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Nkinsi NT, Galagan SR, Benzekri NA, Govere S, Drain PK. Food Insecurity at HIV Diagnosis Associated with Subsequent Viremia Amongst Adults Living with HIV in an Urban Township of South Africa. AIDS Behav 2023; 27:3687-3694. [PMID: 37249804 DOI: 10.1007/s10461-023-04085-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/31/2023]
Abstract
We assessed the temporal impact of food insecurity on 12-month antiretroviral (ART) adherence, retention in care, hospitalization, and HIV viremia (> 1000 copies/mL) in ART naïve adults presenting for HIV testing in Umlazi, South Africa. At the time of HIV testing and prior to ART initiation, we determined each participants' food security status using the validated Household Food Insecurity Access Scale (HFIAS). Following HIV testing and ART initiation, we then assessed the above outcomes of each study participant at 3-month intervals for a total of 12 months. Among 2,383 participants with HIV in this study, 253 (10.6%) experienced food insecurity. We found that food insecurity is associated with 20% higher adjusted prevalence odd ratios (aPOR) of having HIV viremia (> 1000 copies/mL) at 12 months following initial diagnosis (aPOR 1.2, 95% CI 1.1-1.4). We found no significant differences in ART adherence, retention in care, and hospitalization occurrences between the food secure and food insecure cohorts.
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Affiliation(s)
- Naomi T Nkinsi
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
- Department of Global Health, University of Washington, Seattle, USA.
| | - Sean R Galagan
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | - Paul K Drain
- School of Medicine, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Seattle, USA
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Sondo AK, Diendéré EA, Meda BI, Diallo I, Zoungrana J, Poda A, Manga NM, Bicaba B, Gnamou A, Kagoné CJ, Sawadogo G, Yaméogo I, Benzekri NA, Tarnagda Z, Kouanda S, Ouédraogo-Traoré R, Ouédraogo MS, Seydi M. Severe dengue in adults and children, Ouagadougou (Burkina Faso), West Africa, October 2015–January 2017. IJID Regions 2021; 1:53-59. [PMID: 35757818 PMCID: PMC9216438 DOI: 10.1016/j.ijregi.2021.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/29/2022]
Abstract
Severe dengue was common in this sudy. In contrast to multiple prior studies, the risk of severe dengue was greater for patients with primary dengue compared to those with secondary infection. Additional risk factors for severe dengue included age, male sex, haemoglobin S, diabetes, and hypertension. Case mapping showed that dengue cases were more concentrated in sectors located in the centre of the city and close to the health centres.
Introduction Although dengue is the most common arbovirus infection worldwide, studies of severe dengue in Africa are lacking, and risk factors for severe dengue have been insufficiently described. This study was conducted in the context of the 2016 dengue epidemic in Burkina Faso to determine the prevalence of severe dengue, identify factors associated with severe dengue, and perform mapping of dengue cases in the country's capital, Ouagadougou. Methods This cross-sectional study was conducted from November 2015 to January 2017. Data were collected in 15 public and private health centres, and included sociodemographic, clinical and patient outcome variables. Dengue was diagnosed using SD Bioline Dengue Duo rapid diagnostic tests. Data were analysed using Epi-Info Version 7. Logistic regression was used to identify predictors of severe dengue. P<0.05 was considered significant. Dengue case mapping was performed using Geographic Information System software (ArcGIS). Results Of the 811 patients who tested positive for dengue, 609 (75%) had early dengue (AgNS1 positive) and 272 (33.5%) had severe dengue. Patient age ranged from 1 to 83 years (median 30.5 years) and 393 (48.3%) were female. Renal failure (13.1%) and severe bleeding (10.6%) were the most common signs of severe dengue. Risk factors for severe dengue included age, male sex, haemoglobin S, diabetes, hypertension, and primary dengue. Dengue cases were more concentrated in sectors located in the centre of the city and close to the health centres. Conclusion Dengue is increasingly common in Africa and factors associated with severity should be sought systematically as soon as a patient tests positive. Additional studies are needed to determine if the factors found to be associated with severity can be used to identify patients at risk for dengue-related complications, and to provide early and specialized management to reduce morbidity and mortality related to dengue in Africa.
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Affiliation(s)
- Apoline Kongnimissom Sondo
- Department of Infectious and Tropical Diseases, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
- Joseph Ki-Zerbo University, Health Sciences and Research Training Unit, Ouagadougou, Burkina Faso
- Corresponding author. Address: Department of Infectious and Tropical Diseases, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso. Tel.: +226 70077198.
| | - Eric Arnaud Diendéré
- Department of Infectious and Tropical Diseases, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | | | - Ismaèl Diallo
- Joseph Ki-Zerbo University, Health Sciences and Research Training Unit, Ouagadougou, Burkina Faso
| | | | - Armel Poda
- National Institute of Health Sciences, Bobo-Dioulasso. Burkina Faso
| | - Noel Magloire Manga
- Unit of Training and Research in Health Sciences, Assane Seck University, Ziguinchor, Senegal
| | - Brice Bicaba
- Ministry of Health, Directorate of Disease Control, Ouagadougou, Burkina Faso
| | - Arouna Gnamou
- Department of Infectious and Tropical Diseases, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Charles Joel Kagoné
- Department of Infectious and Tropical Diseases, Yalgado Ouedraogo Teaching Hospital, Ouagadougou, Burkina Faso
| | - Guetawendé Sawadogo
- Ministry of Health, Directorate of Disease Control, Ouagadougou, Burkina Faso
| | - Issaka Yaméogo
- Ministry of Health, Directorate of Disease Control, Ouagadougou, Burkina Faso
| | - Noelle A. Benzekri
- University of Washington, Department of Medicine, Division of Infectious Diseases, Seattle, WA, USA
| | - Zekiba Tarnagda
- Health Science Research Institute, Bio-Medical Department, Ouagadougou, Burkina Faso
| | - Séni Kouanda
- Health Science Research Institute, Bio-Medical Department, Ouagadougou, Burkina Faso
| | - Ramata Ouédraogo-Traoré
- Joseph Ki-Zerbo University, Health Sciences and Research Training Unit, Ouagadougou, Burkina Faso
| | | | - Moussa Seydi
- Infectious and Tropical Diseases Clinics, Fann University Hospital, Dakar, Senegal
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Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Sall I, Diatta JP, Faye K, Sall F, Cisse O, Ndour CT, Sow PS, Malomar JJ, Hawes SE, Seydi M, Gottlieb GS. Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study. Am J Trop Med Hyg 2021; 105:1290-1297. [PMID: 34424856 PMCID: PMC8592183 DOI: 10.4269/ajtmh.21-0280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022] Open
Abstract
Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Cheikh T Ndour
- Division de Lutte contre le Sida et les Infections Sexuellement Transmissibles, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Epidemiology, University of Washington, Seattle, Washington.,Department of Global Health, University of Washington, Seattle, Washington
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Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Diatta JP, Faye K, Sall I, Sall F, Cisse O, Malomar JJ, Ndour CT, Sow PS, Hawes SE, Seydi M, Gottlieb GS. Food insecurity predicts loss to follow-up among people living with HIV in Senegal, West Africa. AIDS Care 2021; 34:878-886. [PMID: 33682545 PMCID: PMC8937041 DOI: 10.1080/09540121.2021.1894316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The goals of this study were to assess retention on antiretroviral therapy (ART) and to identify predictors of loss to follow-up (LTFU) among people living with HIV (PLHIV) in Senegal. HIV-positive individuals presenting for initiation of ART in Dakar and Ziguinchor were enrolled and followed for 12 months. Data were collected using interviews, clinical evaluations, laboratory analyses, chart review, and active patient tracing. Of the 207 individuals enrolled, 70% were female, 32% had no formal education, and 28% were severely food insecure. At the end of the follow-up period, 58% were retained on ART, 15% were deceased, 4% had transferred care, 5% had migrated, and 16% were lost to follow-up. Enrollment in Ziguinchor (OR 2.71 [1.01–7.22]) and severe food insecurity (OR 2.55 [1.09–5.96]) were predictive of LTFU. Sex, age, CD4 count, BMI <18.5, country of birth, marital status, number of children, household size, education, consultation with traditional healers, transportation time, and transportation cost were not associated with LTFU. The strongest predictor of severe food insecurity was lack of formal education (OR 2.75 [1.30–5.80]). Addressing the upstream drivers of food insecurity and implementing strategies to enhance food security for PLHIV may be effective approaches to reduce LTFU and strengthen the HIV care cascade in the region.
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Affiliation(s)
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Benzekri NA, Sambou JF, Ndong S, Diallo MB, Tamba IT, Faye D, Sall I, Diatta JP, Faye K, Cisse O, Sall F, Guèye NFN, Ndour CT, Sow PS, Malomar JJ, Hawes SE, Seydi M, Gottlieb GS. The impact of food insecurity on HIV outcomes in Senegal, West Africa: a prospective longitudinal study. BMC Public Health 2021; 21:451. [PMID: 33676463 PMCID: PMC7936446 DOI: 10.1186/s12889-021-10444-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding the impact of food insecurity on HIV outcomes is critical for the development and implementation of effective, evidence-based interventions to address food insecurity and improve the HIV care cascade. We conducted a prospective, longitudinal study to determine the impact of food insecurity on HIV outcomes in Senegal, West Africa. Methods HIV-infected individuals presenting for care and initiation of ART through the Senegalese National AIDS program in Dakar and Ziguinchor were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart review at enrollment, month 6, and month 12. Logistic regression was used to determine the association between food insecurity and HIV outcomes. Results Among the 207 participants in this study, 70% were female and the median age was 37 years. The majority (69%) were food insecure at enrollment, 29% were severely food insecure, and 38% were undernourished. Nearly a third (32%) had no formal education, 23% practiced agriculture, and 40% owned livestock. The median daily food expenditure per person was $0.58. The median round trip transportation time to clinic was 90 min (IQR 30–240). The median cost of transportation to clinic was $1.74. At month 12, 69% were food insecure, 23% were severely food insecure, and 14% were undernourished. At month 12, 43% had not disclosed their HIV status; food insecurity was associated with non-disclosure of HIV-status due to fear of stigmatization and feelings of shame. Severe food insecurity was a strong predictor of loss to follow-up (OR 3.13 [1.08–9.06]) and persistent severe food insecurity was associated with virologic failure (OR 5.14 [1.01–26.29]) and poor adherence to ART 8.00 [1.11–57.57]. Poor nutritional status was associated with poor immunologic recovery (OR 4.24 [1.56–11.47]), virologic failure (OR 3.39 [1.13–10.21]), and death (OR 3.35 [1.40–8.03]). Conclusion Severity and duration of food insecurity are important factors in understanding the relationship between food insecurity and HIV outcomes. Our findings highlight the importance of nutritional status, socioeconomic opportunity, and self-stigmatization in the complex pathway between food insecurity and HIV outcomes. Interdisciplinary, multisectoral efforts are needed to develop and implement effective interventions to address food insecurity among people living with HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10444-1.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Mouhamadou Baïla Diallo
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Ndèye Fatou Ngom Guèye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Senegal
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St., Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Benzekri NA, Sambou JF, Tamba IT, Diatta JP, Sall I, Cisse O, Thiam M, Bassene G, Badji NM, Faye K, Sall F, Malomar JJ, Seydi M, Gottlieb GS. Nutrition support for HIV-TB co-infected adults in Senegal, West Africa: A randomized pilot implementation study. PLoS One 2019; 14:e0219118. [PMID: 31318879 PMCID: PMC6638996 DOI: 10.1371/journal.pone.0219118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/17/2018] [Accepted: 06/16/2019] [Indexed: 11/23/2022] Open
Abstract
Background Food insecurity can contribute to poor adherence to both tuberculosis treatment and HIV antiretroviral therapy (ART). Interventions that target food insecurity have the potential to increase treatment adherence, improve clinical outcomes, and decrease mortality. The goals of this study were to compare the feasibility, acceptability, and potential impact of implementing two different forms of nutrition support for HIV-TB co-infected adults in the Casamance region of Senegal. Methods We conducted a randomized pilot implementation study among HIV-TB co-infected adults initiating treatment for TB (ClinicalTrials.gov Identifier: NCT03711721). Subjects received nutrition support in the form of a local food basket or Ready-to-Use Therapeutic Food (RUTF), distributed on a monthly basis for six months. Results A total of 178 monthly study encounters were completed by 26 HIV-TB co-infected adults; 14 received food baskets and 12 received RUTF. For both the food basket and RUTF, 100% of subjects obtained the supplement at every study encounter, transferred the supplement from the clinic to their household, and consumed the supplement. The food basket had greater acceptability and was more likely to be shared with members of the household. Adherence to TB treatment and ART exceeded 95%, and all outcomes, including CD4 cell count, hemoglobin, nutritional status, and food security, improved over the study period. All subjects completed TB treatment and were smear negative at treatment completion. The total cost of the local food basket was approximately $0.68 per day versus $0.99 for the RUTF. Conclusion The implementation of nutrition support for HIV-TB co-infected adults in Senegal is feasible and may provide an effective strategy to improve adherence, treatment completion, and clinical outcomes for less than 1 USD per day. Further studies to determine the impact of nutrition support among a larger population of HIV-TB co-infected individuals are indicated.
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Affiliation(s)
- Noelle A. Benzekri
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | | | | | | | | | | | | | | | | | - Khadim Faye
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Fatima Sall
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | | | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Benzekri NA, Sambou JF, Ndong S, Tamba IT, Faye D, Diallo MB, Diatta JP, Faye K, Sall I, Sall F, Manga NM, Malomar JJ, Ndour CT, Hawes SE, Seydi M, Gottlieb GS. Prevalence, predictors, and management of advanced HIV disease among individuals initiating ART in Senegal, West Africa. BMC Infect Dis 2019; 19:261. [PMID: 30876400 PMCID: PMC6420737 DOI: 10.1186/s12879-019-3826-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 02/15/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The WHO guidelines for the management of advanced HIV disease recommend a package of care consisting of rapid initiation of antiretroviral therapy (ART), enhanced screening and diagnosis of tuberculosis (TB) and cryptococcal meningitis, co-trimoxazole prophylaxis, isoniazid preventive therapy (IPT), fluconazole pre-emptive therapy, and adherence support. The goals of this study were to determine the prevalence of advanced HIV disease among individuals initiating ART in Senegal, to identify predictors of advanced disease, and to evaluate adherence to the WHO guidelines. METHODS This study was conducted among HIV-positive individuals initiating ART in Dakar and Ziguinchor, Senegal. Clinical evaluations, laboratory analyses, questionnaires and chart review were conducted. Logistic regression was used to identify predictors of advanced disease. RESULTS A total of 198 subjects were enrolled; 70% were female. The majority of subjects (71%) had advanced HIV disease, defined by the WHO as a CD4 count < 200 cells/mm3 or clinical stage 3 or 4. The median CD4 count was 185 cells/mm3. The strongest predictors of advanced disease were age ≥ 35 (OR 5.80, 95%CI 2.35-14.30) and having sought care from a traditional healer (OR 3.86, 95%CI 1.17-12.78). Approximately one third of subjects initiated ART within 7 days of diagnosis. Co-trimoxazole prophylaxis was provided to 65% of subjects with CD4 counts ≤350 cells/mm3 or stage 3 or 4 disease. TB symptom screening was available for 166 subjects; 54% reported TB symptoms. Among those with TB symptoms, 39% underwent diagnostic evaluation. Among those eligible for IPT, one subject received isoniazid. No subjects underwent CrAg screening or received fluconazole to prevent cryptococcal meningitis. CONCLUSIONS This is the first study to report an association between seeking care from a traditional healer and presentation with WHO defined advanced disease in sub-Saharan Africa. Given the widespread use of traditional healers in sub-Saharan Africa, future studies to further explore this finding are indicated. Although the majority of individuals in this study presented with advanced disease and warranted management according to WHO guidelines, there were numerous missed opportunities to prevent HIV-associated morbidity and mortality. Programmatic evaluation is needed to identify barriers to implementation of the WHO guidelines and enhanced funding for operational research is indicated.
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Affiliation(s)
- Noelle A Benzekri
- Department of Medicine, University of Washington, Box 358061, 750 Republican St, Seattle, WA, 98109-4725, USA.
| | | | - Sanou Ndong
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | | | - Mouhamadou Baïla Diallo
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | - Khadim Faye
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | - Fatima Sall
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | | | | | - Cheikh T Ndour
- Division de Lutte contre le Sida et les IST, Ministère de la Santé et de l'Action Sociale, Dakar, Sénégal
| | - Stephen E Hawes
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier National Universitaire (CHNU) de Fann, Dakar, Senegal
| | - Geoffrey S Gottlieb
- Department of Medicine, University of Washington, Box 358061, 750 Republican St, Seattle, WA, 98109-4725, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Benzekri NA, Seydi M, N Doye I, Toure M, Sy MP, Kiviat NB, Sow PS, Gottlieb GS, Hawes SE. Correction: Increasing prevalence of hypertension among HIV-positive and negative adults in Senegal, West Africa, 1994-2015. PLoS One 2019; 14:e0212250. [PMID: 30731007 PMCID: PMC6366686 DOI: 10.1371/journal.pone.0212250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0208635.].
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Benzekri NA, Seydi M, N. Doye I, Toure M, Sy MP, Kiviat NB, Sow PS, Gottlieb GS, Hawes SE. Increasing prevalence of hypertension among HIV-positive and negative adults in Senegal, West Africa, 1994-2015. PLoS One 2018; 13:e0208635. [PMID: 30596667 PMCID: PMC6312281 DOI: 10.1371/journal.pone.0208635] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 11/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Non-communicable diseases, including hypertension (HTN), are increasingly recognized as important causes of morbidity and mortality among people living with HIV (PLHIV) in resource-limited settings. The goals of this study were to determine the prevalence of HTN among PLHIV in Senegal over time and to identify predictors of HTN among HIV-positive versus HIV-negative adults. METHODS We conducted a retrospective study using data from individuals enrolled in previous studies in Senegal from 1994-2015. Blood pressure (BP) measurements taken during study visits were used for analysis. HTN was defined as systolic BP≥140 or diastolic BP≥90. We used logistic regression to identify predictors of HTN. RESULTS We analyzed data from 2848 adults (1687 HIV-positive, 1161 HIV-negative). Among PLHIV, the prevalence of HTN increased from 11% during 1994-1999 to 22% during 2010-2015. Among HIV-negative individuals, the prevalence of HTN increased from 16% to 32%. Among both groups, the odds of HTN more than doubled from 1994-1999 to 2010-2015 (HIV-positive OR 2·4, 95% CI 1·1-5·0; HIV-negative OR 2·6, 95% CI 1·5-4·6). One quarter of all individuals with HTN had stage 2 HTN. The strongest risk factor for HTN was obesity (HIV-positive OR 3·2, 95% CI 1·7-5·8; p<0·01; HIV-negative OR 7·8, 95% CI 4·5-13·6; p<0·01). Male sex and age ≥50 were also predictive of HTN among both groups. Among HIV-positive subjects, WHO stage 1 or 2 disease was predictive of HTN and among HIV-negative subjects, having no formal education was predictive. CONCLUSION Over the past 20 years, the prevalence of HTN has doubled among both HIV-positive and HIV-negative adults in Senegal. Our study indicates that there is an increasing need for the integration of chronic disease management into HIV programs in Senegal. Furthermore, our findings highlight the need for enhanced prevention, recognition, and management of non-communicable diseases, including hypertension and obesity, among both HIV-positive and HIV-negative individuals in Senegal.
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Affiliation(s)
- Noelle A. Benzekri
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Moussa Seydi
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | | | - Macoumba Toure
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Marie Pierre Sy
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Nancy B. Kiviat
- Department of Pathology, University of Washington, Seattle, WA, United States of America
| | - Papa Salif Sow
- Services des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Stephen E. Hawes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
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Benzekri NA, Seydi M, NDoye I, Toure M, Kiviat NB, Sow PS, Hawes SE, Gottlieb GS. HIV and the dual burden of malnutrition in Senegal, 1994-2012. Int J STD AIDS 2018; 29:1165-1173. [PMID: 29914295 DOI: 10.1177/0956462418777364] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to determine the nutritional status of HIV-positive versus HIV-negative adults in Senegal and to identify predictors of nutritional status among people living with HIV (PLHIV). We conducted a retrospective study using data from individuals enrolled in previous studies in Senegal. Undernutrition was defined as body mass index (BMI) <18.5 and overnutrition was defined as BMI ≥25.0. Subcategories of overnutrition were overweight (defined as BMI 25.0-29.9) and obesity (BMI ≥30.0). Predictors of nutritional status were identified using multinomial logistic regression. Data from 2448 adults were included; 1471 (60%) were HIV positive. Among HIV-negative individuals, the prevalence of undernutrition decreased from 23% in 1994-1999 to 5% in 2006-2012, while the prevalence of overnutrition increased from 19 to 55%. Among PLHIV, undernutrition decreased from 52 to 37% and overnutrition increased from 10 to 15%. Women had greater odds of obesity (odds ratio [OR] 11.4; p < 0.01). Among HIV-positive women, undernutrition was associated with WHO stage 3 or 4 and CD4 cell count <200; antiretroviral therapy (ART) and education were protective. Obesity was associated with age > 35 years, commercial sex work, and alcohol use. Among HIV-positive men, WHO stage 3 or 4 and CD4 cell count <200 were predictive of undernutrition; ART was protective. Our study highlights the need for the integration of nutrition interventions into HIV programs in Senegal and suggests that for nutrition programs to be most effective, strategies may need to differ when targeting men versus women. Furthermore, improving access to education and focusing on women for nutrition interventions could be of particularly high impact at the household level.
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Affiliation(s)
- Noelle A Benzekri
- 1 Department of Medicine, University of Washington, Seattle, WA, USA
| | - Moussa Seydi
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Ibrahima NDoye
- 3 Conseil National de Lutte contre le Sida, Dakar, Senegal
| | - Macoumba Toure
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Nancy B Kiviat
- 4 Department of Pathology, University of Washington, Seattle, WA, USA
| | - Papa Salif Sow
- 2 Centre Hospitalier Universitaire de Fann, Dakar, Senegal
| | - Stephen E Hawes
- 5 Department of Global Health, University of Washington, Seattle, WA, USA.,6 Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Geoffrey S Gottlieb
- 1 Department of Medicine, University of Washington, Seattle, WA, USA.,5 Department of Global Health, University of Washington, Seattle, WA, USA
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Benzekri NA, Sambou JF, Diaw B, Sall EHI, Sall F, Niang A, Ba S, Guèye NFN, Diallo MB, Hawes SE, Seydi M, Gottlieb GS. The dimensions of food insecurity and malnutrition among people living with HIV in Senegal, West Africa. AIDS Care 2017; 29:1510-1516. [PMID: 28612658 DOI: 10.1080/09540121.2017.1338652] [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: 10/19/2022]
Abstract
An understanding of the factors contributing to food insecurity and malnutrition among people living with HIV (PLHIV) in Senegal is urgently needed in order to develop effective interventions. The goals of this study were to identify differences in the dimensions of food security among PLHIV in Dakar versus Ziguinchor, Senegal, to determine which of these dimensions are most predictive of severe food insecurity, and to identify factors associated with malnutrition. We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Interviews were conducted with ninety-five food insecure, HIV-infected subjects. Daily household income and daily food expenditure per household member were the strongest predictors of severe food insecurity. The practice of agriculture, livestock ownership, nutritional status, and HIV outcomes were not predictive of severe food insecurity. CD4 count <350/mm3 was the strongest predictor of malnutrition. Severe food insecurity, daily household income, daily food expenditure per household member, dietary diversity score, skipping meals, the practice of agriculture, livestock ownership, ART status, and adherence were not predictive of malnutrition. This is the first study to analyze the dimensions of food security among PLHIV in Senegal. We discovered important differences in food access, availability, stability, and utilization in Dakar versus Ziguinchor. We found that economic access was the strongest predictor of severe food insecurity and poorly controlled HIV was the strongest predictor of malnutrition. Our findings suggest that the interventions needed to address food insecurity differ from those necessary to target malnutrition, and that effective interventions may differ in Dakar versus Ziguinchor. Furthermore, this study highlights a need for a greater understanding of the relationship between HIV and malnutrition among individuals receiving ART in resource-limited settings.
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Affiliation(s)
- Noelle A Benzekri
- a Department of Medicine , University of Washington , Seattle , WA , USA
| | - Jacques F Sambou
- b Le Pavillon de Traitement Ambulatoire , Centre de Santé de Ziguinchor , Ziguinchor , Sénégal
| | - Binetou Diaw
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - El Hadji Ibrahima Sall
- b Le Pavillon de Traitement Ambulatoire , Centre de Santé de Ziguinchor , Ziguinchor , Sénégal
| | - Fatima Sall
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - Alassane Niang
- b Le Pavillon de Traitement Ambulatoire , Centre de Santé de Ziguinchor , Ziguinchor , Sénégal
| | - Selly Ba
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - Ndèye Fatou Ngom Guèye
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - Mouhamadou Baïla Diallo
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - Stephen E Hawes
- d Department of Global Health , University of Washington , Seattle , WA , USA.,e Department of Epidemiology , University of Washington , Seattle , WA , USA
| | - Moussa Seydi
- c Service des Maladies Infectieuses et Tropical , Centre Hospitalier Universitaire de Fann , Dakar , Sénégal
| | - Geoffrey S Gottlieb
- a Department of Medicine , University of Washington , Seattle , WA , USA.,d Department of Global Health , University of Washington , Seattle , WA , USA
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Benzekri NA, Sambou J, Diaw B, Sall EHI, Sall F, Niang A, Ba S, Ngom Guèye NF, Diallo MB, Hawes SE, Seydi M, Gottlieb GS. High Prevalence of Severe Food Insecurity and Malnutrition among HIV-Infected Adults in Senegal, West Africa. PLoS One 2015; 10:e0141819. [PMID: 26529509 PMCID: PMC4631507 DOI: 10.1371/journal.pone.0141819] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 10/13/2015] [Indexed: 12/31/2022] Open
Abstract
Background Malnutrition and food insecurity are associated with increased mortality and poor clinical outcomes among people living with HIV/AIDS; however, the prevalence of malnutrition and food insecurity among people living with HIV/AIDS in Senegal, West Africa is unknown. The objective of this study was to determine the prevalence and severity of food insecurity and malnutrition among HIV-infected adults in Senegal, and to identify associations between food insecurity, malnutrition, and HIV outcomes. Methods We conducted a cross-sectional study at outpatient clinics in Dakar and Ziguinchor, Senegal. Data were collected using participant interviews, anthropometry, the Household Food Insecurity Access Scale, the Individual Dietary Diversity Scale, and chart review. Results One hundred and nine HIV-1 and/or HIV-2 participants were enrolled. The prevalence of food insecurity was 84.6% in Dakar and 89.5% in Ziguinchor. The prevalence of severe food insecurity was 59.6% in Dakar and 75.4% in Ziguinchor. The prevalence of malnutrition (BMI <18.5) was 19.2% in Dakar and 26.3% in Ziguinchor. Severe food insecurity was associated with missing clinic appointments (p = 0.01) and not taking antiretroviral therapy due to hunger (p = 0.02). Malnutrition was associated with lower CD4 cell counts (p = 0.01). Conclusions Severe food insecurity and malnutrition are highly prevalent among HIV-infected adults in both Dakar and Ziguinchor, and are associated with poor HIV outcomes. Our findings warrant further studies to determine the root causes of malnutrition and food insecurity in Senegal, and the short- and long-term impacts of malnutrition and food insecurity on HIV care. Urgent interventions are needed to address the unacceptably high rates of malnutrition and food insecurity in this population.
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Affiliation(s)
- Noelle A. Benzekri
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | | | - Binetou Diaw
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | - Fatima Sall
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | - Selly Ba
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | | | | | - Stephen E. Hawes
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Department of Epidemiology, University of Washington, Seattle, WA, United States of America
| | - Moussa Seydi
- Centre Hospitalier Universitaire de Fann, Dakar, Sénégal
| | - Geoffrey S. Gottlieb
- Department of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Global Health, University of Washington, Seattle, WA, United States of America
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Wong JM, Nyachieo DO, Benzekri NA, Cosmas L, Ondari D, Yekta S, Montgomery JM, Williamson JM, Breiman RF. Sustained high incidence of injuries from burns in a densely populated urban slum in Kenya: an emerging public health priority. Burns 2014; 40:1194-200. [PMID: 24461306 DOI: 10.1016/j.burns.2013.12.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [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: 08/22/2013] [Revised: 12/12/2013] [Accepted: 12/13/2013] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Ninety-five percent of burn deaths occur in low- and middle-income countries (LMICs); however, longitudinal household-level studies have not been done in urban slum settings, where overcrowding and unsafe cook stoves may increase likelihood of injury. METHODS Using a prospective, population-based disease surveillance system in the urban slum of Kibera in Kenya, we examined the incidence of household-level burns of all severities from 2006-2011. RESULTS Of approximately 28,500 enrolled individuals (6000 households), we identified 3072 burns. The overall incidence was 27.9/1000 person-years-of-observation. Children <5 years old sustained burns at 3.8-fold greater rate compared to (p<0.001) those ≥5 years old. Females ≥5 years old sustained burns at a rate that was 1.35-fold (p<0.001) greater than males within the same age distribution. Hospitalizations were uncommon (0.65% of all burns). CONCLUSIONS The incidence of burns, 10-fold greater than in most published reports from Africa and Asia, suggests that such injuries may contribute more significantly than previously thought to morbidity in LMICs, and may be increased by urbanization. As migration from rural areas into urban slums rapidly increases in many African countries, characterizing and addressing the rising burden of burns is likely to become a public health priority.
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Affiliation(s)
- Joshua M Wong
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Dhillon O Nyachieo
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Noelle A Benzekri
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Leonard Cosmas
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Daniel Ondari
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Shahla Yekta
- Division of Plastic and Reconstructive Surgery, University of Toronto, Toronto, ON, Canada
| | - Joel M Montgomery
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - John M Williamson
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration
| | - Robert F Breiman
- Global Disease Detection Division, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya and the Kenya Medical Research Institute (KEMRI)-CDC Research Collaboration.
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Roess AA, Monroe BP, Kinzoni EA, Gallagher S, Ibata SR, Badinga N, Molouania TM, Mabola FS, Mombouli JV, Carroll DS, MacNeil A, Benzekri NA, Moses C, Damon IK, Reynolds MG. Assessing the effectiveness of a community intervention for monkeypox prevention in the Congo basin. PLoS Negl Trop Dis 2011; 5:e1356. [PMID: 22028942 PMCID: PMC3196471 DOI: 10.1371/journal.pntd.0001356] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 08/29/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In areas where health resources are limited, community participation in the recognition and reporting of disease hazards is critical for the identification of outbreaks. This is particularly true for zoonotic diseases such as monkeypox that principally affect people living in remote areas with few health services. Here we report the findings of an evaluation measuring the effectiveness of a film-based community outreach program designed to improve the understanding of monkeypox symptoms, transmission and prevention, by residents of the Republic of the Congo (ROC) who are at risk for disease acquisition. METHODOLOGY/PRINCIPAL FINDINGS During 90 days, monkeypox outreach was conducted for ∼23,860 people in northern ROC. Two hundred seventy-one attendees (selected via a structured sample) were interviewed before and after participating in a small-group outreach session. The proportion of interviewees demonstrating monkeypox-specific knowledge before and after was compared. Significant gains were measured in areas of disease recognition, transmission, and mitigation of risk. The ability to recognize at least one disease symptom and a willingness to take a family member with monkeypox to the hospital increased from 49 and 45% to 95 and 87%, respectively (p<0.001, both). Willingness to deter behaviors associated with zoonotic risk, such as eating the carcass of a primate found dead in the forest, remained fundamentally unchanged however, suggesting additional messaging may be needed. CONCLUSIONS/SIGNIFICANCE These results suggest that our current program of film-based educational activities is effective in improving disease-specific knowledge and may encourage individuals to seek out the advice of health workers when monkeypox is suspected.
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Affiliation(s)
- Amira A. Roess
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Benjamin P. Monroe
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Eric A. Kinzoni
- International Conservation and Education Fund, Washington, D.C., United States of America
| | - Seamus Gallagher
- International Conservation and Education Fund, Washington, D.C., United States of America
| | - Saturnin R. Ibata
- International Conservation and Education Fund, Washington, D.C., United States of America
| | | | - Trolienne M. Molouania
- International Conservation and Education Fund, Washington, D.C., United States of America
| | - Fredy S. Mabola
- International Conservation and Education Fund, Washington, D.C., United States of America
| | - Jean V. Mombouli
- Laboratoire National de Santé Publique, Brazzaville, Republic of the Congo
| | - Darin S. Carroll
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam MacNeil
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Noelle A. Benzekri
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Cynthia Moses
- International Conservation and Education Fund, Washington, D.C., United States of America
| | - Inger K. Damon
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mary G. Reynolds
- Poxvirus and Rabies Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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