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Tshuma N, Ngbede ED, Nyengerai T, Mtapuri O, Moyo S, Mphuthi DD, Nyasulu P. Understanding health outcome drivers among adherence club patients in clinics of Gauteng, South Africa: a structural equation modelling (SEM) approach. AIDS Res Ther 2023; 20:71. [PMID: 37798794 PMCID: PMC10557202 DOI: 10.1186/s12981-023-00565-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND There has been growing interest in understanding the drivers of health outcomes, both in developed and developing countries. The drivers of health outcomes, on the other hand, are the factors that influence the likelihood of experiencing positive or negative health outcomes. Human Immunodeficiency Virus (HIV) continues to be a significant global public health challenge, with an estimated 38 million people living with the aim of this study was therefore to develop and empirically test a conceptual research model using SEM, aimed at explaining the magnitude of various factors influencing HIV and other health outcomes among patients attending Adherence Clubs. METHOD This was a cross sectional survey study design conducted in 16 health facilities in the City of Ekurhuleni in Gauteng Province, South Africa. A total of 730 adherence club patients were systematically sampled to participate in a closed ended questionnaire survey. The questionnaire was assessed by Cronbach's alpha coefficient for internal consistency. The proposed model was tested using structural equation modelling (AMOS software: ADC, Chicago, IL, USA). RESULTS A total of 730 adherence club members participated in the study. Of these, 425 (58.2%) were female and 305 (41.8%) were male. The overall results indicated a good reliability of all the scale involved in this study as Cronbach alphas ranged from 0.706 to 0.874, and composite reliability from 0.735 to 0.874. The structural model showed that the constructs health seeking behavior (β = 0.267, p = 0.000), health care services (β = 0.416, p = 0.000), stigma and discrimination (β = 0.135, p = 0.022) significantly predicted health outcomes and explained 45% of its variance. The construct healthcare service was the highest predictor of health outcomes among patients in adherence clubs. CONCLUSION Patient health seeking behaviour, healthcare services, stigma and discrimination were associated with perceived health outcomes. Since adherence clubs have been found to have a significant impact in improving patient outcomes and quality of life, there is a need to ensure replication of this model.
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Affiliation(s)
- Ndumiso Tshuma
- The Best Health Solutions, Johannesburg, Gauteng, South Africa.
- Texila American University and University of Central Nicaragua, Managua, Nicaragua.
| | - Elakpa Daniel Ngbede
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Tawanda Nyengerai
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Oliver Mtapuri
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- University of KwaZulu Natal, Durban, South Africa
| | - Sangiwe Moyo
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Final Mile, Johannesburg, Gauteng, South Africa
| | - David D Mphuthi
- The Best Health Solutions, Johannesburg, Gauteng, South Africa
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Alemayohu MA, Zanolin ME, Cazzoletti L, Nyasulu P, Garcia-Larsen V. Burden and risk factors of chronic obstructive pulmonary disease in Sub-Saharan African countries, 1990-2019: a systematic analysis for the Global Burden of disease study 2019. EClinicalMedicine 2023; 64:102215. [PMID: 37799614 PMCID: PMC10550520 DOI: 10.1016/j.eclinm.2023.102215] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
Background Sub-Saharan Africa (SSA) has experienced a surge of non-communicable diseases (NCDs) including chronic obstructive pulmonary disease (COPD) over the past two decades. Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), in this study we have estimated the burden and attributable risk factors of COPD across SSA countries between 1990 and 2019. Methods COPD burden and its attributable risk factors were estimated using data from the 2019 GBD. Percentage change was estimated to show the trend of COPD estimates from 1990 to 2019. COPD estimates attributable by risk factors were also reported to ascertain the risk factor that brings the greatest burden by sex and locations (at country and regions level). Findings In 2019, all-age prevalent cases of COPD in SSA were estimated to be 10.3 million (95% Uncertainty Intervals (UI) 9.7 million to 10.9 million) showing an increase of 117% compared with the number of all-age COPD cases in 1990. From 1990 to 2019, SSA underwent an increased percentage change in all-age YLDs due to COPD ranging from 41% in Lesotho to 203% in Equatorial Guinea. The largest premature mortality due to COPD was reported from Central SSA accounting for 729 subjects (95% UI, 509-1078). The highest rate of DALYs attributable to COPD was observed in Lesotho. Household air pollution from solid fuel was the primary contributor of the age standardized YLDs, death rate, and DALYs rate per 100,000 population. Interpretation The prevalence of COPD in SSA has had a steady increase over the past three decades and has progressively become a major public health burden across the region. Household air pollution from solid fuel is the primary contributor to COPD related burden, and its percentage contribution showed a similar trend to the reduction of COPD attributed age-standardized DALY rate. The methodological limitations of surveys and datapoints included in the GBD need to be considered when interpreting these associations. Funding There are no specific fundings received for this study. The Global Burden of Disease study was supported by funding from the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Mulubirhan Assefa Alemayohu
- Unit of Epidemiology and Medical Statistics, University of Verona, Italy
- School Public Health, Mekelle University, Ethiopia
- Biostatistics and Clinical Epidemiology Unit, Department of Public Health, Experimental and Forensic Medicin, University of Pavia, 27100, Pavia, Italy
| | | | - Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, University of Verona, Italy
| | - Peter Nyasulu
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Vanessa Garcia-Larsen
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
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Parker A, Broadhurst AGB, Moolla MS, Amien L, Ahmed R, Taljaard JJ, Meintjes G, Nyasulu P, Koegelenberg CFN. A point-prevalence study of body mass indices in HIV-positive and HIV-negative patients admitted to hospital with COVID-19 in South Africa. Afr J Thorac Crit Care Med 2023; 29:10.7196/AJTCCM.2023.v29i3.660. [PMID: 37970574 PMCID: PMC10642405 DOI: 10.7196/ajtccm.2023.v29i3.660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 08/22/2023] [Indexed: 11/17/2023] Open
Abstract
Background Obesity is now well recognised as a risk factor for severe COVID-19, but the true prevalence of obesity in hospitalised adults with COVID-19 remains unclear because formal body mass indices (BMIs) are not routinely measured on admission. Objectives To describe the true prevalence of obesity measured by the BMI, and associated comorbidities, in patients hospitalised with severe COVID-19, including people with HIV (PWH). Methods We conducted a point-prevalence study of measured BMI in consecutive patients with severe COVID-19 admitted to the medical COVID-19 wards in a tertiary academic hospital in Cape Town, South Africa (SA). Patients were enrolled over a 2-week period during the peak of the first COVID-19 wave in SA. Results We were able to measure the BMI in 122 of the 146 patients admitted during the study period. The prevalence of HIV was 20% (n=24/122). Most of the participants were overweight or obese (n=104; 85%), and 84 (68.9%) met criteria for obesity. The mean (standard deviation) BMI was 33 (7.5), and 34.5 (9.1) in PWH. Of PWH, 83% (n=20/24) were overweight or obese and 75% (n=18) met criteria for obesity. Multimorbidity was present in 22 (92%) of PWH. Conclusion We found that most patients, including PWH, met criteria for being overweight or obese. The high prevalence of obesity in PWH and severe COVID-19 reinforces the need for targeted management of non-communicable diseases, including obesity, in PWH. Study synopsis What the study adds. We found that the true prevalence of obesity, including in people with HIV (PWH), measured with the formal body mass index in hospitalised patients with severe COVID-19 was much higher than reported previously.Multimorbidity was present in over half of all patients, and in 92% of PWH. Implications of the findings. Urgent public health measures are required to tackle the rise in obesity, including in low- and middle-income countries.HIV care must integrate management of non-communicable diseases, including obesity.The pathogenic mechanism of the link between obesity and severe COVID-19 needs further research.
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Affiliation(s)
- A Parker
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - A G B Broadhurst
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - M S Moolla
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Amien
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - R Ahmed
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - J J Taljaard
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - G Meintjes
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, South Africa
| | - P Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - C F N Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Kitenge MK, Fatti G, Eshun-Wilson I, Aluko O, Nyasulu P. Prevalence and trends of advanced HIV disease among antiretroviral therapy-naïve and antiretroviral therapy-experienced patients in South Africa between 2010-2021: a systematic review and meta-analysis. BMC Infect Dis 2023; 23:549. [PMID: 37608300 PMCID: PMC10464046 DOI: 10.1186/s12879-023-08521-4] [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: 02/08/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Despite the significant progress made in South Africa in getting millions of individuals living with HIV into care, many patients still present or re-enter care with Advanced HIV Disease (AHD). We aimed to estimate the prevalence of AHD among ART-naive and ART-experienced patients in South Africa using studies published between January 2010 and May 2022. METHODS We searched for relevant data on PubMed, CINAHL, Scopus and other sources, with a geographical filters limited to South Africa, up to May 31, 2022. Two reviewers conducted all screening, eligibility assessment, data extraction, and critical appraisal. We synthesized the data using the inverse-variance heterogeneity model and Freeman-Tukey transformation. We assessed heterogeneity using the I2 statistic and publication bias using the Egger and Begg's test. RESULTS We identified 2,496 records, of which 53 met the eligibility criteria, involving 11,545,460 individuals. The pooled prevalence of AHD among ART-naive and ART-experienced patients was 43.45% (95% CI 40.1-46.8%, n = 53 studies) and 58.6% (95% CI 55.7 to 61.5%, n = 2) respectively. The time trend analysis showed a decline of 2% in the prevalence of AHD among ART-naive patients per year. However, given the high heterogeneity between studies, the pooled prevalence should be interpreted with caution. CONCLUSION Despite HIV's evolution to a chronic disease, our findings show that the burden of AHD remains high among both ART-naive and ART-experienced patients in South Africa. This emphasizes the importance of regular measurement of CD4 cell count as an essential component of HIV care. In addition, providing innovative adherence support and interventions to retain ART patients in effective care is a crucial priority for those on ART.
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Affiliation(s)
- Marcel K Kitenge
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Tuberculosis and HIV investigative Network (THINK), Durban, Kwazulu-Natal, South Africa.
| | - Geoffrey Fatti
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Kheth'Impilo AIDS Free Living, Cape Town, South Africa
| | - Ingrid Eshun-Wilson
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Infectious Diseases, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Omololu Aluko
- Faculty of Health Sciences, School of Medical Sciences, Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lutala P, Nyasulu P, Muula AS. Perceived readiness for diabetes and cardiovascular care delivery in Mangochi, Malawi: multicentre study from healthcare providers' perspectives. BMC Prim Care 2023; 24:85. [PMID: 36973655 PMCID: PMC10042413 DOI: 10.1186/s12875-023-02033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Despite the expected prevalence rise of 98.1% for diabetes between 2010 and 2030 in sub-Saharan Africa (SSA) and the anticipated rise of both diabetes and cardiovascular diseases (CVDs) in Malawi from their current figures ( 5.6 and 8.9%; respectively), data on the readiness of health facilities to provide diabetes and cardiovascular diseases in Mangochi district is not available. Therefore, this study aimed to assess the readiness of health facilities to provide services for diabetes and cardiovascular diseases. METHODS An exploratory study was conducted from July to early September 2021 in 34 health facilities in Mangochi, Malawi. Forty-two participants were purposefully selected. They included medical officers, clinical officers, medical assistants, and registered nurses. The study used semi-structured interviews (for qualitative data) with a checklist (for quantitative data) to provide information about the readiness of services (such as guidelines and trained staff, drugs, diagnosis capacity and equipment, essential medicines, community services, and education/counseling).The thematic content analysis and basic descriptive statistics were carried out. RESULTS The following main theme emerged from the qualitative part: low use of diabetes-cardiovascular disease (CVD) services. This was due to: health facility factors (shortage of drugs and supplies, poor knowledge, few numbers and lack of training of providers, and absent copies of guidelines), patients factors (poor health-seeking behaviour, lack of education and counseling for many), and community factors (very limited community services for diabetes and CVDs, lack of transport policy and high transportation costs). Data from the checklists revealed low readiness scores across domains (below the 75% target) in diabetes and cardiovascular diseases: trained staff and guidelines (26.5% vs. 32.4%); diagnosis capacity and equipment (63.7% vs. 66.2%); essential medicines (33.5% vs. 41.9%), and community services, and education and counseling (37.5% vs. 42.5%). CONCLUSION There were several noticeable shortfalls identified in the readiness of health facilities to provide diabetes and cardiovascular disease services in Mangochi health facilities. Any future intervention in diabetes-cardiovascular disease care in these areas must include these elements in its basic package.
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Affiliation(s)
- Prosper Lutala
- Department of Family Medicine, School of Medicine and Oral Health, Kamuzu University of Health Sciences (KUHeS), Private Bag 360 Blantyre, Blantyre, Malawi.
- Department of Community & Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi.
| | - Peter Nyasulu
- Department of Global Health, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adamson S Muula
- Department of Community & Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences (KUHeS), Blantyre, Malawi
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Nicol JU, Iwu-Jaja CJ, Hendricks L, Nyasulu P, Young T. The impact of faith-based organizations on maternal and child health care outcomes in Africa: taking stock of research evidence. Pan Afr Med J 2022; 43:168. [PMID: 36825129 PMCID: PMC9941616 DOI: 10.11604/pamj.2022.43.168.32983] [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: 12/27/2021] [Accepted: 06/20/2022] [Indexed: 12/12/2022] Open
Abstract
This evidence synthesis aimed at assessing the effectiveness of Faith-Based Organisations (FBOs) on Maternal and Child Health (MCH) outcomes; and explore the perceptions and experiences of the users and providers of MCH services delivered by FBOs in Africa. This review considered studies from African countries only. Both reviews and primary studies focusing on MCH services provided by FBOs were considered. Quantitative, qualitative, and mixed methods reviews were included with no restriction on the date and language. Primary outcomes included maternal mortality ratio, neonatal mortality, infant mortality, child mortality, quality of care, views, experiences, and perceptions of users of FBOs. We searched up to November 2020 in the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports, the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, PROSPERO register, PDQ-evidence, Health Systems Evidence, CINAHL, EMBASE, and PubMed. We searched references cited by similar studies that may be potentially eligible for inclusion. We then updated the search for primary studies from December 2009 - October 2020. One systematic review and six primary studies met the eligibility criteria for inclusion. Methodological quality varied. These observational and qualitative studies found that FBOs offered the following MCH services - training of healthcare workers, obstetric services, health promotion, sexual education, immunization services, and intermittent preventive therapy for malaria. Maternal and Child Health (MCH) services provided by FBO suggest a reduction in maternal morbidity and mortality. Increased uptake of maternal healthcare services, and increased satisfaction were reported by users of care. However, costs of providing these services varied across the studies and users. This review shows that FBOs play an important role in improving access and delivery of MCH services and have the potential of strengthening the health system at large. Rigorous research is needed to ascertain the effectiveness of FBO-based interventions in strengthening the health systems in Africa.
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Affiliation(s)
- Jeannine Uwimana Nicol
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,,School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kicukiro, Kigali, Rwanda,,Corresponding author: Jeannine Uwimana Nicol, Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Chinwe Juliana Iwu-Jaja
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lynn Hendricks
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,,Social Research Methodology Group, Faculty of Social Sciences, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Peter Nyasulu
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Taryn Young
- Center for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Chanda-Kapata P, Ntoumi F, Kapata N, Lungu P, Mucheleng'anga LA, Chakaya J, Tembo J, Himwaze C, Ansumana R, Asogun D, Mfinanga S, Nyasulu P, Mwaba P, Yeboah-Manu D, Zumla A, Nachega JB. Tuberculosis, HIV/AIDS and Malaria Health Services in sub-Saharan Africa - A Situation Analysis of the Disruptions and Impact of the COVID-19 Pandemic. Int J Infect Dis 2022; 124 Suppl 1:S41-S46. [PMID: 35341998 PMCID: PMC8949686 DOI: 10.1016/j.ijid.2022.03.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The unprecedented and ongoing COVID-19 pandemic has exposed weaknesses in African countries' health systems. The impact of shifted focus on COVID-19 for the past 2 years on routine health services, especially those for the epidemics of Tuberculosis, HIV/AIDS and Malaria, have been dramatic in both quantity and quality. METHODS In this article, we reflect on the COVID-19 related disruptions on the Tuberculosis, HIV/AIDS and Malaria routine health services across Africa. RESULTS The COVID-19 pandemic resulted in disruptions of routine health services and diversion of already limited available resources in sub-Saharan Africa. As a result, disease programs like TB, malaria and HIV have recorded gaps in prevention and treatment with the prospects of reversing gains made towards meeting global targets. The extent of the disruption is yet to be fully quantified at country level as most data available is from modelling estimates before and during the pandemic. CONCLUSIONS Accurate country-level data is required to convince donors and governments to invest more into revamping these health services and help prepare for managing future pandemics without disruption of routine services. Increasing government expenditure on health is a critical part of Africa's economic policy. Strengthening health systems at various levels to overcome the negative impacts of COVID-19, and preparing for future epidemics will require strong visionary political leadership. Innovations in service delivery and technological adaptations are required as countries aim to limit disruptions to routine services.
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Affiliation(s)
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale (FCRM), Brazzaville, Republic of Congo; Institute for Tropical Medicine, University of Tübingen, Germany.
| | - Nathan Kapata
- National Public Health Institute, Ministry of Health, and UNZA-UCLMS Research and Training Program, Lusaka, Zambia.
| | - Patrick Lungu
- University of Zambia, School of Medicine, Department Internal Medicine, Lusaka, Zambia.
| | - Luchenga Adam Mucheleng'anga
- Ministry of Home Affairs, Office of the State Forensic Pathologist, and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Jeremiah Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
| | - John Tembo
- HERPEZ and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Cordelia Himwaze
- University Teaching Hospital, Department of Pathology and Microbiology; and UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
| | - Rashid Ansumana
- Mercy Hospital Research Laboratory, Bo, Freetown, Sierra Leone.
| | - Danny Asogun
- Ambrose Alli University, Ekpoma and Irrua Specialist Teaching Hospital, Nigeria.
| | - Sayoki Mfinanga
- Muhimbili Medical Research Centre National Institute for Medical Research, Dar es Salaam, Tanzania.
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine; Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Peter Mwaba
- Lusaka Apex Medical University, Faculty of Medicine, and UNZA-UCLMS Research and Training Project, Lusaka, Zambia.
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana.
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom; UNZA-UCLMS Research and Training Program Program, Lusaka, Zambia.
| | - Jean B Nachega
- Department of Medicine and Division of Infectious Diseases, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa; Depts of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Depts of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
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Mlangeni N, Adetokunboh O, Lembani M, Malotle M, Nyasulu P. Access to HIV healthcare services by farm workers in sub-Saharan Africa (SSA): a systematic review protocol. BMJ Open 2022; 12:e059806. [PMID: 36307162 PMCID: PMC9621192 DOI: 10.1136/bmjopen-2021-059806] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Sub-Saharan Africa (SSA) region harbours the highest burden of HIV infections in the world. Agricultural work has been reported as one of the occupations with a high prevalence of HIV. Farm workers generally have poor access to health services, which prevents them from receiving proper HIV prevention and care. Furthermore, poor policies and policy implementation, and lack of workplace programmes increases farm workers' vulnerability to HIV infection. Thus, the aim of this study is to conduct a systematic review to assess HIV prevention and treatment services and national policies governing access to healthcare services by farm workers in SSA. METHODS AND ANALYSIS Our systematic review will include studies published from January 1990 to December 2021 within SSA countries. We will use a sensitive search strategy for electronic bibliographic databases and grey literature sources. Databases will include PubMed, CINAHL, Cochrane library, African Index Medicus and Scopus. The main outcomes to be reported will be HIV policy for farmworkers, availability of HIV prevention service(s), availability of treatment and support to farmworkers who are living with HIV, presence of referral structures for farmworkers through the health system and follow-up services for farmworkers who are on antiretroviral therapy. We will synthesise the main characteristics of included studies and use summary measures to describe study characteristics. In a situation where data are not sufficiently homogeneous to perform a quantitative synthesis, we will conduct a narrative synthesis. We will explore themes and relationships between included studies for qualitative data. ETHICS AND DISSEMINATION The study will use publicly available data and ethics exemption has been obtained from Human Research Ethics Committees, Faculty of Medicine & Health Sciences, Stellenbosch University. The results of this study will be disseminated through peer-reviewed journals, conference presentations and seminars. PROSPERO REGISTRATION NUMBER CRD42021277528.
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Affiliation(s)
- Nosimilo Mlangeni
- Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- National Institute for Occupational Health, A Division of National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Olatunji Adetokunboh
- Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- DSI-NRF Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Martina Lembani
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, Western Cape, South Africa
| | - Molebogeng Malotle
- National Institute for Occupational Health, A Division of National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Peter Nyasulu
- Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, Western Cape, South Africa
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
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Lutala P, Nyasulu P, Muula A. Salient beliefs about modifiable risk behaviours among patients living with diabetes, hypertension or both: A qualitative formative study. Afr J Prim Health Care Fam Med 2022; 14:e1-e12. [PMID: 36226929 PMCID: PMC9558168 DOI: 10.4102/phcfm.v14i1.3327] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background Although there is evidence of the key role played by focusing on local knowledge in designing appropriate interventions regarding modifiable risk behaviours among patients living with diabetes and hypertension in Mangochi (and Malawi), little is known about local salient beliefs. Aim With a focus on the theory of planned behaviour as a theoretical lens, this study aimed to identify salient beliefs about modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, south-eastern Malawi. Specifically, the objectives were to identify advantages and disadvantages (behavioural salient beliefs), people who approve or disapprove (normative salient beliefs) and enablers and barriers (control salient beliefs) for measures to change modifiable risk behaviours among patients with diabetes, hypertension or both in Mangochi, Malawi. Setting A hypertension diabetes clinic at Mangochi District Hospital, south-eastern Malawi. Methods A formative qualitative study of a quasi-experimental trial was conducted among 25 patients, purposefully sampled, who were living with diabetes, hypertension or both at Mangochi District Hospital in February 2019. Researchers conducted in-depth interviews with patients using an interview guide informed by the theory of planned behaviour’s elicitation interview guide. Thematic content analysis was used to identify emerging themes. Results A total of 25 participants were recruited, of which 12 (48%) were living with diabetes. Five thematic areas emerged from this analysis: physical and psychological fitness, social disconnection, perceived support systems, perceived enablers and perceived barriers to change. Conclusion Appropriate words for each salient belief were identified. Future researchers should use the identified salient beliefs when designing interventions based on the theory of planned behaviour in diabetes and hypertension. Contribution The paper adds to the body of knowledge informing the use of theory of planned behavior in addressing modifiable risk factors among practitioners, specialists and academics in primary care and Family Medicine in the field of noncommunicable diseases in Mangochi Malawi and beyond.
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Affiliation(s)
- Prosper Lutala
- Department of Family Medicine, Faculty of Medicine and Oral Health, Kamuzu University of Health Sciences, Blantyre; and NCD-BRITE Consortium, Faculty of Public and Global Health, Kamuzu University of Health Sciences, Blantyre.
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Sibuyi IN, de la Harpe R, Nyasulu P. A Stakeholder-Centered mHealth Implementation Inquiry Within the Digital Health Innovation Ecosystem in South Africa: MomConnect as a Demonstration Case. JMIR Mhealth Uhealth 2022; 10:e18188. [PMID: 35708756 PMCID: PMC9247812 DOI: 10.2196/18188] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/02/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background
The internet is a useful web-based multimedia platform for accessing and disseminating information unconstrained by time, distance, and place. To the health care sector’s benefit, the advent and proliferation of mobile devices have provided an opportunity for interventions that combine asynchronous technology-aided health services to improve the lives of the less privileged and marginalized people and their communities, particularly in developing societies.
Objective
This study aimed to report on the perspectives of the different stakeholders involved in the study and to review an existing government mobile health (mHealth) program. It forms part of a study to design a re-engineered strategy based on the best demonstrated practices (considerations and methods) and learned experiences from the perspectives of multiple stakeholders within the digital health innovation ecosystem in South Africa.
Methods
This study used an ethnographic approach involving document review, stakeholder mapping, semistructured individual interviews, focus group discussions, and participant observations to explore, describe, and analyze the perspectives of its heterogeneous participant categories representing purposively sampled but different constituencies.
Results
Overall, 80 participants were involved in the study, in addition to the 6 meetings the researcher attended with members of a government-appointed task team. In addition, 46 archived records and reports were consulted and reviewed as part of gathering data relating to the government’s MomConnect project. Among the consulted stakeholders, there was general consensus that the existing government-sponsored MomConnect program should be implemented beyond mere piloting, to as best as possible capacity within the available resources and time. It was further intimated that the scalability and sustainability of mHealth services as part of an innovative digital health ecosystem was hamstrung by challenges that included stakeholder mismanagement, impact assessment inadequacies, management of data, lack of effective leadership and political support, inappropriate technology choices, eHealth and mHealth funding, integration of mHealth to existing health programs in tandem with Goal 3 of the Sustainable Development Goals, integration of lessons learned from other mHealth initiatives to avoid resource wastage and duplication of efforts, proactive evaluation of both mHealth and eHealth strategies, and change management and developing human resources for eHealth.
Conclusions
This study has only laid a foundation for the re-engineering of mHealth services within the digital health innovation ecosystem. This study articulated the need for stakeholder collaboration, such as continuous engagement among academics, technologists, and mHealth fieldwork professionals. Such compelling collaboration is accentuated more by the South African realities of the best practices in the fieldwork, which may not necessarily be documented in peer-reviewed or systematic research documents from which South African professionals, research experts, and practitioners could learn. Further research is needed for the retrospective analysis of mHealth initiatives and forecasting of the sustainability of current and future mHealth initiatives in South Africa.
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Affiliation(s)
- Idon-Nkhenso Sibuyi
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Retha de la Harpe
- Faculty of Informatics and Design, Cape Peninsula University of Technology, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
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11
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Mmotsa TM, Ngandu NK, Adetokunboh OO, Nyasulu P. Male partner unknown HIV status as a risk factor for HIV incidence and clinical outcomes in prevention of mother-to-child transmission of HIV programmes in 21 WHO priority countries: a systematic review protocol. BMJ Open 2022; 12:e057190. [PMID: 35393320 PMCID: PMC8990715 DOI: 10.1136/bmjopen-2021-057190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Research has shown an association between increased disclosure of HIV status by pregnant and breastfeeding women and improved clinical health and that of their infant. Increasing awareness about their male partner's HIV status will no doubt lead to even better outcomes at the population level. Male partner involvement is important for improving outcomes of prevention of mother-to-child transmission of HIV (MTCT) as it improves social support and commitment from both parents of the baby to ensure sustained good health. Although lack of knowledge of the HIV status of a male partner is of great concern, limited research has been done to determine whether it remains one of the barriers to reaching the proposed goals of eliminating MTCT in pregnant or postpartum women. Our aim is to determine if lack of knowledge of a male partner's HIV status is a significant risk factor for HIV incidence and poor HIV clinical outcomes among pregnant women and postpartum women and their infants. METHODS AND ANALYSIS A systematic review and meta-analysis of experimental and observational studies will be conducted. The review will focus on knowledge of male partner's HIV status in the 21 priority countries most affected by HIV in Africa. We will search electronic databases such as PubMed/Medline, Scopus, Web of Science and Cochrane library, Science Direct, CINAHL, LILACS and SciELO databases from January 2011 to December 2021. We will also search the Pan African and WHO clinical trial registries and conference archives. We will conduct a quality assessment of eligible studies and evaluate the heterogeneity of the pooled studies using the I 2 statistic. The statistical analysis will be performed using STATA statistical software V.16. ETHICS AND DISSEMINATION The study will use publicly available data and ethics exemption has been obtained from Human Research Ethics Committees, Faculty of Medicine & Health Sciences, Stellenbosch University. The protocol was registered on Prospective Register of Systematic Reviews, registration number CRD42021247686, in May 2021. Findings of this systematic review will be disseminated in peer-review journals including various media platforms, that is, webinars, symposia, conferences or congresses. PROSPERO REGISTRATION NUMBER Registration number CRD42021247686.
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Affiliation(s)
| | - Nobubelo Kwanele Ngandu
- HIV Prevention Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Olatunji O Adetokunboh
- DSI-NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, Western Cape, South Africa
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
- The University of the People, Pasadena, California, USA
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nyasulu P. 1146Assessing the uncertainty around age-mixing patterns in HIV transmission inferred from phylogenetic trees. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Understand age-mixing patterns in HIV transmission is a key to design and implement HIV prevention interventions. As such, the use of phylogenetic tree seems promising since this approach is based on data from a transmission network.
Methods
Through a simulation study, we used transmission clusters computed from phylogenetic trees to investigate age-mixing patterns. From transmission clusters, we estimated a transmission network using pairings. We inferred measurements, which depict age-mixing patterns in transmission i.e. ‘proportions of men/women of a certain age-group paired with women/men of another age-group’, and mean, median, and standard deviation of average age difference between women/men with their respective pairs. We investigated the uncertainty around these measurements as a function of sampling coverage in different sequence missingness scenarios.
Results
According to the simulation set-up of age mixing in partnership, there are relationships, which are less likely and others highly likely. Explicitly, partnerships between younger men (<25 years) and older women (25 to 50 years) are less likely to happen in the sexual network, whereas partnership between younger women (<25 years) and older men (25 to 50 years) are more likely to happen as are age group relationship having intermediate magnitude in partnership.
Conclusion
Transmission clusters allow us to strive with more improved information regarding cross-generation transmission. It enables us to understand the importance of age mixing beyond describing the mean age difference, and that one needs to consider the variation of age differences between pairs of individuals as well as among the partners of a given individual.
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Nhandara R, Ayele B, Ozougwu L, Sigwadhi L, Nyasulu P. 1148Determinants of adherence to clinic appointments among Tuberculosis and HIV co-infected individuals, Johannesburg, South Africa. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Tuberculosis (TB) is one of the leading cause of morbidity and mortality among people living with HIV/AIDS. The growing burden of TB/HIV co-infection continues to strain the healthcare system due to association with long duration of treatment. This is a catalyst for poor treatment adherence, which is a major public health challenge due to its propensity to drive drug resistance. This study evaluated the effects of treatment duration on adherence to treatment among TB/HIV co-infected patients.
Method
This was a cross sectional study that involved 10427 patients’ ≥18 years of age with HIV infection and co-infected with TB. We measure adherence to clinic appointments as ’good’ if ≥ 90% and poor if < 90%. We used multivariate logistic regression to evaluate factors associated with adherence to clinic appointments.
Results
1528 patients were co-infected with TB, of these 17.4% of them attained good adherence to clinic appointments. Patients with TB/HIV co-infection who were on treatment for a longer period were less likely to adhere to clinic appointments (AOR: 0.98 95% CI: 0.97, 0.99). This confirms the notion that advanced disease has a negative impact on adherence to clinic attendance for follow up reviews.
Conclusions
Duration on treatment among TB/HIV co-infected patients is associated with treatment adherence. It is therefore vital to reinforce public health intervention that would enhance sustained treatment adherence and mitigate its impact on development of drug resistance.
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Niyukuri D, Nyasulu P, Delva W. Assessing the uncertainty around age-mixing patterns in HIV transmission inferred from phylogenetic trees. PLoS One 2021; 16:e0249013. [PMID: 33765091 PMCID: PMC7993798 DOI: 10.1371/journal.pone.0249013] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022] Open
Abstract
Understanding age-mixing patterns in Human Immunodeficiency Virus (HIV) transmission networks can enhance the design and implementation of HIV prevention strategies in sub-Saharan Africa. Due to ethical consideration, it is less likely possible to conduct a benchmark study to assess which sampling strategy, and sub-optimal sampling coverage which can yield best estimates for these patterns. We conducted a simulation study, using phylogenetic trees to infer estimates of age-mixing patterns in HIV transmission, through the computation of proportions of pairings between men and women, who were phylogenetically linked across different age groups (15-24 years, 25-39 years, and 40-49 years); and the means, and standard deviations of their age difference. We investigated also the uncertainty around these estimates as a function of the sampling coverage in four sampling strategies: when missing sequence data were missing completely at random (MCAR), and missing at random (MAR) with at most 30%-50%-70% of women in different age groups being in the sample. The results suggested that age-mixing patterns in HIV transmission can be unveiled from proportions of phylogenetic pairings between men and women across age groups; and the mean, and standard deviation of their age difference. A 55% sampling coverage was sufficient to provide the best values of estimates of age-mixing patterns in HIV transmission with MCAR scenario. But we should be cautious in interpreting proportions of men phylogenetically linked to women because they may be overestimated or underestimated, even at higher sampling coverage. The findings showed that, MCAR was the best sampling strategy. This means, it is advisable not to use sequence data collected in settings where we can find a systematic imbalance of age and gender to investigate age-mixing in HIV transmission. If not possible, ensure to take into consideration the imbalance in interpreting the results.
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Affiliation(s)
- David Niyukuri
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- The South African Department of Science and Technology–National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Wim Delva
- Division of Epidemiology & Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- The South African Department of Science and Technology–National Research Foundation (DST-NRF) Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Cape Town, South Africa
- Center for Statistics, I-BioStat, Hasselt University, Diepenbeek, Belgium
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
- Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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Musakwa NO, Bor J, Nattey C, Lönnermark E, Nyasulu P, Long L, Evans D. Perceived barriers to the uptake of health services among first-year university students in Johannesburg, South Africa. PLoS One 2021; 16:e0245427. [PMID: 33481852 PMCID: PMC7822246 DOI: 10.1371/journal.pone.0245427] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/03/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Young people face many barriers to accessing appropriate health care services including screening for HIV and tuberculosis (TB). The study aimed to identify perceived barriers to the uptake of health services among young adults entering the tertiary education system in South Africa. METHODS We conducted a cross-sectional study among first-year students aged 18-25 years, registered at one of three universities in Johannesburg, South Africa, in 2017. Participants completed a self-administered paper-based questionnaire. We describe perceived barriers to accessing health services, stratified by gender and recent engagement in TB or HIV services, together with sources of information about HIV and TB. RESULTS Seven hundred and ninety-two (792) students were included in the study of which 54.8% were female. Perceived barriers to accessing services included long waiting time (n = 342,43.2%), attitude of health workers (n = 263,33.2%), lack of sufficient information/poor health literacy (n = 148,18.7%), and inability to leave/stay away from studies (n = 137,17.3%). Among participants who tested for HIV in the past 6 months (n = 400, 50.5%), waiting time and attitude of health care workers were perceived as barriers to accessing services. Compared to males, females were more likely to view attitudes of health workers (40.3% vs. 25.0%; p = 0.001) and inability to leave/stay away from studies (20.5% vs.13.4%; p = 0.025) as potential barriers. While just over half of the students (50.5%; 400/792) in this study had accessed health services in the past 6 months, very few (15.0%) opted to use campus health services, and even less (5%) reported receiving information about HIV and TB from the university itself. CONCLUSION Despite perceived barriers to accessing HIV and TB services off campus, fewer than one in five students starting out at university opted to use campus health services. Campus health services could address many of the barriers unique to university students.
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Affiliation(s)
- Nozipho Orykah Musakwa
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacob Bor
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Cornelius Nattey
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elisabet Lönnermark
- Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, Faculty of Health Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lawrence Long
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston University, Boston, MA, United States of America
| | - Denise Evans
- Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Methazia J, Ngamasana EL, Utembe W, Ogunrombi M, Nyasulu P. An investigation of maternal anaemia among HIV infected pregnant women on antiretroviral treatment in Johannesburg, South Africa. Pan Afr Med J 2020; 37:93. [PMID: 33425126 PMCID: PMC7757230 DOI: 10.11604/pamj.2020.37.93.22244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION maternal anaemia is a major public health problem in developing countries. Data suggests that anaemia contributes to the progression of Human Immunodeficiency Virus (HIV)-infection. The aim of this study was to investigate if pregnancy was an aggravating factor for anaemia among HIV-positive women on anti-retroviral treatment (ART). METHODS we analyzed data of all HIV-positive women aged 18-49 years receiving ART at Themba Lethu Clinic, Helen Joseph Hospital, Johannesburg, South Africa, from 1st April 2004- 30t hApril 2011. HIV-positive pregnant women were matched with non-pregnant women using the year of initiation of treatment. The outcome of interest ´anaemia´ was defined as "no anaemia", "anaemia" and "moderate/severe anaemia". We fitted an ordered logistic regression model to predict the likelihood of having severe/moderate anaemia versus no anaemia. We included pregnancy status as a predictor of the outcome and controlled the effect of other covariates in the analysis. RESULTS the study included 236 HIV positive patients, of which half (n=118, 50%) were pregnant. At baseline, about (n=143, 60%) of patients were anaemic. The proportion of pregnant women classified as anaemic (anaemia, moderate/severe) differed significantly (p=0.02) from that of non-pregnant women. The following characteristics were significantly associated with anaemia at baseline: Body mass index (BMI) category (p=0.01); World Health Organization (WHO) stage (p=0.001) and CD4 count (p=0.001). Seven months after initiation of treatment, the proportion of HIV positive women with anaemia decreased significantly. CONCLUSION anaemia is a significant risk factor for untoward health outcomes, especially among HIV-positive pregnant women. Early ART access might result in a significant decrease in anaemia in pregnancy.
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Affiliation(s)
- Jewelle Methazia
- Ibis Reproductive Health, Parktown, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emery Ladi Ngamasana
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Wells Utembe
- National Institute for Occupational Health, National Health Laboratory Services, Johannesburg, South Africa
| | - Modupe Ogunrombi
- Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Allwood BW, Koegelenberg CF, Irusen E, Lalla U, Davids R, Chothia Y, Davids R, Prozesky H, Taljaard J, Parker A, Decloedt E, Jordan P, Lahri S, Moosa R, Schrueder N, Du Toit R, Viljoen A, English R, Ayele B, Nyasulu P. Clinical evolution, management and outcomes of patients with COVID-19 admitted at Tygerberg Hospital, Cape Town, South Africa: a research protocol. BMJ Open 2020; 10:e039455. [PMID: 32868368 PMCID: PMC7462165 DOI: 10.1136/bmjopen-2020-039455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/11/2020] [Accepted: 08/06/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The outbreak of the SARS-CoV-2 virus causing COVID-19, declared a global pandemic by the WHO, is a novel infection with a high rate of morbidity and mortality. In South Africa, 55 421 cases have been confirmed as of 10 June 2020, with most cases in the Western Cape Province. Coronavirus leaves us in a position of uncertainty regarding the best clinical approach to successfully manage the expected high number of severely ill patients with COVID-19. This presents a unique opportunity to gather data to inform best practices in clinical approach and public health interventions to control COVID-19 locally. Furthermore, this pandemic challenges our resolve due to the high burden of HIV and tuberculosis (TB) in our country as data are scarce. This study endeavours to determine the clinical presentation, severity and prognosis of patients with COVID-19 admitted to our hospital. METHODS AND ANALYSIS The study will use multiple approaches taking into account the evolving nature of the COVID-19 pandemic. Prospective observational design to describe specific patterns of risk predictors of poor outcomes among patients with severe COVID-19 admitted to Tygerberg Hospital. Data will be collected from medical records of patients with severe COVID-19 admitted at Tygerberg Hospital. Using the Cox proportional hazards model, we will investigate the association between the survival time of patients with COVID-19 in relation to one or more of the predictor variables including HIV and TB. ETHICS AND DISSEMINATION The research team obtained ethical approval from the Health Research Ethics Committee of the Faculty of Medicine and Health Sciences, Stellenbosch University and Research Committee of the Tygerberg Hospital. All procedures for the ethical conduct of scientific investigation will be adhered to by the research team. The findings will be disseminated in clinical seminars, scientific forums and conferences targeting clinical care providers and policy-makers.
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Affiliation(s)
- Brian W Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Coenraad Fn Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Elvis Irusen
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Usha Lalla
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Razeen Davids
- Division of Nephrology, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yazied Chothia
- Division of Nephrology, Department of Medicine, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ryan Davids
- Department of Anesthesia and Critical Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Hans Prozesky
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jantjie Taljaard
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Arifa Parker
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Portia Jordan
- Department of Nursing, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Sa'ad Lahri
- Department of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rafique Moosa
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Neshaad Schrueder
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Riette Du Toit
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Abraham Viljoen
- Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Birhanu Ayele
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Chibawara T, Mbuagbaw L, Kitenge M, Nyasulu P. Effects of antiretroviral therapy in HIV-positive adults on new HIV infections among young women: a systematic review protocol. Syst Rev 2019; 8:68. [PMID: 30837002 PMCID: PMC6402083 DOI: 10.1186/s13643-019-0982-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/25/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The HIV/AIDS pandemic has struck regions, countries, and populations in different ways. With the introduction of antiretroviral drugs, people living with HIV (PLHIV) have a much better prognosis, even though there are still many new infections in young women. The role of widespread antiretroviral therapy (ART) on the incidence of HIV in young women is unknown. METHODS We will conduct a comprehensive search of MEDLINE (PubMed), Excerpta Medica database (EMBASE), Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization's (WHO's) library database, Latin American and Caribbean Health Sciences Literature (LILACS), conference abstracts, and gray literature sources to identify any relevant literature. We will include randomized and non-randomized clinical trials and cohort studies in which ART was offered to adults aged 18 and above reporting outcomes in females aged 15 to 24 years. The outcomes of interest are HIV incidence, ART initiation, adherence, retention, and viral load suppression. We will screen titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements will be resolved by consensus. We will extract data on the risk of HIV infection in younger females after the use of ART in the adult population. DISCUSSION To our knowledge, this is the first systematic review to look at the impact of ART use among adults on HIV incidence in young women. The results of this review will be used in a modeling study to simulate the effects of using ART as an effective tool to prevent sexual transmission of HIV to young women. Our findings will inform the treatment-as-prevention (TasP) strategy to reduce new HIV infections among young women. SYSTEMATIC REVIEW REGISTRATION The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42018099174 .
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Affiliation(s)
- Trust Chibawara
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare, Hamilton, ON, Canada.,Centre for Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Marcel Kitenge
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Médecins Sans Frontières, Doctors Without Borders-Rustenburg, Rustenburg, North West, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. .,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Mabunda K, Ngamasana EL, Babalola JO, Zunza M, Nyasulu P. Determinants of poor adherence to antiretroviral treatment using a combined effect of age and education among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa. Pan Afr Med J 2019; 32:37. [PMID: 31143342 PMCID: PMC6522179 DOI: 10.11604/pamj.2019.32.37.17722] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 01/01/2023] Open
Abstract
Introduction sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic. Methods a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value < 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire. Results a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence. Conclusion the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.
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Affiliation(s)
- Kuhlula Mabunda
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | | | - Joseph Omoniyi Babalola
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moleen Zunza
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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20
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Nyasulu P, Fredericks M, Basera TJ, Broomhead S. Knowledge and risk perception of sexually transmitted infections and relevant health care services among high school students in the Platfontein San community, Northern Cape Province, South Africa. Adolesc Health Med Ther 2018; 9:189-197. [PMID: 30532607 PMCID: PMC6247973 DOI: 10.2147/ahmt.s154401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The historically marginalized Platfontein San youths have a high rate of teenage pregnancies and sexually transmitted infections (STIs). The aim of the study was to assess the knowledge and perception of male and female school-going youths in Platfontein of STIs and HIV/AIDS, and the health care services that are available to them. Participants and methods A descriptive cross-sectional survey with a sample of 201 learners in grades 6–12 at the !Xunkwesa Combined School in Platfontein was conducted in July 2007. A pretested self-administered questionnaire was used for data collection. Results The study found that STI knowledge was 70.1% and HIV and AIDS was 11.9%. Perceptions of risk among the learners were uniformly low; 24% for contracting a STI and 26% for HIV. About 59% (n=119) of the respondents were either unaware or not sure of the primary health care (PHC) services within the community. Overall, 65% of the students reported using PHC services while 35% exclusively used traditional healers. Slightly less than half (43%) of the learners acquired information about sexual and reproductive health through the Life Skills curriculum at school. Conclusion The study highlights the importance of increasing HIV awareness and inculcating sexual and reproductive health into the school curriculum. The study further shows the imperative need to recognize the role of traditional medicine in the health care choices of this community. Traditional value systems need to be incorporated into the way that education and health care is proposed to the community leaders, to increase acceptance and utilization of health services.
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Affiliation(s)
- Peter Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, .,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
| | - Mercedes Fredericks
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
| | - Tariro J Basera
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
| | - Sean Broomhead
- Health Information Systems Program, Waterkloof Ridge, Pretoria, South Africa
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21
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Nyasulu P, Sikwese S, Chirwa T, Makanjee C, Mmanga M, Babalola JO, Mpunga J, Banda HT, Muula AS, Munthali AC. Knowledge, beliefs, and perceptions of tuberculosis among community members in Ntcheu district, Malawi. J Multidiscip Healthc 2018; 11:375-389. [PMID: 30147328 PMCID: PMC6101012 DOI: 10.2147/jmdh.s156949] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Introduction The global burden of tuberculosis (TB) remains significantly high, with overreliance on biomedical interventions and inadequate exploration of the socioeconomic and cultural context of the infected population. A desired reduction in disease burden can be enhanced through a broader theoretical understanding of people’s health beliefs and concerns about TB. In this qualitative study, we explore the knowledge, beliefs, and perceptions of community members and people diagnosed with TB toward TB in Ntcheu district, Malawi. Methods Using a qualitative phenomenological study design, data were obtained from eight focus-group discussions and 16 individual in-depth interviews. The community’s experiences and perceptions of TB were captured without using any preconceived framework. Adult participants who had had or never had a diagnosis of TB were purposively selected by sex and age and enrolled for the study. Discussions and individual interviews lasting about 60 minutes each were audiotaped, transcribed, and translated into English and analyzed using MaxQDA 10 software for qualitative analysis. Results Most participants believed that TB was curable and would go for diagnosis if they had symptoms suggestive of the disease. However, based on their beliefs, individuals expressed some apprehension about the spread of TB and the social implications of being diagnosed with the disease. This perception affected participants’ responses about seeking diagnosis and treatment. Conclusion A supportive and collective approach consisting of a combination of mass media, interactive communication campaigns, emphasizing TB symptoms, transmission, and stigma could be useful in addressing barriers to early diagnosis and care-seeking behavior.
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Affiliation(s)
- Peter Nyasulu
- Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, .,School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
| | - Simon Sikwese
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, .,Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
| | - Chandra Makanjee
- Department of Medical Radiation Sciences, University of Canberra, Canberra, WA, Australia
| | - Madalitso Mmanga
- District TB Office, Department of Environmental Health, District Health Office, Ntcheu, Malawi
| | - Joseph Omoniyi Babalola
- Division of Community Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - James Mpunga
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe
| | - Hastings T Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe
| | - Adamson S Muula
- Department of Community Health, College of Medicine, University of Malawi, Blantyre.,African Centre of Excellence in Public Health and Herbal Medicine, College of Medicine, University of Malawi, Blantyre
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Nnambalirwa M, Govathson C, Evans D, McNamara L, Maskew M, Nyasulu P. Markers of poor adherence among adults with HIV attending Themba Lethu HIV Clinic, Helen Joseph Hospital, Johannesburg, South Africa. Trans R Soc Trop Med Hyg 2018; 110:696-704. [PMID: 28938050 PMCID: PMC5914359 DOI: 10.1093/trstmh/trx003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/05/2017] [Indexed: 11/15/2022] Open
Abstract
Background To date, there is no consensus on ideal ways to measure antiretroviral treatment (ART) adherence in resource limited settings. This study aimed to identify markers of poor adherence to ART. Methods Retrospective data of HIV-positive ART-naïve adults initiating standard first-line ART at Themba Lethu Clinic, Helen Joseph Hospital, Johannesburg, South Africa from April 2004 to December 2011 were analysed. Poisson regression models with robust error variance were used to assessed the following potential markers of poor adherence ‘last self-reported adherence, missed clinic visits, mean corpuscular volume (MCV), CD4 count against definition of adherence, suppressed HIV viral load using traditional test metrics’. Results A total of 11 724 patients were eligible; 1712 (14.6%) had unsuppressed viral load within 6 months after initiating ART. The main marker of poor adherence was a combination of change in CD4 count and MCV; change in CD4 ≥expected and change in MCV <14.5 fL (RR 2.82, 95% CI 2.16–3.67), change in CD4 <expected and change in MCV <14.5 fL (RR 5.49, 95% CI 4.13–7.30) compared to change in CD4 ≥expected and change in MCV ≥14.5 fL. Conclusions A combination of less than expected increase in CD4 and MCV at 6 months after treatment initation was found to be a marker of poor adherence. This could help identify and monitor poor treatment adherence in the absence of viral load testing.
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Affiliation(s)
- Maria Nnambalirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Caroline Govathson
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lynne McNamara
- Clinical HIV Research Unit, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mhairi Maskew
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Nyasulu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa
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Sarfo B, Vanderpuye NA, Addison A, Nyasulu P. HIV Case Management Support Service Is Associated with Improved CD4 Counts of Patients Receiving Care at the Antiretroviral Clinic of Pantang Hospital, Ghana. AIDS Res Treat 2017; 2017:4697473. [PMID: 29085677 PMCID: PMC5632479 DOI: 10.1155/2017/4697473] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 08/17/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Factors associated with individual patient-level management of HIV have received minimal attention in sub-Saharan Africa. This study determined the association between support services and cluster of differentiation 4 (CD4) counts among HIV patients attending ART clinic in Ghana. METHODOLOGY This was a cross-sectional study involving adults with HIV recruited between 1 August 2014 and 31 January 2015. Data on support services were obtained through a closed-ended personal interview while the CD4 counts data were collected from their medical records. Data were entered into EpiData and analyzed using Stata software. RESULTS Of the 201 patients who participated in the study, 67% (129/191) received case management support service. Counseling about how to prevent the spread of HIV (crude odds ratio (cOR) (95% confidence interval (CI)) (2.79 (1.17-6.68)), mental health services (0.2 (0.04-1.00)), and case management support service (2.80 (1.34-5.82))) was associated with improved CD4 counts of 350 cells/mm3 or more. After adjusting for counseling about how to prevent the spread of HIV and mental health services, case management support service was significantly associated with CD4 counts of 350 cells/mm3 or more (aOR = 2.36 (CI = 1.01-5.49)). CONCLUSION Case management support service for HIV patients receiving ART improves their CD4 counts above 350 cells/mm3. Incorporating HIV case management services in ART regimen should be a priority in sub-Saharan Africa.
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Affiliation(s)
- Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | - Abigail Addison
- Department of Epidemiology and Disease Control, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana
| | - Peter Nyasulu
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wallis L, Hasselberg M, Barkman C, Bogoch I, Broomhead S, Dumont G, Groenewald J, Lundin J, Norell Bergendahl J, Nyasulu P, Olofsson M, Weinehall L, Laflamme L. A roadmap for the implementation of mHealth innovations for image-based diagnostic support in clinical and public-health settings: a focus on front-line health workers and health-system organizations. Glob Health Action 2017; 10:1340254. [PMID: 28838310 PMCID: PMC5645694 DOI: 10.1080/16549716.2017.1340254] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/06/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Diagnostic support for clinicians is a domain of application of mHealth technologies with a slow uptake despite promising opportunities, such as image-based clinical support. The absence of a roadmap for the adoption and implementation of these types of applications is a further obstacle. OBJECTIVES This article provides the groundwork for a roadmap to implement image-based support for clinicians, focusing on how to overcome potential barriers affecting front-line users, the health-care organization and the technical system. METHODS A consensual approach was used during a two-day roundtable meeting gathering a convenience sample of stakeholders (n = 50) from clinical, research, policymaking and business fields and from different countries. A series of sessions was held including small group discussions followed by reports to the plenary. Session moderators synthesized the reports in a number of theme-specific strategies that were presented to the participants again at the end of the meeting for them to determine their individual priority. RESULTS There were four to seven strategies derived from the thematic sessions. Once reviewed and prioritized by the participants some received greater priorities than others. As an example, of the seven strategies related to the front-line users, three received greater priority: the need for any system to significantly add value to the users; the usability of mHealth apps; and the goodness-of-fit into the work flow. Further, three aspects cut across the themes: ease of integration of the mHealth applications; solid ICT infrastructure and support network; and interoperability. CONCLUSIONS Research and development in image-based diagnostic pave the way to making health care more accessible and more equitable. The successful implementation of those solutions will necessitate a seamless introduction into routines, adequate technical support and significant added value.
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Affiliation(s)
- Lee Wallis
- Division of Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Bellville, South Africa
| | - Marie Hasselberg
- Department of Public Health Sciences, Global Health, Karolinska Institutet, Stockholm, Sweden
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Catharina Barkman
- Stockholm County Council, Forum for Health Policy, Stockholm, Sweden
| | - Isaac Bogoch
- Divisions of General Internal Medicine and Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sean Broomhead
- African Centre for eHealth Excellence, Cape Town, South Africa
- Health information Systems Programme, Pretoria, South Africa
| | - Guy Dumont
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, Canada
| | - Johann Groenewald
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Johan Lundin
- Department of Public Health Sciences, Global Health, Karolinska Institutet, Stockholm, Sweden
- Institute for Molecular Medicine Finland – FIMM, University of Helsinki, Helsinki, Finland
| | | | - Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maud Olofsson
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
| | - Lars Weinehall
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lucie Laflamme
- Department of Public Health Sciences, Global Health, Karolinska Institutet, Stockholm, Sweden
- Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, South Africa
- Institute for Social and Health Sciences, University of South Africa, Johannesburg, South Africa
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Batbold U, Butov DO, Kutsyna GA, Damdinpurev N, Grinishina EA, Mijiddorj O, Kovolev ME, Baasanjav K, Butova TS, Sandagdorj M, Batbold O, Tseveendorj A, Chunt E, Zaitzeva SI, Stepanenko HL, Makeeva NI, Mospan IV, Pylypchuk VS, Rowe JL, Nyasulu P, Jirathitikal V, Bain AI, Tarakanovskaya MG, Bourinbaiar AS. Double-blind, placebo-controlled, 1:1 randomized Phase III clinical trial of Immunoxel honey lozenges as an adjunct immunotherapy in 269 patients with pulmonary tuberculosis. Immunotherapy 2016; 9:13-24. [PMID: 27868466 DOI: 10.2217/imt-2016-0079] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 11/21/2022] Open
Abstract
AIM Safer and shorter antituberculosis treatment (ATT) regimens represent the unmet medical need. PATIENTS & METHODS The patients were randomly assigned into two arms: the first (n = 137) received once-daily sublingual honey lozenge formulated with botanical immunomodulator Immunoxel and the second (n = 132) received placebo lozenges along with conventional ATT. Immunoxel and placebo arms were demographically similar: 102 versus 106 had drug-susceptible TB; 28 versus 20 multidrug-resistant TB (MDR-TB); 7 versus 7 extensively drug-resistant TB (XDR-TB); and 22 versus 20 TB-HIV. The primary end point was sputum smear conversion. RESULTS After 1 month 87 out 132 (65.9%) of Immunoxel recipients became sputum smear negative, whereas 32 out of 127 (25.2%) in placebo group had converted (p < 0.0001). Sputum clearance produced by Immunoxel was equally effective across all forms of TB. In the immunotherapy arm the average weight gain was 2 kg, but placebo recipients gained only 0.6 kg. Immunoxel reduced TB-associated inflammation as evidenced by defervescence and normalization of elevated leukocyte counts and erythrocyte sedimentation rate. No adverse effects were seen at any time. The liver function tests indicate that ATT-caused hepatotoxicity was counteracted by Immunoxel. These results are in agreement with prior 20 trials of Immunoxel conducted over the past 17 years. CONCLUSION Immunoxel is affordable, safe, effective, fast-acting, commercially available immunotherapeutic intervention to supplement conventional TB chemotherapy. Clinicaltrials.gov ID: NCT01061593.
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Affiliation(s)
- Uyanga Batbold
- Misheel Clinic of Lung Surgery, Sonsgolyn Street, Ulaanbaatar, Mongolia
| | - Dmytro O Butov
- Regional TB Hospital No 1, Il'yicha Avenue 2, Kharkiv, Ukraine.,Kharkiv National Medical University, Lenin Avenue 4, Kharkiv, Ukraine
| | | | | | | | - Otgonbayar Mijiddorj
- Bayanzurkh District TB Dispensary, Dzhalkhanz Khutagtu Damdinbazaryn Street, Ulaanbaatar, Mongolia
| | - Mikola E Kovolev
- Regional TB Dispensary No 7, Moskovskyi Avenue 197, Kharkiv, Ukraine
| | | | - Tatyana S Butova
- Regional TB Dispensary No 1, Newton Street 145, Kharkiv, Ukraine
| | | | | | | | | | | | | | - Natalia I Makeeva
- Kharkiv National Medical University, Lenin Avenue 4, Kharkiv, Ukraine
| | | | | | - John L Rowe
- Island Abbey Food Science Ltd, Innovation Way, Charlottetown, PE C1E 2X3, Canada
| | - Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash University, Roodepoort, South Africa
| | | | - Allen I Bain
- Immunitor Inc., 365-2906 West Broadway, Vancouver, BC V6K 2G8, Canada
| | | | - Aldar S Bourinbaiar
- Sukhbaatar District TB Dispensary, Zaluuchuudin Street, Ulaanbaatar, Mongolia.,Immunitor LLC., Peace Avenue 25, Ulaanbaatar, Mongolia
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Motsomi K, Makanjee C, Basera T, Nyasulu P. Factors affecting effective communication about sexual and reproductive health issues between parents and adolescents in zandspruit informal settlement, Johannesburg, South Africa. Pan Afr Med J 2016; 25:120. [PMID: 28292083 PMCID: PMC5325495 DOI: 10.11604/pamj.2016.25.120.9208] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [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: 02/26/2016] [Accepted: 07/11/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Communication between parents and adolescents regarding sexuality is an important reproductive health topic. Due to complexities associated with adolescent's physiological development, sexuality should be dealt with holistically. This study aimed to investigate factors affecting effective communication between parents and adolescents concerning sexual and reproductive health issues. METHODS An exploratory qualitative study using the focus group discussions method was done to explore amongst other things; social, cultural and religious barriers to communication. Thematic content analysis was done. RESULTS Factors identified included: embarrassment when discussing sexual topics; adolescent misperceptions that guardians want to engage in sexual activities with them; strong belief amongst guardians that reproductive health discussions with adolescents encourages sexual experimentation; belief that adolescents were too young to understand; non-conducive environment for open discussions of sexual and reproductive health matters; cultural and religious beliefs. CONCLUSION In view of these findings, there are still barriers in terms of parent-adolescent engagement on issues related to risks associated with sexual behaviours and erroneous reproductive health choices among adolescents. Therefore, there is a need to encourage engagement by creating neutral platforms facilitated by community healthcare providers and/ or social workers. This will help create awareness and bridge the communication and interaction gap by emphasising the importance of effective engagement among adolescents and their parents on matters related to risks associated with sexual behaviours and erroneous reproductive health choices. Post implantation intervention studies are needed to inform on the outcomes of the intervention.
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Affiliation(s)
- Kegaugetswe Motsomi
- School of Health Sciences, Monash South Africa, Ruimsig, Johannesburg, South Africa; Right to Care, Perth Road, Helen Joseph Hospital, Themba Lethu Wing, Westdene
| | - Chandra Makanjee
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, South Africa
| | - Tariro Basera
- School of Health Sciences, Monash South Africa, Ruimsig, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Nyasulu
- School of Health Sciences, Monash South Africa, Ruimsig, Johannesburg, South Africa; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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27
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Nyasulu P, Phiri F, Sikwese S, Chirwa T, Singini I, Banda HT, Banda R, Mhembere T, Chimbali H, Ngwira B, Munthali AC. Factors Influencing Delayed Health Care Seeking Among Pulmonary Tuberculosis Suspects in Rural Communities in Ntcheu District, Malawi. Qual Health Res 2016; 26:1275-1288. [PMID: 26015428 DOI: 10.1177/1049732315588083] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Delayed diagnosis and treatment of tuberculosis (TB) among individuals suspected of having TB may lead to continued transmission of Mycobacterium tuberculosis in communities, higher mortality rates, and increase in government health expenditure because of prolonged illness due to late diagnosis and treatment initiation. The study explored factors leading to delayed health care seeking among individuals living in Ntcheu District, Malawi. Two key informant interviews, 16 in-depth interviews, and three focus group discussions were conducted. Participants were aged 18 years and older and never had TB. Data were analyzed using content analysis and factors were identified: inadequate knowledge about cause and transmission of TB, low self-awareness of personal risk to TB, cultural and traditional beliefs about sources of TB, stigma, and strong belief in witchcraft as a cause of illness. The TB Control Program needs to invest in social mobilization and education of communities to mitigate early health care seeking.
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Affiliation(s)
- Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash, South Africa School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Simon Sikwese
- Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Singini
- Johns Hopkins Research Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Hastings T Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Rhoda Banda
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - Tichaona Mhembere
- Department of Public Health, School of Health Sciences, Monash, South Africa
| | - Henry Chimbali
- Health Promotion Services Department, Ministry of Health, Lilongwe, Malawi
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
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Sibanda Q, Musenge E, Nyasulu P, Muzah B. Factors associated with Ano-genital warts occurrence among Human Immunodeficiency Virus (HIV) infected patients in Gauteng, South Africa. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Setswe G, Witthuhn J, Muyanga S, Nyasulu P. The new National Health Insurance policy in South Africa: Public perceptions and expectations. International Journal of Healthcare Management 2016. [DOI: 10.1080/20479700.2016.1142695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nyasulu P, Kambale S, Chirwa T, Umanah T, Singini I, Sikwese S, Banda HT, Banda RP, Chimbali H, Ngwira B, Munthali A. Knowledge and perception about tuberculosis among children attending primary school in Ntcheu District, Malawi. J Multidiscip Healthc 2016; 9:121-31. [PMID: 27069367 PMCID: PMC4818047 DOI: 10.2147/jmdh.s97409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Knowledge and perceptions about tuberculosis (TB) can influence care-seeking behavior and adherence to treatment. Previous studies in Malawi were conducted to assess knowledge and attitudes regarding TB in adults, with limited data on knowledge in children. OBJECTIVES This study assessed knowledge and perceptions about TB in children aged 10-14 years attending primary school in Ntcheu District, Malawi. DESIGN A cross-sectional study was conducted in four primary schools in Ntcheu District. Data on knowledge and perception of TB were collected using a structured questionnaire. Pearson chi-square test was used to determine the association between socioeconomic factors and TB knowledge and perception. A P<0.05 was considered significant. RESULTS The study found that the learners had high knowledge regarding the cause, spread, and TB preventive measures. Almost 90% of learners knew that TB is caused by a germ, however, a lower proportion knew about TB symptoms ie, night sweats (49%) and enlarged cervical lymph nodes (40%). We found that 68% of learners did not know the duration of anti-TB treatment. No association was found between age, learners' grade, and knowledge (P>0.05). CONCLUSION Lack of knowledge regarding TB and gaps identified, may be due to a deficiency in the content of the school curriculum or the availability of information, education, and communication materials. This is the first study to report on knowledge and perceptions of TB among primary school learners in Malawi. These results will inform the development of relevant information, education, and communication materials to enhance awareness about TB among school going children.
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Affiliation(s)
- Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Susan Kambale
- World Health Organization, Country Office, Lilongwe, Malawi
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Teye Umanah
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa, University of Malawi, Malawi
| | - Isaac Singini
- Johns Hopkins Research Project, College of Medicine, University of Malawi, Malawi
| | - Simon Sikwese
- Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Hastings T Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Rhoda P Banda
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - Henry Chimbali
- Health Promotion Section, Ministry of Health, Lilongwe, Malawi
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
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Chipolombwe J, Török ME, Mbelle N, Nyasulu P. Methicillin-resistant Staphylococcus aureus multiple sites surveillance: a systemic review of the literature. Infect Drug Resist 2016; 9:35-42. [PMID: 26929653 PMCID: PMC4758793 DOI: 10.2147/idr.s95372] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 11/23/2022] Open
Abstract
Purpose The objective of this study was to evaluate the optimal number of sampling sites for detection of methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods We performed a Medline search from January 1966 to February 2014 for articles that reported the prevalence of MRSA at different body sites. Studies were characterized by study design, country and period of the study, number of patients and/or isolates of MRSA, specimen type, sites of MRSA isolation, study population sampled, diagnostic testing method, and percentage of the MRSA isolates at each site in relation to the total number of sites. Results We reviewed 3,211 abstracts and 177 manuscripts, of which 17 met the criteria for analysis (n=52,642 patients). MRSA colonization prevalence varied from 8% to 99% at different body sites. The nasal cavity as a single site had MRSA detection sensitivity of 68% (34%–91%). The throat and nares gave the highest detection rates as single sites. A combination of two swabs improved MRSA detection rates with the best combination being groin/throat (89.6%; 62.5%–100%). A combination of three swab sites improved MRSA detection rate to 94.2% (81%–100%) with the best combination being groin/nose/throat. Certain combinations were associated with low detection rates. MRSA detection rates also varied with different culture methods. Conclusion A combination of three swabs from different body sites resulted in the highest detection rate for MRSA colonization. The use of three swab sites would likely improve the recognition and treatment of MRSA colonization, which may in turn reduce infection and transmission of MRSA to other patients.
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Affiliation(s)
- John Chipolombwe
- Department of Internal Medicine, Mzuzu Central Hospital, Ministry of Health, Mzuzu, Malawi
| | | | - Nontombi Mbelle
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Peter Nyasulu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa
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Atilola GO, Nyasulu P. Evaluation of the Modified HIV Proximate Determinant Framework in Zimbabwe using Statistical and Geo-Statistical Methods. Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Setswe G, Muyanga S, Witthuhn J, Nyasulu P. Public awareness and knowledge of the National Health Insurance in South Africa. Pan Afr Med J 2015; 22:19. [PMID: 26600918 PMCID: PMC4646437 DOI: 10.11604/pamj.2015.22.19.6131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/19/2015] [Indexed: 11/26/2022] Open
Abstract
Introduction Individuals residing in Limpopo, KwaZulu-Natal and the Eastern Cape provinces who had access to public health services were surveyed to determine public knowledge and awareness of the new National Health Insurance (NHI). Methods A descriptive cross-sectional study was conducted and a total of 748 adult respondents were sampled using a two-stage systematic sampling design. Data were collected using mobile phone assisted personal interviews. Results The study found that 80.3% of the respondents were aware of the NHI and slightly less than half (49.8%) of the respondents did not have knowledge of how the NHI works and 71.8% lacked awareness about the origin of the development of the NHI concept in South Africa. The knowledge of what the NHI would pay for was poor and 48.1% knew that the NHI Fund would pay for medical expenses if a person got sick and 45.7% knew that with health insurance, basic health requirement is ensured and that if one becomes ill, medical treatment would be paid for by the NHI Fund, 50.9% of respondents did not understand how the NHI Fund will pay for health care received, only 44.8% understood how the NHI will pay for health care services received. Conclusion The public education campaigns to increase knowledge and understanding of the NHI scheme might have been inadequate hence might not have penetrated many communities. It is recommended that a comprehensive community consultation plan be established to increase awareness and knowledge of the NHI among community members targeting clinics, schools, pension pay points and other community sites.
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Affiliation(s)
- Geoffrey Setswe
- Human Sciences Research Council, 134 Pretorius Street, Pretoria, South Africa ; Department of Health Studies, University of South Africa, P.O. 392, UNISA, 0003, Republic of South Africa
| | - Samson Muyanga
- Department of Public Health, School of Health Sciences, Monash, South Africa
| | - Jacqueline Witthuhn
- Department of Public Health, School of Health Sciences, Monash, South Africa
| | - Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash, South Africa ; School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Setswe G, Nyasulu P. Are sexually transmitted infections the neglected orphan in our response to HIV/AIDS, STI, and TB (HAST) in South Africa? International Journal of Healthcare Management 2015. [DOI: 10.1179/2047970015z.000000000148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Setswe G, Nyasulu P. West Africa health workers tackling Ebola: living up to their Oath. International Journal of Healthcare Management 2015. [DOI: 10.1179/2047970015z.000000000131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Chizimba R, Christofides N, Chirwa T, Singini I, Ozumba C, Sikwese S, Banda HT, Banda R, Chimbali H, Ngwira B, Munthali A, Nyasulu P. The association between multiple sources of information and risk perceptions of tuberculosis, Ntcheu district, Malawi. PLoS One 2015; 10:e0122998. [PMID: 25885532 PMCID: PMC4401750 DOI: 10.1371/journal.pone.0122998] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/26/2015] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculosis (TB) is one of the main causes of death in developing countries. Awareness and perception of risk of TB could influence early detection, diagnosis and care seeking at treatment centers. However, perceptions about TB are influenced by sources of information. Aim This study aimed to determine the association between multiple sources of information, and perceptions of risk of TB among adults aged 18–49 years. Methods A cross-sectional study was conducted in Ntcheu district in Malawi. A total of 121 adults were sampled in a three-stage simple random sampling technique. Data were collected using a structured questionnaire. Perceptions of risk were measured using specific statements that reflected common myths and misconceptions. Low risk perception implied a person having strong belief in myths and misconceptions about TB and high risk perception meant a person having no belief in myths or misconceptions and demonstrated understanding of the disease. Results Females were more likely to have low risk perceptions about TB compared to males (67.7% vs. 32.5%, p = 0.01). The higher the household asset index the more likely an individual had higher risk perceptions about TB (p = 0.006). The perception of risk of TB was associated with sources of information (p = 0.03). Use of both interpersonal communication and mass media was 2.8 times more likely to be associated with increased perception of risk of TB (Odds Ratio [OR] = 2.8; 95% Confidence interva1[CI]: 3.1–15. 6; p = 0.01). After adjusting for sex and asset ownership, use of interpersonal communication and mass media were more likely to be associated with higher perception of risk of TB (OR, 2.0; 95% CI: 1.65–10.72; p = 0.003) compared with interpersonal communication only (OR 1.6, 95%; CI: 1.13–8.98, p = 0.027). Conclusion The study found that there was association between multiple sources of information, and higher perceptions of risk of TB among adults aged 18–49 years.
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Affiliation(s)
- Robert Chizimba
- Health Department, Save the Children International, Lilongwe, Malawi
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicola Christofides
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Tobias Chirwa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Isaac Singini
- Johns Hopkins Research Project, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Chineme Ozumba
- Department of Public Health, School of Health Sciences, Monash, South Africa
| | - Simon Sikwese
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Pakachere Institute of Health and Development Communication, Blantyre, Malawi
| | - Hastings T. Banda
- Research for Equity and Community Health (REACH) Trust, Lilongwe, Malawi
| | - Rhoda Banda
- National Tuberculosis Control Program, Community Health Sciences Unit, Ministry of Health, Lilongwe, Malawi
| | - Henry Chimbali
- Health Promotion Services, Ministry of Health, Lilongwe, Malawi
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Peter Nyasulu
- Department of Public Health, School of Health Sciences, Monash, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Adedokun B, Nyasulu P, Maseko F, Adedini S, Akinyemi J, Afolabi S, de Wet N, Sulaimon A, Sambai C, Utembe W, Opiyo R, Awotidebe T, Chirwa E, Nabakwe E, Niragire F, Uwizeye D, Niwemahoro C, Kamndaya M, Mwakalinga V, Otwombe K. Sharing perspectives and experiences of doctoral fellows in the first cohort of Consortium for Advanced Research Training in Africa: 2011-2014. Glob Health Action 2014; 7:25127. [PMID: 25280739 PMCID: PMC4185087 DOI: 10.3402/gha.v7.25127] [Citation(s) in RCA: 13] [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: 06/06/2014] [Revised: 07/31/2014] [Accepted: 07/31/2014] [Indexed: 12/02/2022] Open
Abstract
Background Resolution of public health problems in Africa remains a challenge because of insufficient skilled human resource capacity. The Consortium for Advanced Research Training in Africa (CARTA) was established to enhance capacity in multi-disciplinary health research that will make a positive impact on population health in Africa. Objective The first cohort of the CARTA program describes their perspectives and experiences during the 4 years of fellowship and puts forward suggestions for future progress and direction of research in Africa. Conclusions The model of training as shown by the CARTA program is an effective model of research capacity building in African academic institutions. An expansion of the program is therefore warranted to reach out to more African academics in search of advanced research training.
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Affiliation(s)
- Babatunde Adedokun
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria;
| | - Peter Nyasulu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health Sciences, Monash University, Johannesburg, South Africa
| | - Fresier Maseko
- College of Medicine, Faculty of Community Health, University of Malawi, Lilongwe, Malawi
| | - Sunday Adedini
- Demography and Social Statistics, Obafemi Awolowo University Ile-Ife, Nigeria; Demography and Population Studies, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Sulaimon Afolabi
- Demography and Population Studies, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole de Wet
- Demography and Population Studies, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa
| | - Adedokun Sulaimon
- Demography and Social Statistics, Obafemi Awolowo University Ile-Ife, Nigeria
| | - Caroline Sambai
- Department of Literature, Theatre and Film Studies, Moi University, Eldoret, Kenya
| | - Wells Utembe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Physics and Biochemical Sciences, Malawi Polytechnic, University of Malawi, Blantyre, Malawi
| | - Rose Opiyo
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Taofeek Awotidebe
- Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria; Department of Human Kinetics and Health Education, Faculty of Education, University of Ibadan, Ibadan, Nigeria
| | - Esnat Chirwa
- Department of Mathematics and Statistics, University of Malawi, Blantyre, Malawi; MRC/Wits Developmental Pathways for Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Esther Nabakwe
- Department of Child Health and Pediatrics, College of Health Sciences, Moi University, Eldoret, Kenya; Department of Anthropology and Human Ecology, School of Arts and Social Sciences, Moi University, Eldoret, Kenya
| | - François Niragire
- Department of Applied Statistics, University of Rwanda, Huye, Rwanda
| | - Dieudonné Uwizeye
- Department of Sustainable Development, University of Rwanda, Huye, Rwanda; Centre for Population Studies and Research, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Celine Niwemahoro
- Department of Applied Statistics, University of Rwanda, Huye, Rwanda; Centre for Population Studies and Research, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Mphatso Kamndaya
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Mathematics and Statistics, University of Malawi, Blantyre, Malawi
| | - Victoria Mwakalinga
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Kennedy Otwombe
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Muloongo K, Tshuma N, Chimoyi L, Setswe G, Sarfo B, Nyasulu P. Factors contributing to home-based acceptability of rapid testing for HIV infection among the inner city commuter population in Johannesburg, South Africa. Trans R Soc Trop Med Hyg 2014; 108:632-8. [PMID: 25129890 DOI: 10.1093/trstmh/tru122] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The study aimed to determine factors contributing to the acceptability of home-based HIV counselling and testing (HBHCT) among commuters in Johannesburg inner city. METHODS Simple random sampling was used to select participants in a venue based intercept survey at Noord Street taxi rank in Johannesburg central business district. A total of 1146 individuals were interviewed and logistic regression analysis assessed factors associated with HBHCT acceptability. RESULTS HBHCT acceptability was 64%. Home testing was preferred as an alternative to testing at a health facility. High school education (adjusted odds ratio [aOR] 0.61, CI: 0.46-0.85), inner city residence aOR 0.70, CI: 0.52-0.94), previous HIV testing in the hospital (aOR 0.22, CI: 0.15-0.32) and at home (aOR 0.18, CI: 0.11-0.27) were significantly less likely associated with HBHCT acceptability. Being married (aOR 1.64, CI: 1.15-2.32), recent HIV testing (aOR 1.85, CI: 1.15-2.99) and having experienced negative health worker attitude (aOR 2.41, CI: 1.66-3.48) were significantly more likely associated with HBHCT acceptability. CONCLUSIONS High acceptability of HBHCT among urban-based commuters plus factors that would deter HBHCT acceptability were identified. Further research to identify strategies to improve HBHCT acceptability among commuter populations is needed.
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Affiliation(s)
- Keith Muloongo
- Community AIDS Response, Norwood, Johannesburg, South Africa
| | - Ndumiso Tshuma
- Community AIDS Response, Norwood, Johannesburg, South Africa
| | - Lucy Chimoyi
- Wits Reproductive Health and HIV Research Institute (WHRI), Hillbrow, Johannesburg, South Africa
| | - Geoffrey Setswe
- HIV/AIDS, STI and TB (HAST) Research Program, Human Sciences Research Council Pretoria, South Africa
| | - Bismark Sarfo
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Peter Nyasulu
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa School of Health Sciences, Monash University, Ruimsig, Johannesburg, South Africa
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Nyasulu P, Boniface R, Zulliger R, MacPherson P, Moshabela M. Predictors of diagnostic delays among pulmonary tuberculosis suspects attending health care services at Tintswalo rural hospital, Mpumalanga Province. Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ustrup M, Ngwira B, Stockman LJ, Deming M, Nyasulu P, Bowie C, Msyamboza K, Meyrowitsch DW, Cunliffe NA, Bresee J, Fischer TK. Potential barriers to healthcare in Malawi for under-five children with cough and fever: a national household survey. J Health Popul Nutr 2014; 32:68-78. [PMID: 24847595 PMCID: PMC4089074] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Failure to access healthcare is an important contributor to child mortality in many developing countries. In a national household survey in Malawi, we explored demographic and socioeconomic barriers to healthcare for childhood illnesses and assessed the direct and indirect costs of seeking care. Using a cluster-sample design, we selected 2,697 households and interviewed 1,669 caretakers. The main reason for households not being surveyed was the absence of a primary caretaker in the household. Among 2,077 children aged less than five years, 504 episodes of cough and fever during the previous two weeks were reported. A trained healthcare provider was visited for 48.0% of illness episodes. A multivariate regression model showed that children from the poorest households (p = 0.02) and children aged > 12 months (p = 0.02) were less likely to seek care when ill compared to those living in wealthier households and children of higher age-group respectively. Families from rural households spent more time travelling compared to urban households (68.9 vs 14.1 minutes; p < 0.001). In addition, visiting a trained healthcare provider was associated with longer travel time (p < 0.001) and higher direct costs (p < 0.001) compared to visiting an untrained provider. Thus, several barriers to accessing healthcare in Malawi for childhood illnesses exist. Continued efforts to reduce these barriers are needed to narrow the gap in the health and healthcare equity in Malawi.
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Affiliation(s)
- Marte Ustrup
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bagrey Ngwira
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | | | - Michael Deming
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Peter Nyasulu
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cameron Bowie
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Kelias Msyamboza
- Department of Community Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Dan W. Meyrowitsch
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nigel A. Cunliffe
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Joseph Bresee
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Thea K. Fischer
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Chirwa T, Nyasulu P, Chirwa E, Ketlogetswe A, Bello G, Dambe I, Ndalama D, Joshua M. Levels of tuberculosis treatment adherence among sputum smear positive pulmonary tuberculosis patients attending care at Zomba Central hospital, southern Malawi, 2007-2008. PLoS One 2013; 8:e63050. [PMID: 23723972 PMCID: PMC3665834 DOI: 10.1371/journal.pone.0063050] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 03/28/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite great efforts to control Tuberculosis (TB), progress is compromised by low adherence to medication, leading to prolonged duration of infectiousness and continued transmission. Investigating low adherence is of high importance from TB programmatic perspective. Though data on actual days of missed treatment exist, the effect of such on TB cure rates has not been investigated. METHODS TB operational research data were extracted for smear-positive pulmonary TB patients registered at Zomba Central hospital, Malawi from January 2007 to December 2008. RESULTS Of the 524 patients, 302 (57.6%) were males and 340 (64.9%) fully adhered to treatment. Excluding 5 individuals with missing data on cure, four hundred and eighty-one (92.7%) were cured of TB, and of these 162 (33.7%) missed at least one day of treatment. Respectively, 49/64 (76.6%) and 71/76 (93.4%) of those who missed treatment in the intensive and continuation phases were cured of TB (p = 0.005). The adjusted logistic regression analysis showed that those who missed 15-29 days of treatment (OR = 0.04, 95% CI: 0.01, 0.14) were less likely to be cured of TB compared with those who fully adhered. CONCLUSION Treatment non-adherence was high and was observed even within the first 2 months of treatment. Thus, even at an earlier critical stage of treatment, simple algorithms need to be developed to identify and monitor patients at higher risk of non-adherence. Efforts on treatment compliance counselling should focus on enhanced counselling to improve adherence during the intensive treatment phase.
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Affiliation(s)
- Tobias Chirwa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand (Wits), Johannesburg, South Africa.
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Ndiaye M, Nyasulu P, Nguyen H, Lowenthal ED, Gross R, Mills EJ, Nachega JB. Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study. Patient Prefer Adherence 2013; 7:891-5. [PMID: 24049440 PMCID: PMC3775698 DOI: 10.2147/ppa.s47628] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Little is known about factors associated with suboptimal antiretroviral treatment (ART) adherence among adolescents in Sub-Saharan Africa. Our objective was to determine the level of ART adherence and predictors of non-adherence among human immunodeficiency virus (HIV)-infected adolescents at the Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana. METHODS In a cross-sectional study, 82 HIV-infected adolescents receiving ART and their caregivers were administered a structured questionnaire. The patient's clinical information was retrieved from medical records. Outcome measures included excellent pill count ART adherence (>95%) and virologic suppression (HIV viral load <400 copies/mL). Multivariate logistic regression analysis was performed to identify independent predictors of ART non-adherence. RESULTS The overall median (interquartile range) ART adherence was 99% (96.5-100) (N = 82). Seventy-six percent of adolescents had excellent pill count ART adherence levels and 94% achieved virologic suppression. Male adolescents made up 65% of the non-adherent group (P = 0.02). Those who displayed suboptimal ART adherence were more likely to report having ever missed ART doses due to failure to pick up medication at the pharmacy (30.0% versus 9.7%, P = 0.03). In the multivariate logistic regression model, male sex (odds ratio [OR] 3.29, 95% confidence interval [CI] 1.13-9.54; P = 0.03) was the only factor which was independently associated with suboptimal ART adherence. CONCLUSIONS A high proportion of HIV-infected adolescents studied had excellent ART adherence and virologic suppression, with male adolescents at higher risk of suboptimal adherence than females. Further research to investigate how sex relates to suboptimal adherence may aid in the design of targeted intervention strategies.
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Affiliation(s)
- Maimouna Ndiaye
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Peter Nyasulu
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hoang Nguyen
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Tay Ho Clinics, Department of Medicine, Hanoi Health Services, Hanoi, Vietnam
| | - Elizabeth D Lowenthal
- Departments of Pediatrics and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Robert Gross
- Departments of Medicine and Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Edward J Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jean B Nachega
- Department of Medicine and Centre for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Epidemiology, Infectious Disease Epidemiology Research Program, Pittsburgh University Graduate School of Public Health, Pittsburgh, PA, USA
- Departments of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Correspondence: Jean B Nachega, Pittsburgh Graduate School of Public Health 130 DeSoto Street, Pittsburgh, PA 15261, USA, Tel +1 4 410-800 7803, Fax +1 4 410-502 6733, Email ;
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Nyasulu P, Perovic O, Murray J, Luchters S, Chasela C, Koornhof H. Trends and pattern of antimicrobial resistance among blood culture isolates of selected bacterial pathogens in South Africa, 2005-2009. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Nyasulu P, Murray J, Perovic O, Koornhof H. Antimicrobial Resistance Surveillance among Nosocomial Pathogens in South Africa: Systematic Review of Published Literature. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.jecm.2011.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Roberts B, Morgan OW, Sultani MG, Nyasulu P, Rwebangila S, Sondorp E, Chandramohan D, Checchi F. Economic feasibility of a new method to estimate mortality in crisis-affected and resource-poor settings. PLoS One 2011; 6:e25175. [PMID: 21949879 PMCID: PMC3176324 DOI: 10.1371/journal.pone.0025175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 03/02/2011] [Accepted: 08/29/2011] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mortality data provide essential evidence on the health status of populations in crisis-affected and resource-poor settings and to guide and assess relief operations. Retrospective surveys are commonly used to collect mortality data in such populations, but require substantial resources and have important methodological limitations. We evaluated the feasibility of an alternative method for rapidly quantifying mortality (the informant method). The study objective was to assess the economic feasibility of the informant method. METHODS The informant method captures deaths through an exhaustive search for all deaths occurring in a population over a defined and recent recall period, using key community informants and next-of-kin of decedents. Between July and October 2008, we implemented and evaluated the informant method in: Kabul, Afghanistan; Mae La camp for Karen refugees, Thai-Burma border; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We documented the time and cost inputs for the informant method in each site, and compared these with projections for hypothetical retrospective mortality surveys implemented in the same site with a 6 month recall period and with a 30 day recall period. FINDINGS The informant method was estimated to require an average of 29% less time inputs and 33% less monetary inputs across all four study sites when compared with retrospective surveys with a 6 month recall period, and 88% less time inputs and 86% less monetary inputs when compared with retrospective surveys with a 1 month recall period. Verbal autopsy questionnaires were feasible and efficient, constituting only 4% of total person-time for the informant method's implementation in Chiradzulu District. CONCLUSIONS The informant method requires fewer resources and incurs less respondent burden. The method's generally impressive feasibility and the near real-time mortality data it provides warrant further work to develop the method given the importance of mortality measurement in such settings.
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Affiliation(s)
- Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Abstract
In September 2008, we measured all-cause mortality in Chiradzulu District, Malawi (population 291, 000) over a 60-day retrospective period, using capture-recapture analysis of three lists of deaths provided by (i) key community informants, (ii) graveyard officials and (iii) health system sources. Estimated crude and under-5-year mortality rates were 18.6 (95% CI 13.9-24.5) and 30.6 (95% CI 17.5-59.9) deaths per 1000 person-years. We also classified causes of death through verbal autopsy interviews on 50 deaths over the previous 40 days. Half of deaths were attributable to infection, and half of deaths among children aged under 5 were attributable to neonatal causes. HIV/AIDS was the leading cause of death (16.6%), with a cause-attributable mortality rate of 1.8 (0.4-3.6) deaths per 1000 person-years.
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Affiliation(s)
- Francesco Checchi
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Roberts B, Morgan OW, Sultani MG, Nyasulu P, Rwebangila S, Myatt M, Sondorp E, Chandramohan D, Checchi F. A new method to estimate mortality in crisis-affected and resource-poor settings: validation study. Int J Epidemiol 2010; 39:1584-96. [PMID: 21044978 PMCID: PMC2992632 DOI: 10.1093/ije/dyq188] [Citation(s) in RCA: 19] [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] [Accepted: 09/09/2010] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Data on mortality rates are crucial to guide health interventions in crisis-affected and resource-poor settings. The methods currently available to collect mortality data in such settings feature important methodological limitations. We developed and validated a new method to provide near real-time mortality estimates in such settings. METHODS We selected four study sites: Kabul, Afghanistan; Mae La refugee camp, Thailand; Chiradzulu District, Malawi; and Lugufu and Mtabila refugee camps, Tanzania. We recorded information about all deaths in a 60-day period by asking key community informants and decedents' next of kin to refer interviewers to bereaved households. We used the total number of deaths and population estimates to calculate mortality rates for 60- and 30-day periods. For validation we compared these rates with a best estimate of mortality using capture-recapture analysis with two further independent lists of deaths. RESULTS The population covered by the new method was 76 ,476 persons in Kabul, 43,794 in Mae La camp, 54,418 in Chiradzulu District and 80,136 in the Tanzania camps. The informant method showed moderate sensitivity (55.0% in Kabul, 64.0% in Mae La, 72.5% in Chiradzulu and 67.7% in Tanzania), but performed better than the active surveillance system in the Tanzania refugee camps. CONCLUSIONS The informant method currently features moderate sensitivity for accurately assessing mortality, but warrants further development, particularly considering its advantages over current options (ease of implementation and analysis and near-real estimates of mortality rates). Strategies should be tested to improve the performance of the informant method.
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Affiliation(s)
- Bayard Roberts
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Oliver W Morgan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mohammed Ghaus Sultani
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Nyasulu
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Sunday Rwebangila
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Mark Myatt
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Egbert Sondorp
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Chandramohan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Francesco Checchi
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK, United States Centers for Disease Control and Prevention, Atlanta, GA, USA, Médecins Sans Frontières France, Malawi Programme, Chiradzulu, Malawi, United Nations High Commissioner for Refugees, Tanzania Office, Kigoma, Tanzania, Brixton Health, Plymouth, UK and Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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