1
|
Otieno P, Akelo V, Khagayi S, Omore R, Akoth K, Nyanjom M, Ngere S, Ochola K, Maixenchs M, Kone A, Blevins J, Zielinski-Gutierrez E, Barr BAT. Acceptability of minimally invasive autopsy by community members and healthcare workers in Siaya and Kisumu counties, western Kenya, 2017-2018. PLOS Glob Public Health 2023; 3:e0001319. [PMID: 37747874 PMCID: PMC10519588 DOI: 10.1371/journal.pgph.0001319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/03/2023] [Indexed: 09/27/2023]
Abstract
Worldwide, nearly six million children under the age of five (<5s) die annually, a substantial proportion of which are due to preventable and treatable diseases. Efforts to reduce child mortality indicators in the most affected regions are often undermined by a lack of accurate cause of death data. To generate timely and more accurate causes of death data for <5s, the Child Health and Mortality Prevention Surveillance (CHAMPS) Network established mortality surveillance in multiple countries using Minimally Invasive Tissue Sampling (MITS) in <5 deaths. Here we present acceptability of MITS by community members and healthcare workers in Siaya and Kisumu counties, western Kenya. From April 2017 to February 2018, we conducted 40 in-depth interviews and five focus group discussions with healthcare workers and community members, before and during CHAMPS implementation. Participants were purposively selected. Field observations to understand traditional death-related practices were also performed. Interviews were transcribed into Nvivo 11.0 for data organization and management. Analysis was guided by the grounded theory approach. Facilitators of acceptability were desire to understand why death occurred, timely performance of MITS procedures, potential for MITS results in improving clinical practice and specific assistance provided to families by the CHAMPS program. However, cultural and religious beliefs highlighted important challenges to acceptability, including CHAMPS teams recruiting after a child's death, rumours and myths, unmet expectations from families, and fear by healthcare workers that some families could use MITS results to sue for negligence. Increasing MITS uptake requires sustained strategies to strengthen the identified facilitators of acceptability and simultaneously address the barriers. MITS acceptance will contribute to better characterization of causes of death and support the development of improved interventions aimed at reducing <5 mortality.
Collapse
Affiliation(s)
- Peter Otieno
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Victor Akelo
- U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Kelvin Akoth
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Maryanne Nyanjom
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Sara Ngere
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Ken Ochola
- Kenya Medical Research Institute, Center for Global Health Research, Kisumu, Kenya
| | - Maria Maixenchs
- IS Global, Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Ahoua Kone
- Emory University, Atlanta, Georgia, United States of America
| | - John Blevins
- Emory University, Atlanta, Georgia, United States of America
| | | | - Beth A. Tippett Barr
- U.S. Centers for Disease Control and Prevention, Kisumu, Kenya
- Nyanja Health Research Institute, Salima, Malawi
| |
Collapse
|
2
|
Mahtab S, Madewell ZJ, Madhi SA, Wise A, Swart PJ, Velaphi S, Mandomando I, Bramugy J, Mabunda R, Xerinda E, Scott AG, Assefa N, Madrid L, Bweihun M, Temesgen F, Onyango D, Akelo V, Oliech R, Otieno P, Verani JR, Arifeen SE, Gurley ES, Alam M, Rahman A, Hossain MZ, Sow S, Kotloff K, Tapia M, Keita AM, Sanogo D, Ogbuanu I, Ojulong J, Lako S, Ita O, Kaluma E, Wilson T, Mutevedzi P, Barr BAT, Whitney CG, Blau DM, Bassat Q. Stillbirths and Neonatal Deaths Caused by Group B Streptococcus in Africa and South Asia Identified Through Child Health and Mortality Prevention Surveillance (CHAMPS). Open Forum Infect Dis 2023; 10:ofad356. [PMID: 37674633 PMCID: PMC10478157 DOI: 10.1093/ofid/ofad356] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/10/2023] [Indexed: 09/08/2023] Open
Abstract
Background Invasive Group B Streptococcus (GBS) is a common cause of early-onset neonatal sepsis and is also associated with stillbirth. This study aimed to determine the proportion of stillborn infants and infants who died between 0 and 90 days attributable to GBS using postmortem minimally invasive tissue sampling (MITS) in 7 low- and middle-income countries (LMICs) participating in Child Health and Mortality Prevention Surveillance (CHAMPS). Methods Deaths that occurred between December 2016 and December 2021 were investigated with MITS, including culture for bacteria of blood and cerebrospinal fluid (CSF), multipathogen polymerase chain reaction on blood, CSF, and lung tissue and histopathology of lung, liver, and brain. Data collection included clinical record review and verbal autopsy. Expert panels reviewed all information and assigned causes of death. Results We evaluated 2966 deaths, including stillborn infants (n = 1322), infants who died during first day of life (0 to <24 hours, n = 597), early neonatal deaths (END) (1 day to <7 days; END; n = 593), and deaths from 7 to 90 days (n = 454). Group B Streptococcus was determined to be in the causal pathway of death for 2.7% of infants (79 of 2, 966; range, 0.3% in Sierra Leone to 7.2% in South Africa), including 2.3% (31 of 1322) of stillbirths, 4.7% (28 of 597) 0 to <24 hours, 1.9% (11 of 593) END, and 2.0% (9 of 454) of deaths from 7 to 90 days of age. Among deaths attributed to GBS with birth weight data available, 61.9% (39 of 63) of decedents weighed <2500 grams at birth. Group B Streptococcus sepsis was the postmortem diagnosis for 100% (31 of 31) of stillbirths. For deaths <90 days, postmortem diagnoses included GBS sepsis (83.3%, 40 of 48), GBS meningitis (4.2%, 2 of 48), and GBS pneumonia (2.1%, 1 of 48). Conclusions Our study reveals significant heterogeneity in the contribution of invasive GBS disease to infant mortality across different countries, emphasizing the need for tailored prevention strategies. Moreover, our findings highlight the substantial impact of GBS on stillbirths, shedding light on a previously underestimated aspect in LMICs.
Collapse
Affiliation(s)
- Sana Mahtab
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Zachary J Madewell
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shabir A Madhi
- South African Medical Research Council, Vaccines Infectious Diseases and Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amy Wise
- National Health for Laboratory Service in South Africa, Johannesburg, South Africa
| | - Peter J Swart
- Department of Obstetrics and Gynecology, Rahima Mossa Mother and Child Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Sithembiso Velaphi
- Department of Pediatrics, Chris Hani Baragwanath Academic Hospital, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Inacio Mandomando
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Justina Bramugy
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Rita Mabunda
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
| | - Elisio Xerinda
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Anthony G Scott
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Lola Madrid
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | | | - Dickens Onyango
- Kisumu County Department of Health, Ministry of Health, Kisumu, Kenya
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu, Kenya
| | - Richard Oliech
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Jennifer R Verani
- National Center for Immunization and Respiratory Disease, Centers for Disease Control, Atlanta, Georgia, USA
| | - Shams El Arifeen
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Emily S Gurley
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Muntasir Alam
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | - Afruna Rahman
- International Center for Diarrhoeal Diseases Research (icddr, b), Dhaka, Bangladesh
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Karen Kotloff
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Milagritos Tapia
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Adama Mamby Keita
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | - Doh Sanogo
- Centre pour le Développement des Vaccins (CVD-Mali), Ministère de la Santé, Bamako, Mali
| | | | | | - Sandra Lako
- Aberdeen Women's Centre in Freetown, Sierra Leone
| | | | | | - Tais Wilson
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Portia Mutevedzi
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Beth A Tippett Barr
- Kenya Medical Research Institute-Center for Global Health Research (KEMRI-CGHR), Kisumu, Kenya
| | - Cynthia G Whitney
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Dianna M Blau
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- ISGlobal—Hospital Clínic, Unversitat de Barcelona, Barcelona, Spain
- Institutó Catalana de Recerca I Estudis Avançats (ICREA), Barcelona, Spain
- Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| |
Collapse
|
3
|
Otieno P, Asiki G, Wilunda C, Wami W, Agyemang C. Cardiometabolic multimorbidity and associated patterns of healthcare utilization and quality of life: Results from the Study on Global AGEing and Adult Health (SAGE) Wave 2 in Ghana. PLOS Glob Public Health 2023; 3:e0002215. [PMID: 37585386 PMCID: PMC10431646 DOI: 10.1371/journal.pgph.0002215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/07/2023] [Indexed: 08/18/2023]
Abstract
Understanding the patterns of multimorbidity, defined as the co-occurrence of more than one chronic condition, is important for planning health system capacity and response. This study assessed the association of different cardiometabolic multimorbidity combinations with healthcare utilization and quality of life (QoL). Data were from the World Health Organization (WHO) study on global AGEing and adult health Wave 2 (2015) conducted in Ghana. We analysed the clustering of cardiometabolic diseases including angina, stroke, type 2 diabetes, and hypertension with unrelated conditions such as asthma, chronic lung disease, arthritis, cataract and depression. The clusters of adults with cardiometabolic multimorbidity were identified using latent class analysis and agglomerative hierarchical clustering algorithms. We used negative binomial regression to determine the association of multimorbidity combinations with outpatient visits. The association of multimorbidity clusters with hospitalization and QoL were assessed using multivariable logistic and linear regressions. Data from 3,128 adults aged over 50 years were analysed. We identified four distinct classes of multimorbidity: relatively "healthy class" with no multimorbidity (47.9%): abdominal obesity only (40.7%): cardiometabolic and arthritis class comprising participants with hypertension, type 2 diabetes, stroke, abdominal and general obesity, arthritis and cataract (5.7%); and cardiopulmonary and depression class including participants with angina, chronic lung disease, asthma, and depression (5.7%). Relative to the class with no multimorbidity, the cardiopulmonary and depression class was associated with a higher frequency of outpatient visits [β = 0.3; 95% CI 0.1 to 0.6] and higher odds of hospitalization [aOR = 1.9; 95% CI 1.0 to 3.7]. However, cardiometabolic and arthritis class was associated with a higher frequency of outpatient visits [β = 0.8; 95% CI 0.3 to 1.2] and not hospitalization [aOR = 1.1; 95% CI 0.5 to 2.9]. The mean QoL scores was lowest among participants in the cardiopulmonary and depression class [β = -4.8; 95% CI -7.3 to -2.3] followed by the cardiometabolic and arthritis class [β = -3.9; 95% CI -6.4 to -1.4]. Our findings show that cardiometabolic multimorbidity among older persons in Ghana cluster together in distinct patterns that differ in healthcare utilization. This evidence may be used in healthcare planning to optimize treatment and care.
Collapse
Affiliation(s)
- Peter Otieno
- African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Welcome Wami
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
- Department of Global Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Otieno P, Agyemang C, Wainaina C, Igonya EK, Ouedraogo R, Wambiya EOA, Osindo J, Asiki G. Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study. BMJ Open 2023; 13:e074274. [PMID: 37567749 PMCID: PMC10423776 DOI: 10.1136/bmjopen-2023-074274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Understanding the facilitators and barriers to managing hypertension and type 2 diabetes (T2D) will inform the design of a contextually appropriate integrated chronic care model in Kenya. We explored the perceived facilitators and barriers to the integrated management of hypertension and T2D in Kenya using the Rainbow Model of Integrated Care. DESIGN This was a qualitative study using data from a larger mixed-methods study on the health system response to chronic disease management in Kenya, conducted between July 2019 and February 2020. Data were collected through 44 key informant interviews (KIIs) and eight focus group discussions (FGDs). SETTING Multistage sampling procedures were used to select a random sample of 12 study counties in Kenya. PARTICIPANTS The participants for the KIIs comprised purposively selected healthcare providers, county health managers, policy experts and representatives from non-state organisations. The participants for the FGDs included patients with hypertension and T2D. OUTCOME MEASURES Patients' and providers' perspectives of the health system facilitators and barriers to the integrated management of hypertension and T2D in Kenya. RESULTS The clinical integration facilitators included patient peer support groups for hypertension and T2D. The major professional integration facilitators included task shifting, continuous medical education and integration of community resource persons. The national referral system, hospital insurance fund and health management information system emerged as the major facilitators for organisational and functional integration. The system integration facilitators included decentralisation of services and multisectoral partnerships. The major barriers comprised vertical healthcare services characterised by service unavailability, unresponsiveness and unaffordability. Others included a shortage of skilled personnel, a lack of interoperable e-health platforms and care integration policy implementation gaps. CONCLUSIONS Our study identified barriers and facilitators that may be harnessed to improve the integrated management of hypertension and T2D. The facilitators should be strengthened, and barriers to care integration redressed.
Collapse
Affiliation(s)
- Peter Otieno
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Caroline Wainaina
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Emmy Kageha Igonya
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Ramatou Ouedraogo
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Jane Osindo
- Department of Emerging and Re-emerging Infectious Diseases, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
5
|
Otieno P, Agyemang C, Wao H, Wambiya E, Ng'oda M, Mwanga D, Oguta J, Kibe P, Asiki G. Effectiveness of integrated chronic care models for cardiometabolic multimorbidity in sub-Saharan Africa: a systematic review and meta-analysis. BMJ Open 2023; 13:e073652. [PMID: 37369405 PMCID: PMC10410889 DOI: 10.1136/bmjopen-2023-073652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This review aimed at identifying the elements of integrated care models for cardiometabolic multimorbidity in sub-Saharan Africa (SSA) and their effects on clinical or mental health outcomes including systolic blood pressure (SBP), blood sugar, depression scores and other patient-reported outcomes such as quality of life and medication adherence. DESIGN Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach. DATA SOURCES We systematically searched PubMed, Embase, Scopus, Web of Science, Global Health CINAHL, African Journals Online, Informit, PsycINFO, ClinicalTrials.gov, Pan African Clinical Trials Registry and grey literature from OpenSIGLE for studies published between 1999 and 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trial studies featuring integrated care models with two or more elements of Wagner's chronic care model. DATA EXTRACTION AND SYNTHESIS Two independent reviewers used standardised methods to search and screen included studies. Publication bias was assessed using the Doi plot and Luis Furuya Kanamori Index. Meta-analysis was conducted using random effects models. RESULTS In all, we included 10 randomised controlled trials from 11 publications with 4864 participants from six SSA countries (South Africa, Kenya, Nigeria, Eswatini, Ghana and Uganda). The overall quality of evidence based on GRADE criteria was moderate. A random-effects meta-analysis of six studies involving 1754 participants shows that integrated compared with standard care conferred a moderately lower mean SBP (mean difference=-4.85 mm Hg, 95% CI -7.37 to -2.34) for people with cardiometabolic multimorbidity; Hedges' g effect size (g=-0.25, (-0.39 to -0.11). However, integrated care compared with usual care showed mixed results for glycated haemoglobin, depression, medication adherence and quality of life. CONCLUSION Integrated care improved SBP among patients living with cardiometabolic multimorbidity in SSA. More studies on integrated care are required to improve the evidence pool on chronic care models for multimorbidity in SSA. These include implementation studies and cost-effectiveness studies. PROSPERO REGISTRATION NUMBER CRD42020187756.
Collapse
Affiliation(s)
- Peter Otieno
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Amsterdam, Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Hesborn Wao
- Research and Related Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Elvis Wambiya
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Maurine Ng'oda
- Emerging and Re-emerging infectious Diseases Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Daniel Mwanga
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - James Oguta
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
- African Network of Research Scientists, Nairobi, Kenya
| | - Peter Kibe
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- African Network of Research Scientists, Nairobi, Kenya
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
6
|
Otieno P, Agyemang C, Wami W, Wilunda C, Sanya RE, Asiki G. Assessing the Readiness to Provide Integrated Management of Cardiovascular Diseases and Type 2 Diabetes in Kenya: Results from a National Survey. Glob Heart 2023; 18:32. [PMID: 37334400 PMCID: PMC10275139 DOI: 10.5334/gh.1213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 05/26/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Integrated chronic disease management is the desired core function of a responsive healthcare system. However, many challenges surround its implementation in Sub-Saharan Africa. The current study assessed the readiness of healthcare facilities to provide integrated management of cardiovascular diseases (CVDs) and type 2 diabetes in Kenya. Methods We used data from a nationally representative cross-sectional survey of 258 public and private health facilities conducted in Kenya between 2019 and 2020. Data were collected using a standardised facility assessment questionnaire and observation checklists modified from the World Health Organization Package of Essential Non-communicable Diseases. The primary outcome was the readiness to provide integrated care for CVDs and diabetes-defined as the mean availability of tracer items comprising trained staff and clinical guidelines, diagnostic equipment, essential medicines, diagnosis, treatment and follow-up. A cut-off threshold of ≥70% was used to classify facilities as 'ready'. Gardner-Altman plots and modified Poisson regression were used to examine the facility characteristics associated with care integration readiness. Results Of the surveyed facilities, only a quarter (24.1%) were ready to provide integrated care for CVDs and type 2 diabetes. Care integration readiness was lower in public versus private facilities [aPR = 0.6; 95% CI 0.4 to 0.9], and primary healthcare facilities were less likely to be ready compared to hospitals [aPR = 0.2; 95% CI 0.1 to 0.4]. Facilities located in Central Kenya [aPR = 0.3; 95% CI 0.1 to 0.9], and the Rift Valley region [aPR = 0.4; 95% CI 0.1 to 0.9], were less likely to be ready compared to the capital Nairobi. Conclusions There are gaps in the readiness of healthcare facilities particularly primary healthcare facilities in Kenya to provide integrated care services for CVDs and diabetes. Our findings inform the review of current supply-side interventions for integrated management of CVDs and type 2 diabetes, especially in lower-level public health facilities in Kenya.
Collapse
Affiliation(s)
- Peter Otieno
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, The Netherlands
| | - Charles Agyemang
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Welcome Wami
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, The Netherlands
| | - Calistus Wilunda
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Richard E. Sanya
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Gershim Asiki
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
7
|
Otieno P, Agyemang C, Wilunda C, Sanya RE, Iddi S, Wami W, Van Andel J, van der Kloet B, Teerling J, Siteyi A, Asiki G. Effect of Patient Support Groups for Hypertension on Blood Pressure among Patients with and Without Multimorbidity: Findings from a Cohort Study of Patients on a Home-Based Self-Management Program in Kenya. Glob Heart 2023; 18:28. [PMID: 37305067 PMCID: PMC10253234 DOI: 10.5334/gh.1208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Patient support group interventions have been widely used to manage chronic diseases in Kenya. However, the potential benefits of these groups on patient health outcomes, and how this is influenced by multimorbidity, have not been rigorously evaluated. Objective We assessed the effect of a patient support group intervention on blood pressure (BP) management and the potential moderating effect of multimorbidity among low- and middle-income patients with hypertension in Kenya. Methods We analysed data from a non-randomized, quasi-experimental study of 410 patients with hypertension on a home-based self-management program conducted from September 2019 to September 2020. The program included the formation and participation in patient support groups. Using a modified STEPS questionnaire, data were collected on BP, anthropometry and other measurements at enrolment and after 12 months of follow-up. Multimorbidity was defined as the simultaneous presence of hypertension and at least one or more related conditions with similar pathophysiology (concordant multimorbidity) or unrelated chronic conditions (discordant multimorbidity). Propensity score (PS) weighting was used to adjust for baseline differences among 243 patients who participated in the support groups and 167 who did not. We estimated the effects of patient support groups and moderating effects of multimorbidity on BP management using multivariable ordinary linear regression weighted by PS. Findings Participation in support groups significantly reduced systolic BP by 5.4 mmHg compared to non-participation in the groups [β = -5.4; 95% CI -1.9 to -8.8]. However, among participants in the support group intervention, the mean systolic BP at follow-up assessment for those with concordant multimorbidity was 8.8 mmHg higher than those with no multimorbidity [β = 8.8; 95% CI 0.8 to 16.8]. Conclusion Although patient support groups are potentially important adjuncts to home-based self-care, multimorbidity attenuates their effectiveness. There is a need to tailor patient support group interventions to match the needs of the people living with multimorbidity in low- and middle-income settings in Kenya.
Collapse
Affiliation(s)
- Peter Otieno
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, NL
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Calistus Wilunda
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Richard E. Sanya
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Samuel Iddi
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
| | - Welcome Wami
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, NL
| | | | | | | | | | - Gershim Asiki
- African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
8
|
Otieno P, Asiki G, Wekesah F, Wilunda C, Sanya RE, Wami W, Agyemang C. Multimorbidity of cardiometabolic diseases: a cross-sectional study of patterns, clusters and associated risk factors in sub-Saharan Africa. BMJ Open 2023; 13:e064275. [PMID: 36759029 PMCID: PMC9923299 DOI: 10.1136/bmjopen-2022-064275] [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: 02/11/2023] Open
Abstract
OBJECTIVE To determine the patterns of cardiometabolic multimorbidity and associated risk factors in sub-Saharan Africa (SSA). DESIGN We used data from the WHO STEPwise approach to non-communicable disease risk factor surveillance cross-sectional surveys conducted between 2014 and 2017. PARTICIPANTS The participants comprised 39, 658 respondents aged 15-69 years randomly selected from nine SSA countries using a multistage stratified sampling design. PRIMARY OUTCOME MEASURE Using latent class analysis and agglomerative hierarchical clustering algorithms, we analysed the clustering of cardiometabolic diseases (CMDs) including high blood sugar, hypercholesterolaemia, hypertension and cardiovascular diseases (CVDs) such as heart attack, angina and stroke. Clusters of lifestyle risk factors: harmful salt intake, physical inactivity, obesity, tobacco and alcohol use were also computed. Prevalence ratios (PR) from modified Poisson regression were used to assess the association of cardiometabolic multimorbidity with sociodemographic and lifestyle risk factors. RESULTS Two distinct classes of CMDs were identified: relatively healthy group with minimal CMDs (95.2%) and cardiometabolic multimorbidity class comprising participants with high blood sugar, hypercholesterolaemia, hypertension and CVDs (4.8%). The clusters of lifestyle risk factors included alcohol, tobacco and harmful salt consumption (27.0%), and physical inactivity and obesity (5.8%). The cardiometabolic multimorbidity cluster exhibited unique sociodemographic and lifestyle risk profiles. Being female (PR=1.7, 95% CI (1.5 to 2.0), middle-aged (35-54 years) (3.9 (95% CI 3.2 to 4.8)), compared with age 15-34 years, employed (1.2 (95% CI 1.1 to 1.4)), having tertiary education (2.5 (95% CI 2.0 to 3.3)), vs no formal education and clustering of physical inactivity and obesity (2.4 (95% CI 2.0 to 2.8)) were associated with a higher likelihood of cardiometabolic multimorbidity. CONCLUSION Our findings show that cardiometabolic multimorbidity and lifestyle risk factors cluster in distinct patterns with a disproportionate burden among women, middle-aged, persons in high socioeconomic positions, and those with sedentary lifestyles and obesity. These results provide insights for health systems response in SSA to focus on these clusters as potential targets for integrated care.
Collapse
Affiliation(s)
- Peter Otieno
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Gershim Asiki
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Frederick Wekesah
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
- Lown Scholars Program, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Calistus Wilunda
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Richard E Sanya
- Chronic Diseases Management Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Welcome Wami
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Ngere SH, Akelo V, Ondeng’e K, Ridzon R, Otieno P, Nyanjom M, Omore R, Barr BAT. Traditional Medicine Beliefs and Practices among Caregivers of Children under Five Years-The Child Health and Mortality Prevention Surveillance (CHAMPS), Western Kenya: A qualitative study. PLoS One 2022; 17:e0276735. [PMID: 36322582 PMCID: PMC9629611 DOI: 10.1371/journal.pone.0276735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/13/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Approximately 80% of the population residing in sub-Saharan Africa relies on Traditional Medicine (TM). However, literature on factors motivating the use of TM for children under the age of five in these settings is limited. Such information can guide policy formulation for integration of TM into mainstream health care services. This study aimed to describe the motivation on use of TM among caregivers of children residing in rural and urban communities in western Kenya. METHODS The socio-behavioral sciences (SBS) arm of the Child Health and Mortality Prevention Surveillance (CHAMPS) program in western Kenya, conducted a cross-sectional qualitative study in Manyatta-an urban informal settlement located in Kisumu town and Karemo-a rural setting in Siaya County. We performed 29 in-depth interviews, 5 focus group discussions and 11 semi-structured interviews with community representatives (n = 53), health workers (n = 17), and community leaders (n = 18). All the participants were purposively sampled. We performed thematic analysis using both inductive and deductive approaches. Data management was completed on Nvivo 11.0 software (QSR International, Melbourne, Australia). RESULTS Our findings reveal that some caregivers prefer TM to treat some childhood diseases. Use of TM was informed by illness beliefs about etiology of disease. We observed an appreciation from the study participants that malaria can effectively be treated by Conventional Medicine (CM) while TM was preferred to treat measles and diseases believed to be associated with supernatural etiology such as witchcraft, evil spirit or breaching cultural taboos. TM was also used in instances where CM failed to provide a diagnosis or when CM was 'slow'. TM in such cases was used as a last resort. CONCLUSION We observed varied beliefs that motivate caregivers' choice of TM use among children in western Kenya. It is therefore crucial to consider perceptions and socio-cultural beliefs about illnesses when formulating interventions that are geared towards child health.
Collapse
Affiliation(s)
- Sarah Hawi Ngere
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
- * E-mail:
| | - Victor Akelo
- Centers for Disease Control and prevention (CDC), Nairobi, Kenya
| | - Ken Ondeng’e
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Renee Ridzon
- Centers for Disease Control and prevention (CDC), Nairobi, Kenya
| | - Peter Otieno
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Maryanne Nyanjom
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | - Richard Omore
- Kenya Medical Research Institute, Center for Global Health Research, (KEMRI-CGHR), Kisumu, Kenya
| | | |
Collapse
|
10
|
Ammoun R, Wami WM, Otieno P, Schultsz C, Kyobutungi C, Asiki G. Readiness of health facilities to deliver non-communicable diseases services in Kenya: a national cross-sectional survey. BMC Health Serv Res 2022; 22:985. [PMID: 35918710 PMCID: PMC9344761 DOI: 10.1186/s12913-022-08364-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for an estimated 71% of all global deaths annually and nearly 80% of these deaths occur in low- and middle-income countries. This study aimed to assess the readiness of existing healthcare systems at different levels of health care in delivering NCDs management and prevention services in Kenya. Methods A cross-sectional survey of 258 facilities was conducted between June 2019 and December 2020 using multistage sampling, examining facility readiness based on the availability of indicators such as equipment, diagnostic capacity, medicines and commodities, trained staff and guidelines for NCDs management. Readiness scores were calculated as the mean availability of tracer items expressed as a percentage and a cut-off threshold of ≥ 70% was used to classify facilities as “ready” to manage NCDs. Descriptive and bivariate analyses were performed to assess the readiness of facilities by type, level, and location settings. Logistic regressions were used to identify factors associated with the readiness of facilities to provide disease-specific services. Results Of the surveyed facilities, 93.8% offered chronic respiratory disease (CRD) diagnosis and/or management services, 82.2% diabetes mellitus, 65.1% cardiovascular disease (CVD), and only 24.4% cervical cancer screening services. The mean readiness scores for diabetes mellitus (71%; 95% CI: 67–74) and CVD (69%; 95% CI: 66–72) were relatively high. Although CRD services were reportedly the most widely available, its mean readiness score was low (48%; 95% CI: 45–50). The majority of facilities offering cervical cancer services had all the necessary tracer items available to provide these services. Modeling results revealed that private facilities were more likely to be “ready” to offer NCDs services than public facilities. Similarly, hospitals were more likely “ready” to provide NCDs services than primary health facilities. These disparities in service readiness extended to the regional and urban/rural divide. Conclusions Important gaps in the current readiness of facilities to manage NCDs in Kenya at different levels of health care were revealed, showing variations by disease and healthcare facility type. A collective approach is therefore needed to bridge the gap between resource availability and population healthcare needs. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08364-w.
Collapse
Affiliation(s)
- Rita Ammoun
- Faculty of Médicine, Limoges Université, 2 Rue du Docteur Marcland, 87025, LIMOGES CEDEX, France
| | - Welcome Mkhululi Wami
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya. .,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands.
| | - Peter Otieno
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya
| | - Constance Schultsz
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Catherine Kyobutungi
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Meibergdreef 9 1105 AZ, Amsterdam, the Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, 2nd Floor Manga Close, Off Kirawa Road, P.O. Box 10787 - 0100, Kitisuru, Nairobi, Kenya.,Department of Women's and Children's Health (KBH), Karolinka Institutet, Tomtebodavägen 18A, 171 77, Solna, Sweden
| |
Collapse
|
11
|
Röösli M, Fuhrimann S, Atuhaire A, Rother HA, Dabrowski J, Eskenazi B, Jørs E, Jepson PC, London L, Naidoo S, Rohlman DS, Saunyama I, van Wendel de Joode B, Adeleye AO, Alagbo OO, Aliaj D, Azanaw J, Beerappa R, Brugger C, Chaiklieng S, Chetty-Mhlanga S, Chitra GA, Dhananjayan V, Ejomah A, Enyoh CE, Galani YJH, Hogarh JN, Ihedioha JN, Ingabire JP, Isgren E, Loko YLE, Maree L, Metou’ou Ernest N, Moda HM, Mubiru E, Mwema MF, Ndagire I, Olutona GO, Otieno P, Paguirigan JM, Quansah R, Ssemugabo C, Solomon S, Sosan MB, Sulaiman MB, Teklu BM, Tongo I, Uyi O, Cueva-Vásquez H, Veludo A, Viglietti P, Dalvie MA. Interventions to Reduce Pesticide Exposure from the Agricultural Sector in Africa: A Workshop Report. Int J Environ Res Public Health 2022; 19:ijerph19158973. [PMID: 35897345 PMCID: PMC9330002 DOI: 10.3390/ijerph19158973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022]
Abstract
Despite the fact that several cases of unsafe pesticide use among farmers in different parts of Africa have been documented, there is limited evidence regarding which specific interventions are effective in reducing pesticide exposure and associated risks to human health and ecology. The overall goal of the African Pesticide Intervention Project (APsent) study is to better understand ongoing research and public health activities related to interventions in Africa through the implementation of suitable target-specific situations or use contexts. A systematic review of the scientific literature on pesticide intervention studies with a focus on Africa was conducted. This was followed by a qualitative survey among stakeholders involved in pesticide research or management in the African region to learn about barriers to and promoters of successful interventions. The project was concluded with an international workshop in November 2021, where a broad range of topics relevant to occupational and environmental health risks were discussed such as acute poisoning, street pesticides, switching to alternatives, or disposal of empty pesticide containers. Key areas of improvement identified were training on pesticide usage techniques, research on the effectiveness of interventions targeted at exposure reduction and/or behavioral changes, awareness raising, implementation of adequate policies, and enforcement of regulations and processes.
Collapse
Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland; (C.B.); (S.C.-M.); (A.V.)
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
- Correspondence: (M.R.); (S.F.); (M.A.D.)
| | - Samuel Fuhrimann
- Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland; (C.B.); (S.C.-M.); (A.V.)
- Faculty of Science, University of Basel, 4001 Basel, Switzerland
- Correspondence: (M.R.); (S.F.); (M.A.D.)
| | - Aggrey Atuhaire
- Uganda National Association of Community and Occupational Health (UNACOH), YMCA Building, Plot 37/41, Buganda Road, Kampala P.O. BOX 12590, Uganda;
| | - Hanna-Andrea Rother
- Division of Environmental Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7729, South Africa; (H.-A.R.); (L.L.)
| | - James Dabrowski
- Sustainability Research Unit, Nelson Mandela University, P.O. Box 6531, George 6530, South Africa;
| | - Brenda Eskenazi
- Center for Environmental Research and Community Health (CERCH), School of Public Health, University of California, Berkeley, CA 94720, USA;
| | - Erik Jørs
- Odense University Hospital, University of Southern Denmark, 5230 Odense, Denmark;
| | - Paul C. Jepson
- Oregon IPM Center, Oregon State University, Corvallis, OR 97331, USA;
| | - Leslie London
- Division of Environmental Health, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7729, South Africa; (H.-A.R.); (L.L.)
| | - Saloshni Naidoo
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban 4000, South Africa;
| | - Diane S. Rohlman
- College of Public Health, University of Iowa, Iowa City, IA 52242, USA;
| | - Ivy Saunyama
- Food and Agriculture Organization of the United Nations, Subregional Office for Southern Africa, Block 1 Tendeseka Office Park, Eastlea, Harare, Zimbabwe 00153 Rome, Italy;
| | - Berna van Wendel de Joode
- Infants’ Environmental Health Program (ISA), Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional de Costa Rica, Heredia 40101, Costa Rica;
| | - Adeoluwa O. Adeleye
- Department of Crop Production and Protection, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (A.O.A.); (O.O.A.); (M.B.S.)
| | - Oyebanji O. Alagbo
- Department of Crop Production and Protection, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (A.O.A.); (O.O.A.); (M.B.S.)
| | - Dem Aliaj
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland;
| | - Jember Azanaw
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia;
| | - Ravichandran Beerappa
- ICMR-Regional Occupational Health Centre (Southern), Bangalore 562110, India; (R.B.); (V.D.)
| | - Curdin Brugger
- Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland; (C.B.); (S.C.-M.); (A.V.)
| | - Sunisa Chaiklieng
- Department of Environmental Health, Occupational Health and Safety, Faculty of Public Health, Khon Kaen University, Khon Kaen 40002, Thailand;
| | - Shala Chetty-Mhlanga
- Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland; (C.B.); (S.C.-M.); (A.V.)
| | - Grace A. Chitra
- Global Institute of Public Health, Ananthapuri Hospitals and Research Institute, Trivandrum 695024, Kerala, India;
| | - Venugopal Dhananjayan
- ICMR-Regional Occupational Health Centre (Southern), Bangalore 562110, India; (R.B.); (V.D.)
| | - Afure Ejomah
- Department of Animal and Environmental Biology, University of Benin, P.M.B. 1154, Benin City 300212, Nigeria; (A.E.); (O.U.)
| | - Christian Ebere Enyoh
- Green and Sustainable Chemical Technologies, Graduate School of Science and Engineering, Saitama University, Saitama 3388570, Japan;
| | - Yamdeu Joseph Hubert Galani
- Section of Natural and Applied Sciences, School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury CT1 1QU, UK;
| | - Jonathan N. Hogarh
- Department of Environmental Science, College of Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana;
| | - Janefrances N. Ihedioha
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka 410001, Nigeria; (J.N.I.); (M.B.S.)
| | - Jeanne Priscille Ingabire
- Horticulture Program, Rwanda Agriculture and Animal Resources Development Board, Kigali 5016, Rwanda;
| | - Ellinor Isgren
- Lund University Centre for Sustainability Studies (LUCSUS), P.O. Box 170, SE-221 00 Lund, Sweden;
| | - Yêyinou Laura Estelle Loko
- Ecole Nationale Supérieure des Biosciences et Biotechnologies Appliquées (ENSBBA), Université Nationale des Sciences, Technologies, Ingénierie et Mathématiques (UNSTIM), BP 2282 Abomey, Benin;
| | - Liana Maree
- Department of Medical Bioscience, University of the Western Cape, Bellville 7493, South Africa;
| | - Nkoum Metou’ou Ernest
- Ministry of Agriculture and Rural Development, Cameroon, Direction of Regulation and Quality Control of Agricultural Inputs and Product, Messa, Yaoundé P.O. Box 2082, Cameroon;
| | - Haruna Musa Moda
- Department of Health Professions, Manchester Metropolitan University, Manchester M15 6BG, UK;
| | - Edward Mubiru
- Chemistry Department, School of Physical Sciences, College of Natural Sciences, Makerere University, Kampala, Uganda;
| | - Mwema Felix Mwema
- School of Materials, Energy, Water and Environmental Sciences, The Nelson Mandela African Institution of Science and Technology, Arusha P.O. Box 447, Tanzania;
| | - Immaculate Ndagire
- Southern and Eastern Africa Trade Information and Negotiation Institute (SEATINI) Uganda, Kampala P.O. Box 3138, Uganda;
| | - Godwin O. Olutona
- Industrial Chemistry Programme, College of Agriculture Engineering and Science, Bowen University, Iwo 232101, Nigeria;
| | - Peter Otieno
- Pest Control Products Board, Loresho, Nairobi P.O. Box 13794-00800, Kenya;
| | - Jordan M. Paguirigan
- Common Services Laboratory, Food and Drug Administration (FDA) Philippines, Alabang, Muntinlupa 1781, Philippines;
| | - Reginald Quansah
- School of Public Health, University of Ghana, Accra P.O. Box LG13, Ghana;
| | - Charles Ssemugabo
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala P.O. Box 7072, Uganda;
| | - Seruwo Solomon
- CropLife Uganda, Chicken House, Plot1, Old Kampala Road, Second Floor Room 17, Kampala P.O. Box 36592, Uganda;
| | - Mosudi B. Sosan
- Department of Crop Production and Protection, Obafemi Awolowo University, Ile-Ife 220282, Nigeria; (A.O.A.); (O.O.A.); (M.B.S.)
| | - Mohammad Bashir Sulaiman
- Department of Pure and Industrial Chemistry, University of Nigeria, Nsukka 410001, Nigeria; (J.N.I.); (M.B.S.)
| | - Berhan M. Teklu
- Ethiopian Agriculture Authority, Addis Ababa P.O. Box 313003, Ethiopia;
- Faculty of Naval and Ocean Engineering, Istanbul Technical University, Maslak P.O. Box 34469, Turkey
| | - Isioma Tongo
- Laboratory for Ecotoxicology and Environmental Forensics, Department of Animal and Environmental Biology, University of Benin, P.M.B. 1154, Benin City 300212, Nigeria;
| | - Osariyekemwen Uyi
- Department of Animal and Environmental Biology, University of Benin, P.M.B. 1154, Benin City 300212, Nigeria; (A.E.); (O.U.)
- Department of Zoology and Entomology, Faculty of Natural and Agricultural Sciences, University of the Free State, P.O. Box 339, Bloemfontein 9300, South Africa
| | - Henry Cueva-Vásquez
- Facultad de Ciencias de la Salud, Carrera de Medicina Humana Lima, Universidad Científica del Sur, Lima 15067, Peru;
| | - Adriana Veludo
- Swiss Tropical and Public Health Institute (Swiss TPH), 4123 Allschwil, Switzerland; (C.B.); (S.C.-M.); (A.V.)
| | - Paola Viglietti
- Centre for Environmental and Occupational Health (CEOHR), School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa;
| | - Mohamed Aqiel Dalvie
- Centre for Environmental and Occupational Health (CEOHR), School of Public Health and Family Medicine, University of Cape Town, Cape Town 7700, South Africa;
- Correspondence: (M.R.); (S.F.); (M.A.D.)
| |
Collapse
|
12
|
Otieno P, Angeles G, Quiñones S, van Halsema V, Novignon J, Palermo T. Health services availability and readiness moderate cash transfer impacts on health insurance enrolment: evidence from the LEAP 1000 cash transfer program in Ghana. BMC Health Serv Res 2022; 22:599. [PMID: 35509055 PMCID: PMC9066897 DOI: 10.1186/s12913-022-07964-w] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding health insurance coverage is a priority under Sustainable Development Goal 3. To address the intersection between poverty and health and remove cost barriers, the government of Ghana established the National Health Insurance Scheme (NHIS). Government further linked NHIS with the Livelihood Empowerment Against Poverty (LEAP) 1000 cash transfer program by waiving premium fees for LEAP 1000 households. This linkage led to increased NHIS enrolment, however, large enrolment gaps remained. One potential reason for failure to enroll may relate to the poor quality of health services. METHODS We examine whether LEAP 1000 impacts on NHIS enrolment were moderated by health facilities' service availability and readiness. RESULTS We find that adults in areas with the highest service availability and readiness are 18 percentage points more likely to enroll in NHIS because of LEAP 1000, compared to program effects of only 9 percentage points in low service availability and readiness areas. Similar differences were seen for enrolment among children (20 v. 0 percentage points) and women of reproductive age (25 v. 10 percentage points). CONCLUSIONS We find compelling evidence that supply-side factors relating to service readiness and availability boost positive impacts of a cash transfer program on NHIS enrolment. Our work suggests that demand-side interventions coupled with supply-side strengthening may facilitate greater population-level benefits down the line. In the quest for expanding financial protection towards accelerating the achievement of universal health coverage, policymakers in Ghana should prioritize the integration of efforts to simultaneously address demand- and supply-side factors. TRIAL REGISTRATION This study is registered in the International Initiative for Impact Evaluation's (3ie) Registry for International Development Impact Evaluations ( RIDIE-STUDY-ID-55942496d53af ).
Collapse
Affiliation(s)
- Peter Otieno
- African Population and Health Research Center, P.O. Box 10787-00100, Nairobi, Kenya
| | - Gustavo Angeles
- Department of Maternal and Child Health, UNC Gillings School of Global Public Health, 400 Meadowmont Circle CB #3446, Chapel Hill, NC, USA
| | - Sarah Quiñones
- Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA
| | | | - Jacob Novignon
- Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Tia Palermo
- Department of Epidemiology and Environmental Health, University at Buffalo, SUNY, 270 Farber Hall, Buffalo, NY, USA.
| | | |
Collapse
|
13
|
Wami WM, Asiki G, Kyobutungi CK, Otieno P. 1102Assessing variability among health care facilities in delivering chronic disease management in Kenya. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.691] [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
Non-communicable diseases (NCDs) account for an estimated 71% of global deaths. In Kenya, 31% of mortality is attributed to chronic illnesses and half of these are premature deaths. The study aimed to assess variation in the capacity of health facilities in Kenya in delivering NCDs diagnosis or management: diabetes, cardiovascular disease, chronic respiratory disease, and cervical cancer screening.
Methods
A cross-sectional survey of 258 facilities was conducted between June–December 2019. Service-specific indicators: basic equipment, diagnostics, trained staff and guidelines, and essential medicines were captured using a structured questionnaire and summarised as domain scores. All results were weighted to account for the national distribution of facilities.
Results
More than half of the facilities (60%; 95% CI: 51-70%) had all basic functioning equipment, and only 29% (95% CI: 25-33%) had trained staff and guidelines for diagnosis or management of mental illnesses. Despite this, 54% (95% CI: 46-53%) of all facilities had diagnostic capacity to detect these NCDs. Furthermore, 53% (95% CI: 49-56%) of the facilities across all levels of care had medicines for managing hypertension and diabetes. The overall readiness score for NCDs diagnosis or management was 47% (95% CI: 43–51%) and varied significantly across the levels of care.
Conclusions
A wide variation in basic resource capacity to diagnose or manage NCDs was noted between levels of care. A gap in the capacity of health facilities to manage chronic illnesses exists across all levels of care in Kenya.
Key messages
To meet the recommended chronic illnesses management targets, there is a need to strengthen the existing capacity of the health system and bridge the gap across levels of care.
Collapse
Affiliation(s)
- Welcome Mkhululi Wami
- African Population and Health Research Center, Nairobi, Kenya
- Amsterdam Institude for Global Health and Development, Amsterdam, Netherlands
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | | | - Peter Otieno
- African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
14
|
Reynolds EC, Onyango D, Mwando R, Oele E, Misore T, Agaya J, Otieno P, Tippett Barr BA, Lee GO, Akelo V. Mothers' Perspectives of Complementary Feeding Practices in an Urban Informal Settlement in Kisumu County, Western Kenya. Curr Dev Nutr 2021; 5:nzab065. [PMID: 34095736 PMCID: PMC8171250 DOI: 10.1093/cdn/nzab065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In informal settlements, the benefits of urban dwelling are diminished by conditions of poverty that exacerbate child undernutrition. The Child Health and Mortality Prevention Surveillance (CHAMPS) project has identified malnutrition as the leading underlying cause of death in children under 5 in the Manyatta urban informal settlement in Kisumu County, Kenya. OBJECTIVE This qualitative study, nested within the CHAMPS project, aimed to understand community perspectives on complementary feeding practices in this settlement. METHODS In-depth interviews were conducted with 20 mothers who lived in the urban informal settlement and had a child 6-23 months old. Two focus group discussions were conducted, 1 with mothers and 1 with community health workers (CHWs), to further explore themes related to complementary feeding. RESULTS Mothers were knowledgeable about globally recommended feeding practices, but such practices were often not implemented due to 1) the community/household water and sanitation environment, 2) the community/household food environment, 3) a lack of income and employment opportunities for women, and 4) sociocultural factors. Together, these create an environment that is not conducive to optimal child feeding practices. CONCLUSIONS To improve complementary feeding practices and child nutritional outcomes in Kenya's informal urban settings, both community- and individual-level factors should be addressed. Possible interventions include investment in water infrastructure and social protection programs, such as cash transfers.
Collapse
Affiliation(s)
- Elise C Reynolds
- University of Michigan School of Public Health, Ann Arbor,
MI, USA
- University of California, Davis, Davis, CA, USA
| | | | - Rael Mwando
- Kisumu County Department of Health, Kisumu, Kenya
| | | | | | - Janet Agaya
- Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Beth A Tippett Barr
- US Centers for Disease Control and Prevention–Kenya, Kisumu and
Nairobi , Kenya
| | - Gwenyth O Lee
- University of Michigan School of Public Health, Ann Arbor,
MI, USA
| | - Victor Akelo
- US Centers for Disease Control and Prevention–Kenya, Kisumu and
Nairobi , Kenya
| |
Collapse
|
15
|
Mutai WC, Mureithi MW, Anzala O, Revathi G, Kullin B, Burugu M, Kyany'a C, Odoyo E, Otieno P, Musila L. High Prevalence of Multidrug-Resistant Clostridioides difficile Following Extensive Use of Antimicrobials in Hospitalized Patients in Kenya. Front Cell Infect Microbiol 2021; 10:604986. [PMID: 33628744 PMCID: PMC7897694 DOI: 10.3389/fcimb.2020.604986] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 09/10/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction Clostridioides difficile is a neglected pathogen in many African countries as it is generally not regarded as one of the major contributors toward the diarrheal disease burden in the continent. However, several studies have suggested that C. difficile infection (CDI) may be underreported in many African settings. The aim of this study was to determine the prevalence of CDI in hospitalized patients, evaluate antimicrobial exposure, and detect toxin and antimicrobial resistance profiles of the isolated C. difficile strains. Methods In this cross-sectional study, 333 hospitalized patients with hospital-onset diarrhoea were selected. The stool samples were collected and cultured on cycloserine-cefoxitin egg yolk agar (CCEY). Isolates were presumptively identified by phenotypic characteristics and Gram stain and confirmed by singleplex real-time PCR (qPCR) assays detecting the species-specific tpi gene, toxin A (tcdA) gene, toxin B (tcdB) gene, and the binary toxin (cdtA/cdtB) genes. Confirmed C. difficile isolates were tested against a panel of eight antimicrobials (vancomycin, metronidazole, rifampicin, ciprofloxacin, tetracycline, clindamycin, erythromycin, and ceftriaxone) using E-test strips. Results C. difficile was detected in 57 (25%) of diarrheal patients over the age of two, 56 (98.2%) of whom received antimicrobials before the diarrheal episode. Amongst the 71 confirmed isolates, 69 (97.1%) harbored at least one toxin gene. More than half of the toxigenic isolates harbored a truncated tcdA gene. All isolates were sensitive to vancomycin, while three isolates (2.1%) were resistant to metronidazole (MIC >32 mg/L). High levels of resistance were observed to rifampicin (65/71, 91.5%), erythromycin (63/71, 88.7%), ciprofloxacin (59/71, 83.1%), clindamycin (57/71, 80.3%), and ceftriaxone (36/71, 50.7.8%). Among the resistant isolates, 61 (85.9%) were multidrug-resistant. Conclusion Multidrug-resistant C. difficile strains were a significant cause of healthcare facility-onset C. difficile infections in patients with prior antimicrobial exposure in this Kenyan hospital.
Collapse
Affiliation(s)
- Winnie C Mutai
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Marianne W Mureithi
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Omu Anzala
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Gunturu Revathi
- Department of Pathology, Division of Medical Microbiology, Aga Khan University Hospital, Nairobi, Kenya
| | - Brian Kullin
- Department of Molecular and Cell Biology, Faculty of Science, University of Cape Town, Cape Town, South Africa
| | - Magdaline Burugu
- Department of Medical Microbiology, School of Medicine, University of Nairobi, Nairobi, Kenya
| | | | - Erick Odoyo
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Peter Otieno
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Lillian Musila
- US Army Medical Research Directorate-Africa, Nairobi, Kenya
| |
Collapse
|
16
|
Blevins J, O'Mara Sage E, Kone A, Maixenchs M, Raghunathan PL, Guilaze RA, Cossa S, Girma Z, Zegeye Y, Ackley C, Hussain F, Islam S, Myburgh N, Ngwenya N, Madhi SA, Otieno P, Ochola K, Munguambe K, Breiman RF. Using Participatory Workshops to Assess Alignment or Tension in the Community for Minimally Invasive Tissue Sampling Prior to Start of Child Mortality Surveillance: Lessons From 5 Sites Across the CHAMPS Network. Clin Infect Dis 2020; 69:S280-S290. [PMID: 31598665 PMCID: PMC6785692 DOI: 10.1093/cid/ciz563] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/18/2019] [Indexed: 11/29/2022] Open
Abstract
The Child Health and Mortality Prevention Surveillance (CHAMPS) program is a 7-country network (as of December 2018) established by the Bill & Melinda Gates Foundation to identify the causes of death in children in communities with high rates of under-5 mortality. The program carries out both mortality and pregnancy surveillance, and mortality surveillance employs minimally invasive tissue sampling (MITS) to gather small samples of body fluids and tissue from the bodies of children who have died. While this method will lead to greater knowledge of the specific causes of childhood mortality, the procedure is in tension with cultural and religious norms in many of the countries where CHAMPS works—Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. Participatory Inquiry Into Community Knowledge of Child Health and Mortality Prevention (PICK-CHAMP) is a community entry activity designed to introduce CHAMPS to communities and gather initial perspectives on alignments and tensions between CHAMPS activities and community perceptions and priorities. Participants’ responses revealed medium levels of overall alignment in all sites (with the exception of South Africa, where alignment was high) and medium levels of tension (with the exception of Ethiopia, where tension was high). Alignment was high and tension was low for pregnancy surveillance across all sites, whereas Ethiopia reflected low alignment and high tension for MITS. Participants across all sites indicated that support for MITS was possible only if the procedure did not interfere with burial practices and rituals.
Collapse
Affiliation(s)
- John Blevins
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Elizabeth O'Mara Sage
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ahoua Kone
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| | - Maria Maixenchs
- ISGlobal, Hospital Clinic-Universitat de Barcelona, Spain.,Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Pratima L Raghunathan
- Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rui A Guilaze
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Saquina Cossa
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique
| | - Zerihun Girma
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yosef Zegeye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Caroline Ackley
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Faruqe Hussain
- PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh
| | - Saiful Islam
- PEI, Infectious Disease Division, icddr,b, Dhaka, Bangladesh.,University of New South Wales, Syndey, Australia
| | - Nellie Myburgh
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa
| | - Noni Ngwenya
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Faculty of Health Sciences Johannesburg, South Africa.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases, University of the Witwatersrand, Faculty of Health Sciences, Johannesburg, South Africa
| | | | | | - Khátia Munguambe
- Centro de Investigacao en Saude de Manhica (CISM), Maputo, Mozambique.,Community Health Department, Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique
| | - Robert F Breiman
- Emory Global Health Institute, Emory University, Atlanta, Georgia, USA
| |
Collapse
|
17
|
Donfouet HPP, Mohamed SF, Otieno P, Wambiya E, Mutua MK, Danaei G. Economic valuation of setting up a social health enterprise in urban poor-resource setting in Kenya. Soc Sci Med 2020; 266:113294. [PMID: 32927381 DOI: 10.1016/j.socscimed.2020.113294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/07/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
The failure of the market and government to provide quality healthcare services have been the motivation to set up social health enterprise. However, the value for money associated with setting up a social health enterprise in sub-Sahara African countries has been relatively unexplored in the literature. The study presents the first empirical estimates of the mean willingness-to-pay (WTP) for setting up a social health enterprise that will simultaneously run a health center and provide health insurance scheme in an urban resource-poor setting and explores whether the benefits outweigh the costs. The contingent valuation method is used to estimate the mean WTP for the health insurance scheme proposed by the social health enterprise in Viwandani slum (Nairobi, Kenya). The survey was conducted between June and July 2018 on 300 households. We find that the feasibility of setting up a social health enterprise could be promising with 97 percent of respondents willing to pay about US$ 2 per person per month for a scheme that would provide quality healthcare services. More importantly, setting up the social health enterprise will yield a positive net profit, and investors could expect US$ 1.11 in benefits for each US$ 1 of costs of investment in setting up the social health enterprise. We, therefore, conclude that this health policy in this urban resource-poor setting could be a viable solution to reach the neglected urban households in the Kenyan slums.
Collapse
Affiliation(s)
- Hermann Pythagore Pierre Donfouet
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya; University of Rennes 1, CREM UMR-CNRS 6211, 7 Place Hoche, 35065, RENNES Cedex, France.
| | - Shukri F Mohamed
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Peter Otieno
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Elvis Wambiya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Martin Kavao Mutua
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya.
| | - Goodarz Danaei
- Harvard T.H. Chan School of Public Health, United States.
| |
Collapse
|
18
|
Kisiangani I, Elmi M, Bakibinga P, Mohamed SF, Kisia L, Kibe PM, Otieno P, Afeich N, Nyaga AA, Njoroge N, Noor R, Ziraba AK. Persistent barriers to the use of maternal, newborn and child health services in Garissa sub-county, Kenya: a qualitative study. BMC Pregnancy Childbirth 2020; 20:277. [PMID: 32380975 PMCID: PMC7204007 DOI: 10.1186/s12884-020-02955-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/16/2020] [Indexed: 11/22/2022] Open
Abstract
Background North Eastern Kenya has persistently had poor maternal, new-born and child health (MNCH) indicators. Barriers to access and utilisation of MNCH services are structural, individual and community-level factors rooted in sociocultural norms. A package of interventions was designed and implemented in Garissa sub-County aimed at creating demand for services. Community Health Volunteers (CHVs) were trained to generate demand for and facilitate access to MNCH care in communities, while health care providers were trained on providing culturally acceptable and sensitive services. Minor structural improvements were made in the control areas of two facilities to absorb the demand created. Community leaders and other social actors were engaged as influencers for demand creation as well as to hold service providers accountable. This qualitative research was part of a larger mixed methods study and only the qualitative results are presented. In this paper, we explore the barriers to health care seeking that were deemed persistent by the end of the intervention period following a similar assessment at baseline. Methods An exploratory qualitative research design with participatory approach was undertaken as part of an impact evaluation of an innovation project in three sites (two interventions and one control). Semi-structured interviews were conducted with women who had given birth during the intervention period. Focus group discussions were conducted among the wider community members and key informant interviews among healthcare managers and other stakeholders. Participants were purposively selected. Data were analysed using content analysis by reading through transcripts. Interview data from different sources on a single event were triangulated to increase the internal validity and analysis of multiple cases strengthened external validity. Results Three themes were pre-established: 1) barriers and solutions to MNCH use at the community and health system level; 2) perceptions about women delivering in health facilities and 3) community/social norms on using health facilities. Generally, participants reported satisfaction with services offered in the intervention health facilities and many indicated that they would use the services again. There were notable differences between the intervention and control site in attitudes towards use of services (skilled birth attendance, postnatal care). Despite the apparent improvements, there still exist barriers to MNCH services use. Persistent barriers identified were gender of service provider, insecurity, poverty, lack of transport, distance from health facilities, lack of information, absence of staff especially at night-time and quality of maternity care. Conclusion Attitudes towards MNCH services are generally positive, however some barriers still hinder utilization. The County health department and community leaders need to sustain the momentum gained by ensuring that service access and quality challenges are continually addressed.
Collapse
Affiliation(s)
- Isaac Kisiangani
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya.
| | - Mohamed Elmi
- Preventive Health Care, P.O. Box 639, Wajir, 70200, Kenya
| | - Pauline Bakibinga
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Shukri F Mohamed
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Lyagamula Kisia
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Peter M Kibe
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Peter Otieno
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Naïm Afeich
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Avenue West, Montreal, QC, H3A 1A2, Canada
| | - Amina Abdullahi Nyaga
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| | - Ngugi Njoroge
- Sisters Maternity Home, P.O. Box 545, Garissa, 70100, Kenya
| | - Rumana Noor
- Sisters Maternity Home, P.O. Box 545, Garissa, 70100, Kenya
| | - Abdhalah Kasiira Ziraba
- Health and Systems for Health Research Unit, African Population and Health Research Center, P.O. Box 10787, Nairobi, 00100, Kenya
| |
Collapse
|
19
|
Wang H, Cheng Z, Yuan H, Zhu N, Lou Z, Otieno P. Occurrence of banned and commonly used pesticide residues in concentrated leachate: Implications for ecological risk assessment. Sci Total Environ 2020; 710:136287. [PMID: 31923666 DOI: 10.1016/j.scitotenv.2019.136287] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 05/27/2023]
Abstract
Amounts of banned and current pesticides have been used in domestic and agricultural pest control, and their residues have accumulated along the waste stream. In this work, pesticides were characterized in concentrated leachates (CLs) from 5 municipal landfill sites, 2 incineration plants and 1 composting plant in six provinces. A total of 31 pesticides were detected which included 8 organochlorine pesticides (OCPs, 303-2974 ng/L), 16 organophosphorus pesticides (OPPs, 1380-13,274 ng/L) and 7 synthetic pyrethroids (SPs, 319-5636 ng/L). Despite the ten years ban of hexachlorocyclohexane, methamidophos and parathion-methyl, they were still in CL at a mean value of 320 ng/L and 88 ng/L, respectively. The average Σ8OCPs, Σ16OPPs and Σ7SPs in CL from landfill sites were approximately 2.8, 1.1 and 4.5 times higher than those from incineration plants, which might have been influenced by pH, moisture and/or HRT. Additionally, it was found that CL from incineration plants and composting plant with lower pesticide contents posed a much higher acute and chronic eco-risk. Methamidophos was the dominant pesticide in CL from incineration plants, which was much higher than any other pesticides detected. The annual emissions of Σ8OCPs, Σ16OPPs and Σ7SPs discharged from landfill-CL were estimated to be 2370, 10,357 and 2994 g, respectively. It was evident from the study that long-term release of CL after waste disposal could cause potential risk of ecological pollution.
Collapse
Affiliation(s)
- Hui Wang
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Zhaowen Cheng
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Haiping Yuan
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; Shanghai Engineering Research Center of Solid Waste Treatment and Resource, Shanghai 200240, China
| | - Nanwen Zhu
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China; Shanghai Engineering Research Center of Solid Waste Treatment and Resource, Shanghai 200240, China
| | - Ziyang Lou
- School of Environmental Science and Engineering, Shanghai Jiao Tong University, Shanghai 200240, China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, China; China Institute for Urban Governance, Shanghai Jiao Tong University, Shanghai 200240, China; Shanghai Engineering Research Center of Solid Waste Treatment and Resource, Shanghai 200240, China.
| | - Peter Otieno
- Department of Chemistry, Maseno University, Maseno, Kenya; Institute of Ecological Chemistry, Helmholtz Zentrum Müenchen, German National Research Centre for Environmental Health, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
| |
Collapse
|
20
|
Donkor N, Farrell K, Ocho O, Sheppard C, Caesar LA, Andrews L, Modeste S, Otieno P, Acquah S. Correlates of obesity indices and cardiovascular disease risk factors among Trinidadian nurses. International Journal of Africa Nursing Sciences 2020. [DOI: 10.1016/j.ijans.2020.100194] [Citation(s) in RCA: 1] [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: 12/23/2022] Open
|
21
|
Kugo M, Keter L, Maiyo A, Kinyua J, Ndemwa P, Maina G, Otieno P, Songok EM. Fortification of Carica papaya fruit seeds to school meal snacks may aid Africa mass deworming programs: a preliminary survey. Altern Ther Health Med 2018; 18:327. [PMID: 30526582 PMCID: PMC6286506 DOI: 10.1186/s12906-018-2379-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/16/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Soil transmitted helminths (STHs) are among the world's neglected tropical diseases. Morbidity due to STHs is greatest in school-age children who typically have the highest burden of infection. In 2001, WHO passed a resolution for the use of large-scale mass drug administration (MDA) to deworm vulnerable children through school based programs. Though effective, there is concern that MDA might not be sustainable over extended periods. Additionally the current MDA strategy does not consider child malnutrition, a very common malady in resource limited countries. We report a pilot evaluation of an innovation that bundles school feeding and deworming. METHODS We designed a maize (corn) flour fortified with grounded dried papaya (Carica papaya) seeds and used it to prepare porridge as per the usual school meal recipe Children from three primary schools from Nandi County in Kenya were randomized into three arms: One school received 300 ml papaya fortified porridge daily (papaya group), the second school received similar serving of plain porridge without the pawpaw ingredient (control group) and the third school received plain porridge and the conventional MDA approach of one time 400 mg dosage of albendazole (albendazole arm). Prior to the randomization, an initial baseline stool microscopy analysis was done to determine presence and intensity of intestinal worms. Core indicators of nutrition-height, weight and hemoglobin counts were also assessed. The children were monitored daily for two months and final stool sample analysis and clinical monitoring done at the end of the study. Baseline and follow-up data were analyzed and compared through SAS version 9.1 statistical package. RESULTS A total of 326 children participated in the trial. The overall prevalence of Ascaris lumbricoides was 29.4% (96), Trichuris Trichura 5.2% (17) and hookworm 1 (0.3%). Papaya seed fortified porridge reduced the Ascaris lumbricoides egg count by 63.9% after the two month period (mean 209.7epg to 75.7 p < 0.002) as compared to the albendazole arm 78.8% (129.5 epg to 27.5, p value 0.006). The control group showed an increase in egg count (42.epg to 56.3) though it was not statistically significant. Hemoglobin counts in the papaya group increased from a mean of 2 g/dL (11.5 g/dL to 13.5 g/dL, p < 0.001), as compared to the albendazole arm that increased by 1 g/dL (12.8-13.9, p < 0.001). No significant change was observed in the placebo arm (13.2 to 13.1). Interestingly the papaya group showed a significant reduction of children with Tinea capitis (ringworms) (54.4 to 34%, p < 0.002) as compared to the albendazole arm that showed an increase in ringworm infestation though not statistically significant (39.7 to 64.7% p = 0.608). CONCLUSION Papaya seed fortified porridge had a significant effect on reduction of Ascaris lumbricoides burden. It had a better nutritional outcome and effect on child fungal infections than albendazole. Its application as a routine school meal may aid current national school based nutrition and deworming programs in Africa. TRIAL REGISTRATION This study was retrospectively registered at Clinicaltrials.gov Ref. NCT02725255 on 31st March 2016.
Collapse
|
22
|
Richards N, Zorrilla I, Lalah J, Otieno P, Fernandez I, Calvino M, Garcia J. Talons and beaks are viable but underutilized samples for detecting organophosphorus and carbamate pesticide poisoning in raptors. ACTA ACUST UNITED AC 2018. [DOI: 10.4314/vulnew.v72i1.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
23
|
Zhou Z, Mitchell RM, Kariuki S, Odero C, Otieno P, Otieno K, Onyona P, Were V, Wiegand RE, Gimnig JE, Walker ED, Desai M, Shi YP. Assessment of submicroscopic infections and gametocyte carriage of Plasmodium falciparum during peak malaria transmission season in a community-based cross-sectional survey in western Kenya, 2012. Malar J 2016; 15:421. [PMID: 27543112 PMCID: PMC4992329 DOI: 10.1186/s12936-016-1482-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/10/2016] [Indexed: 11/10/2022] Open
Abstract
Background Although malaria control intervention has greatly decreased malaria morbidity and mortality in many African countries, further decline in parasite prevalence has stagnated in western Kenya. In order to assess if malaria transmission reservoir is associated with this stagnation, submicroscopic infection and gametocyte carriage was estimated. Risk factors and associations between malaria control interventions and gametocyte carriage were further investigated in this study. Methods A total of 996 dried blood spot samples were used from two strata, all smear-positives (516 samples) and randomly selected smear-negatives (480 samples), from a community cross-sectional survey conducted at peak transmission season in 2012 in Siaya County, western Kenya. Plasmodium falciparum parasite presence and density were determined by stained blood smear and by 18S mRNA transcripts using nucleic acid sequence-based amplification assay (NASBA), gametocyte presence and density were determined by blood smear and by Pfs25 mRNA-NASBA, and gametocyte diversity by Pfg377 mRNA RT-PCR and RT-qPCR. Results Of the randomly selected smear-negative samples, 69.6 % (334/480) were positive by 18S-NASBA while 18S-NASBA detected 99.6 % (514/516) smear positive samples. Overall, 80.2 % of the weighted population was parasite positive by 18S-NASBA vs 30.6 % by smear diagnosis and 44.0 % of the weighted population was gametocyte positive by Pfs25-NASBA vs 2.6 % by smear diagnosis. Children 5–15 years old were more likely to be parasitaemic and gametocytaemic by NASBA than individuals >15 years old or children <5 years old while gametocyte density decreased with age. Anaemia and self-reported fever within the past 24 h were associated with increased odds of gametocytaemia. Fever was also positively associated with parasite density, but not with gametocyte density. Anti-malarial use within the past 2 weeks decreased the odds of gametocytaemia, but not the odds of parasitaemia. In contrast, recent anti-malarial use was associated with lowered parasite density, but not the gametocyte density. Use of ITNs was associated with lower odds for parasitaemia in part of the study area with a longer history of ITN interventions. In the same part of study area, the odds of having multiple gametocyte alleles were also lower in individuals using ITNs than in those not using ITNs and parasite density was positively associated with gametocyte diversity. Conclusion A large proportion of submicroscopic parasites and gametocytes in western Kenya might contribute to the stagnation in malaria prevalence, suggesting that additional interventions targeting the infectious reservoir are needed. As school aged children and persons with anaemia and fever were major sources for gametocyte reservoir, these groups should be targeted for intervention and prevention to reduce malaria transmission. Anti-malarial use was associated with lower parasite density and odds of gametocytaemia, but not the gametocyte density, indicating a limitation of anti-malarial impact on the transmission reservoir. ITN use had a protective role against parasitaemia and gametocyte diversity in western Kenya. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1482-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Zhiyong Zhou
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Rebecca M Mitchell
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Christopher Odero
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Peter Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kephas Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Philip Onyona
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan E Wiegand
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John E Gimnig
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Edward D Walker
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, MI, USA
| | - Meghna Desai
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ya Ping Shi
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
24
|
Dellicour S, Hill J, Bruce J, Ouma P, Marwanga D, Otieno P, Desai M, Hamel MJ, Kariuki S, Webster J. Effectiveness of the delivery of interventions to prevent malaria in pregnancy in Kenya. Malar J 2016; 15:221. [PMID: 27091142 PMCID: PMC4835845 DOI: 10.1186/s12936-016-1261-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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: 12/19/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background Coverage with malaria in pregnancy interventions remains unacceptably low. Implementation research is needed to identify and quantify the bottlenecks for the delivery and use of these life-saving interventions through antenatal clinics (ANC). Methods A cross-sectional study was carried out in ANC across nine health facilities in western Kenya. Data were collected for an individual ANC visit through structured observations and exit interviews with the same ANC clients. The cumulative and intermediate systems effectiveness for the delivery of intermittent preventive treatment (IPTp) and insecticide-treated nets (ITNs) to eligible pregnant women on this one specific visit to ANC were estimated. Results Overall the ANC systems effectiveness for delivering malaria in pregnancy interventions was suboptimal. Only 40 and 53 % of eligible women received IPTp by directly observed therapy as per policy in hospitals and health centres/dispensaries respectively. The overall systems effectiveness for the receipt of IPTp disregarding directly observed therapy was 62 and 72 % for hospitals and lower level health facilities, respectively. The overall systems effectiveness for ITNs for first ANC visit was 63 and 67 % for hospitals and lower level facilities, respectively. Conclusion This study found that delivery of IPTp and ITNs through ANC was ineffective and more so for higher-level facilities. This illustrates missed opportunities and provider level bottlenecks to the scale up and use of interventions to control malaria in pregnancy delivered through ANC. The high level of clustering within health facilities suggest that future studies should assess the feasibility of implementing interventions to improve systems effectiveness tailored to the health facility level. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1261-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Stephanie Dellicour
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jane Bruce
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter Ouma
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Doris Marwanga
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Peter Otieno
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Meghna Desai
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Mary J Hamel
- Malaria Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Simon Kariuki
- Malaria Branch, Kenya Medical Research Institute Centre for Global Health Research, Kisumu, Kenya
| | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
25
|
Jonnalagadda S, LaCourse SM, Otieno P, Lohman-Payne B, Maleche-Obimbo E, Cranmer LM, John-Stewart GC. Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women. Int J Tuberc Lung Dis 2016; 19:792-8. [PMID: 26056103 DOI: 10.5588/ijtld.14.0878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined. OBJECTIVE To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB. DESIGN We used data and cryopreserved peripheral blood mononuclear cells from a historical cohort of HIV-infected women enrolled at 32 weeks' gestation and followed for 1 year postpartum between 1999 and 2005. RESULTS Of 89 women initially IGRA-negative during pregnancy, 11 (12.4%) became positive, 53 (59.5%) remained negative and 25 (28.1%) were indeterminate at 1 year postpartum. Mean interferon-gamma (IFN-γ) response among converters increased from ~1 to >50 spot-forming cells/well (P = 0.015). IGRA conversion was significantly associated with partner HIV infection, flush toilets, maternal illness and cough during follow-up, but not maternal CD4 count or HIV viral load. CONCLUSION The high rates of IGRA conversion seen among HIV-infected postpartum women in our study are similar to those of other groups at high risk for M. tuberculosis infection. This has important implications for M. tuberculosis infection screening strategies and provision of preventive therapy for the health of women and their infants.
Collapse
Affiliation(s)
- S Jonnalagadda
- Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - S M LaCourse
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - P Otieno
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - B Lohman-Payne
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Paediatrics & Child Health, University of Nairobi, Nairobi, Kenya; Institute for Immunology and Informatics and Department of Cell and Molecular Biology, University of Rhode Island, Providence, Rhode Island, USA
| | | | - L M Cranmer
- Emory School of Medicine and Children's Healthcare of Atlanta, Division of Pediatric Infectious Disease, Atlanta, Georgia, USA
| | - G C John-Stewart
- Department of Epidemiology, Department of Medicine, University of Washington, Seattle, Washington, USA; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA; Department of Global Health, University of Washington, Seattle, USA; Department of Global Health, University of Washington, Seattle, USA
| |
Collapse
|
26
|
Gimnig JE, Otieno P, Were V, Marwanga D, Abong’o D, Wiegand R, Williamson J, Wolkon A, Zhou Y, Bayoh MN, Lobo NF, Laserson K, Kariuki S, Hamel MJ. The Effect of Indoor Residual Spraying on the Prevalence of Malaria Parasite Infection, Clinical Malaria and Anemia in an Area of Perennial Transmission and Moderate Coverage of Insecticide Treated Nets in Western Kenya. PLoS One 2016; 11:e0145282. [PMID: 26731524 PMCID: PMC4701193 DOI: 10.1371/journal.pone.0145282] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 06/08/2015] [Accepted: 12/02/2015] [Indexed: 11/19/2022] Open
Abstract
Background Insecticide treated nets (ITNs) and indoor residual spraying (IRS) have been scaled up for malaria prevention in sub-Saharan Africa. However, there are few studies on the benefit of implementing IRS in areas with moderate to high coverage of ITNs. We evaluated the impact of an IRS program on malaria related outcomes in western Kenya, an area of intense perennial malaria transmission and moderate ITN coverage (55–65% use of any net the previous night). Methods The Kenya Division of Malaria Control, with support from the US President’s Malaria Initiative, conducted IRS in one lowland endemic district with moderate coverage of ITNs. Surveys were conducted in the IRS district and a neighboring district before IRS, after one round of IRS in July-Sept 2008 and after a second round of IRS in April-May 2009. IRS was conducted with pyrethroid insecticides. At each survey, 30 clusters were selected for sampling and within each cluster, 12 compounds were randomly selected. The primary outcomes measured in all residents of selected compounds included malaria parasitemia, clinical malaria (P. falciparum infection plus history of fever) and anemia (Hb<8) of all residents in randomly selected compounds. At each survey round, individuals from the IRS district were matched to those from the non-IRS district using propensity scores and multivariate logistic regression models were constructed based on the matched dataset. Results At baseline and after one round of IRS, there were no differences between the two districts in the prevalence of malaria parasitemia, clinical malaria or anemia. After two rounds of IRS, the prevalence of malaria parasitemia was 6.4% in the IRS district compared to 16.7% in the comparison district (OR = 0.36, 95% CI = 0.22–0.59, p<0.001). The prevalence of clinical malaria was also lower in the IRS district (1.8% vs. 4.9%, OR = 0.37, 95% CI = 0.20–0.68, p = 0.001). The prevalence of anemia was lower in the IRS district but only in children under 5 years of age (2.8% vs. 9.3%, OR = 0.30, 95% CI = 0.13–0.71, p = 0.006). Multivariate models incorporating both IRS and ITNs indicated that both had an impact on malaria parasitemia and clinical malaria but the independent effect of ITNs was reduced in the district that had received two rounds of IRS. There was no statistically significant independent effect of ITNs on the prevalence of anemia in any age group. Conclusions Both IRS and ITNs are effective tools for reducing malaria burden and when implemented in an area of moderate to high transmission with moderate ITN coverage, there may be an added benefit of IRS. The value of adding ITNs to IRS is less clear as their benefits may be masked by IRS. Additional monitoring of malaria control programs that implement ITNs and IRS concurrently is encouraged to better understand how to maximize the benefits of both interventions, particularly in the context of increasing pyrethroid resistance.
Collapse
Affiliation(s)
- John E. Gimnig
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
- * E-mail:
| | - Peter Otieno
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Vincent Were
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Doris Marwanga
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Daisy Abong’o
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Ryan Wiegand
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - John Williamson
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Adam Wolkon
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ying Zhou
- Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - M. Nabie Bayoh
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Neil F. Lobo
- Eck Institute for Global Health, Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Kayla Laserson
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Simon Kariuki
- Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Mary J. Hamel
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
27
|
Lou Z, Bilitewski B, Zhu N, Chai X, Li B, Zhao Y, Otieno P. Greenhouse gas emission and its potential mitigation process from the waste sector in a large-scale exhibition. J Environ Sci (China) 2015; 31:44-50. [PMID: 25968257 DOI: 10.1016/j.jes.2014.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Revised: 10/17/2014] [Accepted: 12/24/2014] [Indexed: 06/04/2023]
Abstract
As one of the largest human activities, World Expo is an important source of anthropogenic Greenhouse Gas emission (GHG), and the GHG emission and other environmental impacts of the Expo Shanghai 2010, where around 59,397 tons of waste was generated during 184 Expo running days, were assessed by life cycle assessment (LCA). Two scenarios, i.e., the actual and expected figures of the waste sector, were assessed and compared, and 124.01 kg CO2-equivalent (CO2-eq.), 4.43 kg SO2-eq., 4.88 kg NO3--eq., and 3509 m3 water per ton tourist waste were found to be released in terms of global warming (GW), acidification (AC), nutrient enrichment (NE) and spoiled groundwater resources (SGWR), respectively. The total GHG emission was around 3499 ton CO2-eq. from the waste sector in Expo Park, among which 86.47% was generated during the waste landfilling at the rate of 107.24 kg CO2-eq., and CH4, CO and other hydrocarbons (HC) were the main contributors. If the waste sorting process had been implemented according to the plan scenario, around 497 ton CO2-eq. savings could have been attained. Unlike municipal solid waste, with more organic matter content, an incineration plant is more suitable for tourist waste disposal due to its high heating value, from the GHG reduction perspective.
Collapse
Affiliation(s)
- Ziyang Lou
- School of Environmental Science and Engineering, Shanghai Jiaotong University, Shanghai 200240, China; Institute for Waste Management and Contaminated Sites Treatment, TU Dresden Faculty of Forestry, Geo and Hydro Sciences, Pratzschwitzer Str. 15, 01796 Pirna, Germany; State Key Laboratory of Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Tongji University, Shanghai 200092, China
| | - Bernd Bilitewski
- Institute for Waste Management and Contaminated Sites Treatment, TU Dresden Faculty of Forestry, Geo and Hydro Sciences, Pratzschwitzer Str. 15, 01796 Pirna, Germany
| | - Nanwen Zhu
- School of Environmental Science and Engineering, Shanghai Jiaotong University, Shanghai 200240, China
| | - Xiaoli Chai
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Tongji University, Shanghai 200092, China
| | - Bing Li
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Tongji University, Shanghai 200092, China
| | - Youcai Zhao
- State Key Laboratory of Pollution Control and Resource Reuse, School of Environmental Science and Engineering, Tongji University, Shanghai 200092, China.
| | - Peter Otieno
- Institute of Ecological Chemistry, Helmholtz Zentrum Müenchen, German National Research Centre for Environmental Health, Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany; Maseno University, Department of Chemistry, P.O. Box 333-40105, Maseno, Kenya
| |
Collapse
|
28
|
Wong J, Hamel MJ, Drakeley CJ, Kariuki S, Shi YP, Lal AA, Nahlen BL, Bloland PB, Lindblade KA, Were V, Otieno K, Otieno P, Odero C, Slutsker L, Vulule JM, Gimnig JE. Serological markers for monitoring historical changes in malaria transmission intensity in a highly endemic region of Western Kenya, 1994-2009. Malar J 2014; 13:451. [PMID: 25416454 PMCID: PMC4258276 DOI: 10.1186/1475-2875-13-451] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [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: 08/17/2014] [Accepted: 11/11/2014] [Indexed: 11/25/2022] Open
Abstract
Background Monitoring local malaria transmission intensity is essential for planning evidence-based control strategies and evaluating their impact over time. Anti-malarial antibodies provide information on cumulative exposure and have proven useful, in areas where transmission has dropped to low sustained levels, for retrospectively reconstructing the timing and magnitude of transmission reduction. It is unclear whether serological markers are also informative in high transmission settings, where interventions may reduce transmission, but to a level where considerable exposure continues. Methods This study was conducted through ongoing KEMRI and CDC collaboration. Asembo, in Western Kenya, is an area where intense malaria transmission was drastically reduced during a 1997–1999 community-randomized, controlled insecticide-treated net (ITN) trial. Two approaches were taken to reconstruct malaria transmission history during the period from 1994 to 2009. First, point measurements were calculated for seroprevalence, mean antibody titre, and seroconversion rate (SCR) against three Plasmodium falciparum antigens (AMA-1, MSP-119, and CSP) at five time points for comparison against traditional malaria indices (parasite prevalence and entomological inoculation rate). Second, within individual post-ITN years, age-stratified seroprevalence data were analysed retrospectively for an abrupt drop in SCR by fitting alternative reversible catalytic conversion models that allowed for change in SCR. Results Generally, point measurements of seroprevalence, antibody titres and SCR produced consistent patterns indicating that a gradual but substantial drop in malaria transmission (46-70%) occurred from 1994 to 2007, followed by a marginal increase beginning in 2008 or 2009. In particular, proportionate changes in seroprevalence and SCR point estimates (relative to 1994 baseline values) for AMA-1 and CSP, but not MSP-119, correlated closely with trends in parasite prevalence throughout the entire 15-year study period. However, retrospective analyses using datasets from 2007, 2008 and 2009 failed to detect any abrupt drop in transmission coinciding with the timing of the 1997–1999 ITN trial. Conclusions In this highly endemic area, serological markers were useful for generating accurate point estimates of malaria transmission intensity, but not for retrospective analysis of historical changes. Further investigation, including exploration of different malaria antigens and/or alternative models of population seroconversion, may yield serological tools that are more informative in high transmission settings. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-451) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jacklyn Wong
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Bayoh MN, Walker ED, Kosgei J, Ombok M, Olang GB, Githeko AK, Killeen GF, Otieno P, Desai M, Lobo NF, Vulule JM, Hamel MJ, Kariuki S, Gimnig JE. Persistently high estimates of late night, indoor exposure to malaria vectors despite high coverage of insecticide treated nets. Parasit Vectors 2014; 7:380. [PMID: 25141761 PMCID: PMC4261540 DOI: 10.1186/1756-3305-7-380] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [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: 06/23/2014] [Accepted: 08/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It has been speculated that widespread and sustained use of insecticide treated bed nets (ITNs) for over 10 years in Asembo, western Kenya, may have selected for changes in the location (indoor versus outdoor) and time (from late night to earlier in the evening) of biting of the predominant species of human malaria vectors (Anopheles funestus, Anopheles gambiae sensu stricto, and Anopheles arabiensis). METHODS Mosquitoes were collected by human landing catches over a six week period in June and July, 2011, indoors and outdoors from 17 h to 07 h, in 75 villages in Asembo, western Kenya. Collections were separated by hour of the night, and mosquitoes were identified to species and tested for sporozoite infection with Plasmodium falciparum. A subset was dissected to determine parity. Human behavior (time going to bed and rising, time spent indoors and outdoors) was quantified by cross-sectional survey. Data from past studies of a similar design and in nearby settings, but conducted before the ITN scale up commenced in the early 2000s, were compared with those from the present study. RESULTS Of 1,960 Anopheles mosquitoes collected in 2011, 1,267 (64.6%) were morphologically identified as An. funestus, 663 (33.8%) as An. gambiae sensu lato (An. gambiae s.s. and An. arabiensis combined), and 30 (1.5%) as other anophelines. Of the 663 An. gambiae s.l. collected, 385 were successfully tested by PCR among which 235 (61.0%) were identified as An. gambiae s.s. while 150 (39.0%) were identified as An. arabiensis. Compared with data collected before the scale-up of ITNs, daily entomological inoculation rates (EIRs) were consistently lower for An. gambiae s.l. (indoor EIR = 0.432 in 1985-1988, 0.458 in 1989-1990, 0.023 in 2011), and An. arabiensis specifically (indoor EIR = 0.532 in 1989-1990, 0.039 in 2009, 0.006 in 2011) but not An. funestus (indoor EIR = 0.029 in 1985-1988, 0.147 in 1989-1990, 0.010 in 2009 and 0.103 in 2011). Sporozoite rates were lowest in 2009 but rose again in 2011. Compared with data collected before the scale-up of ITNs, An. arabiensis and An. funestus were more likely to bite outdoors and/or early in the evening (p < 0.001 for all comparisons). However, when estimates of human exposure that would occur indoors (πi) or while asleep (πs) in the absence of an ITN were generated based on human behavioral patterns, the changes were modest with >90% of exposure of non-ITN users to mosquito bites occurring while people were indoors in all years. The proportion of bites occurring among non-ITN users while they were asleep was ≥90% for all species except for An. arabiensis. For this species, 97% of bites occurred while people were asleep in 1989-1990 while in 2009 and 2011, 80% and 84% of bites occurred while people were asleep for those not using ITNs. Assuming ITNs prevent a theoretical maximum of 93.7% of bites, it was estimated that 64-77% of bites would have occurred among persons using nets while they were asleep in 1989-1990, while 20-52% of bites would have occurred among persons using nets while they were asleep in 2009 and 2011. CONCLUSIONS This study found no evidence to support the contention that populations of Anopheles vectors of malaria in Asembo, western Kenya, are exhibiting departures from the well-known pattern of late night, indoor biting characteristic of these typically highly anthropophilic species. While outdoor, early evening transmission likely does occur in western Kenya, the majority of transmission still occurs indoors, late at night. Therefore, malaria control interventions such as ITNs that aim to reduce indoor biting by mosquitoes should continue to be prioritized.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - John E Gimnig
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
30
|
Hill J, Dellicour S, Bruce J, Ouma P, Smedley J, Otieno P, Ombock M, Kariuki S, Desai M, Hamel MJ, ter Kuile FO, Webster J. Effectiveness of antenatal clinics to deliver intermittent preventive treatment and insecticide treated nets for the control of malaria in pregnancy in Kenya. PLoS One 2013; 8:e64913. [PMID: 23798997 PMCID: PMC3683044 DOI: 10.1371/journal.pone.0064913] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [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: 03/14/2013] [Accepted: 04/19/2013] [Indexed: 12/17/2022] Open
Abstract
Background Malaria in pregnancy can have devastating consequences for mother and baby. Coverage with the WHO prevention strategy for sub-Saharan Africa of intermittent-preventive-treatment (IPTp) with two doses of sulphadoxine-pyrimethamine (SP) and insecticide-treated-nets (ITNs) in pregnancy is low. We analysed household survey data to evaluate the effectiveness of antenatal clinics (ANC) to deliver IPTp and ITNs to pregnant women in Nyando district, Kenya. Methods We assessed the systems effectiveness of ANC to deliver IPTp and ITNs to pregnant women and the impact on low birthweight (LBW). Logistic regression was used to identify predictors of receipt of IPTp and ITN use during pregnancy. Results Among 89% of recently pregnant women who attended ANC at least once between 4–9 months gestation, 59% reported receiving one dose of SP and 90% attended ANC again, of whom 57% received a second dose, resulting in a cumulative effectiveness for IPTp of 27%, most of whom used an ITN (96%). Overall ITN use was 89%, and ANC the main source (76%). Women were less likely to receive IPTp if they had low malaria knowledge (0.26, 95% CI 0.08–0.83), had a child who had died (OR 0.36, 95% CI 0.14–0.95), or if they first attended ANC late (OR 0.20, 95% CI 0.06–0.67). Women who experienced side effects to SP (OR 0.18, CI 0.03–0.90) or had low malaria knowledge (OR 0.78, 95% CI 0.11–5.43) were less likely to receive IPTp by directly observed therapy. Ineffective delivery of IPTp reduced its potential impact by 231 LBW cases averted (95% CI 64–359) per 10,000 pregnant women. Conclusion IPTp presents greater challenges to deliver through ANC than ITNs in this setting. The reduction in public health impact on LBW resulting from ineffective delivery of IPTp is estimated to be substantial. Urgent efforts are required to improve service delivery of this important intervention.
Collapse
Affiliation(s)
- Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Gimnig JE, Walker ED, Otieno P, Kosgei J, Olang G, Ombok M, Williamson J, Marwanga D, Abong'o D, Desai M, Kariuki S, Hamel MJ, Lobo NF, Vulule J, Bayoh MN. Incidence of malaria among mosquito collectors conducting human landing catches in western Kenya. Am J Trop Med Hyg 2012; 88:301-8. [PMID: 23249685 DOI: 10.4269/ajtmh.2012.12-0209] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The human landing catch (HLC) has long been the gold standard for estimating malaria transmission by mosquitoes, but has come under scrutiny because of ethical concerns of exposing collectors to infectious bites. We estimated the incidence of Plasmodium falciparum malaria infection in a cohort of 152 persons conducting HLCs and compared it with that of 147 non-collectors in western Kenya. Participants were presumptively cleared of malaria with Coartem™ (artemether-lumefantrine) and tested for malaria every 2 weeks for 12 weeks. The HLC collections were conducted four nights per week for six weeks. Collectors were provided chemoprophylaxis with Malarone™ (atovaquone-proguanil) during the six weeks of HLC activities and one week after HLC activities were completed. The incidence of malaria was 96.6% lower in collectors than in non-collectors (hazard ratio = 0.034, P < 0.0001). Therefore, with proper prophylaxis, concern about increased risk of malaria among collectors should not be an impediment to conducting HLC studies.
Collapse
Affiliation(s)
- John E Gimnig
- Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Hamel MJ, Otieno P, Bayoh N, Kariuki S, Were V, Marwanga D, Laserson KF, Williamson J, Slutsker L, Gimnig J. The combination of indoor residual spraying and insecticide-treated nets provides added protection against malaria compared with insecticide-treated nets alone. Am J Trop Med Hyg 2012; 85:1080-6. [PMID: 22144448 DOI: 10.4269/ajtmh.2011.10-0684] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Both insecticide-treated bed nets (ITNs) and indoor residual spraying (IRS) reduce malaria in high malaria transmission areas. The combined effect of these interventions is unknown. We conducted a non-randomized prospective cohort study to determine protective efficacy of IRS with ITNs (ITN + IRS) compared with ITNs alone (ITN only) in preventing Plasmodium falciparum parasitemia. At baseline, participants provided blood samples for malaria smears, were presumptively treated for malaria, and received ITNs. Blood smears were made monthly and at sick visits. In total, 1,804 participants were enrolled. Incidence of P. falciparum parasitemia in the ITN + IRS and ITN only groups was 18 and 44 infections per 100 persons-years at risk, respectively (unadjusted rate ratio = 0.41; 95% confidence interval [CI] = 0.31-0.56). Adjusted protective efficacy of ITN + IRS compared with ITN only was 62% (95% CI = 0.50-0.72). The combination of IRS and ITN might be a feasible strategy to further reduce malaria transmission in areas of persistent perennial malaria transmission.
Collapse
Affiliation(s)
- Mary J Hamel
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia 30301, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Marx G, John-Stewart G, Bosire R, Wamalwa D, Otieno P, Farquhar C. Diagnosis of sexually transmitted infections and bacterial vaginosis among HIV-1-infected pregnant women in Nairobi. Int J STD AIDS 2011; 21:549-52. [PMID: 20975086 DOI: 10.1258/ijsa.2010.010005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
HIV-infected women with sexually transmitted infections (STIs) or bacterial vaginosis (BV) during pregnancy are at increased risk for poor obstetric outcomes. In resource-limited settings, diagnostic testing for STIs and BV is often not available and most pregnant women are managed using syndromic algorithms. As part of a Nairobi perinatal cohort, HIV-1-infected pregnant women were interviewed and samples were collected for STIs and BV testing. Diagnostic accuracy of STIs and BV by syndromic algorithms was evaluated with comparison to the reference standard. Among 441 women, prevalence of BV was 37%, trichomoniasis 16%, chlamydia 4%, syphilis 3% and gonorrhoea 2%. Significantly more women with STIs were aged 21-years-old, had not attended secondary school and had a history of STIs. Syndromic diagnosis of STIs and BV demonstrated a sensitivity of 45% and 57%, and positive predictive value of 30% and 42%, respectively. Among these HIV-infected, pregnant women, STIs and vaginal infections were common and syndromic diagnosis was insensitive, resulting in missed opportunities to intervene and improve infant and maternal health.
Collapse
Affiliation(s)
- G Marx
- Department of Medicine, University of Washington, Seattle, USA.
| | | | | | | | | | | |
Collapse
|
34
|
Conteh L, Sicuri E, Manzi F, Hutton G, Obonyo B, Tediosi F, Biao P, Masika P, Matovu F, Otieno P, Gosling RD, Hamel M, Odhiambo FO, Grobusch MP, Kremsner PG, Chandramohan D, Aponte JJ, Egan A, Schellenberg D, Macete E, Slutsker L, Newman RD, Alonso P, Menéndez C, Tanner M. The cost-effectiveness of intermittent preventive treatment for malaria in infants in Sub-Saharan Africa. PLoS One 2010; 5:e10313. [PMID: 20559558 PMCID: PMC2886103 DOI: 10.1371/journal.pone.0010313] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 02/18/2010] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Intermittent preventive treatment in infants (IPTi) has been shown to decrease clinical malaria by approximately 30% in the first year of life and is a promising malaria control strategy for Sub-Saharan Africa which can be delivered alongside the Expanded Programme on Immunisation (EPI). To date, there have been limited data on the cost-effectiveness of this strategy using sulfadoxine pyrimethamine (SP) and no published data on cost-effectiveness using other antimalarials. METHODS We analysed data from 5 countries in sub-Saharan Africa using a total of 5 different IPTi drug regimens; SP, mefloquine (MQ), 3 days of chlorproguanil-dapsone (CD), SP plus 3 days of artesunate (SP-AS3) and 3 days of amodiaquine-artesunate (AQ3-AS3).The cost per malaria episode averted and cost per Disability-Adjusted Life-Year (DALY) averted were modeled using both trial specific protective efficacy (PE) for all IPTi drugs and a pooled PE for IPTi with SP, malaria incidence, an estimated malaria case fatality rate of 1.57%, IPTi delivery costs and country specific provider and household malaria treatment costs. FINDINGS In sites where IPTi had a significant effect on reducing malaria, the cost per episode averted for IPTi-SP was very low, USD 1.36-4.03 based on trial specific data and USD 0.68-2.27 based on the pooled analysis. For IPTi using alternative antimalarials, the lowest cost per case averted was for AQ3-AS3 in western Kenya (USD 4.62) and the highest was for MQ in Korowge, Tanzania (USD 18.56). Where efficacious, based only on intervention costs, IPTi was shown to be cost effective in all the sites and highly cost-effective in all but one of the sites, ranging from USD 2.90 (Ifakara, Tanzania with SP) to USD 39.63 (Korogwe, Tanzania with MQ) per DALY averted. In addition, IPTi reduced health system costs and showed significant savings to households from malaria cases averted. A threshold analysis showed that there is room for the IPTi-efficacy to fall and still remain highly cost effective in all sites where IPTi had a statistically significant effect on clinical malaria. CONCLUSIONS IPTi delivered alongside the EPI is a highly cost effective intervention against clinical malaria with a range of drugs in a range of malaria transmission settings. Where IPTi did not have a statistically significant impact on malaria, generally in low transmission sites, it was not cost effective.
Collapse
Affiliation(s)
- Lesong Conteh
- Swiss Tropical and Public Health Institute, Basel, Switzerland.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Odhiambo FO, Hamel MJ, Williamson J, Lindblade K, ter Kuile FO, Peterson E, Otieno P, Kariuki S, Vulule J, Slutsker L, Newman RD. Intermittent preventive treatment in infants for the prevention of malaria in rural Western kenya: a randomized, double-blind placebo-controlled trial. PLoS One 2010; 5:e10016. [PMID: 20368815 PMCID: PMC2848869 DOI: 10.1371/journal.pone.0010016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [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: 06/10/2009] [Accepted: 03/09/2010] [Indexed: 11/26/2022] Open
Abstract
Background Intermittent preventive treatment in infants (IPTi) with sulphadoxine-pyrimethamine (SP) for the prevention of malaria has shown promising results in six trials. However, resistance to SP is rising and alternative drug combinations need to be evaluated to better understand the role of treatment versus prophylactic effects. Methods Between March 2004 and March 2008, in an area of western Kenya with year round malaria transmission with high seasonal intensity and high usage of insecticide-treated nets, we conducted a randomized, double-blind placebo-controlled trial with SP plus 3 days of artesunate (SP-AS3), 3 days of amodiaquine-artesunate (AQ3-AS3), or 3 days of short-acting chlorproguanil-dapsone (CD3) administered at routine expanded programme of immunization visits (10 weeks, 14 weeks and 9 months). Principal Findings 1,365 subjects were included in the analysis. The incidence of first or only episode of clinical malaria during the first year of life (primary endpoint) was 0.98 episodes/person-year in the placebo group, 0.74 in the SP-AS3 group, 0.76 in the AQ3-AS3 group, and 0.82 in the CD3 group. The protective efficacy (PE) and 95% confidence intervals against the primary endpoint were: 25.7% (6.3, 41.1); 25.9% (6.8, 41.0); and 16.3% (−5.2, 33.5) in the SP-AS3, AQ3-AS3, and CD3 groups, respectively. The PEs for moderate-to-severe anaemia were: 27.5% (−6.9, 50.8); 23.1% (−11.9, 47.2); and 11.4% (−28.6, 39.0). The duration of the protective effect remained significant for up to 5 to 8 weeks for SP-AS3 and AQ3-AS3. There was no evidence for a sustained beneficial or rebound effect in the second year of life. All regimens were well tolerated. Conclusions These results support the view that IPTi with long-acting regimens provide protection against clinical malaria for up to 8 weeks even in the presence of high ITN coverage, and that the prophylactic rather than the treatment effect of IPTi appears central to its protective efficacy. Trial Registration ClinicalTrials.gov NCT00111163
Collapse
Affiliation(s)
- Frank O Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Farquhar C, VanCott T, Bosire R, Bermudez C, Mbori-Ngacha D, Lohman-Payne B, Nduati R, Otieno P, John-Stewart G. Salivary human immunodeficiency virus (HIV)-1-specific immunoglobulin A in HIV-1-exposed infants in Kenya. Clin Exp Immunol 2008; 153:37-43. [PMID: 18505437 DOI: 10.1111/j.1365-2249.2008.03664.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Humoral immunity, and specifically immunoglobulin A (IgA) that is directed against human immunodeficiency virus (HIV)-1, may contribute to protection against HIV-1 acquisition at mucosal surfaces. HIV-1-specific IgA has been detected in genital tract secretions of HIV-1-uninfected commercial sex workers with HIV-1 exposure, and may be produced in parotid saliva by infants exposed orally to HIV-1 during delivery and breastfeeding. To explore this hypothesis, we collected saliva from 145 infants aged < or = 6 months enrolled in a perinatal HIV-1 transmission study in Nairobi and from 55 control infants without HIV-1 exposure who were born to HIV-1-seronegative mothers. Among the 145 infants, 115 (79%) remained uninfected during the 12-month study period and 30 (21%) became HIV-1-infected during follow-up. Nine (8%) of the 115 HIV-1-exposed, uninfected infants had detectable levels of HIV-1 gp160-specific IgA compared with four (13%) of 30 infected infants and none of 55 control infants (P = 0.47 and P = 0.03 respectively). Among the nine HIV-1-exposed, uninfected infants with positive assays, median age was 1 month and none acquired HIV-1 during follow-up. We conclude that HIV-1-specific salivary IgA responses may be generated by very young infants exposed perinatally to maternal HIV-1. Mucosal responses would be an appropriate target for paediatric vaccines against breast milk HIV-1 transmission.
Collapse
Affiliation(s)
- C Farquhar
- Department of Medicine, University of Washington, Seattle, Washington 98104-2499, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Gichuhi C, Obimbo E, Mbori-Ngacha D, Mwatha A, Otieno P, Farquhar C, Wariua G, Wamalwa D, Bosire R, John-Stewart G. Predictors of mortality in HIV-1 exposed uninfected post-neonatal infants at the Kenyatta National Hospital, Nairobi. ACTA ACUST UNITED AC 2006; 82:447-51. [PMID: 16619717 DOI: 10.4314/eamj.v82i9.9334] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To identify potential predictors of mortality, to determine mortality rate and to identify prevalent causes of death in a cohort of HIV-1 exposed uninfected infants. DESIGN Prospective cohort study. SETTING Kenyatta National Hospital, Nairobi, Kenya. SUBJECTS Three hundred and fifty one HIV-1 exposed uninfected post-neonatal infants who survived to one year of age. RESULTS Sixteen infants died (post-neonatal mortality rate of 47/1000 live births), 14 (88%) before six months of age. The most frequently identified medical conditions at death included bronchopneumonia, diarrhoea and failure to thrive. In multivariate analysis, prematurity (RR=10.5, 95%CI 3.8-29.1, p<0.001), teenage motherhood (RR=3.6, Cl 1.0-13.2, p=0.05) and symptomatic maternal HIV-1 disease (RR=2.7, CI 0.9-7.7, p=0.06) were associated with infant mortality. CONCLUSION Prematurity, teenage motherhood and symptomatic HIV-1 maternal disease were important predictors for post-neonatal mortality in this cohort of HIV-1 exposed uninfected infants. These factors should be considered in monitoring and follow up in prevention of mother-to-child HIV-1 transmission (PMTCT) programs.
Collapse
Affiliation(s)
- C Gichuhi
- Department of Clinical Pharmacology and Therapeutics, College of Health Sciences, University of Nairobi, P.O. Box 19676, Nairobi, Kenya
| | | | | | | | | | | | | | | | | | | |
Collapse
|