 43640-00100, Nairobi, Kenya
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Nabwera HM, Fegan G, Shavadia J, Denje D, Mandaliya K, Bates I, Maitland K, Hassall OW. Pediatric blood transfusion practices at a regional referral hospital in Kenya. Transfusion 2016; 56:2732-2738. [PMID: 27611471 PMCID: PMC5111588 DOI: 10.1111/trf.13774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/02/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Severe anemia in children is a major public health problem in sub-Saharan Africa. In this study we describe clinical and operational aspects of blood transfusion in children admitted to Coast Provincial General Hospital, Kenya. STUDY DESIGN AND METHODS This was an observational study where over a 2-year period, demographic and laboratory data were collected on all children for whom the hospital blood bank received a transfusion request. Clinical data were obtained by retrospective review of case notes over the first year. RESULTS There were 2789 requests for blood for children (median age, 1.8 years; interquartile range [IQR], 0.6-6.6 years); 70% (1950) of the samples were crossmatched with 85% (1663/1950) issued. Ninety percent (1505/1663) were presumed transfused. Median time from laboratory receipt of request to collection of blood was 3.6 hours (IQR, 1.4-12.8 hr). Case notes of 590 children were reviewed and median pretransfusion hemoglobin level was 6.0 g/dL (IQR, 4.2-9.1 g/dL). Ninety-four percent (186) were transfused "appropriately" while 52% (120) were transfused "inappropriately." There was significant disagreement between the clinical and laboratory diagnosis of severe anemia (exact McNemar's test; p < 0.0001). Antimalarials were prescribed for 65% (259) of children who received blood transfusions but only 41% (106) of these had a positive blood film. CONCLUSION In this setting, clinicians often order blood based on the clinical impression of "severe anemia." This has implications for laboratory workload and the blood supply itself. However, the majority of children with severe anemia were appropriately transfused. The use of antimalarials with blood transfusions irrespective of blood film results is common practice.
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Affiliation(s)
- Helen M. Nabwera
- Centre for Geographic Medicine Research (Coast)Kenya Medical Research Institute/Wellcome Trust Research ProgrammeKilifiKenya
- Liverpool School of Tropical MedicineLiverpoolUK
| | - Greg Fegan
- Centre for Geographic Medicine Research (Coast)Kenya Medical Research Institute/Wellcome Trust Research ProgrammeKilifiKenya
- Centre for Clinical Vaccinology & Tropical MedicineUniversity of OxfordOxfordUK
- Swansea Trials UnitSwansea University Medical SchoolSwanseaUK
| | | | | | - Kishor Mandaliya
- Coast Provincial General HospitalMombasaKenya
- Regional Blood Transfusion CentreMombasaKenya
| | - Imelda Bates
- Liverpool School of Tropical MedicineLiverpoolUK
| | - Kathryn Maitland
- Centre for Geographic Medicine Research (Coast)Kenya Medical Research Institute/Wellcome Trust Research ProgrammeKilifiKenya
- Department of MedicineImperial CollegeLondonUK
| | - Oliver W. Hassall
- Centre for Geographic Medicine Research (Coast)Kenya Medical Research Institute/Wellcome Trust Research ProgrammeKilifiKenya
- Liverpool School of Tropical MedicineLiverpoolUK
- Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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Hassan AS, Nabwera HM, Mwaringa SM, Obonyo CA, Sanders EJ, Rinke de Wit TF, Cane PA, Berkley JA. HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: a cross-sectional study. AIDS Res Ther 2014; 11:9. [PMID: 24456757 PMCID: PMC3922732 DOI: 10.1186/1742-6405-11-9] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Accepted: 01/19/2014] [Indexed: 12/03/2022] Open
Abstract
Background An increasing number of people on antiretroviral therapy (ART) in sub-Saharan Africa has led to declines in HIV related morbidity and mortality. However, virologic failure (VF) and acquired drug resistance (ADR) may negatively affect these gains. This study describes the prevalence and correlates of HIV-1 VF and ADR among first-line ART experienced adults at a rural HIV clinic in Coastal Kenya. Methods HIV-infected adults on first-line ART for ≥6 months were cross-sectionally recruited between November 2008 and March 2011. The primary outcome was VF, defined as a one-off plasma viral load of ≥400 copies/ml. The secondary outcome was ADR, defined as the presence of resistance associated mutations. Logistic regression and Fishers exact test were used to describe correlates of VF and ADR respectively. Results Of the 232 eligible participants on ART over a median duration of 13.9 months, 57 (24.6% [95% CI: 19.2 – 30.6]) had VF. Fifty-five viraemic samples were successfully amplified and sequenced. Of these, 29 (52.7% [95% CI: 38.8 – 66.3]) had at least one ADR, with 25 samples having dual-class resistance mutations. The most prevalent ADR mutations were the M184V (n = 24), K103N/S (n = 14) and Y181C/Y/I/V (n = 8). Twenty-six of the 55 successfully amplified viraemic samples (47.3%) did not have any detectable resistance mutation. Younger age (15–34 vs. ≥35 years: adjusted odd ratios [95% CI], p-value: 0.3 [0.1–0.6], p = 0.002) and unsatisfactory adherence (<95% vs. ≥95%: 3.0 [1.5–6.5], p = 0.003) were strong correlates of VF. Younger age, unsatisfactory adherence and high viral load were also strong correlates of ADR. Conclusions High levels of VF and ADR were observed in younger patients and those with unsatisfactory adherence. Youth-friendly ART initiatives and strengthened adherence support should be prioritized in this Coastal Kenyan setting. To prevent unnecessary/premature switches, targeted HIV drug resistance testing for patients with confirmed VF should be considered.
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Hassan AS, Mwaringa SM, Obonyo CA, Nabwera HM, Sanders EJ, Rinke de Wit TF, Cane PA, Berkley JA. Low prevalence of transmitted HIV type 1 drug resistance among antiretroviral-naive adults in a rural HIV clinic in Kenya. AIDS Res Hum Retroviruses 2013; 29:129-35. [PMID: 22900472 DOI: 10.1089/aid.2012.0167] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Low levels of HIV-1 transmitted drug resistance (TDR) have previously been reported from many parts of sub-Saharan Africa (sSA). However, recent data, mostly from urban settings, suggest an increase in the prevalence of HIV-1 TDR. Our objective was to determine the prevalence of TDR mutations among HIV-1-infected, antiretroviral (ARV)-naive adults enrolling for care in a rural HIV clinic in Kenya. Two cross-sectional studies were carried out between July 2008 and June 2010. Plasma samples from ARV-naive adults (>15 years old) at the time of registering for care after HIV diagnosis and before starting ARVs were used. A portion of the pol subgenomic region of the virus containing the protease and part of the reverse transcriptase genes was amplified and sequenced. TDR mutations were identified and interpreted using the Stanford HIV drug resistance database and the WHO list for surveillance of drug resistance strains. Overall, samples from 182 ARV-naive adults [mean age (95% CI): 34.9 (33.3-36.4) years] were successfully amplified and sequenced. Two TDR mutations to nucleoside reverse transcriptase inhibitors [n=1 (T215D)] and protease inhibitors [n=1 (M46L)] were identified, giving an overall TDR prevalence of 1.1% (95% CI: 0.1-3.9). Despite reports of an increase in the prevalence of HIV-1 TDR in some urban settings in sSA, we report a prevalence of HIV-1 TDR of less than 5% at a rural HIV clinic in coastal Kenya. Continued broader surveillance is needed to monitor the extent of TDR in sSA.
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Affiliation(s)
| | | | | | | | - Eduard J. Sanders
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
| | - Tobias F. Rinke de Wit
- PharmAccess Foundation, Amsterdam, The Netherlands
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - James A. Berkley
- KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, United Kingdom
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Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, Awuondo KK, Mutinda MN, Molyneux CS, Berkley JA. Dynamics and constraints of early infant diagnosis of HIV infection in Rural Kenya. AIDS Behav 2012; 16:5-12. [PMID: 21213034 PMCID: PMC3254874 DOI: 10.1007/s10461-010-9877-7] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [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] [Indexed: 11/24/2022]
Abstract
A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.
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Affiliation(s)
- Amin S. Hassan
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Erick M. Sakwa
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Helen M. Nabwera
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Miriam M. Taegtmeyer
- Kilifi District Hospital, Kilifi, Kenya
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Robert M. Kimutai
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - Ken K. Awuondo
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | | | - Catherine S. Molyneux
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
| | - James A. Berkley
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Clinical Vaccinology and Tropical Medicine, University of Oxford, Oxford, UK
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Hassan AS, Fielding KL, Thuo NM, Nabwera HM, Sanders EJ, Berkley JA. Early loss to follow-up of recently diagnosed HIV-infected adults from routine pre-ART care in a rural district hospital in Kenya: a cohort study. Trop Med Int Health 2011; 17:82-93. [PMID: 22943164 PMCID: PMC4230408 DOI: 10.1111/j.1365-3156.2011.02889.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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: 02/02/2023]
Abstract
OBJECTIVE To determine the rate and predictors of early loss to follow-up (LTFU) for recently diagnosed HIV-infected, antiretroviral therapy (ART)-ineligible adults in rural Kenya. METHODS Prospective cohort study. Clients registering for HIV care between July 2008 and August 2009 were followed up for 6 months. Baseline data were used to assess predictors of pre-ART LTFU (not returning for care within 2 months of a scheduled appointment), LTFU before the second visit and LTFU after the second visit. Logistic regression was used to determine factors associated with LTFU before the second visit, while Cox regression was used to assess predictors of time to LTFU and LTFU after the second visit. RESULTS Of 530 eligible clients, 178 (33.6%) were LTFU from pre-ART care (11.1/100 person-months). Of these, 96 (53.9%) were LTFU before the second visit. Distance (>5 km vs. <1 km: adjusted hazard ratio 2.6 [1.9-3.7], P < 0.01) and marital status (married vs. single: 0.5 [0.3-0.6], P < 0.01) independently predicted pre-ART LTFU. Distance and marital status were independently associated with LTFU before the second visit, while distance, education status and seasonality showed weak evidence of predicting LTFU after the second visit. HIV disease severity did not predict pre-ART LTFU. CONCLUSIONS A third of recently diagnosed HIV-infected, ART-ineligible clients were LTFU within 6 months of registration. Predictors of LTFU among ART-ineligible clients are different from those among clients on ART. These findings warrant consideration of an enhanced pre-ART care package aimed at improving retention and timely ART initiation.
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Affiliation(s)
- Amin S Hassan
- KEMRI/Wellcome Trust Centre for Geographic Medicine Research (Coast), Kilifi, Kenya.
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Nabwera HM, Mwaringa S, Kimutai R, Berkley JA. Audit of outcomes of early initiation of antiretroviral therapy in children admitted to the paediatric wards at Kilifi district hospital, Kenya. J Int AIDS Soc 2010. [PMCID: PMC3112934 DOI: 10.1186/1758-2652-13-s4-p156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nabwera HM, Purnell S, Bates I. Development of a quality assurance handbook to improve educational courses in Africa. Hum Resour Health 2008; 6:28. [PMID: 19094199 PMCID: PMC2615788 DOI: 10.1186/1478-4491-6-28] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Accepted: 12/18/2008] [Indexed: 05/27/2023]
Abstract
BACKGROUND The attainment of the Millennium Development Goals has been hampered by the lack of skilled and well-informed health care workers in many developing countries. The departure of health care workers from developing countries is one of the most important causes. One of the motivations for leaving is that developed countries have well-established health care systems that incorporate continuing medical education, which enables health care workers to develop their skills and knowledge base. This provision is lacking in many developing countries. The provision of higher-education programmes of good quality within developing countries therefore, contributes to building capacity of the health care workforce in these countries. METHODS The Liverpool School of Tropical Medicine is involved in delivering off-site higher educational programmes to health care workers in Africa. Our colleagues at one of these sites requested a guide to help them ensure that their professional development courses met international educational standards. We reviewed published literature that outlines the principles of quality assurance in higher education from various institutions worldwide. Using this information, we designed a handbook that outlines the quality assurance principles in a simple and practical way. This was intended to enable institutions, even in developing countries, to adapt these principles in accordance with their local resource capacity. We subsequently piloted this handbook at one of the sites in Ghana. The feedback from this aided the development of the handbook. The development of this handbook was participatory in nature. RESULTS The handbook addresses six main themes that are the minimum requirements that a higher education course should incorporate to ensure that it meets internationally recognized standards. These include: recruitment and admissions, course design and delivery, student assessments, approval and review processes, support for students and staff training and welfare. It has been piloted in Ghana and the feedback was incorporated into the handbook. The handbook is currently available free of charge online and being used by various institutions across the world. We have had responses from individuals and institutions in Africa, Asia, North America and Europe. CONCLUSION The principles outlined in the handbook provide a regulatory framework for locally establishing higher education courses of good quality that will contribute to enhancing the teaching and learning experience of students in courses in the developing world. This would contribute to providing a skilled and sustainable health care workforce that would reduce the need for health care workers to travel overseas in search of good higher education courses.
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Affiliation(s)
- Helen M Nabwera
- Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, UK
| | - Sue Purnell
- Educational Development Division, Centre for Lifelong Learning, University of Liverpool, Liverpool, UK
| | - Imelda Bates
- Liverpool School of Tropical Medicine, University of Liverpool, Liverpool, UK
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Nabwera HM, Nguyen-Van-Tam JS, Logan RF, Logan RP. Prevalence of Helicobacter pylori infection in Kenyan schoolchildren aged 3-15 years and risk factors for infection. Eur J Gastroenterol Hepatol 2000; 12:483-7. [PMID: 10833089 DOI: 10.1097/00042737-200012050-00002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To determine the prevalence of Helicobacter pylori (Hp) infection in Kenyan schoolchildren aged 3-15 years and the risk factors for infection. DESIGN A cross-sectional survey and study of risk factors. SUBJECTS Primary-school children in Trans Nzoia district, Kenya. METHODS Hp status was determined using the 13C-urea breath test. Risk factors were assessed using a structured interview schedule. RESULTS Of 205 children interviewed, valid breath test results were obtained for 192 (93.7%), of whom 155 (80.7% (95% CI 75.2-86.3)) were infected. Univariate analysis showed weak associations between Hp infection and rural areas (location of home, Relative Risk (RR)= 1.2 (1.0-1.4); location of school, RR = 1.2 (1.0-1.3)) and lower socio-economic status (RR = 1.2 (1.0-1.4)). Access to only a pit-latrine in the home (RR = 1.2 (1.0-1.4)) and plate-sharing with other family members in the home also increased the likelihood of Hp infection (RR = 1.3 (1.1 -1.6)). However, after logistic regression modelling only plate-sharing in the home remained as an independent risk factor (odds ratio (OR) = 2.8 (1.3-6.3)). CONCLUSIONS The prevalence of Hp infection in Kenyan schoolchildren aged 3-15 years is already high, suggesting that most acquisition occurs before age 3 years. Children who normally shared a plate with other family members during meals in the home had a higher prevalence of infection, suggesting that oro-oral transmission may be important in this population. Future studies in developing countries should focus on younger children (before age 3 years), and consider the possibility of adult-child, oro-oral transmission in order to establish likely modes of transmission.
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Affiliation(s)
- H M Nabwera
- Division of Public Health Medicine and Epidemiology, University of Nottingham Medical School, Queen's Medical Centre, UK
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Nabwera HM, Logan RP. Epidemiology of Helicobacter pylori: transmission, translocation and extragastric reservoirs. J Physiol Pharmacol 1999; 50:711-22. [PMID: 10695553] [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] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Although H. pylori infection is endemic and despite more than 10 years of research, the mode and route of transmission remain elusive. This may, in part, be due to the inherent problems of detecting H. pylori noninvasively. The prevalence of infection varies between countries and is closely related to Growth Domestic Product. An age-cohort effect and data from longitudinal studies suggest that the incidence of infection is much higher in children than adults. In developing countries the prevalence of infection is often more than 80% in young adults, in contrast to less than 10% for similar age groups in developed countries. The observations of mosaicism (in the VacA gene) and a panmycytic population structure imply exchange of genetic material either in or outside of the host, which is supported by the increasing recognition of polyclonal infection and suggests that secondary infection occurs after primary acquisition. In addition, in children persistent primary infection may sometimes occur only after previous (repeated) exposure and/or transient colonisation of the gastric mucosa. H. pylori and other gastric Helicobacter spp are always noninvasive, but other human nongastric Helicobacter spp have sometimes been isolated from the systemic circulation in immunocompromised patients. For nonhuman hosts, intestinal Helicobacter spp are thought to translocate more frequently from the colon to the liver. Within the human host, the oral cavity is the principal extragastric reservoir, although case reports suggest that H. pylori may sometimes be found beyond the 2nd part of the duodenum. The hypothesis that H. pylori is a zoonosis or transmitted as coccoid forms by a vector (pets, houseflies) is not supported by recent research showing that H. pylori is entirely unable to support an aerobic or anaerobic metabolism and that coccoid forms are non-viable. H. pylori is primarily acquired in infancy, most probably via the oroorogastric route, from other family members or close contacts encountered after weaning or socialisation. Further studies to support or refute this hypothesis are required.
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Affiliation(s)
- H M Nabwera
- Division of Gastroenterology, University Hospital Queens Medical Centre, Nottingham, UK
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