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Gammeltoft TM, Nguyen TA, Dung TK, Thi Dang NA, Phuong Nguyen TM, Nguyen VT, Bygbjerg IC. The pioneers of Vietnam's epidemiological transition: an ethnographic study of pregnant women's experiences of gestational diabetes. Glob Health Action 2024; 17:2341521. [PMID: 38693861 PMCID: PMC11067556 DOI: 10.1080/16549716.2024.2341521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/07/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND Gestational diabetes mellitus (GDM) is an abnormal glucose metabolism diagnosed during pregnancy that can have serious adverse consequences for mother and child. GDM is an exceptional health condition, as its management serves not only as treatment but also as prevention, reducing the risk of future diabetes in mother and child. OBJECTIVES This qualitative study aimed to explore how pregnant women experience and respond to GDM, focusing particularly on the role of the family environment in shaping women's experiences. METHODS The research was carried out in Vietnam's Thái Bình province in April-May 2023. We conducted in-depth ethnographic interviews with 21 women with GDM, visiting them in their homes. Our theoretical starting point was phenomenological anthropology, and the data were analysed using a thematic analysis approach. RESULTS At the centre of women's experiences was the contrast between GDM as a biomedical and a social condition. Whereas GDM was biomedically diagnosed and managed in the healthcare system, it was often deemed insignificant or non-existent by family members. This made GDM a biomedically present but socially absent health condition. This paradox posed challenges to women's GDM self-care, placing them in pioneering social positions. CONCLUSIONS The biomedical presence yet social absence of GDM turned women into pioneers at biomedical, digital, epidemiological, and family frontiers. This article calls for appreciation of pregnant women's pioneering roles and for health systems action to involve women and families in the development of GDM policies and programmes at a time of sweeping global health changes.
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Affiliation(s)
- Tine M. Gammeltoft
- Department of Anthropology, University of Copenhagen, København, Denmark
| | - Thi Ai Nguyen
- Department of Health Management & Organization, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Kim Dung
- Department of Epidemiology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Ngoc-Anh Thi Dang
- Department of Environmental Health, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Thi Minh Phuong Nguyen
- Department of Health Sociology, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Van Tien Nguyen
- Department of Health Management & Organization, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Hue, Vietnam
| | - Ib C. Bygbjerg
- Department of Public Health, Global Health Section, University of Copenhagen, København, Denmark
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Meyrowitsch DW, Thi Dang NA, Phong TV, Nielsen J, Søndergaard J, Cuong ND, Le Minh H, Vu TKD, Bygbjerg IC, Gammeltoft TM, Thanh ND. The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam. Public Health 2024; 228:171-177. [PMID: 38364677 DOI: 10.1016/j.puhe.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To measure the effects of diabetes clubs on peer support, disclosure of diabetes status, and the source of information regarding the management of diabetes among persons living with type-2 diabetes (T2D) in rural Vietnam. STUDY DESIGN A pre- and post-pilot intervention study was carried out in Thai Binh Province, Vietnam (n = 222). RESULTS Post-intervention, 57.7 % reported using experiences shared by other persons with T2D during the diabetes club sessions. Compared to pre-intervention, there was an increase in the proportion of persons with T2D who disclosed their diabetes status to friends and/or community members (an increase of 15.3 and 13.8 percentage points, respectively). The proportion of persons who reported gathering their own information regarding diabetes management without any support from others decreased from 15.7 % to 6.3 %. Those who reported a relative inside their home or a relative outside their household as their primary source of T2D-relevant information increased from 10.8 % to 18.6 % and from 2.7 % to 9.5 %, respectively. Persons who mentioned that they did not have a need for further support for their diabetes care increased from 18.5 % to 32.0 %. Specific support regarding diabetes-related knowledge received from family members, friends, and/or community members increased from 27.5 % to 62.2 % CONCLUSIONS: These findings suggest a promising potential for the implementation of diabetes clubs to enhance diabetes-relevant knowledge and the quality of self-management among persons living with T2D diabetes in rural areas of Vietnam.
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Affiliation(s)
- D W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark.
| | - N-A Thi Dang
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T V Phong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - J Nielsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - N D Cuong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - H Le Minh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T K D Vu
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - T M Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - N D Thanh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
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Byashalira KC, Chamba NG, Alkabab Y, Ntinginya NE, Affenaar JW, Heysell SK, Ramaiya KL, Lillebaek T, Bygbjerg IC, Christensen DL, Mpagama SG, Mmbaga BT. Point-of-care glycated hemoglobin a1c testing for the identification of hyperglycemia severity among individuals with dual tuberculosis and diabetes mellitus in Tanzania. Int J Mycobacteriol 2023; 12:429-435. [PMID: 38149539 DOI: 10.4103/ijmy.ijmy_119_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023] Open
Abstract
Background Poor glycemic control during tuberculosis (TB) treatment is challenging, as the optimum treatment strategy remains unclear. We assessed hyperglycemia severity using glycated hemoglobin (HbA1c) test and predictors of severe hyperglycemia at the time of TB diagnosis in three resources-diverse regions in Tanzania. Methods This was a substudy from a large cohort study implemented in three regions of Tanzania. TB individuals with diabetes mellitus (DM) (prior history of DM or newly diagnosed DM) were assessed for hyperglycemic levels using HbA1c test and stratified as mild (<53 mmol/mol), moderate (≥53-<86 mmol/mol), and severe (≥86 mmo/mol). Results From October 2019 to September 2020, 1344 confirmed TB individuals were screened for DM and 105 (7.8%) individuals had dual TB/DM and were assessed for glycemic levels. Of these, 69 (67.7%) had a prior history of DM and 26 (24.8%) were living with human immunodeficiency virus. Their mean age was 49.0 (±15.0) years and 56.2% were male. The majority (77.1%) had pulmonary TB, and 96.2% were newly diagnosed TB individuals. HbA1c test identified 41(39.0%), 37 (35.2%), and 27 (25.7%) individuals with severe, moderate, and mild the hyperglycaemia respectively. Female sex (odds ratio [OR]: 3.55, 95% confidence interval [CI]: 1.06-11.92, P = 0.040) and previous history of DM (OR: 3.71, 95% CI: 1.33-10.33, P = 0.013) were independent risk factors for severe hyperglycemic at the time of TB diagnosis. Conclusion By integrating early HbA1c testing, a substantial proportion of individuals with severe hyperglycemia were identified. HbA1c testing can be recommended to identify and triage patients requiring personalized intensified DM management in resource-limited programmatic settings.
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Affiliation(s)
- Kenneth C Byashalira
- Kilimanjaro Christian Medical University College, Moshi; Kibong'oto Infectious Disease Hospital, Sanya Juu, Siha, Tanzania
| | - Nyasatu G Chamba
- Kilimanjaro Christian Medical University College; Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases, Medical University of South Carolina, USA
| | - Nyanda E Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, Tanzania
| | - Jan-Willem Affenaar
- Sydney Institute for Infectious Diseases; School of Pharmacy, Faculty of Medicine and Health, The University of Sydney; Westmead Hospital, Sydney, NSW, Australia
| | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, USA
| | | | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen; International Reference Laboratory of Mycobacteriology Statens Serum Institut, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah G Mpagama
- Kilimanjaro Christian Medical University College, Moshi; Kibong'oto Infectious Disease Hospital, Sanya Juu, Siha, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College; Kilimanjaro Clinical Research Institute, Moshi; Department of Paediatric and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Christensen DL, Westgate K, Griffiths L, Sironga J, Maro VP, Helge JW, Larsen S, Bygbjerg IC, Ramaiya KL, Jensen J, Brage S. Energy expenditure and intensity of ritual jumping-dancing in male Maasai. Am J Hum Biol 2023; 35:e23907. [PMID: 37132455 DOI: 10.1002/ajhb.23907] [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: 02/11/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES Traditional jumping-dance rituals performed by Maasai men involve prolonged physical exertion that may contribute significantly to overall physical activity level. We aimed to objectively quantify the metabolic intensity of jumping-dance activity and assess associations with habitual physical activity and cardiorespiratory fitness (CRF). METHODS Twenty Maasai men (18-37 years) from rural Tanzania volunteered to participate in the study. Habitual physical activity was monitored using combined heart rate (HR) and movement sensing over 3 days, and jumping-dance engagement was self-reported. A 1-h jumping-dance session resembling a traditional ritual was organized, during which participants' vertical acceleration and HR were monitored. An incremental, submaximal 8-min step test was performed to calibrate HR to physical activity energy expenditure (PAEE) and assess CRF. RESULTS Mean (range) habitual PAEE was 60 (37-116) kJ day-1 kg-1 , and CRF was 43 (32-54) mL O2 min-1 kg-1 . The jumping-dance activity was performed at an absolute HR of 122 (83-169) beats·min-1 , and PAEE of 283 (84-484) J min-1 kg-1 or 42 (18-75)% when expressed relative to CRF. The total PAEE for the session was 17 (range 5-29) kJ kg-1 , ~28% of the daily total. Self-reported engagement in habitual jumping-dance frequency was 3.8 (1-7) sessions/week, with a total duration of 2.1 (0.5-6.0) h/session. CONCLUSIONS Intensity during traditional jumping-dance activity was moderate, but on average sevenfold higher than habitual physical activity. These rituals are common, and can make a substantial contribution to overall physical activity in Maasai men, and thus be promoted as a culture-specific activity to increase energy expenditure and maintain good health in this population.
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Affiliation(s)
- Dirk L Christensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kate Westgate
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Lewis Griffiths
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Joseph Sironga
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Internal Medicine, Monduli District Hospital, Monduli, Tanzania
| | - Venance P Maro
- Department of Internal Medicine, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jørn W Helge
- Biomedical Institute, University of Copenhagen, Copenhagen, Denmark
| | - Steen Larsen
- Biomedical Institute, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kaushik L Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | - Jorgen Jensen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Soren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Mpagama SG, Byashalira KC, Chamba NG, Heysell SK, Alimohamed MZ, Shayo PJ, Kalolo A, Chongolo AM, Gitige CG, Mmbaga BT, Ntinginya NE, Alffenaar JWC, Bygbjerg IC, Lillebaek T, Christensen DL, Ramaiya KL. Implementing Innovative Approaches to Improve Health Care Delivery Systems for Integrating Communicable and Non-Communicable Diseases Using Tuberculosis and Diabetes as a Model in Tanzania. Int J Environ Res Public Health 2023; 20:6670. [PMID: 37681810 PMCID: PMC10487244 DOI: 10.3390/ijerph20176670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 09/09/2023]
Abstract
Background: Many evidence-based health interventions, particularly in low-income settings, have failed to deliver the expected impact. We designed an Adaptive Diseases Control Expert Programme in Tanzania (ADEPT) to address systemic challenges in health care delivery and examined the feasibility, acceptability and effectiveness of the model using tuberculosis (TB) and diabetes mellitus (DM) as a prototype. Methods: This was an effectiveness-implementation hybrid type-3 design that was implemented in Dar es Salaam, Iringa and Kilimanjaro regions. The strategy included a stepwise training approach with web-based platforms adapting the Gibbs' reflective cycle. Health facilities with TB services were supplemented with DM diagnostics, including glycated haemoglobin A1c (HbA1c). The clinical audit was deployed as a measure of fidelity. Retrospective and cross-sectional designs were used to assess the fidelity, acceptability and feasibility of the model. Results: From 2019-2021, the clinical audit showed that ADEPT intervention health facilities more often identified median 8 (IQR 6-19) individuals with dual TB and DM, compared with control health facilities, median of 1 (IQR 0-3) (p = 0.02). Likewise, the clinical utility of HbA1c on intervention sites was 63% (IQR:35-75%) in TB/DM individuals compared to none in the control sites at all levels, whereas other components of the standard of clinical management of patients with dual TB and DM did not significantly differ. The health facilities showed no difference in screening for additional comorbidities such as hypertension and malnutrition. The stepwise training enrolled a total of 46 nurse officers and medical doctors/specialists for web-based training and 40 (87%) attended the workshop. Thirty-one (67%), 18 nurse officers and 13 medical doctors/specialists, implemented the second step of training others and yielded a total of 519 additional front-line health care workers trained: 371 nurses and 148 clinicians. Overall, the ADEPT model was scored as feasible by metrics applied to both front-line health care providers and health facilities. Conclusions: It was feasible to use a stepwise training and clinical audit to support the integration of TB and DM management and it was largely acceptable and effective in differing regions within Tanzania. When adapted in the Tanzania health system context, the model will likely improve quality of services.
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Affiliation(s)
- Stellah G. Mpagama
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
| | - Kenneth C. Byashalira
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
| | - Nyasatu G. Chamba
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
- Kilimanjaro Clinical Research Institute, Moshi Kilimanjaro 25116, Tanzania
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA 22908-1340, USA;
| | - Mohamed Z. Alimohamed
- Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania; (M.Z.A.); (K.L.R.)
- Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Pendomartha J. Shayo
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Albino Kalolo
- Department of Public Health, Faculty of Medicine, St. Francis University College of Health and Allied Sciences, Ifakara 67501, Tanzania;
| | - Anna M. Chongolo
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Catherine G. Gitige
- Kibong’oto Infectious Diseases Hospital, Mae Street, Lomakaa Road, Siha Kilimanjaro 25401, Tanzania; (K.C.B.); (P.J.S.); (A.M.C.); (C.G.G.)
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical University College, Moshi Kilimanjaro 25116, Tanzania; (N.G.C.); (B.T.M.)
- Kilimanjaro Clinical Research Institute, Moshi Kilimanjaro 25116, Tanzania
| | - Nyanda E. Ntinginya
- National Institute of Medical Research-Mbeya Medical Research Centre, Hospital Hill Road, Mbeya 53110, Tanzania;
| | - Jan-Willem C. Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW 2006, Australia;
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, NSW 2145, Australia
- Westmead Hospital, Sydney, NSW 2145, Australia
| | - Ib C. Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, DK-2300 Copenhagen, Denmark
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1353 Copenhagen, Denmark; (I.C.B.); (T.L.); (D.L.C.)
| | - Kaushik L. Ramaiya
- Department of Internal Medicine, Hindu Manda Hospital, Ilala, Dar es Salaam 11104, Tanzania; (M.Z.A.); (K.L.R.)
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Christensen DL, Mutabingwa TK, Bygbjerg IC, Vaag AA, Grunnet LG, Lajeunesse-Trempe F, Nielsen J, Schmiegelow C, Ramaiya KL, Myburgh KH. Skeletal muscle fibre type and enzymatic activity in adult offspring following placental and peripheral malaria exposure in foetal life. Front Public Health 2023; 11:1122393. [PMID: 37333553 PMCID: PMC10275361 DOI: 10.3389/fpubh.2023.1122393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/12/2023] [Indexed: 06/20/2023] Open
Abstract
Background Maternal malaria may restrict foetal growth. Impaired utero-placental blood flow due to malaria infection may cause hypoxia-induced altered skeletal muscle fibre type distribution in the offspring, which may contribute to insulin resistance and impaired glucose metabolism. This study assessed muscle fibre distribution 20 years after placental and/or peripheral in-utero malaria exposure compared to no exposure, i.e., PPM+, PM+, and M-, respectively. Methods We traced 101 men and women offspring of mothers who participated in a malaria chemosuppression study in Muheza, Tanzania. Of 76 eligible participants, 50 individuals (29 men and 21 women) had skeletal muscle biopsy taken from m. vastus lateralis in the right leg. As previously reported, fasting and 30 min post-oral glucose challenge plasma glucose values were higher, and insulin secretion disposition index was lower, in the PPM+ group. Aerobic capacity (fitness) was estimated by an indirect VO2max test on a stationary bicycle. Muscle fibre sub-type (myosin heavy chain, MHC) distribution was analysed, as were muscle enzyme activities (citrate synthase (CS), 3-hydroxyacyl-CoA dehydrogenase, myophosphorylase, phosphofructokinase, lactate dehydrogenase, and creatine kinase activities. Between-group analyses were adjusted for MHC-I %. Results No differences in aerobic capacity were found between groups. Despite subtle elevations of plasma glucose levels in the PPM+ group, there was no difference in MHC sub-types or muscle enzymatic activities between the malaria-exposed and non-exposed groups. Conclusion The current study did not show differences in MHC towards glycolytic sub-types or enzymatic activity across the sub-groups. The results support the notion of the mild elevations of plasma glucose levels in people exposed to placental malaria in pregnancy being due to compromised pancreatic insulin secretion rather than insulin resistance.
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Affiliation(s)
| | | | - Ib C. Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Allan A. Vaag
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Translational Type 2 Diabetes Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Louise G. Grunnet
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Clinical Prevention Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Jannie Nielsen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Kathryn H. Myburgh
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
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Chamba NG, Byashalira KC, Christensen DL, Ramaiya KL, Kapyolo EP, Shayo PJ, Lillebaek T, Ntinginya NE, Mmbaga BT, Bygbjerg IC, Mpagama SG, Manongi RN. Experiences and perceptions of participants on the pathway towards clinical management of dual tuberculosis and diabetes mellitus in Tanzania. Glob Health Action 2022; 15:2143044. [PMID: 36441076 PMCID: PMC9894537 DOI: 10.1080/16549716.2022.2143044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is a common comorbidity among people with tuberculosis (TB). Despite the availability of guidelines on how to integrate dual TB/DM in Tanzania, the practice of integration at various healthcare levels is unclear. OBJECTIVE To explore the participants' experiences and perceptions on the pathway towards clinical management of dual TB/DM. METHOD The research was carried out in Dar es Salaam, Iringa, and Kilimanjaro regions between January and February 2020. A qualitative, in-depth interview approach was used to collect participants' experiences and perspectives on the acquisition of dual TB/DM services at various levels of healthcare facilities. The information gathered were coded and classified thematically. RESULTS The participants' perception of TB services within the healthcare facilities was positive due to the support they received from the healthcare providers. On the other hand, participants reported difficulty receiving management in various health facilities for each condition in terms of access to dual TB/DM care and access to DM medication. This was viewed as a significant challenge for the participants with dual TB/DM. CONCLUSIONS The current disjunction and disruption in healthcare for people with dual TB/DM makes it difficult to access services at various levels of health facilities. For optimal clinical management for people with dual TB/DM, patient-centered strategies and integrated approaches are urgently needed.
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Affiliation(s)
- Nyasatu G. Chamba
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Department of Internal Medicine, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania,CONTACT Nyasatu G. Chamba Department of Internal Medicine, Kilimanjaro Christian Medical University College, P.O.Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
| | - Kenneth C. Byashalira
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kaushik L. Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Eliakimu P. Kapyolo
- Department of Clinical research, National Institute for Medical Research, Dodoma Medical Research Centre, Dodoma, United Republic of Tanzania
| | - PendoMartha J. Shayo
- Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Troels Lillebaek
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
| | - Nyanda E. Ntinginya
- National Institute for Medical Research, Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kilimanjaro Clinical Research Institute, Directorate of Research and Consultancies, Moshi, United Republic of Tanzania
| | - Ib C. Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah G. Mpagama
- Kilimanjaro Christian Medical University College, Faculty of Medicine, Moshi, United Republic of Tanzania,Kibong’oto Infectious Disease Hospital, Department of Research, Sanya Juu, United Republic of Tanzania
| | - Rachel N. Manongi
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania
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Mtove G, Minja DTR, Abdul O, Gesase S, Maleta K, Divala TH, Patson N, Ashorn U, Laufer MK, Madanitsa M, Ashorn P, Mathanga D, Chinkhumba J, Gutman JR, Ter Kuile FO, Møller SL, Bygbjerg IC, Alifrangis M, Theander T, Lusingu JPA, Schmiegelow C. The choice of reference chart affects the strength of the association between malaria in pregnancy and small for gestational age: an individual participant data meta-analysis comparing the Intergrowth-21 with a Tanzanian birthweight chart. Malar J 2022; 21:292. [PMID: 36224585 PMCID: PMC9559842 DOI: 10.1186/s12936-022-04307-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of small for gestational age (SGA) may vary depending on the chosen weight-for-gestational-age reference chart. An individual participant data meta-analysis was conducted to assess the implications of using a local reference (STOPPAM) instead of a universal reference (Intergrowth-21) on the association between malaria in pregnancy and SGA. METHODS Individual participant data of 6,236 newborns were pooled from seven conveniently identified studies conducted in Tanzania and Malawi from 2003-2018 with data on malaria in pregnancy, birthweight, and ultrasound estimated gestational age. Mixed-effects regression models were used to compare the association between malaria in pregnancy and SGA when using the STOPPAM and the Intergrowth-21 references, respectively. RESULTS The 10th percentile for birthweights-for-gestational age was lower for STOPPAM than for Intergrowth-21, leading to a prevalence of SGASTOPPAM of 14.2% and SGAIG21 of 18.0%, p < 0.001. The association between malaria in pregnancy and SGA was stronger for STOPPAM (adjusted odds ratio (aOR) 1.30 [1.09-1.56], p < 0.01) than for Intergrowth-21 (aOR 1.19 [1.00-1.40], p = 0.04), particularly among paucigravidae (SGASTOPPAM aOR 1.36 [1.09-1.71], p < 0.01 vs SGAIG21 aOR 1.21 [0.97-1.50], p = 0.08). CONCLUSIONS The prevalence of SGA may be overestimated and the impact of malaria in pregnancy underestimated when using Intergrowth-21. Comparing local reference charts to global references when assessing and interpreting the impact of malaria in pregnancy may be appropriate.
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Affiliation(s)
- George Mtove
- Tanga Medical Research Centre, National Institute for Medical Research, P. O. Box, 210, Tanga, Tanzania.
| | - Daniel T R Minja
- Tanga Medical Research Centre, National Institute for Medical Research, P. O. Box, 210, Tanga, Tanzania
| | - Omari Abdul
- Tanga Medical Research Centre, National Institute for Medical Research, P. O. Box, 210, Tanga, Tanzania
| | - Samwel Gesase
- Tanga Medical Research Centre, National Institute for Medical Research, P. O. Box, 210, Tanga, Tanzania
| | | | | | - Noel Patson
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Ulla Ashorn
- Tampere Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | | | | | - Per Ashorn
- Faculty of Medicine and Health Technology, Center for Child, Adolescent, and Maternal Health Research, Tampere University, Tampere, Finland
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland
| | - Don Mathanga
- Kamuzu University of Health Sciences, Blantyre, Malawi
| | | | - Julie R Gutman
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, US Centers for Diseases Control and Prevention, Atlanta, GA, USA
| | - Feiko O Ter Kuile
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Thor Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - John P A Lusingu
- Tanga Medical Research Centre, National Institute for Medical Research, P. O. Box, 210, Tanga, Tanzania
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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9
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Byashalira K, Chamba N, Alkabab Y, Mbelele P, Mpolya E, Ntinginya N, Shayo PJ, Ramaiya KL, Lillebaek T, Heysell SK, Mmbaga BT, Bygbjerg IC, Mpagama S, Christensen DL. Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania. Trop Med Int Health 2022; 27:815-822. [DOI: 10.1111/tmi.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth Byashalira
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Nyasatu Chamba
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases and International Health University of Virginia USA
| | - Peter Mbelele
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Emmanuel Mpolya
- Department of Global Health and Bio‐Medical Sciences Nelson Mandela African Institution of Science
| | - Nyanda Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre Mbeya Tanzania
| | | | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut Copenhagen Denmark
- Global Health Section, Department of Public Health University of Copenhagen Denmark
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health University of Virginia USA
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kilimanjaro Christian Medical Centre Moshi Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - Ib C. Bygbjerg
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut Copenhagen Denmark
| | - Stellah Mpagama
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health University of Copenhagen Denmark
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10
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Christensen DL, Jørgensen SW, Koch LS, Nordsborg NB, Sironga J, Ramaiya KL, Larsen S, Brage S, Bygbjerg IC, Maro VP, Helge JW. Directly measured aerobic fitness in male Maasai of Tanzania. Am J Hum Biol 2022; 34:e23674. [PMID: 34487396 PMCID: PMC7613916 DOI: 10.1002/ajhb.23674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/10/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES The agro-pastoralist Maasai of East Africa are highly physically active, but their aerobic fitness has so far only been estimated using heart rate (HR) response to submaximal exercise and not directly measured. Thus, we aimed to measure aerobic fitness directly using respiratory gas analysis in a group of Maasai, and habitual physical activity energy expenditure (PAEE) as explanatory variable. METHODS In total, 21 (10 rural, 11 semi-urban) of 30 volunteering Tanzanian Maasai men were eligible to participate. Respiratory gas exchange was measured during a graded exercise test until exhaustion on a stationary bicycle to determine aerobic fitness. Maximal effort criteria were at least two of the following (1) leveling off, (2) respiratory exchange ratio (RER) >1.10, and (3) maximum HR within 10 bpm of age-estimated maximum HR. Habitual PAEE was estimated using combined accelerometry and HR monitoring. Anthropometry, biochemistry, blood pressure, resting HR, and dietary intake information were collected for background information. RESULTS Mean age was 43.2 (range 26-60) years, and hemoglobin was higher in the rural versus semi-urban Maasai (16.9 vs. 15.4 g/dl, p = .02). Mean aerobic fitness (34.4 vs. 33.3 mlO2 /min/kg, p = .79), and mean PAEE (58.5 vs. 52.9 kJ/day/kg, p = .64) were similar in rural and semi-urban Maasai, respectively. CONCLUSIONS Aerobic fitness was low to moderate in male rural and semi-urban Maasai. This may be explained by relatively low PAEE in comparison to previous objectively measured activity levels in Maasai, which indicates recent lifestyle changes.
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Affiliation(s)
| | - Sine W. Jørgensen
- Section of Endocrinology, Copenhagen University Hospital (Slagelse), Denmark
| | - Lars S. Koch
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Nikolai B. Nordsborg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Steen Larsen
- Center of Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland
| | - Søren Brage
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ib C. Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Venance P. Maro
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jørn W. Helge
- Center of Healthy Aging, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Grunnet LG, Bygbjerg IC, Mutabingwa TK, Lajeunesse-Trempe F, Nielsen J, Schmiegelow C, Vaag AA, Ramaiya K, Christensen DL. Influence of placental and peripheral malaria exposure in fetal life on cardiometabolic traits in adult offspring. BMJ Open Diabetes Res Care 2022; 10:10/2/e002639. [PMID: 35379692 PMCID: PMC8981354 DOI: 10.1136/bmjdrc-2021-002639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/13/2022] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Fetal malaria exposure may lead to intrauterine growth restriction and increase the risk of developing diabetes and cardiovascular diseases in adulthood. We investigated the extent to which fetal peripheral and placental malaria exposure impacts insulin sensitivity and secretion, body composition and cardiometabolic health 20 years after in utero malaria exposure. RESEARCH DESIGN AND METHODS We traced 101 men and women in Muheza district, Tanga region whose mothers participated in a malaria chemosuppression during a pregnancy study in 1989-1992. All potential participants were screened for malaria, hepatitis B and HIV to ascertain study eligibility. Seventy-six individuals (44 men, 32 women) were included in this cohort study. The participants underwent a thorough clinical examination including anthropometric measurements, ultrasound scanning for abdominal fat distribution, blood pressure, 75 g oral glucose tolerance test, an intravenous glucose tolerance test followed by a hyperinsulinemic euglycemic clamp and a submaximal exercise test. RESULTS Offspring exposed to placental malaria during pregnancy had significantly higher 30-minute plasma post-glucose load levels, but no significant difference in peripheral insulin resistance, insulin secretion or other cardiometabolic traits compared with non-exposed individuals. CONCLUSIONS Using the state-of-the-art euglycemic clamp technique, we were unable to prove our a priori primary hypothesis of peripheral insulin resistance in young adult offspring of pregnancies affected by malaria. However, the subtle elevations of plasma glucose might represent an early risk marker for later development of type 2 diabetes if combined with aging and a more obesogenic living environment.
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Affiliation(s)
- Louise G Grunnet
- Clinical Prevention Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Ib C Bygbjerg
- Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Theonest K Mutabingwa
- Faculty of Medicine, Hubert Kairuki Memorial University, Dar es Salaam, United Republic of Tanzania
| | | | - Jannie Nielsen
- Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Hubert Department of Gobal Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Allan A Vaag
- Clinical Prevention Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
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12
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Launbo N, Davidsen E, Granich-Armenta A, Bygbjerg IC, Sánchez M, Ramirez-Silva I, Avila-Jimenez L, Christensen DL, Rivera-Dommarco JA, Cantoral A, Nielsen KK, Grunnet LG. Overlooked paradox of the coexistence of overweight/obesity and anaemia during pregnancy. Nutrition 2022; 99-100:111650. [DOI: 10.1016/j.nut.2022.111650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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13
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Chamba NG, Byashalira KC, Shayo PJ, Ramaiya KL, Manongi RN, Daud P, Mmbaga BT, Ntinginya NE, Lillebaek T, Bygbjerg IC, Christensen DL, Mpagama SG. Where can Tanzania health system integrate clinical management of patients with dual tuberculosis and diabetes mellitus? A cross-sectional survey at varying levels of health facilities. Public Health in Practice 2022; 3:100242. [PMID: 36101768 PMCID: PMC9461549 DOI: 10.1016/j.puhip.2022.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 11/01/2022] Open
Abstract
Objective Study design Methods Results Conclusion
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14
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Mpagama SG, Ramaiya K, Lillebæk T, Mmbaga BT, Sumari-de Boer M, Ntinginya NE, Alffenaar JW, Heysell SK, Bygbjerg IC, Christensen DL. Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study. BMJ Open 2021; 11:e041521. [PMID: 33910944 PMCID: PMC8094344 DOI: 10.1136/bmjopen-2020-041521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 02/04/2021] [Accepted: 04/12/2021] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Most sub-Saharan African countries endure a high burden of communicable infections but also face a rise of non-communicable diseases (NCDs). Interventions targeting particular epidemics are often executed within vertical programmes. We establish an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) model with three domains; stepwise training approach, integration of communicable and NCDs and a learning system. The model aims to shift traditional vertical programmes to an adaptive diseases management approach through integrating communicable and NCDs using the tuberculosis (TB) and diabetes mellitus (DM) dual epidemic as a case study. We aim to describe the ADEPT protocol with underpinned implementation and operational research on TB/DM. METHODS AND ANALYSIS The model implement a collaborative TB and DM services protocol as endorsed by WHO in Tanzania. Evaluation of the process and outcomes will follow the logic framework. A mixed research design with both qualitative and quantitative approaches will be used in applied research action. Anticipated implementation research outcomes include at the health facilities level for organising TB/DM services, pathways of patients with TB/DM seeking care in different health facilities, factors in service delivery that need deimplementation and the ADEPT model implementation feasibility, acceptability and fidelity. Expected operational research outcomes include additional identified patients with dual TB/DM, the prevalence of comorbidities like hypertension in patients with TB/DM and final treatment outcomes of TB/DM including treatment-related complications. Findings will inform the future policies and practices for integrating communicable and NCDs services. ETHICS AND DISSEMINATION Ethical approval was granted by The National Research Health Ethical Committee (Ref-No. NIMR/HQ/R.8a/Vol.IX/2988) and the implementation endorsed by the government authorities. Findings will be proactively disseminated through multiple mechanisms including peer-reviewed journals, and engagement with various stakeholders' example in conferences and social media.
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Affiliation(s)
- Stellah G Mpagama
- Medical, Kibong'oto Infectious Diseases Hospital, Sanya Juu, Tanzania
| | - Kaushik Ramaiya
- Department of Internal Medicine, Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania
| | | | | | | | | | | | - Scott K Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, Virginia, USA
| | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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15
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Hansson H, Minja DTR, Moeller SL, Lusingu JPA, Bygbjerg IC, Yde AM, Jensen RW, Nag S, Msemo OA, Theander TG, Alifrangis M, Schmiegelow C. Reduced birth weight caused by sextuple drug resistant Plasmodium falciparum infection in early 2nd trimester. J Infect Dis 2021; 224:1605-1613. [PMID: 33684211 DOI: 10.1093/infdis/jiab117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/26/2021] [Indexed: 11/12/2022] Open
Abstract
Mutations in the Plasmodium falciparum genes Pfdhfr and Pfdhps, particularly the sextuple mutant haplotype threatens the antimalarial effectiveness of sulfadoxine-pyrimethamine as intermittent preventive treatment during pregnancy (IPTp). To explore the impact of sextuple mutant haplotype infections on outcome measures after provision of IPTp-SP, we monitored birth outcomes in women followed from prior to conception or from the first trimester until delivery. Women infected with sextuple haplotypes in early 2 nd trimester specifically, delivered newborns with a lower birth weight (-267g, 95% CI -454; -59, p=0·01) compared to women who did not have malaria during pregnancy and women infected with less SP resistant haplotypes (-461g, 95% CI -877; -44, p=0·03). Thus, sextuple haplotype infections seems to impact the effectiveness of SP for IPTp and directly impact birth outcome by lowering birth weight. Close monitoring and targeted malaria control during early pregnancy is therefore crucial to improve birth outcomes.
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Affiliation(s)
- Helle Hansson
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Sofie L Moeller
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade, Copenhagen K, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Ib C Bygbjerg
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade, Copenhagen K, Denmark
| | - Anna-Mathilde Yde
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Rasmus W Jensen
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Sidsel Nag
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Omari A Msemo
- National Institute for Medical Research, Tanga Research Centre, Bombo Area, Tanga, Tanzania
| | - Thor G Theander
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Michael Alifrangis
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, University of Copenhagen, Denmark and Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej, Copenhagen N, Denmark
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16
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Moeller SL, Nyengaard JR, Larsen LG, Nielsen K, Bygbjerg IC, Msemo OA, Lusingu JPA, Minja DTR, Theander TG, Schmiegelow C. Malaria in Early Pregnancy and the Development of the Placental Vasculature. J Infect Dis 2020; 220:1425-1434. [PMID: 30590576 DOI: 10.1093/infdis/jiy735] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Pregnancy malaria has a negative impact on fetal outcome. It is uncertain whether infections in early pregnancy have a clinical impact by impeding the development of the placental vasculature. METHODS Tanzanian women (n = 138) were closely monitored during pregnancy. Placentas collected at birth were investigated using stereology to establish the characteristics of placental villi and vessels. Placental vasculature measures were compared between women infected with malaria and controls. RESULTS Compared with controls, placentas from women infected with malaria before a gestational age (GA) of 15 weeks had a decreased volume of transport villi (mean decrease [standard deviation], 12.45 [5.39] cm3; P = .02), an increased diffusion distance in diffusion vessels (mean increase, 3.33 [1.27] µm; P = .01), and a compensatory increase in diffusion vessel surface area (mean increase, 1.81 [0.74 m2]; P = .02). In women who had malaria before a GA of 15 weeks diffusion vessel surface area and transport vessel length distance were positive predictors for birth weight (multilinear regression: P = .007 and P = .055 for diffusion surface area and transport length, respectively) and GA at delivery (P = .005 and P = .04). CONCLUSIONS Malaria infection in early pregnancy impedes placental vascular development. The resulting phenotypic changes, which can be detected at delivery, are associated with birth weight and gestational length. CLINICAL TRIALS REGISTRATION NCT02191683.
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Affiliation(s)
| | - Jens R Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, Aarhus University
| | - Lise G Larsen
- Department of Pathology, Zealand University Hospital, Naestved, Denmark
| | | | - Ib C Bygbjerg
- Division of Global Health, Department of Public Health
| | | | - John P A Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | | | - Thor G Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen
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17
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Hegelund MH, Faurholt-Jepsen D, Bygbjerg IC. Prevention of opportunistic non-communicable diseases. Int Health 2020; 12:1-2. [PMID: 30855663 PMCID: PMC6964215 DOI: 10.1093/inthealth/ihz011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 02/03/2019] [Accepted: 02/15/2019] [Indexed: 11/15/2022] Open
Abstract
As strategies targeting undernutrition and infections become increasingly successful in low- and middle-income countries (LMICs), a second challenge has appeared, namely premature onset of non-communicable diseases (NCDs). In LMICs, NCDs are often related to exposure to undernutrition and infections. As NCDs strike societies and individuals with impaired resistance or a deficient health (care) state, why not label such diseases ‘opportunistic’, in analogy with opportunistic infections attacking individuals with HIV? We propose the concept of opportunistic NCDs, hoping that fighting against infections, and for better maternal and child health, is becoming acknowledged as essential for the early prevention of NCDs.
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Affiliation(s)
- Maria H Hegelund
- Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, Denmark
| | | | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, CSS, building 9, Copenhagen K, Denmark
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18
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Theilgaard ZP, Chiduo MG, Flamholc L, Gerstoft J, Bygbjerg IC, Lemnge MM, Katzenstein TL. Retired Nurses Can Improve Retention in Prevention of Mother-to-Child Transmission Programmes. East Afr Health Res J 2019; 3:88-95. [PMID: 34308201 PMCID: PMC8279289 DOI: 10.24248/eahrj-d-19-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 09/06/2019] [Indexed: 12/03/2022] Open
Abstract
Background: The success of prevention of mother-to-child transmission (PMTCT) programmes depends on retention of mothers throughout the PMTCT cascade. Methods: In a clinical trial of short-course combination antiretroviral therapy (cART) for PMTCT in Tanzania, senior nurses were employed to reduce the substantial loss-to-follow up (LTFU) rate. Results: Following intervention, the relative risk (RR) of receiving a CD4 count result and antiretroviral therapy was 1.16 (95% confidence interval [CI], 1.05 to 1.27), the RR of delivery at clinic was 2.51 (95% CI, 2.06 to 3.06), the RR for reporting for follow-up at 6 to 8 weeks postpartum was 4.63 (95% CI, 3.41 to 6.27), and the RR for being retained until 9 months postpartum was 28.19 (95% CI, 11.81 to 67.28). No significant impact on transmission was found. Conclusion: Significantly higher retention was found after senior nurses were employed. No impact on transmission was found. Relatively low transmission was found in both study arms.
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Affiliation(s)
- Zahra Persson Theilgaard
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mercy G Chiduo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Leo Flamholc
- Department of Infectious Diseases, University Hospital of Malmö, Malmö, Sweden
| | - Jan Gerstoft
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Terese L Katzenstein
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Hjort L, Lykke Møller S, Minja D, Msemo O, Nielsen BB, Lund Christensen D, Theander T, Nielsen K, Larsen LG, Grunnet LG, Groop L, Prasad R, Lusingu J, Schmiegelow C, Bygbjerg IC. FOETAL for NCD-FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life: a prospective preconception study in rural Tanzania. BMJ Open 2019; 9:e024861. [PMID: 31122967 PMCID: PMC6537995 DOI: 10.1136/bmjopen-2018-024861] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Low-income and middle-income countries such as Tanzania experience a high prevalence of non-communicable diseases (NCDs), including anaemia. Studying if and how anaemia affects growth, placenta development, epigenetic patterns and newborns' risk of NCDs may provide approaches to prevent NCDs. PARTICIPANTS The FOETALforNCD (FOetal Exposure and Epidemiological Transitions: the role of Anaemia in early Life for Non-Communicable Diseases in later life) Study is a population-based preconception, pregnancy and birth cohort study (n=1415, n=538, n=427, respectively), conducted in a rural region of North-East Tanzania. All participants were recruited prior to conception or early in pregnancy and followed throughout pregnancy as well as at birth. Data collection included: maternal blood, screening for NCDs and malaria, ultrasound in each trimester, neonatal anthropometry at birth and at 1 month of age, cord blood, placental and cord biopsies for stereology and epigenetic analyses. FINDINGS TO DATE At preconception, the average age, body mass index and blood pressure of the women were 28 years, 23 kg/m2 and 117/75 mm Hg, respectively. In total, 458 (36.7%) women had anaemia (haemoglobin Hb <12 g/dL) and 34 (3.6%) women were HIV-positive at preconception. During pregnancy 359 (66.7%) women had anaemia of which 85 (15.8%) women had moderate-to-severe anaemia (Hb ≤9 g/dL) and 33 (6.1%) women had severe anaemia (Hb ≤8 g/dL). In total, 185 (34.4%) women were diagnosed with malaria during pregnancy. FUTURE PLANS The project will provide new knowledge on how health, even before conception, might modify the risk of developing NCDs and how to promote better health during pregnancy. The present project ended data collection 1 month after giving birth, but follow-up is continuing through regular monitoring of growth and development and health events according to the National Road Map Strategic Plan in Tanzania. This data will link fetal adverse event to childhood development, and depending on further grant allocation, through a life course follow-up.
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Affiliation(s)
- Line Hjort
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
| | - Sofie Lykke Møller
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Daniel Minja
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
| | - Omari Msemo
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
| | | | - Dirk Lund Christensen
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Thor Theander
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Karsten Nielsen
- Department of Histopathology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Louise Groth Grunnet
- Department of Endocrinology, Rigshospitalet, Copenhagen, Denmark
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
| | - Leif Groop
- Department of Clinical Sciences, Clinical Research Centre, Lunds Universitet, Lund, Sweden
- Finnish Institute of Molecular Medicine, Helsinki University, Helsinki, Finland
| | - Rashmi Prasad
- Department of Clinical Sciences, Clinical Research Centre, Lunds Universitet, Lund, Sweden
| | - John Lusingu
- National Institute for Medical Research, Tanga Research centre, Tanga, United Republic of Tanzania
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Christentze Schmiegelow
- Center for Medical Parasitology, Department of Immunology and Microbiology, Copenhagen University, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Section of Global Health, Departmentof Public Health, Copenhagen University, Copenhagen, Denmark
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Moeller SL, Schmiegelow C, Larsen LG, Nielsen K, Msemo OA, Lusingu JPA, Minja DTR, Theander TG, Bygbjerg IC, Nyengaard JR. Anemia in late pregnancy induces an adaptive response in fetoplacental vascularization. Placenta 2019; 80:49-58. [PMID: 31103067 DOI: 10.1016/j.placenta.2019.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Anemia during pregnancy may compromise fetal and newborn's health, however, little is known about how and when the fetoplacental vascularization is most vulnerable to anemia. METHODS Using systematic and isotropic uniform random sampling, placental samples were collected from 189 placentas in a cohort study of Tanzanian women whose hemoglobin concentration was measured throughout pregnancy. Fetoplacental vessels and villi were defined as exerting either a transport or diffusion function. The vascularization patterns for transport and diffusion vessels and villi were assessed by stereology. Blood vessel length, surface area and diffusion distance as well as placental villi volume were calculated. RESULTS Anemia from a gestational age of 23 weeks was significantly associated with increased fetoplacental vascularization in vessels and villi compared to women who were non-anemic throughout pregnancy. Transport surface vessel area: 0.31 m2 [95% CI: 0.18-0.55], P = 0.01; Transport villi volume 19.8 cm3 [95% CI: 6.37-33.2], P = 0.004, Transport vessel diameter 7.23 μm [95% CI: 1.23-13.3], P = 0.02. Diffusion vessel surface: 3.23 m2 [95% CI: 1.55-4.91], P < 0.001 and diffusion villi volume: 29.8 cm3 [95% CI: 10.0-49.5], P = 0.003). Finally, all the measured transport vessel and villi significantly parameters and diffusion vessel surface, vessel diameter and diffusion distance were associated with birth weight. DISCUSSION Increased fetoplacental vascularization related to anemia from a gestational age of 23 weeks in pregnancy together with the association between fetoplacental vascularity and birth weight suggest that the timing of anemia determines the effect on fetoplacental vascularization and underlines the clinical relevance for proper development of fetoplacental vasculature.
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Affiliation(s)
- Sofie L Moeller
- Division of Global Health, Department of Public Health, Oester Farimagsgade 5, Building 9, University of Copenhagen, DK-1014, Copenhagen, Denmark.
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Blegdamsvej 3B, University of Copenhagen, DK-2200, Copenhagen, Denmark.
| | - Lise G Larsen
- Department of Pathology, Zealand University Hospital, Naestved, DK-4700, Naestved, Denmark.
| | - Karsten Nielsen
- Department of Pathology, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, C112, DK-8200, Aarhus, Denmark.
| | - Omari Abdul Msemo
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - John P A Lusingu
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - Daniel T R Minja
- National Institute for Medical Research, Korogwe, 210, Tanga, Tanzania.
| | - Thor G Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Blegdamsvej 3B, University of Copenhagen, DK-2200, Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Division of Global Health, Department of Public Health, Oester Farimagsgade 5, Building 9, University of Copenhagen, DK-1014, Copenhagen, Denmark.
| | - Jens R Nyengaard
- Core Center for Molecular Morphology, Section for Stereology and Microscopy, Centre for Stochastic Geometry and Advanced Bioimaging, Department of Clinical Medicine, C113, level 1, Palle Juul Jensens Boulevard 99, Aarhus University, DK-8200, Aarhus N, Denmark.
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Msemo OA, Bygbjerg IC, Møller SL, Nielsen BB, Ødum L, Perslev K, Lusingu JPA, Kavishe RA, Minja DTR, Schmiegelow C. Prevalence and risk factors of preconception anemia: A community based cross sectional study of rural women of reproductive age in northeastern Tanzania. PLoS One 2018; 13:e0208413. [PMID: 30562390 PMCID: PMC6298689 DOI: 10.1371/journal.pone.0208413] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 11/16/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Anemia is a major public health problem that adversely affects pregnancy outcomes. The prevalence of anemia among pregnant women before conception is not well known in Tanzania. The aim of this study was to determine the prevalence, types, and risk factors of preconception anemia in women of reproductive age from a rural Tanzanian setting. METHODS Trained field workers visited households to identify all female residents aged 18-40 years and invited them to the nearby health facility for screening and enrolment into this study. Baseline samples were collected to measure hemoglobin levels, serum ferritin, vitamin B12, folate, C-reactive protein, alanine amino-transferase, the presence of malaria, HIV, and soil transmitted helminth infections. Anthropometric and socio-economic data were recorded alongside with clinical information of participants. Logistic regression analysis was used to determine the adjusted odds ratios (AOR) for the factors associated with preconception anemia. FINDINGS Of 1248 women enrolled before conception, 36.7% (95% confidence interval (CI) 34.1-39.4) had anemia (hemoglobin <12 g/dL) and 37.6% (95% CI 34.9-40.4) had iron deficiency. For more than half of the anemic cases, iron deficiency was also diagnosed (58.8%, 95% CI 54.2-63.3). Anemia was independently associated with increased age (AOR 1.05, 95% CI 1.03-1.07), malaria infection at enrolment (AOR 2.21, 95% CI 1.37-3.58), inflammation (AOR 1.77, 95% CI 1.21-2.60) and iron deficiency (AOR 4.68, 95% CI 3.55-6.17). The odds of anemia were reduced among women with increased mid-upper arm circumference (AOR 0.90, 95% CI 0.84-0.96). CONCLUSION Anemia among women of reproductive age before conception was prevalent in this rural setting. Increased age, iron deficiency, malaria infection and inflammation were significant risk factors associated with preconception anemia, whereas increased mid-upper arm circumference was protective against anemia. Interventions to ensure adequate iron levels as well as malaria control before conception are needed to prevent anemia before and during pregnancy and improve birth outcomes in this setting. TRIAL REGISTRATION NCT02191683.
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Affiliation(s)
- Omari A. Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Ib C. Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sofie L. Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte B. Nielsen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Ødum
- Department of Clinical Biochemistry, Roskilde Hospital, Rokslide, Denmark
| | - Kathrine Perslev
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
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22
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Kragelund Nielsen K, Damm P, Bygbjerg IC, Kapur A. Barriers and facilitators for implementing programmes and services to address hyperglycaemia in pregnancy in low and middle income countries: A systematic review. Diabetes Res Clin Pract 2018; 145:102-118. [PMID: 29684614 DOI: 10.1016/j.diabres.2018.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/04/2018] [Indexed: 10/17/2022]
Abstract
AIMS An estimated 87.6% of hyperglycaemia in pregnancy cases are in low and middle income countries (LMICs). The aim of this study is to review the evidence on barriers and facilitators to programmes and services addressing hyperglycaemia in pregnancy in LMICs. METHODS A systematic review and narrative synthesis was conducted based on searches in PubMed. A total of 23 qualitative and quantitative studies were included. RESULTS Barriers and facilitators exist at the health system level, individual level and social and societal levels and are often interacting. At the health system level they relate to capacity in terms of human and material resources; availability of feasible and appropriate guidelines; organisational management and referral pathways. Individual level barriers and facilitators include knowledge; risk perception; illness beliefs; financial condition; work obligations; concerns for the baby and hardship associated with services. At the social and societal level important factors are: perceptions and norms related to women's roles, mobility and health; the knowledge and support of women's social network; and structural aspects. CONCLUSIONS Numerous factors influence programmes and services addressing hyperglycaemia in pregnancy in LMICs. Thus, several components are needed to ensure detection, treatment and follow-up of women with hyperglycaemia in pregnancy.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Health Promotion Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Dept. of Obstetrics, Rigshospitalet, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
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23
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Maaløe N, Andersen CB, Housseine N, Meguid T, Bygbjerg IC, van Roosmalen J. Effect of locally tailored clinical guidelines on intrapartum management of severe hypertensive disorders at Zanzibar's tertiary hospital (the PartoMa study). Int J Gynaecol Obstet 2018; 144:27-36. [PMID: 30307609 PMCID: PMC7379925 DOI: 10.1002/ijgo.12692] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 03/23/2018] [Revised: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
Objective To estimate the effect of locally tailored clinical guidelines on intrapartum care and perinatal outcomes among women with severe hypertensive disorders in pregnancy (sHDP). Methods A pre–post study at Zanzibar's low‐resource Mnazi Mmoja Hospital was conducted. All labouring women with sHDP were included at baseline (October 2014 to January 2015) and at 9–12 months after implementation of the ongoing intervention (October 2015 to January 2016). Background characteristics, clinical practice, and delivery outcomes were assessed by criterion‐based case file reviews. Results Overall, 188 of 2761 (6.8%) women had sHDP at baseline, and 196 of 2398 (8.2%) did so during the intervention months. The median time between last blood pressure recording and delivery decreased during the intervention compared with baseline (P=0.015). Among women with severe hypertension, antihypertensive treatment increased during the intervention compared with baseline (relative risk [RR] 1.37, 95% confidence interval [CI] 1.14–1.66). Among the neonates delivered (birthweight ≥1000 g), stillbirths decreased (RR 0.56, 95% CI 0.35–0.90) and Apgar scores of seven or more increased during the intervention compared with baseline (RR 1.17, 95% CI 1.03–1.33). Conclusion Although health system strengthening remains crucial, locally tailored clinical guidelines seemed to help work‐overloaded birth attendants at a low‐resource hospital to improve care for women with sHDP. ClinicalTrials.org NCT02318420. Among women with severe hypertensive disorders at Zanzibar's referral hospital, locally tailored intrapartum guidelines were associated with care improvements and 44% risk reduction of stillbirth.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Camilla B Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Natasha Housseine
- Mnazi Mmoja Hospital, Zanzibar City, Tanzania.,Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, Netherlands
| | - Tarek Meguid
- Mnazi Mmoja Hospital, Zanzibar City, Tanzania.,O'Neill Institute for National and Global Health Law, Georgetown University, Washington, DC, USA
| | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, Amsterdam, Netherlands
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24
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Msemo OA, Schmiegelow C, Nielsen BB, Kousholt H, Grunnet LG, Christensen DL, Lusingu JPA, Møller SL, Kavishe RA, Minja DTR, Bygbjerg IC. Risk factors of pre-hypertension and hypertension among non-pregnant women of reproductive age in northeastern Tanzania: a community based cross-sectional study. Trop Med Int Health 2018; 23:1176-1187. [PMID: 30280462 DOI: 10.1111/tmi.13149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine risk factors of pre-hypertension and hypertension in a cohort of 1247 rural Tanzanian women before conception. METHODS Demographic and socioeconomic data, anthropometric measurements, past medical and obstetric history and other risk factors for pre-hypertension and hypertension were collected using a structured questionnaire. Multiple logistic regression analysis was used to evaluate the associations between anthropometric indices and other risk factors of pre-hypertension and hypertension. The predictive power of different anthropometric indicators for identification of pre-hypertension and hypertension patients was determined by Receiver Operating Characteristic curves (ROC). RESULTS The median (range) age was 28.0 (18-40) years. The age-standardised prevalences of pre-hypertension and hypertension were 37.2 (95% CI 34.0-40.6) and 8.5% (95%CI 6.7-10.8), respectively. Of hypertensive patients (n = 98), only 20 (20.4%) were aware of their condition. In multivariate analysis, increasing age, obesity and haemoglobin levels were significantly associated with pre-hypertension and hypertension. CONCLUSION Despite a low prevalence of hypertension, over one third of the women had pre-hypertension. This poses a great challenge ahead as pre-hypertensive women may progress into hypertension as they grow older without appropriate interventions. Obesity was the single most important modifiable risk factor for pre-hypertension and hypertension.
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Affiliation(s)
- Omari A Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte B Nielsen
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Aarhus, Denmark
| | - Hannah Kousholt
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Louise G Grunnet
- Department of Endocrinology, University of Copenhagen Hospital, Copenhagen, Denmark
| | - Dirk L Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Sofie L Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel T R Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Ishengoma DS, Mmbando BP, Mandara CI, Chiduo MG, Francis F, Timiza W, Msemo H, Kijazi A, Lemnge MM, Malecela MN, Snow RW, Alifrangis M, Bygbjerg IC. Trends of Plasmodium falciparum prevalence in two communities of Muheza district North-eastern Tanzania: correlation between parasite prevalence, malaria interventions and rainfall in the context of re-emergence of malaria after two decades of progressively declining transmission. Malar J 2018; 17:252. [PMID: 29976204 PMCID: PMC6034219 DOI: 10.1186/s12936-018-2395-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 03/05/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
Background Although the recent decline of malaria burden in some African countries has been attributed to a scale-up of interventions, such as bed nets (insecticide-treated bed nets, ITNs/long-lasting insecticidal nets, LLINs), the contribution of other factors to these changes has not been rigorously assessed. This study assessed the trends of Plasmodium falciparum prevalence in Magoda (1992–2017) and Mpapayu (1998–2017) villages of Muheza district, North-eastern Tanzania, in relation to changes in the levels of different interventions and rainfall patterns. Methods Individuals aged 0–19 years were recruited in cross-sectional surveys to determine the prevalence of P. falciparum infections in relation to different malaria interventions deployed, particularly bed nets and anti-malarial drugs. Trends and patterns of rainfall in Muheza for 35 years (from 1981 to 2016) were assessed to determine changes in the amount and pattern of rainfall and their possible impacts on P. falciparum prevalence besides of those ascribed to interventions. Results High prevalence (84–54%) was reported between 1992 and 2000 in Magoda, and 1998 and 2000 in Mpapayu, but it declined sharply from 2001 to 2004 (from 52.0 to 25.0%), followed by a progressive decline between 2008 and 2012 (to ≤ 7% in both villages). However, the prevalence increased significantly from 2013 to 2016 reaching ≥ 20.0% in 2016 (both villages), but declined in the two villages to ≤ 13% in 2017. Overall and age specific P. falciparum prevalence decreased in both villages over the years but with a peak prevalence shifting from children aged 5–9 years to those aged 10–19 years from 2008 onwards. Bed net coverage increased from < 4% in 1998 to > 98% in 2001 and was ≥ 85.0% in 2004 in both villages; followed by fluctuations with coverage ranging from 35.0 to ≤ 98% between 2008 and 2017. The 12-month weighted anomaly standardized precipitation index showed a marked rainfall deficit in 1990–1996 and 1999–2010 coinciding with declining prevalence and despite relatively high bed net coverage from 2000. From 1992, the risk of infection decreased steadily up to 2013 when the lowest risk was observed (RR = 0.07; 95% CI 0.06–0.08, P < 0.001), but it was significantly higher during periods with positive rainfall anomalies (RR = 2.79; 95% CI 2.23–3.50, P < 0.001). The risk was lower among individuals not owning bed nets compared to those with nets (RR = 1.35; 95% CI 1.22–1.49, P < 0.001). Conclusions A decline in prevalence up to 2012 and resurgence thereafter was likely associated with changes in monthly rainfall, offset against changing malaria interventions. A sustained surveillance covering multiple factors needs to be undertaken and climate must be taken into consideration when relating control interventions to malaria prevalence. Electronic supplementary material The online version of this article (10.1186/s12936-018-2395-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Deus S Ishengoma
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania.
| | - Bruno P Mmbando
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Celine I Mandara
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Mercy G Chiduo
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | - Filbert Francis
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | | | - Hellen Msemo
- Tanzania Meteorological Agency, Dar es Salaam, Tanzania
| | - Agnes Kijazi
- Tanzania Meteorological Agency, Dar es Salaam, Tanzania
| | - Martha M Lemnge
- Tanga Research Centre, National Institute for Medical Research, Tanga, Tanzania
| | | | - Robert W Snow
- Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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26
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Bygbjerg IC, Simonsen L, Schiøler KL. Elimination of Falciparum Malaria and Emergence of Severe Dengue: An Independent or Interdependent Phenomenon? Front Microbiol 2018; 9:1120. [PMID: 29899735 PMCID: PMC5989664 DOI: 10.3389/fmicb.2018.01120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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: 01/23/2018] [Accepted: 05/11/2018] [Indexed: 11/23/2022] Open
Abstract
The global malaria burden, including falciparum malaria, has been reduced by 50% since 2000, though less so in Sub-Saharan Africa. Regional malaria elimination campaigns beginning in the 1940s, up-scaled in the 1950s, succeeded in the 1970s in eliminating malaria from Europe, North America, the Caribbean (except Haiti), and parts of Asia and South- and Central America. Dengue has grown dramatically throughout the pantropical regions since the 1950s, first in Southeast Asia in the form of large-scale epidemics including severe dengue, though mostly sparing Sub-Saharan Africa. Globally, the WHO estimates 50 million dengue infections every year, while others estimate almost 400 million infections, including 100 million clinical cases. Curiously, despite wide geographic overlap between malaria and dengue-endemic areas, published reports of co-infections have been scarce until recently. Superimposed acute dengue infection might be expected to result in more severe combined disease because both pathogens can induce shock and hemorrhage. However, a recent review found no reports on more severe morbidity or higher mortality associated with co-infections. Cases of severe dual infections have almost exclusively been reported from South America, and predominantly in persons infected by Plasmodium vivax. We hypothesize that malaria infection may partially protect against dengue – in particular falciparum malaria against severe dengue – and that this inter-species cross-protection may explain the near absence of severe dengue from the Sub-Saharan region and parts of South Asia until recently. We speculate that malaria infection elicits cross-reactive antibodies or other immune responses that infer cross-protection, or at least partial cross-protection, against symptomatic and severe dengue. Plasmodia have been shown to give rise to polyclonal B-cell activation and to heterophilic antibodies, while some anti-dengue IgM tests have high degree of cross-reactivity with sera from malaria patients. In the following, the historical evolution of falciparum malaria and dengue is briefly reviewed, and we explore early evidence of subclinical dengue in high-transmission malaria areas as well as conflicting reports on severity of co-morbidity. We also discuss examples of other interspecies interactions.
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Affiliation(s)
- Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Karin L Schiøler
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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27
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Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen A, Khamis RS, Mohamed AG, Ali MM, Said SM, van Roosmalen J, Bygbjerg IC. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (The PartoMa study). BJOG 2017; 125:235-245. [PMID: 28892306 DOI: 10.1111/1471-0528.14933] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. DESIGN Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. SETTING Tanzanian low-resource referral hospital, Mnazi Mmoja Hospital. POPULATION Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention
month (1 October 2015 until 31 January 2016) [corrected]. METHODS Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi-randomly selected subgroups (n = 283 and n = 264, respectively). MAIN OUTCOME MEASURES Stillbirths and neonates with 5-minute Apgar score ≤5. RESULTS Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53-0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41-0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60-240) to 74 minutes (IQR 30-130) (Mann-Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37-0.81) and timely use improved. CONCLUSION Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. TWEETABLE ABSTRACT: #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low-resource hospital PLAIN LANGUAGE SUMMARY: PartoMa guidelines help birth attendants in Tanzania to save lives Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived. At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth. At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied. The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8-page pocket booklet providing locally achievable and simple decision support for care during birth. Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high. Use of the PartoMa guidelines is associated with: A decrease by one-third in stillbirths (59 to 39 per 1000 total births) A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births) The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th-12th month of use. Such a 'before-after' study cannot exclude the possibility of other causes of better survival at birth. However, the improved survival is consistent with improved care during birth, which is in line with the PartoMa guidelines.
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Affiliation(s)
- N Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - N Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,School of Health & Medical Sciences, State University of Zanzibar, Zanzibar, Tanzania
| | - B B Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Akg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R S Khamis
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | | | - M M Ali
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - S M Said
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - J van Roosmalen
- Athena Institute, VU University of Amsterdam, Amsterdam, the Netherlands
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Nielsen J, Bahendeka SK, Whyte SR, Meyrowitsch DW, Bygbjerg IC, Witte DR. Household and familial resemblance in risk factors for type 2 diabetes and related cardiometabolic diseases in rural Uganda: a cross-sectional community sample. BMJ Open 2017; 7:e015214. [PMID: 28939566 PMCID: PMC5623496 DOI: 10.1136/bmjopen-2016-015214] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Prevention of type 2 diabetes (T2D) has been successfully established in randomised clinical trials. However, the best methods for the translation of this evidence into effective population-wide interventions remain unclear. To assess whether households could be a target for T2D prevention and screening, we investigated the resemblance of T2D risk factors at household level and by type of familial dyadic relationship in a rural Ugandan community. METHODS This cross-sectional household-based study included 437 individuals ≥13 years of age from 90 rural households in south-western Uganda. Resemblance in glycosylated haemoglobin (HbA1c), anthropometry, blood pressure, fitness status and sitting time were analysed using a general mixed model with random effects (by household or dyad) to calculate household intraclass correlation coefficients (ICCs) and dyadic regression coefficients. Logistic regression with household as a random effect was used to calculate the ORs for individuals having a condition or risk factor if another household member had the same condition. RESULTS The strongest degree of household member resemblances in T2D risk factors was seen in relation to fitness status (ICC=0.24), HbA1c (ICC=0.18) and systolic blood pressure (ICC=0.11). Regarding dyadic resemblance, the highest standardised regression coefficient was seen in fitness status for spouses (0.54, 95% CI 0.32 to 0.76), parent-offspring (0.41, 95% CI 0.28 0.54) and siblings (0.41, 95% CI 0.25 to 0.57). Overall, parent-offspring and sibling pairs were the dyads with strongest resemblance, followed by spouses. CONCLUSIONS The marked degree of resemblance in T2D risk factors at household level and between spouses, parent-offspring and sibling dyads suggest that shared behavioural and environmental factors may influence risk factor levels among cohabiting individuals, which point to the potential of the household setting for screening and prevention of T2D.
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Affiliation(s)
- Jannie Nielsen
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | | | - Susan R Whyte
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Dan W Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Daniel R Witte
- Department of Public Health, University of Aarhus, Aarhus, Denmark
- Danish Diabetes Academy, Odense, Denmark
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Aftab H, Christensen DL, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC. Tuberculosis-Related Diabetes: Is It Reversible after Complete Treatment? Am J Trop Med Hyg 2017; 97:1099-1102. [PMID: 28820679 DOI: 10.4269/ajtmh.16-0816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Individuals with newly diagnosed tuberculosis (TB) were screened for diabetes (DM) with fasting plasma glucose (FPG) in Pakistan. A significant decrease in FPG was observed when TB was treated. Of those with newly diagnosed DM, 46% and 62% no longer had hyperglycemia after 3 and 6 months, respectively. Individuals with known DM also showed a significant decrease in fasting plasma levels when treated for TB, but after 3 months none had normoglycemia, and after 6 months 9.2% were normoglycemic. Thus, TB-related DM may abate when the stress terminates, as is the case in gestational DM. However, because stress hyperglycemia may be associated with subsequent risk of developing DM, follow-up is recommended.
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Affiliation(s)
- Huma Aftab
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk L Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Rigshospitalet, Denmark
| | - Jørgen H Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Nielsen KK, Rheinländer T, Kapur A, Damm P, Seshiah V, Bygbjerg IC. Factors influencing timely initiation and completion of gestational diabetes mellitus screening and diagnosis - a qualitative study from Tamil Nadu, India. BMC Pregnancy Childbirth 2017; 17:255. [PMID: 28764665 PMCID: PMC5539632 DOI: 10.1186/s12884-017-1429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 07/11/2016] [Accepted: 07/18/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 2007, universal screening for gestational diabetes mellitus (GDM) was introduced in Tamil Nadu, India. To identify factors hindering or facilitating timely initiation and completion of the GDM screening and diagnosis process, our study investigated how pregnant women in rural and urban Tamil Nadu access and navigate different GDM related health services. METHODS The study was carried out in two settings: an urban private diabetes centre and a rural government primary health centre. Observations of the process of screening and diagnosis at the health centres as well as semi-structured interviews with 30 pregnant women and nine health care providers were conducted. Data was analysed using qualitative content analysis. RESULTS There were significant differences in the process of GDM screening and diagnosis in the urban and rural settings. Several factors hindering or facilitating timely initiation and completion of the process were identified. Timely attendance required awareness, motivation and opportunity to attend. Women had to attend the health centre at the right time and sometimes at the right gestational age to initiate the test, wait to complete the test and obtain the test report in time to initiate further action. All these steps and requirements were influenced by factors within and outside the health system such as getting right information from health care providers, clinic timings, characteristics of the test, availability of transport, social network and support, and social norms and cultural practices. CONCLUSIONS Minimising and aligning complex stepwise processes of prenatal care and GDM screening delivery and attention to the factors influencing it are important for further improving and expanding GDM screening and related services, not only in Tamil Nadu but in other similar low and middle income settings. This study stresses the importance of guidelines and diagnostic criteria which are simple and feasible on the ground.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, 2820 Gentofte, Denmark
| | - Thilde Rheinländer
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Anil Kapur
- World Diabetes Foundation, Brogaardsvej 70, 2820 Gentofte, Denmark
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Rigshospitalet, The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Veerasamy Seshiah
- Dr. Seshiah Diabetes Research Institute and Dr. Balaji Diabetes Care Centre, 729 Poonamallee High Road, Aminjikarai, Chennai, Tamil Nadu 600029 India
| | - Ib C. Bygbjerg
- Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014 Copenhagen, Denmark
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Aftab H, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC, Christensen DL. Comparative study of HbA 1c and fasting plasma glucose vs the oral glucose tolerance test for diagnosis of diabetes in people with tuberculosis. Diabet Med 2017; 34:800-803. [PMID: 28326618 DOI: 10.1111/dme.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
Abstract
AIM To compare HbA1c and fasting plasma glucose assessment, with the 2-h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis. METHODS Individuals (N=268) with newly diagnosed smear-positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA1c and ≥7.0mmol/l for fasting plasma glucose. RESULTS The proportion of participants diagnosed with diabetes was 4.9% (n =13) by oral glucose tolerance test, while 11.9% (n =32) and 14.6% (n =39) were diagnosed with diabetes using HbA1c and fasting plasma glucose criteria, respectively. The area under the receiver-operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests (P=0.07). CONCLUSIONS HbA1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA1c may be a more reliable test in individuals with transient hyperglycaemia.
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Affiliation(s)
- H Aftab
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Ambreen
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - M Jamil
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - P Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - J H Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Christensen DL, Bygbjerg IC, Meyrowitsch DW. [Global differences in causes and diagnostics of cardio-metabolic diseases]. Ugeskr Laeger 2017; 179:V11160815. [PMID: 28504630] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardio-metabolic diseases (CMDs) such as obesity, type 2 diabetes (T2D) and hypertension are now highly prevalent throughout low- and middle-income countries, even though half of the T2D cases cannot be explained by obesity. Non-obese T2D individuals may have been exposed to foetal programming and/or be genetically susceptible to abdominal obesity. There is evidence for ethnic-specific risks for cardiometabolic disease. This calls for expanding research collaboration with so-called South partners in order to qualify decision making on diagnosis and prevention of CMDs at global level.
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Aftab H, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC, Christensen DL. High prevalence of diabetes and anthropometric heterogeneity among tuberculosis patients in Pakistan. Trop Med Int Health 2017; 22:465-473. [PMID: 28102021 DOI: 10.1111/tmi.12842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In Pakistan, the prevalence of diabetes (DM) among adults is 6.9% and expected to double by 2040. DM may facilitate transmission and halter the elimination of tuberculosis (TB). We aimed to determine the prevalence of DM among patients with TB in Pakistan, and to investigate anthropometric biochemical and haemodynamic associations between TB patients with and without DM. METHODS We conducted a cross-sectional study at Gulab Devi Chest Hospital in Lahore, Punjab. A total of 3027 newly diagnosed smear-positive TB patients ≥25 years of age were screened for DM by HbA1c regardless of previous DM history. RESULTS The prevalence of screen-detected DM and known DM among the TB participants was 13.5% and 26.1%, respectively, resulting in a combined DM prevalence of 39.6%. Most participants were male (64.4%). Using bivariate analyses, participants with DM were significantly older (49.8 vs. 40.6 years) with higher haemoglobin (men, 12.1 vs. 11.8 g/dl, women 11.5 vs. 10.7 g/dl), body mass index (21.0 vs. 17.6 kg/m2 ) and waist-hip ratio (men, 0.87 vs. 0.81, women, 0.87 vs. 0.79) (all P < 0.05) than participants without DM. Stratifying by screen-detected and known DM, these differences remained significant when using multivariate analysis. CONCLUSION We report a high prevalence of DM among patients with TB who may be anthropometrically and biochemically distinct from TB patients without DM, and this heterogeneity further transcends the different DM groups.
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Affiliation(s)
- Huma Aftab
- Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
| | | | | | - Peter Garred
- Laboratory of Molecular Medicine, Rigshospitalet, Denmark
| | - Jørgen H Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ib C Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
| | - Dirk L Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
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Nielsen J, Bahendeka SK, Bygbjerg IC, Meyrowitsch DW, Whyte SR. Diabetes Treatment as "Homework": Consequences for Household Knowledge and Health Practices in Rural Uganda. Health Educ Behav 2017; 43:100S-11S. [PMID: 27037141 DOI: 10.1177/1090198115610569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Health professionals assign diabetes patients "homework" in that they give them instructions on how to manage diabetes, recognizing that most diabetes care takes place in the home setting. We studied how homework is practiced and whether knowledge and behavioral practices related to diabetes self-management diffuse from patients to their housemates. METHOD This mixed-methods study combined quantitative data from a household survey including 90 rural Ugandan households (50% had a member with type 2 diabetes [T2D]) with qualitative data from health facilities and interviews with 10 patients with T2D. Focus for data collection was knowledge and practices related to diabetes homework. A generalized mixed model was used to analyze quantitative data, while content analysis was used for qualitative data analysis. RESULTS Patients with T2D generally understood the diabetes homework assignments given by health professionals and carried out their homework with support from housemates. Although adherence to recommended diet was variable, housemates were likely to eat a healthier diet than if no patient with T2D lived in the household. Knowledge related to diabetes homework diffused from the patients to housemates and beyond to neighbors and family living elsewhere. Knowledge about primary prevention of T2D was almost absent among health staff, patients, and relatives. CONCLUSIONS Homework practices related to T2D improve diabetes-related knowledge and may facilitate healthy eating in nondiabetic housemates. These findings suggest that having a chronic disease in the household provides an opportunity to improve health in the entire household and address the lack of knowledge about prevention of T2D.
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Affiliation(s)
- Jannie Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dan W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Susan R Whyte
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
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Sarkodie F, Hassall O, Owusu-Dabo E, Owusu-Ofori S, Bates I, Bygbjerg IC, Owusu-Ofori A, Harritshøj LH, Ullum H. Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC). Transfus Med 2016; 27:52-59. [PMID: 27723157 DOI: 10.1111/tme.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. MATERIALS AND METHODS From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros® /Abbott-Architect® algorithm as gold standard. RESULTS A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%). DISCUSSION Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.
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Affiliation(s)
- F Sarkodie
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - O Hassall
- Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - E Owusu-Dabo
- School of Public Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Owusu-Ofori
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - I Bates
- Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - I C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Owusu-Ofori
- Department of Clinical Microbiology Kumasi, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - L H Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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Sarkodie F, Owusu-Dabo E, Hassall O, Bates I, Bygbjerg IC, Ullum H. Recall of symptoms and treatment of syphilis and yaws by healthy blood donors screening positive for syphilis in Kumasi, Ghana. Int J Infect Dis 2016; 50:72-4. [PMID: 27531187 DOI: 10.1016/j.ijid.2016.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 08/01/2016] [Accepted: 08/08/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the recalled medical history, clinical manifestations, and treatment of yaws and syphilis by syphilis seroreactive blood donors in Kumasi, Ghana. METHODS Of the blood donors at Komfo Anokye Teaching Hospital, Kumasi, Ghana tested with the syphilis rapid diagnostic test (RDT) and later by rapid plasma reagin (RPR) test, 526 were seroreactive. Four hundred and seventy-one (89.5%) of these subjects were confirmed with the Ortho-Vitros Syphilis TP test as the gold standard and were interviewed to determine past or present clinical manifestations of yaws and syphilis. RESULTS Of the 471 respondent donors, 28 (5.9%) gave a history of skin lesions and sores; four (14.3%) of these subjects, who were all male and RPR-positive, recalled a diagnosis of syphilis. All four reported having had skin lesions/bumps with slow-healing sores, but only one of them had had these symptoms before the age of 15 years. CONCLUSIONS A small proportion of confirmed seroreactive donors in this sample had any recall of symptoms or treatment for yaws or syphilis. These data suggest that clinical questioning adds little further information to the current screening algorithm. The relative contribution of yaws and syphilis to frequent positive tests in endemic areas remains speculative.
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Affiliation(s)
- Francis Sarkodie
- Komfo Anokye Teaching Hospital, Kumasi, Ghana; Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Kumasi Centre for Collaborative Research, KNUST, Kumasi, Ghana
| | | | - Imelda Bates
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen, University Hospital, Copenhagen, Denmark
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Kamper-Jørgensen Z, Carstensen B, Norredam M, Bygbjerg IC, Andersen PH, Jørgensen ME. Diabetes-related tuberculosis in Denmark: effect of ethnicity, diabetes duration and year of diagnosis. Int J Tuberc Lung Dis 2016; 19:1169-75. [PMID: 26459528 DOI: 10.5588/ijtld.14.0932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between diabetes mellitus (DM) and tuberculosis (TB) has been established on the basis of cross-sectional studies; however, only a few longitudinal studies have been conducted, with inconsistent results. OBJECTIVE To study the effect of ethnicity and the presence and duration of DM on the risk of incident TB based on 15 years of follow-up of the entire Danish population. DESIGN AND METHODS Using Poisson regression analysis, we estimated TB incidence in individuals with DM vs. those without DM by linking nationwide DM and TB registers to the National Civil Register at case level. RESULTS The TB rate ratio was 1.9 in individuals with DM compared to non-DM individuals, regardless of country of birth, with the exception of African-born individuals (rate ratio 0.5). The risk decreased drastically within the first 2 years after the diagnosis of DM; no association was found with longer durations of DM. The risk also decreased the later the year of DM diagnosis. CONCLUSIONS The study confirmed DM as a risk factor for TB, except in the case of African-born individuals. Other non-DM risk factors for TB could act as effect-modifiers on the DM-TB association. Implementing earlier DM diagnosis and improving metabolic control may reduce the risk of DM-related TB.
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Affiliation(s)
- Z Kamper-Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark; Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - B Carstensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
| | - M Norredam
- Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases and Department of Immigrant Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - I C Bygbjerg
- Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - P H Andersen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - M E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
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Abstract
Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients' journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system.
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Affiliation(s)
- Jannie Nielsen
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | | | - Ib C Bygbjerg
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | - Dan W Meyrowitsch
- a Department of Public Health , Global Health Section, University of Copenhagen , Copenhagen , Denmark
| | - Susan R Whyte
- c Department of Anthropology , University of Copenhagen , Copenhagen , Denmark
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Livingstone RS, Grunnet LG, Thomas N, Eapen A, Antonisamy B, Mohan VR, Spurgeon R, Frank ID, Bygbjerg IC, Vaag A. Are hepatic and soleus lipid content, assessed by magnetic resonance spectroscopy, associated with low birth weight or insulin resistance in a rural Indian population of healthy young men? Diabet Med 2016; 33:365-70. [PMID: 26172248 DOI: 10.1111/dme.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Accepted: 07/03/2015] [Indexed: 12/22/2022]
Abstract
AIMS To assess young healthy men from rural India, who had normal or low birth weights, using magnetic resonance spectroscopy to determine the potential differences in ectopic fat storage between birth weight groups, and to determine if ectopic fat storage was associated with insulin resistance in this population. METHODS A total of 54 lean men with normal birth weight and 49 lean men with low birth weight (age range 18-22 years) from rural India were recruited. All the men underwent anthropometry, magnetic resonance spectroscopy, a hyperinsulinaemic-euglycaemic clamp and a dual-energy X-ray absorptiometry. RESULTS The median (interquartile range) values for hepatic cellular lipids, intramyocellular lipids and extramyocellular lipids, measured using magnetic resonance spectroscopy were 0.76 (0.1-1.8)%, 1.27 (1.0-2.3)% and 1.89 (1.3-3.2)%, respectively, for the normal birth weight group and 0.4 (0.1-1.3)%, 1.38 (0.9-2.2)% and 2.07 (1.2-2.8)%, respectively, for the low birth weight group (P > 0.05). No difference in ectopic fat storage was observed between the low and normal birth weight groups, with or without adjustment for age and total fat percentage. Homeostatic model assessment of insulin resistance values were not associated with hepatic cellular, intramyocellular or extramyocellular lipid content in any of the groups. Total fat percentage was the only independent predictor of intramyocellular and extramyocellular lipid content. CONCLUSION Young and lean men from rural India with low birth weight were not observed to have ectopic fat storage in the liver or muscle, and the amount of liver and muscle fat was unrelated to insulin resistance. Older age and/or an urban affluent lifestyle may be required to show a potential role of ectopic fat storage on insulin resistance in Indian people with low or normal birth weight.
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Affiliation(s)
- R S Livingstone
- Department of Radiology, Christian Medical College and Hospital, Vellore, India
| | - L G Grunnet
- Diabetes and Metabolism, Copenhagen University Hospital (Rigshospitalet), Denmark
| | - N Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - A Eapen
- Department of Radiology, Christian Medical College and Hospital, Vellore, India
| | - B Antonisamy
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - V R Mohan
- Department of Community Health, Christian Medical College and Hospital, Vellore, India
| | - R Spurgeon
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - I D Frank
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - I C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Vaag
- Diabetes and Metabolism, Copenhagen University Hospital (Rigshospitalet), Denmark
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Abstract
Background Leprosy, caused by Mycobacterium leprae, is a chronic and progressive granulomatous disease affecting mainly the skin and the peripheral nervous system. If left unrecognized, the infection can lead to permanent nerve damage and disability. The clinical presentation depends on the immune response of the patient and can result in a wide spectrum of symptoms. Leprosy is a rare encounter in Scandinavia but remains endemic in some parts of the world, with some areas reporting an
increasing incidence. We performed a retrospective record review of leprosy cases in Denmark from 1980 to 2010 with the purpose of presenting the most common geographical, demographic and clinical findings and to discuss the diagnostic and therapeutic challenges of patients with leprosy. Case presentation In total 15 cases were reviewed. The majority (87 %) of leprosy patients in Denmark were born in South- and Southeast Asia, and were presumed to have contracted the infection in their countries of origin. Patients were predominately young males (mean age: 28.6 years). Anaesthetic skin lesion with or without nerve enlargement were the most common clinical presentations (73 %). Immunological leprosy reactions were seen in 40 % of the cases. Diagnoses were based on clinical findings and skin biopsies. Treatment length varied but all patients received multidrug regimens. Conclusion Leprosy should be kept in mind when encountering patients with suspicious skin lesions originating from leprosy endemic areas or with history of travel or work in the tropics. Due to the long incubation period with symptoms presenting long after immigration or return, clinicians often do not have the diagnosis in mind. The wide spectrum of symptoms and immunological reactions further complicates the diagnostic process. Treatment of leprosy and the complicated immunological reactions, which frequently accompanies the infection, should be performed in collaboration with a specialist. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1768-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huma Aftab
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark. .,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Susanne D Nielsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark. .,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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41
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Rasmussen JB, Nordin LS, Thomsen JA, Rossing P, Bygbjerg IC, Christensen DL. Several Conventional Risk Markers Suggesting Presence of Albuminuria Are Weak Among Rural Africans With Hypertension. J Clin Hypertens (Greenwich) 2015; 18:27-30. [PMID: 26307089 DOI: 10.1111/jch.12662] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 06/11/2015] [Accepted: 06/15/2015] [Indexed: 01/13/2023]
Abstract
The objective of this cross-sectional study was to investigate risk markers indicating the presence of albuminuria in patients with hypertension in rural sub-Saharan Africa (SSA). Urine albumin-creatinine ratio, glycated hemoglobin (HbA1c ), blood pressure, anthropometry, and other patient characteristics including medications were assessed. We identified 160 patients with hypertension, of whom 68 (42.5%) were co-diagnosed with diabetes mellitus (DM). Among the included participants, 57 (35.6%) had albuminuria (microalbuminuria [n=43] and macroalbuminuria [n=14]). A backward multivariate logistic regression model identified age (per 10-year increment) (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.03-1.95), HbA1c >53 compared with <48 mmol/mol (OR, 3.81; 95% CI, 1.74-8.35), and treatment with dihydropyridine calcium channel blockers (OR, 2.59; 95% CI, 1.09-6.16) as the variables significantly associated with albuminuria. Only dysregulated DM and age were the conventional risk markers that seemed to suggest albuminuria among patients with hypertension in rural SSA.
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Affiliation(s)
- Jon B Rasmussen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen.,Department of Internal Medicine, Copenhagen University Hospital, Herlev
| | - Lovisa S Nordin
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen
| | - Jakúp A Thomsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen
| | - Peter Rossing
- Steno Diabetes Center, Gentofte.,Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen.,Health, Aarhus University, Aarhus, Denmark
| | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen
| | - Dirk L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen
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Ahiabu MA, Tersbøl BP, Biritwum R, Bygbjerg IC, Magnussen P. A retrospective audit of antibiotic prescriptions in primary health-care facilities in Eastern Region, Ghana. Health Policy Plan 2015; 31:250-8. [PMID: 26045328 PMCID: PMC4748131 DOI: 10.1093/heapol/czv048] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 11/13/2022] Open
Abstract
Resistance to antibiotics is increasing globally and is a threat to public health. Research has demonstrated a correlation between antibiotic use and resistance development. Developing countries are the most affected by resistance because of high infectious disease burden, limited access to quality assured antibiotics and more optimal drugs and poor antibiotic use practices. The appropriate use of antibiotics to slow the pace of resistance development is crucial. The study retrospectively assessed antibiotic prescription practices in four public and private primary health-care facilities in Eastern Region, Ghana using the WHO/International Network for the Rational Use of Drugs rational drug use indicators. Using a systematic sampling procedure, 400 prescriptions were selected per facility for the period April 2010 to March 2011. Rational drug use indicators were assessed in the descriptive analysis and logistic regression was used to explore for predictors of antibiotic prescription. Average number of medicines prescribed per encounter was 4.01, and 59.9% of prescriptions had antibiotics whilst 24.2% had injections. In total, 79.2% and 88.1% of prescribed medicines were generics and from the national essential medicine list, respectively. In the multivariate analysis, health facility type (odds ratio [OR] = 2.05; 95% confidence interval [CI]: 1.42, 2.95), patient age (OR = 0.97; 95% CI: 0.97, 0.98), number of medicines on a prescription (OR = 1.85; 95% CI: 1.63, 2.10) and 'no malaria drug' on prescription (OR = 5.05; 95% CI: 2.08, 12.25) were associated with an antibiotic prescription. A diagnosis of upper respiratory tract infection was positively associated with antibiotic use. The level of antibiotic use varied depending on the health facility type and was generally high compared with the national average estimated in 2008. Interventions that reduce diagnostic uncertainty in illness management should be considered. The National Health Insurance Scheme, as the main purchaser of health services in Ghana, offers an opportunity that should be exploited to introduce policies in support of rational drug use.
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Affiliation(s)
- Mary-Anne Ahiabu
- Disease Control and Prevention Department, Ghana Health Service, Ministry of Health, P. O. Box KB 493, Accra, Ghana, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark,
| | - Britt P Tersbøl
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark
| | - Richard Biritwum
- Department of Community Health, College of Health Sciences, University of Ghana P. O. Box KB 4236, Accra, Ghana and
| | - Ib C Bygbjerg
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark
| | - Pascal Magnussen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014 Copenhagen K, Denmark, Centre for Medical Parasitology, University of Copenhagen, CSS Building 22/23, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen K, Denmark
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Nielsen J, Bahendeka SK, Gregg EW, Whyte SR, Bygbjerg IC, Meyrowitsch DW. A comparison of cardiometabolic risk factors in households in rural Uganda with and without a resident with type 2 diabetes, 2012-2013. Prev Chronic Dis 2015; 12:E44. [PMID: 25837257 PMCID: PMC4383445 DOI: 10.5888/pcd12.140486] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Few studies have examined the health consequences of living in a household with a person who has been diagnosed with type 2 diabetes (T2D). We assessed the association of sharing a household with a person with diagnosed T2D and risk factors for cardio-metabolic diseases in Uganda, a low-income country. METHODS Ninety households with 437 residents in southwestern Uganda were studied from December 2012 through March 2013. Forty-five of the households had a member with diagnosed T2D (hereafter "diabetic household"), and 45 households had no member with diagnosed T2D (hereafter "nondiabetic household"). We compared glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), hypertension, anthropometry, aerobic capacity, physical activity, nutrition, smoking, and diabetes-related knowledge of people without diagnosed T2D living in diabetic and nondiabetic households. RESULTS People living in diabetic households had a significantly higher level of diabetes-related knowledge, lower levels of FPG (5.6 mmol/L vs 6.0 mmol/L), and fewer smoked (1.3% vs 12.9%) than residents of nondiabetic households. HbA1c was significantly lower in people aged 30 years or younger (5.2% vs 5.4%) and in males (5.2% vs 5.4%) living in diabetic households compared to residents of nondiabetic households. No differences were found between the 2 types of households in overweight and obesity, upper-arm fat area, intake of staple foods or cooking oil, or physical activity. CONCLUSIONS Sharing a household with a person with T2D may have unexpected benefits on the risk factor profile for cardio-metabolic diseases, probably because of improved health behaviors and a closer connection with the health care system. Thus, future studies should consider the household for interventions targeting primary and secondary prevention of T2D.
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Affiliation(s)
- Jannie Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, Building 9, Mailbox 2099, 1014 Copenhagen K., Denmark.
| | | | - Edward W Gregg
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan R Whyte
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dan W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Abstract
OBJECTIVE Interferon-γ and IP-10 release assays are diagnostic tests for tuberculosis infection. We have compared the accuracy of IP-10 and QuantiFERON-TB Gold In-tube [QFT-IT] in Tanzanian children suspected of having active tuberculosis (TB). METHODS Hospitalized Tanzanian children with symptoms of TB were tested with the QFT-IT and IP-10 tests and retrospectively classified into diagnostic groups. Adults with confirmed TB were assessed in parallel. RESULTS A total of 203 children were included. The median age was 3.0 years (interquartile range: 1.2-7.0), 38% were HIV infected, 36% were aged <2 years, and 58% had a low weight-for-age. IP-10 and QFT-IT test performance was comparable but sensitivity was low: 33% (1 of 3) in children with confirmed TB and 29% (8 of 28) in children with probable TB. Rates of indeterminate responders were high: 29% (59 of 203) for IP-10 and 26% (53 of 203) for QFT-IT. Age <2 years was associated with indeterminate test outcome for both IP-10 (adjusted odds ratio [aOR]: 2.2; P = .02) and QFT-IT (aOR: 2.4; P = .01). TB exposure was associated with positive IP-10 test outcome (aOR: 3.6; P = .01) but not with positive QFT-IT outcome (aOR 1.4; P = .52). In 102 adults, test sensitivity was 80% for both tests (P = .248). CONCLUSIONS Although IP-10 and QFT-IT performed well in Tanzanian adults, the tests exhibited an equally poor performance in diagnosing active TB in children. Test performance was especially compromised in young children. Neither test can be recommended for use in hospitalized children in high-burden settings.
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Affiliation(s)
| | - Michala Vaaben Rose
- Infectious Diseases, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Godfather Kimaro
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Ib C Bygbjerg
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Pernille Ravn
- Clinical Research Centre, and Department for Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; and
| | - Morten Ruhwald
- Department of Infectious Disease Immunology, Statens Serum Institute, Copenhagen, Denmark
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Rasmussen JB, Nordin LS, Rasmussen NS, Thomsen JA, Street LA, Bygbjerg IC, Christensen DL. Random blood glucose may be used to assess long-term glycaemic control among patients with type 2 diabetes mellitus in a rural African clinical setting. Trop Med Int Health 2014; 19:1515-9. [PMID: 25294180 DOI: 10.1111/tmi.12391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the diagnostic accuracy of random blood glucose (RBG) on good glycaemic control among patients with diabetes mellitus (DM) in a rural African setting. METHODS Cross-sectional study at St. Francis' Hospital in eastern Zambia. RBG and HbA1c were measured during one clinical review only. Other information obtained was age, sex, body mass index, waist circumference, blood pressure, urine albumin-creatinine ratio, duration since diagnosis and medication. RESULTS One hundred and one patients with DM (type 1 DM = 23, type 2 DM = 78) were included. Spearman's rank correlation coefficient revealed a significant correlation between RBG and HbA1c among the patients with type 2 DM (r = 0.73, P < 0.001) but not patients with type 1 DM (r = 0.17, P = 0.44). Furthermore, in a multivariate linear regression model (R(2) = 0.71) RBG (per mmol/l increment) (B = 0.28, 95% CI:0.24-0.32, P < 0.001) was significantly associated with HbA1c among the patients with type 2 DM. Based on ROC analysis (AUC = 0.80, SE = 0.05), RBG ≤7.5 mmol/l was determined as the optimal cut-off value for good glycaemic control (HbA1c <7.0% [53 mmol/mol]) among patients with type 2 DM (sensitivity = 76.7%; specificity = 70.8%; positive predictive value = 62.2%; negative predictive value = 82.9%). CONCLUSIONS Random blood glucose could possibly be used to assess glycaemic control among patients with type 2 DM in rural settings of sub-Saharan Africa.
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Affiliation(s)
- Jon B Rasmussen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark; Department of Internal Medicine, Endocrinology Unit, Copenhagen University Hospital, Herlev, Denmark
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Schousboe ML, Ranjitkar S, Rajakaruna RS, Amerasinghe PH, Konradsen F, Morales F, Ord R, Pearce R, Leslie T, Rowland M, Gadalla N, Bygbjerg IC, Alifrangis M, Roper C. Global and local genetic diversity at two microsatellite loci in Plasmodium vivax parasites from Asia, Africa and South America. Malar J 2014; 13:392. [PMID: 25277367 PMCID: PMC4200131 DOI: 10.1186/1475-2875-13-392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 08/28/2014] [Indexed: 11/18/2022] Open
Abstract
Background Even though Plasmodium vivax has the widest worldwide distribution of the human malaria species and imposes a serious impact on global public health, the investigation of genetic diversity in this species has been limited in comparison to Plasmodium falciparum. Markers of genetic diversity are vital to the evaluation of drug and vaccine efficacy, tracking of P. vivax outbreaks, and assessing geographical differentiation between parasite populations. Methods The genetic diversity of eight P. vivax populations (n = 543) was investigated by using two microsatellites (MS), m1501 and m3502, chosen because of their seven and eight base-pair (bp) repeat lengths, respectively. These were compared with published data of the same loci from six other P. vivax populations. Results In total, 1,440 P. vivax samples from 14 countries on three continents were compared. There was highest heterozygosity within Asian populations, where expected heterozygosity (He) was 0.92-0.98, and alleles with a high repeat number were more common. Pairwise FST revealed significant differentiation between most P. vivax populations, with the highest divergence found between Asian and South American populations, yet the majority of the diversity (~89%) was found to exist within rather than between populations. Conclusions The MS markers used were informative in both global and local P. vivax population comparisons and their seven and eight bp repeat length facilitated population comparison using data from independent studies. A complex spatial pattern of MS polymorphisms among global P. vivax populations was observed which has potential utility in future epidemiological studies of the P. vivax parasite. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-392) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Cally Roper
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1 4HT, UK.
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Mubyazi GM, Byskov J, Magnussen P, Bygbjerg IC, Ijumba JN, Marero M, Mboera LEG, Molteni F, Bloch P. Health facility-based data on women receiving sulphadoxine-pyrimethamine during pregnancy in Tanzania: lessons to learn from a cross-sectional survey in Mkuranga and Mufindi districts and other national survey reports. Reprod Health 2014; 11:6. [PMID: 24433529 PMCID: PMC3897926 DOI: 10.1186/1742-4755-11-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 01/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A study of health facility (HF) data on women receiving sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment of malaria during pregnancy (IPTp) was carried out at antenatal care clinics in Mkuranga and Mufindi districts. METHODS A review of health management information system (HMIS) registers, interviews with health-care workers (HWs) and district and national level malaria control program managers corroborated by inter-temporal assessment through observations at HF levels. Statistical data were analyzed in Excel and interpreted in triangulation with qualitative data from interviews and observations. RESULTS Data indicated that IPTp doses administered to women were inadequate and partly inconsistent. HMIS registers lacked space for IPT records, forcing HWs to manipulate their record-keeping. The proportion/number of IPTp recipients in related to the supply of SP for free delivery, to women's attendance behaviours, showed variation by quarter and year of reporting. CONCLUSION It is impossible to achieve rational health service planning when the HMIS is weak. Whilst it is acknowledged that the HMIS is already overloaded, concerted measures are urgently needed to accommodate data on new interventions and other vertical programs if malaria programs are to achieve their goals.
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Affiliation(s)
- Godfrey M Mubyazi
- Department of Health Systems & Policy Research & Centre for Enhancement of Effective Malaria Interventions (CEEMI), National Institute for Medical Research (NIMR) - Headquarters, 2448 Ocean Road, P.O. Box 9653, Dar-Es-Salaam, Tanzania
| | - Jens Byskov
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pascal Magnussen
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Institute of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, Bleddamsvej 3, DK 2200 Copenhagen N, Denmark
| | - Jasper N Ijumba
- Department of Health Systems & Policy Research & Centre for Enhancement of Effective Malaria Interventions (CEEMI), National Institute for Medical Research (NIMR) - Headquarters, 2448 Ocean Road, P.O. Box 9653, Dar-Es-Salaam, Tanzania
- The Nelson Mandela African Institute of Science and Technology, P.O. Box 447, Arusha, Tanzania
| | - Mufungo Marero
- Ministry of Health and Social Welfare, National Malaria Control Programme (NMCP), Dar Es Salaam, P.O. Box 9083, Dar es Salaam, Tanzania
| | - Leonard EG Mboera
- NIMR, Directorate of Information Technology and Communication, National Institute for Medical Research, Headquarters, P.O. Box 9653, Dar es Salaam, Tanzania
| | - Fabrizio Molteni
- Ministry of Health and Social Welfare, National Malaria Control Programme (NMCP), Dar Es Salaam, P.O. Box 9083, Dar es Salaam, Tanzania
| | - Paul Bloch
- DBL - Centre for Health Research and Development, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Center, Steno Health Promotion Center, Gentofte, Denmark
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Tine RCK, Ndiaye P, Ndour CT, Faye B, Ndiaye JL, Sylla K, Ndiaye M, Cisse B, Sow D, Magnussen P, Bygbjerg IC, Gaye O. Acceptability by community health workers in Senegal of combining community case management of malaria and seasonal malaria chemoprevention. Malar J 2013; 12:467. [PMID: 24378018 PMCID: PMC3893441 DOI: 10.1186/1475-2875-12-467] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 12/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community case management of malaria (CCMm) and seasonal malaria chemoprevention (SMC) are anti-malarial interventions that can lead to substantial reduction in malaria burden acting in synergy. However, little is known about the social acceptability of these interventions. A study was undertaken to assess whether combining the interventions would be an acceptable approach to malaria control for community health workers (CHWs). METHODS Sixty-one interviews and six focus group discussions were conducted nested in a cluster-randomized trial assessing the impact of combining CCMm and SMC in a rural area of Senegal. Participants consisted of: (i) members of village associations, (ii) members of families who had access to the interventions as well as members of families who did not access the interventions, (iii) CHWs, and (iv) community leaders, e g, religious guides and village chiefs. RESULTS The interventions were acceptable to the local population and perceived as good strategy to make health care services available to community members and thus, to reduce the delays in access to anti-malarial treatment as well as expenses related to patients' transfer to the health post. The use of malaria rapid diagnostic test (RDT) contributed to improving CHWs diagnostic capacity as well as malaria treatment practices. Study participants notified RDT and drugs stock-out as the major risk for sustainability of the intervention at community level. CONCLUSION Combining CCMm and SMC is a well accepted, community-based approach that can contribute to control malaria in areas where malaria transmission is seasonal.
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Affiliation(s)
- Roger C K Tine
- Service de Parasitologie, Faculté de Médecine et Pharmacie, Dakar, Sénégal.
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Spanakos G, Alifrangis M, Schousboe ML, Patsoula E, Tegos N, Hansson HH, Bygbjerg IC, Vakalis NC, Tseroni M, Kremastinou J, Hadjichristodoulou C. Genotyping Plasmodium vivax isolates from the 2011 outbreak in Greece. Malar J 2013; 12:463. [PMID: 24373457 PMCID: PMC3877964 DOI: 10.1186/1475-2875-12-463] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 12/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Plasmodium vivax malaria was common in Greece until the 1950s with epidemics involving thousands of cases every year. Greece was declared free of malaria by the World Health Organization in 1974. From 1974 to 2010, an average of 39 cases per year were reported, which were mainly imported. However, in 2009 and 2010 six and one autochthonous cases were reported culminating with a total of 40 autochthonous cases reported in 2011, of which 34 originated from a single region: Laconia of Southern Peloponnese. In this study the genotypic complexity of the P. vivax infections from the outbreak in Greece during 2011 is described, to elucidate the possible origin and spread of the disease. METHODS Three polymorphic markers of P. vivax were used; Pvmsp-3α and the microsatellites m1501 and m3502 on P. vivax isolates sampled from individuals diagnosed in Greece. Thirty-nine isolates were available for this study (20 autochthonous and 19 imported), mostly from Evrotas municipality in Laconia region, in southern Greece, (n = 29), with the remaining representing sporadic cases originating from other areas of Greece. RESULTS Genotyping the Evrotas samples revealed seven different haplotypes where the majority of the P. vivax infections expressed two particular Pvmsp-3α-m1501-m3502 haplotypes, A10-128-151 (n = 14) and A10-121-142 (n = 7). These haplotypes appeared throughout the period in autochthonous and imported cases, indicating continuous transmission. In contrast, the P. vivax autochthonous cases from other parts of Greece were largely comprised of unique haplotypes, indicating limited transmission in these other areas. CONCLUSIONS The results indicate that several P. vivax strains were imported into various areas of Greece in 2011, thereby increasing the risk of re-introduction of malaria. In the region of Evrotas ongoing transmission occurred exemplifying that further control measures are urgently needed in this region of southern Europe. In circumstances where medical or travel history is scarce, methods of molecular epidemiology may prove highly useful for the correct classification of the cases.
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Affiliation(s)
- Gregory Spanakos
- Hellenic Centre for Diseases Control and Prevention, Marousi, Greece
- Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mette L Schousboe
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eleni Patsoula
- Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece
| | - Nicholas Tegos
- Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece
| | - Helle H Hansson
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ib C Bygbjerg
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Disease, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas C Vakalis
- Department of Parasitology, Entomology and Tropical Diseases, National School of Public Health, Athens, Greece
| | - Maria Tseroni
- Hellenic Centre for Diseases Control and Prevention, Marousi, Greece
| | - Jenny Kremastinou
- Hellenic Centre for Diseases Control and Prevention, Marousi, Greece
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Tine RCK, Faye B, Ndour CT, Sylla K, Sow D, Ndiaye M, Ndiaye JL, Magnussen P, Alifrangis M, Bygbjerg IC, Gaye O. Parasitic Infections among Children under Five Years in Senegal: Prevalence and Effect on Anaemia and Nutritional Status. ISRN Parasitol 2013; 2013:272701. [PMID: 27335851 PMCID: PMC4890897 DOI: 10.5402/2013/272701] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/21/2013] [Indexed: 11/23/2022]
Abstract
Although malaria is declining in many countries in Africa, malaria and anaemia remain frequent in children. This study was conducted to assess the relationship between malaria parasitaemia, intestinal worms, and anaemia, in children <5 years living in low transmission area in Senegal. A survey was carried out in 30 villages in the central part of Senegal. A two-level random cluster sampling technique was used to select study participant. Children <5 years were enrolled after informed consent. For each child, blood thick and smear tests were performed, haemoglobin concentration was measured with HemoCue, and stool samples were collected and examined using the Ritchie technique. A total of 736 children were recruited. Malaria parasite prevalence was 1.5% (0.7-2.6); anaemia was found in 53.4% (48.2-58.9), while intestinal parasites and stunting represented 26.2% (22.6-30.2) and 22% (18.6-25.5), respectively. In a logistic regression analysis, anaemia was significantly associated with malaria parasitaemia (aOR= 6.3 (1.5-53.5)) and stunting (aOR = 2 (1.2-3.1)); no association was found between intestinal parasites and anaemia. Malaria and anaemia remain closely associated even when malaria is declining. Scaling up antimalarial interventions may contribute to eliminate malaria and reduce the occurrence of anaemia among children.
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Affiliation(s)
- Roger C K Tine
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Babacar Faye
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Cheikh T Ndour
- Clinique des Maladies Infectieuses, Centre Hospitalier Universitaire de Fann, Senegal
| | - Khadime Sylla
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Doudou Sow
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Magatte Ndiaye
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Jean L Ndiaye
- Université Cheikh Anta DIOP de Dakar, Faculté de Médecine, Pharmacie et Odontologie, Service de Parasitologie Médicale, BP 5005, Dakar, Senegal
| | - Pascal Magnussen
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen-CSS, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Michael Alifrangis
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen-CSS, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Ib C Bygbjerg
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen-CSS, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
| | - Oumar Gaye
- Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen-CSS, Øster Farimagsgade 5, 1014 Copenhagen, Denmark
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