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Mchenga M, Burger R, von Fintel D. Can women's reports in client exit interviews be used to measure and track progress of antenatal care services quality? Evidence from a facility assessment census in Malawi. PLoS One 2023; 18:e0274650. [PMID: 37523376 PMCID: PMC10389737 DOI: 10.1371/journal.pone.0274650] [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] [Received: 08/31/2022] [Accepted: 07/12/2023] [Indexed: 08/02/2023] Open
Abstract
INTRODUCTION Unlike household surveys, client exit interviews are conducted immediately after a consultation and therefore provides an opportunity to capture routine performance and level of service quality. This study examines the validity and reliability of women's reports on selected ANC interventions in exit interviews conducted in Malawi. METHODS Using data from the 2013-2014 Malawi service provision facility census, we compared women's reports in exit interviews regarding the contents of ANC received with reports obtained through direct observation by a trained healthcare professional. The validity of six indicators was tested using two measures: the area under the receiver operating characteristic curve (AUC), and the inflation factor (IF). Reliability of women's reports was measured using the Kappa coefficient (κ) and the prevalence-adjusted bias-adjusted kappa (PABAK). Finally, we examined whether reporting reliability varied significantly by individual and facility characteristics. RESULTS Of the six indicators, two concrete and observable measures had high reporting accuracy and met the validity criteria for both AUC ≥ 0.7 and 0.75>IF>1.25, namely whether the provider prescribed or gave malaria prophylaxis (AUC: 0.84, 95% CI: 0.83-0.86; IF: 0.96) or iron/folic tablets (AUC: (0.84 95% CI: 0.81-0.87; IF:1.00). Whereas four measures related to counselling had lower reporting accuracy: whether the provider offered counselling about nutrition in pregnancy (AUC: 0.69, 95%CI: 0.67-0.71; IF = 1.26), delivery preparation (AUC: 0.62, 95% CI: 0.60-065; IF = 0.99), pregnancy related complications (AUC: 0.59, 95%CI: 0.56-0.61; IF = 1.11), and iron/folic acid side effects (AUC:0.58, 95% CI: 0.55-0.60; IF = 1.42). Similarly, the observable measures had high reliability with both κ and PABAK values in the ranges of ≥ 0.61 and ≥ 0.80. Respondent's age, primiparous status, number of antenatal visits, and the type of health provider increased the likelihood of reporting reliability. CONCLUSION In order to enhance the measurement of quality of ANC services, our study emphasizes the importance of carefully considering the type of information women are asked to recall and the timing of the interviews. While household survey programmes such as the demographic health survey and multiple indicator cluster survey are commonly used as data sources for measuring intervention coverage and quality, policy makers should complement such data with more reliable sources like routine data from health information systems.
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Affiliation(s)
- Martina Mchenga
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Graduate School of Economic Sciences and Management, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
| | - Dieter von Fintel
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
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Mkupete MJ, Von Fintel D, Burger R. Decomposing inequality of opportunity in child health in Tanzania: The role of access to water and sanitation. Health Econ 2022; 31:2465-2480. [PMID: 35997640 PMCID: PMC9805148 DOI: 10.1002/hec.4591] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
Poor child nutrition is a major public health challenge in Tanzania. Large between and within regional nutritional inequalities exist in rural and urban areas. We looked at how locational circumstances hinder children from having an equal opportunity for good nutrition. We used the 2008/09 Living Standards Measurement Study data for Tanzania to identify the part played by water and sanitation in rural and urban inequality of opportunity in child nutrition. We used the dissimilarity index and the Shapley decomposition technique to quantify and decompose inequality of opportunity in nutrition. We find that 16% of the circumstance-driven inequality of opportunity needs to be redistributed for equality of opportunity to prevail. We find that in rural areas, about 42% of the inequality of opportunity in nutrition is due to water and sanitation problems and 22% to child age. In urban areas, we find that the inequality of opportunity is related mainly to the child's sex, price fluctuations and intergenerational factors. The findings suggest that policies to improve water and sanitation coverage could help equalize opportunities for children in rural areas. In urban areas, policies that could help equalize opportunities require incentives to change social norms and behavior around feeding practices and vaccination.
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Affiliation(s)
- Mkupete Jaah Mkupete
- University of Dar es SalaamDar es SalaamTanzania
- Stellenbosch UniversityStellenboschSouth Africa
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Decosterd L, Mercier T, Ternon B, Cruchon S, Guignard N, Lahrichi S, Pesse B, Rochat B, Burger R, Lamoth F, Pagani JL, Eggimann P, Csajka C, Choong E, Buclin T, Widmer N, André P, Marchetti O. Corrigendum to “Validation and clinical application of a multiplex high performance liquid chromatography – Tandem mass spectrometry assay for the monitoring of plasma concentrations of 12 antibiotics in patients with severe bacterial infections” [J. Chromatogr. B 1157 (2020) 122160]. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1211:123497. [DOI: 10.1016/j.jchromb.2022.123497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mercier T, Desfontaine V, Cruchon S, Da Silva Pereira Clara J, Briki M, Mazza-Stalder J, Kajkus A, Burger R, Suttels V, Buclin T, Opota O, Koehler N, Sanchez Carballo P, Lange C, André P, Decosterd L, Choong E. A battery of tandem mass spectrometry assays with stable isotope-dilution for the quantification of 15 anti-tuberculosis drugs and two metabolites in patients with susceptible-, multidrug- resistant- and extensively drug-resistant tuberculosis. J Chromatogr B Analyt Technol Biomed Life Sci 2022; 1211:123456. [DOI: 10.1016/j.jchromb.2022.123456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/25/2022]
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Gangaidzo T, von Fintel M, Schutte AE, Burger R. Stressful life events, neighbourhood characteristics, and systolic blood pressure in South Africa. J Hum Hypertens 2022; 37:405-411. [PMID: 35513441 DOI: 10.1038/s41371-022-00695-9] [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] [Received: 11/22/2021] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022]
Abstract
The relationship between negative events, neighbourhood characteristics, and systolic blood pressure in developing countries is not well-documented, particularly using longitudinal data. To explore this relationship, we analysed panel data from the first three waves of the South African National Income Dynamics Study using a correlated random effects model adjusted for confounding risk factors. Our sample comprised of 15,631 respondents in 2008, 14,443 respondents in 2010/2011, and 14,418 respondents in 2012, all aged above 15 years. The prevalence of at least one negative household event across the three waves was approximately 30%. In any of the three waves, the adjusted prevalence of hypertension was 23.84%. This share was 21.75% in 2008 (95% CI 18.06-25.44), 23.16% in 2010/11 (95% CI 19.18-27.14), and 18.39% in 2012 (95% CI 16.03-20.75). In our adjusted correlated random effects model, we found that systolic blood pressure was significantly higher among respondents from households that reported death of a household member (0.85 mmHg; p = 0.02) and a reduction in grant income and remittances (2.14 mm Hg; p = 0.01). We also found no significant association between systolic blood pressure and neighbourhood income level. In a country with social and economic challenges, our results indicate that grief and negative financial events are adversely associated with blood pressure, which may explain in part the significant burden of hypertension in low- and middle-income countries.
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Affiliation(s)
- Trust Gangaidzo
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
| | - Marisa von Fintel
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Aletta Elisabeth Schutte
- School of Population Health, University of New South Wales; The George Institute for Global Health, Sydney, NSW, Australia.,Hypertension in Africa Research Team (HART); MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
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Taurines R, Fekete S, Preuss-Wiedenhoff A, Warnke A, Wewetzer C, Plener P, Burger R, Gerlach M, Romanos M, Egberts KM. Therapeutic drug monitoring in children and adolescents with schizophrenia and other psychotic disorders using risperidone. J Neural Transm (Vienna) 2022; 129:689-701. [PMID: 35303169 PMCID: PMC9188514 DOI: 10.1007/s00702-022-02485-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 02/24/2022] [Indexed: 01/31/2023]
Abstract
Risperidone is commonly used to treat different psychiatric disorders worldwide. Knowledge on dose–concentration relationships of risperidone treatment in children and adolescents with schizophrenia or other psychotic disorders is, however, scarce and no age-specific therapeutic ranges have been established yet. Multicenter data of a therapeutic drug monitoring service were analyzed to evaluate the relationship between risperidone dose and serum concentration of the active moiety (risperidone (RIS) plus its main metabolite 9-hydroxyrisperidone (9-OH-RIS)) in children and adolescents with psychotic disorders. Patient characteristics, doses, serum concentrations and therapeutic outcomes were assessed by standardized measures. The study also aimed to evaluate whether the therapeutic reference range for adults (20–60 ng/ml) is applicable for minors. In the 64 patients (aged 11–18 years) included, a positive correlation between daily dose and the active moiety (RISam) concentration was found (rs = 0.49, p = 0.001) with variation in dose explaining 24% (rs2 = 0.240) of the variability in serum concentrations. While the RISam concentration showed no difference, RIS as well 9-OH-RIS concentrations and the parent to metabolite ratio varied significantly in patients with co-medication of a CYP2D6 inhibitor. Patients with extrapyramidal symptoms (EPS) had on average higher RISam concentrations than patients without (p = 0.05). Considering EPS, the upper threshold of the therapeutic range of RISam was determined to be 33 ng/ml. A rough estimation method also indicated a possibly decreased lower limit of the preliminary therapeutic range in minors compared to adults. These preliminary data may contribute to the definition of a therapeutic window in children and adolescents with schizophrenic disorders treated with risperidone. TDM is recommended in this vulnerable population to prevent concentration-related adverse drug reactions.
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Affiliation(s)
- R Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - S Fekete
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - A Preuss-Wiedenhoff
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - A Warnke
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - C Wewetzer
- Clinic for Child and Adolescent Psychiatry and Psychotherapy, Clinics of the City Cologne GmbH, Cologne, Germany
| | - P Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - R Burger
- Department of Psychiatry, Psychosomatics and Psychotherapy, Laboratory for Therapeutic Drug Monitoring, Centre for Mental Health, University Hospital of Wuerzburg, Wuerzburg, Germany
| | - M Gerlach
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - M Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany
| | - K M Egberts
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center for Mental Health, University Hospital of Wuerzburg, Margarete-Hoeppel-Platz 1, 97080, Wuerzburg, Germany.
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Burger R, Köhler T, Golos AM, Buttenheim AM, English R, Tameris M, Maughan-Brown B. Longitudinal changes in COVID-19 vaccination intent among South African adults: evidence from the NIDS-CRAM panel survey, February to May 2021. BMC Public Health 2022; 22:422. [PMID: 35236319 PMCID: PMC8889513 DOI: 10.1186/s12889-022-12826-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 08/06/2021] [Accepted: 02/04/2022] [Indexed: 12/13/2022] Open
Abstract
Background COVID-19 vaccine hesitancy has threatened the ability of many countries worldwide to contain the pandemic. Given the severe impact of the pandemic in South Africa and disruptions to the roll-out of the vaccine in early 2021, slower-than-expected uptake is a pressing public health challenge in the country. We examined longitudinal changes in COVID-19 vaccination intent among South African adults, as well as determinants of intent to receive a vaccine. Methods We used longitudinal data from Wave 4 (February/March 2021) and Wave 5 (April/May 2021) of the National Income Dynamics Study: Coronavirus Rapid Mobile Survey (NIDS-CRAM), a national and broadly representative panel survey of adults in South Africa. We conducted cross-sectional analyses on aggregate and between-group variation in vaccination intent, examined individual-level changes between waves, and modeled demographic predictors of intent. Results We analysed data for 5629 (Wave 4; 48% male, mean age 41.5 years) and 5862 (Wave 5; 48% male, mean age 41.6 years) respondents. Willingness to get a COVID-19 vaccine significantly increased from 70.8% (95% CI: 68.5–73.1) in Wave 4 to 76.1% (95% CI: 74.2–77.8) in Wave 5. Individual-level analyses indicated that only 6.6% of respondents remained strongly hesitant between survey waves. Although respondents aged 18–24 years were 8.5 percentage points more likely to report hesitancy, hesitant respondents in this group were 5.6 percentage points more likely to change their minds by Wave 5. Concerns about rushed testing and safety of the vaccines were frequent and strongly-held reasons for hesitancy. Conclusions Willingness to receive a COVID-19 vaccine has increased among adults in South Africa, and those who were entrenched in their reluctance make up a small proportion of the country’s population. Younger adults, those in formal housing, and those who trusted COVID-19 information on social media were more likely to be hesitant. Given that stated vaccination intent may not translate into behaviour, our finding that three-quarters of the population were willing to accept the vaccine may reflect an upper bound. Vaccination promotion campaigns should continue to frame vaccine acceptance as the norm and tailor strategies to different demographic groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12826-5.
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Affiliation(s)
- Ronelle Burger
- Research on Socio-Economic Policy, Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Timothy Köhler
- Development Policy Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
| | - Aleksandra M Golos
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Alison M Buttenheim
- Department of Family and Community Health, University of Pennsylvania School of Nursing, 416 Fagin Hall, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - René English
- Division of Health Systems and Public Health. Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Michele Tameris
- South African Tuberculosis Vaccine Initiative, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit, School of Economics, University of Cape Town, Cape Town, South Africa
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Grüne B, Burger R, Bauer D, Schäfer A, Rothfuss A, Stallkamp J, Kriegmair M, Rassweiler-Seyfried MC. Robotic-assisted versus manual Uro-Dyna CT-guided puncture in an ex-vivo kidney model. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)01095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Burger R, Christian C, English R, Maughan-Brown B, Rossouw L. Predictors of mask-wearing during the advent of the COVID-19 pandemic: Evidence from South Africa. Transl Behav Med 2021; 12:6448738. [PMID: 34865174 PMCID: PMC8690224 DOI: 10.1093/tbm/ibab132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background In the absence of a vaccine, the global spread of COVID-19 during 2020 has necessitated non-pharmaceutical interventions to curb the rise of cases. Purpose The article uses the health belief model and a novel rapid mobile survey to examine correlates of reported mask-wearing as a non-pharmaceutical intervention in South Africa between May and August 2020. Methods Two-way tabulations and multivariable analysis via logistic regression modeling describe correlations between reported mask-wearing and factors of interest among a sample of 7074 adults in a two-period national longitudinal survey, the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM). Results In line with the health belief model, results showed that self-efficacy, the prevalence of others’ mask-wearing in the same district, and affluence were positively associated with reported mask-wearing. Those who reported staying at home were significantly less likely to report wearing a mask. There was little evidence that the expected severity of the disease if contracted, affects these decisions. Hypertension, obesity, or being overweight (measured three years earlier) did not have a significant association with mask-wearing. The prevalence of mask-wearing increased significantly from May to August 2020 as COVID-19 cases increased and lockdown restrictions were eased. Contrary to the health belief model, we found that despite having a higher mortality risk, the elderly had significantly lower odds of mask-wearing. Conclusion In South Africa, the mask-wearing adherence has increased rapidly. It is concerning that the elderly had lower odds of mask-wearing. This should be examined further in future research.
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Affiliation(s)
- Ronelle Burger
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
| | - Carmen Christian
- Economics Department, University of the Western Cape, Cape Town, South Africa
| | - Rene English
- Division of Health Systems and Public Health, Global Health Department, Stellenbosch University, Tygerberg campus, Cape Town, South Africa
| | - Brendan Maughan-Brown
- The Southern Africa Labour and Development Research Unit, University of Cape Town, Cape Town, South Africa
| | - Laura Rossouw
- School of Economics and Finance, University of the Witwatersrand, Johannesburg, South Africa
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Burger R, Caldwell J, Claassens M, Mama K, Naidoo P, Rieger M, Rossouw L, van Doorslaer E, Wagstaff A. Who is more likely to return for TB test results? A survey at three high-burden primary healthcare facilities in Cape Town, South Africa. Int J Infect Dis 2021; 113:259-267. [PMID: 34653655 DOI: 10.1016/j.ijid.2021.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 10/06/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In low- and middle-income countries with a high burden of tuberculosis (TB), a large proportion of people who are tested for TB do not return to the health facility to collect their test results and initiate treatment, thus putting themselves at increased risk of adverse outcomes. METHODS This prospective study aimed to identify predictors of returning to the primary health care (PHC) facility to collect TB test results. From 15 August to 15 December 2017, 1105 people who tested for pulmonary TB at three Cape Town PHC facilities were surveyed. Using multi-variate logistic regressions on an analysis sample of 1097 people, three groups of predictors were considered: (i) demographics, health and socio-economic status; (ii) costs and benefits; and (iii) behavioural factors. RESULTS Forty-four percent of people tested returned to the PHC facility to collect their test results within the stipulated 2 days, and 68% returned before the end of the study period. Return was strongly and positively correlated with expecting a TB-positive result, cognitive avoidance and postponement behaviour. CONCLUSION Interventions to improve pre-treatment loss to follow-up should target patients who think they do not have TB, and those with a history of postponement behaviour and cognitive avoidance.
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Affiliation(s)
- Ronelle Burger
- Economics Department, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Mareli Claassens
- Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia; Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Khanya Mama
- Economics Department, University of Stellenbosch, Stellenbosch, South Africa
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Matthias Rieger
- International Institute of Social Studies, Erasmus University Rotterdam, Den Haag, The Netherlands.
| | - Laura Rossouw
- Economics Department, University of Stellenbosch, Stellenbosch, South Africa
| | - Eddy van Doorslaer
- Economics Department, University of Stellenbosch, Stellenbosch, South Africa; Erasmus School of Economics, Erasmus University Rotterdam, Den Haag, The Netherlands; Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Den Haag, The Netherlands; Stellenbosch Institute of Advanced Study, Stellenbosch, South Africa
| | - Adam Wagstaff
- Development Research Group, World Bank, Washington, DC, USA
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Rossouw L, Burger RP, Burger R. Testing an Incentive-Based and Community Health Worker Package Intervention to Improve Maternal Health and Nutrition Outcomes: A Pilot Randomized Controlled Trial. Matern Child Health J 2021; 25:1913-1922. [PMID: 34618311 DOI: 10.1007/s10995-021-03229-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In order to address South Africa's maternal and infant mortality and morbidity rates, patient and community-level preventable factors need to be identified and addressed. However, there are few rigorously implemented and tested studies in low- and middle-income countries that evaluate the impact of community-level interventions on maternal and infant health outcomes. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on maternal depressive symptoms, maternal nutrition and intention to exclusively breastfeed. METHOD The intervention was tested using a pilot randomised controlled trial consisting of 72 (39 treatment and 33 control) adult women, implemented in a low-income, peri-urban area in Cape Town, South Africa. Data was collected using a baseline questionnaire conducted shortly after recruitment, and an end line questionnaire conducted a week after giving birth. RESULTS The intervention resulted in a 0.928-point drop in the maternal depressive symptom scale (which ranges from 1 to 8). We find no evidence that the intervention has either a sizeable or precisely estimated impact on maternal nutrition, measured using middle-upper arm circumference. While the intervention has almost no effect on the infant feeding intention of women who own refrigerators, it has a very large positive effect of 3.349-points (on a scale ranging from 1 to 8) for women without refrigerators. CONCLUSION A package intervention consisting of psycho-social support, additional tailored health information, and an incentive to utilise public antenatal care services has the potential to increase exclusive breastfeeding intention and reduce maternal depressive symptoms among the economically vulnerable.
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Affiliation(s)
- Laura Rossouw
- School of Economics and Finance, University of the Witwatersrand, 1 Jan Smuts Ave, Johannesburg, South Africa.
| | - Rulof Petrus Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Burger R, Bolton WS, Mathew RK. Challenges and opportunities in academic neurosurgery. Br J Hosp Med (Lond) 2021; 82:1-7. [PMID: 34726938 DOI: 10.12968/hmed.2021.0297] [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] [Indexed: 11/11/2022]
Abstract
Clinical academia aims to bridge the gap between clinicians and scientists, by combining academic activity with clinical practice. The term 'clinical academics' generally refers to clinicians who have protected time within their job plans for undertaking academic activities. Engagement with academic activity by trainees is not only essential to fulfil necessary curriculum competencies, but also allows them to explore areas of interest outside of clinical practice and develop advanced academic skills. This article provides an overview of different routes into academic neurosurgery, and discusses the advantages and difficulties in pursuing this career path. It also covers the differences between postgraduate research degrees and explores the different job plan models available at consultant level. Academic neurosurgery is a rewarding career and opportunities should be made available to those who wish to explore it further. Developing academic careers may have a positive impact on wider workforce planning strategies and improve the delivery of high-quality evidence-based neurosurgical care.
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Affiliation(s)
- R Burger
- Department of Neurosurgery, King's College Hospital, London, UK
| | - W S Bolton
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R K Mathew
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK.,Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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Cheng VWT, Heywood R, Zakaria R, Burger R, Fitzpatrick A, Zucker K, Sanghera P, Doherty GJ, Palmieri C, Jenkinson MD. P14.70 BMScope: A systematic mapping review of brain/leptomeningeal metastasis clinical studies from 2010 to 2020. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.177] [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
Brain metastasis (BM) and leptomeningeal disease (LMD) are typified by a poor prognosis and are an area of unmet clinical need. Historically, patients with central nervous system (CNS) disease have been excluded from systemic therapy clinical trials, particularly with active/leptomeningeal disease. However, increasing prevalence of CNS metastasis is leading to greater interest in BM/LMD. We performed a descriptive analysis of clinical studies investigating BM/LMD management, published between Jan 2010 to Mar 2020.
METHODS
A comprehensive, customised search strategy was devised for 12 online bibliographic databases, using the following concepts: “clinical study”, “brain metastasis”, “leptomeningeal disease”, “intervention”, “patient-related outcome”. Double screening for inclusion/exclusion was performed on the Rayyan QCRI web application. Published abstracts were also screened for inclusion from ASCO, ESMO, SNO and EANO between 2015–2020. Following full text screening, conflicts were resolved by consensus and data were extracted using an online standardised tool. Data analysis and data visualisation were performed on the R statistical package.
RESULTS
Overall, 33118 published studies were double screened; 2632 full publications and 628 abstracts were included. Of these, 14.7% reported on unique interventional clinical trials (phase 2 = 267; phase 3 = 80). More than three times the number of clinical trials investigating systemic agents as the sole therapy for BM/LMD were published in Q1 2020 compared to the whole of 2010 (16 vs 5). 42.5% of clinical trials employed a form of local therapy (brain targeted radiotherapy or neurosurgery). Studies reported on patients with BM (n = 2738), LMD (n = 110) or both (n = 119). The majority of studies were performed in North America, Europe or East Asia (88.5% vs 11.5% rest of the world). The top 3 nations involved in published studies were the USA (n = 1155), China (n = 351) and Germany (n = 334). Network analysis demonstrated increasing links between countries. In line with expected BM prevalence, the main tumour sites studied were lung (23.4%), gastrointestinal (17.5%), breast (15%) and melanoma (12.5%). A rising trend of published BM/LMD studies over time was noted, with 83 observational studies/10 clinical trials in 2010 vs. 454 observational studies/80 clinical trials in 2019.
CONCLUSION
These findings demonstrate that over the last decade there has been a growth in BM/LMD research; likely reflecting an increasing disease prevalence, availability of novel and potentially CNS active agents, as well as more advanced local therapy modalities. BM/LMD clinical research is dominated by a few geographical regions and nations; however, there is an apparent shift to more international collaboration. This comprehensive mapping exercise will enable targeted systematic reviews of the existing evidence base on BM/LMD management.
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Affiliation(s)
- V W T Cheng
- Leeds Institute of Medical Research, Leeds, United Kingdom
| | - R Heywood
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Zakaria
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Burger
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - A Fitzpatrick
- Institute of Cancer Research, London, United Kingdom
| | - K Zucker
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - P Sanghera
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - G J Doherty
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - M D Jenkinson
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
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14
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Bredenkamp C, Burger R, Jourdan A, Van Doorslaer E. Changing Inequalities in Health-Adjusted Life Expectancy by Income and Race in South Africa. Health Syst Reform 2021; 7:e1909303. [PMID: 34402377 DOI: 10.1080/23288604.2021.1909303] [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] [Indexed: 10/20/2022] Open
Abstract
Trends in socioeconomic-related health inequalities is a particularly pertinent topic in South Africa where years of systematic discrimination under apartheid bequeathed a legacy of inequalities in health outcomes. We use three nationally representative datasets to examine trends in income- and race-related inequalities in life expectancy (LE) and health-adjusted life expectancy (HALE) since the beginning of the millennium. We find that, in aggregate, (HA)LE at age five fell substantially between 2001 and 2007, but then increased to above 2001 levels by 2016, with the largest changes observed among prime age adults. Income- and race-related inequalities in both LE and HALE favor relatively well-off and non-Black South Africans in all survey years. Both income- and race-related inequalities in (HA)LE grew between 2001 and 2007, and then narrowed between 2007 to 2016. However, while race-related inequalities in (HA)LE in 2016 were smaller than in 2001, income-related inequalities in (HA)LE were greater in 2016 than in 2001. Based on the patterns and timing observed, these trends in income- and race-related inequalities in (HA)LE are most likely related to the delayed initial policy response to the HIV epidemic, the subsequent rapid and effective rollout of anti-retroviral therapy, and the changes in the overall income distribution among Black South Africans. In particular, the growth of the Black middle class narrowed the HA(LE) gap with the non-Black population but reinforced income-related inequalities.
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Affiliation(s)
- Caryn Bredenkamp
- Human Development Practice Group, World Bank, Washington, District Columbia, USA.,Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Alyssa Jourdan
- Debt and Capital Advisory, Deloitte Financial Advisory, Amsterdam, The Netherlands
| | - Eddy Van Doorslaer
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa.,Erasmus School of Health Policy and Management and Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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15
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Hompashe DM, Gerdtham UG, Christian CS, Smith A, Burger R. 'The nurse did not even greet me': how informed versus non-informed patients evaluate health systems responsiveness in South Africa. BMJ Glob Health 2021; 6:bmjgh-2020-004360. [PMID: 33893142 PMCID: PMC8074562 DOI: 10.1136/bmjgh-2020-004360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/13/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Universal Health Coverage is not only about access to health services but also about access to high-quality care, since poor experiences may deter patients from accessing care. Evidence shows that quality of care drives health outcomes, yet little is known about non-clinical dimensions of care, and patients’ experience thereof relative to satisfaction with visits. This paper investigates the role of non-clinical dimensions of care in patient satisfaction. Methods Our study describes the interactions of informed and non-informed patients with primary healthcare workers at 39 public healthcare facilities in two metropolitan centres in two South African provinces. Our analysis included 1357 interactions using standardised patients (for informed patients) and patients’ exit interviews (for non-informed patients). The data were combined for three types of visits: contraception, hypertension and tuberculosis. We describe how satisfaction with care was related to patients’ experiences of non-clinical dimensions. Results We show that when real patients (RPs) reported being satisfied (vs dissatisfied) with a visit, it was associated with a 30% increase in the probability that a patient is greeted at the facilities. Likewise, when the RPs reported being satisfied (vs dissatisfied) with the visit, it was correlated with a 15% increase in the prospect that patients are pleased with healthcare workers’ explanations of health conditions. Conclusion Informed patients are better equipped to assess health-systems responsiveness in healthcare provision. Insights into responsiveness could guide broader efforts aimed at targeted education and empowerment of primary healthcare users to strengthen health systems and shape expectations for appropriate care and conduct.
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Affiliation(s)
- Dumisani MacDonald Hompashe
- Economics, University of Fort Hare Faculty of Management and Commerce, Alice, South Africa .,Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
| | | | | | - Anja Smith
- Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
| | - Ronelle Burger
- Economics, Stellenbosch University Faculty of Economic and Management Sciences, Stellenbosch, South Africa
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16
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Thomas R, Probert WJM, Sauter R, Mwenge L, Singh S, Kanema S, Vanqa N, Harper A, Burger R, Cori A, Pickles M, Bell-Mandla N, Yang B, Bwalya J, Phiri M, Shanaube K, Floyd S, Donnell D, Bock P, Ayles H, Fidler S, Hayes RJ, Fraser C, Hauck K. Cost and cost-effectiveness of a universal HIV testing and treatment intervention in Zambia and South Africa: evidence and projections from the HPTN 071 (PopART) trial. Lancet Glob Health 2021; 9:e668-e680. [PMID: 33721566 PMCID: PMC8050197 DOI: 10.1016/s2214-109x(21)00034-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 12/15/2020] [Accepted: 01/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The HPTN 071 (PopART) trial showed that a combination HIV prevention package including universal HIV testing and treatment (UTT) reduced population-level incidence of HIV compared with standard care. However, evidence is scarce on the costs and cost-effectiveness of such an intervention. METHODS Using an individual-based model, we simulated the PopART intervention and standard care with antiretroviral therapy (ART) provided according to national guidelines for the 21 trial communities in Zambia and South Africa (for all individuals aged >14 years), with model parameters and primary cost data collected during the PopART trial and from published sources. Two intervention scenarios were modelled: annual rounds of PopART from 2014 to 2030 (PopART 2014-30; as the UNAIDS Fast-Track target year) and three rounds of PopART throughout the trial intervention period (PopART 2014-17). For each country, we calculated incremental cost-effectiveness ratios (ICERs) as the cost per disability-adjusted life-year (DALY) and cost per HIV infection averted. Cost-effectiveness acceptability curves were used to indicate the probability of PopART being cost-effective compared with standard care at different thresholds of cost per DALY averted. We also assessed budget impact by projecting undiscounted costs of the intervention compared with standard care up to 2030. FINDINGS During 2014-17, the mean cost per person per year of delivering home-based HIV counselling and testing, linkage to care, promotion of ART adherence, and voluntary medical male circumcision via community HIV care providers for the simulated population was US$6·53 (SD 0·29) in Zambia and US$7·93 (0·16) in South Africa. In the PopART 2014-30 scenario, median ICERs for PopART delivered annually until 2030 were $2111 (95% credible interval [CrI] 1827-2462) per HIV infection averted in Zambia and $3248 (2472-3963) per HIV infection averted in South Africa; and $593 (95% CrI 526-674) per DALY averted in Zambia and $645 (538-757) per DALY averted in South Africa. In the PopART 2014-17 scenario, PopART averted one infection at a cost of $1318 (1098-1591) in Zambia and $2236 (1601-2916) in South Africa, and averted one DALY at $258 (225-298) in Zambia and $326 (266-391) in South Africa, when outcomes were projected until 2030. The intervention had almost 100% probability of being cost-effective at thresholds greater than $700 per DALY averted in Zambia, and greater than $800 per DALY averted in South Africa, in the PopART 2014-30 scenario. Incremental programme costs for annual rounds until 2030 were $46·12 million (for a mean of 341 323 people) in Zambia and $30·24 million (for a mean of 165 852 people) in South Africa. INTERPRETATION Combination prevention with universal home-based testing can be delivered at low annual cost per person but accumulates to a considerable amount when scaled for a growing population. Combination prevention including UTT is cost-effective at thresholds greater than $800 per DALY averted and can be an efficient strategy to reduce HIV incidence in high-prevalence settings. FUNDING US National Institutes of Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, London, UK.
| | - William J M Probert
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Rafael Sauter
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Surya Singh
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Nosivuyile Vanqa
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Abigail Harper
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - Anne Cori
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Michael Pickles
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Nomtha Bell-Mandla
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Blia Yang
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Peter Bock
- Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Zambart, University of Zambia, Lusaka, Zambia; Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Richard J Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Christophe Fraser
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Katharina Hauck
- Medical Research Council Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK; Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London, UK
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17
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Heitz F, Pothuri B, Han S, Chase D, Burger R, Gaba L, Van Le L, Guerra E, Bender D, Korach J, Cloven N, Follana P, Baurain JF, Pisano C, Peen U, Maenpaa J, Bacque E, Li Y, González-Martin A, Monk BJ. Patient-reported outcomes (PRO) in patients receiving niraparib in the PRIMA/ENGOT-OV26/GOG-3012 trial. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Heitz
- Kliniken Essen-Mitte, Department for Gynecology and Gynecologic Oncology
| | - B Pothuri
- Gynecologic Oncology Group (GOG) and Perlmutter Cancer Center, NYU Langone Health, Department of Obstetrics/Gynecology
| | - S Han
- University Hospitals Leuven, Department of Obstetrics and Gynecology
| | - D Chase
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine
| | | | - L Gaba
- Hospital Clinic de Barcelona, Medical Oncology Department
| | - L Van Le
- University of North Carolina at Chapel Hill, Department of Ob/Gyn, Division of Gynecologic Oncology
| | - E Guerra
- Hospital Ramon y Cajal, Medical Oncology Department, Breast and Gynecological Cancer Unit
| | - D Bender
- University of Iowa, Department of Obstetrics and Gynecology
| | - J Korach
- The Chaim Sheba Medical Center, Sackler Medical School Tel Aviv University, Department of Oncology
| | | | - P Follana
- GINECO and Centre Antoine Lacassagne
| | - JF Baurain
- Université Catholique de Louvain and Cliniques Universitaires Saint-Luc
| | - C Pisano
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Department of Urology and Gynecology
| | - U Peen
- Herlev University Hospital
| | | | | | | | - A González-Martin
- Grupo Español de Investigación en Cáncer de Ovario (GEICO) and Clínica Universidad de Navarra, Medical Oncology Department
| | - BJ Monk
- Arizona Oncology (US Oncology Network), University of Arizona College of Medicine
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18
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Pothuri B, Han S, Chase D, Heitz F, Burger R, Gaba L, Van Le L, Guerra E, Bender D, Korach J, Cloven N, Follana P, Baurain JF, Pisano C, Peen U, Maenpaa J, Bacqué E, Li Y, Martín AG, Monk B. 810MO Patient-reported outcomes (PROs) in patients (pts) receiving niraparib in the PRIMA/ENGOT-OV26/GOG-3012 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Stavropoulou E, Coste AT, Beigelman-Aubry C, Letovanec I, Spertini O, Lovis A, Krueger T, Burger R, Bochud PY, Lamoth F. Conidiobolus pachyzygosporus invasive pulmonary infection in a patient with acute myeloid leukemia: case report and review of the literature. BMC Infect Dis 2020; 20:527. [PMID: 32698804 PMCID: PMC7374966 DOI: 10.1186/s12879-020-05218-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Conidiobolus spp. (mainly C. coronatus) are the causal agents of rhino-facial conidiobolomycosis, a limited soft tissue infection, which is essentially observed in immunocompetent individuals from tropical areas. Rare cases of invasive conidiobolomycosis due to C. coronatus or other species (C.incongruus, C.lamprauges) have been reported in immunocompromised patients. We report here the first case of invasive pulmonary fungal infection due to Conidiobolus pachyzygosporus in a Swiss patient with onco-haematologic malignancy. Case presentation A 71 year-old female was admitted in a Swiss hospital for induction chemotherapy of acute myeloid leukemia. A chest CT performed during the neutropenic phase identified three well-circumscribed lung lesions consistent with invasive fungal infection, along with a positive 1,3-beta-d-glucan assay in serum. A transbronchial biopsy of the lung lesions revealed large occasionally septate hyphae. A Conidiobolus spp. was detected by direct 18S rDNA in the tissue biopsy and subsequently identified at species level as C. pachyzygosporus by 28S rDNA sequencing. The infection was cured after isavuconazole therapy, recovery of the immune system and surgical resection of lung lesions. Conclusions This is the first description of C. pachyzygosporus as human pathogen and second case report of invasive conidiobolomycosis from a European country.
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Affiliation(s)
- E Stavropoulou
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - A T Coste
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - C Beigelman-Aubry
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - I Letovanec
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - O Spertini
- Service and Central Laboratory of Hematology, Department of Oncology, Lausanne University hospital and University of Lausanne, Lausanne, Switzerland
| | - A Lovis
- Service of pneumology, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - T Krueger
- Thoracic Surgery Service, Department of Surgery and Anesthesiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - R Burger
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P Y Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - F Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. .,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
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20
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Adesina JA, Piketh SJ, Qhekwana M, Burger R, Language B, Mkhatshwa G. Contrasting indoor and ambient particulate matter concentrations and thermal comfort in coal and non-coal burning households at South Africa Highveld. Sci Total Environ 2020; 699:134403. [PMID: 31678873 DOI: 10.1016/j.scitotenv.2019.134403] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 05/09/2023]
Abstract
One of the key challenges noted in the sustainable development goals for good health and wellbeing (SDGs 3) is both ambient and household air pollution. Household solid fuel combustion represents one of the biggest threat to human health in South Africa. This study helps to understand the impact of solid fuel burning in an indoor and ambient environment. Continuous monitoring of particulate matter (PM4) was carried out in two houses, one used coal as a primary source of energy, while the other did not. For solid fuel burning (SFB) house the winter PM4 average 24-h concentration ranges between 60.9 μg m-3 and 207.5 μg m-3 while at non-solid fuel burning (NSFB) house it ranges between 15.3 μg m-3 and 84.2 μg m-3. In both houses, the national ambient air quality standard (NAAQS) for PM2.5 (40 μg m-3) were exceeded during winter. The summer PM4 levels ranged between 17.4 μg m-3 and 36.6 μg m-3 in the solid fuel burning house and between 14.2 μg m-3 and 39.9 μg m-3 at the non-solid fuel-burning house. During mornings and evenings, indoor concentrations were higher than the outdoor; these periods coincide with the fuel-burning pattern in this community. In the mid-afternoon, the outdoor PM levels sometimes went higher than the indoor levels, perhaps as a result of the pollution from the power plants in the neighbourhood. Using the linear regression model, there were no significant correlations between indoor/outdoor PM4 concentrations during the winter, but there were good correlations for both houses during the summer. There was an observed difference in the thermal comfort at the SFB and NSFB. The temperature at SFB went below the World Health Organisation standard in winter and above during the summer while at NSFB, the temperature was managed within the standard in both seasons.
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Affiliation(s)
- J A Adesina
- Climatology Research Group, School of Geo- and Spatial Science, Unit for Environmental Science and Management, North-West University, Potchefstroom 2520, South Africa.
| | - S J Piketh
- Climatology Research Group, School of Geo- and Spatial Science, Unit for Environmental Science and Management, North-West University, Potchefstroom 2520, South Africa
| | - M Qhekwana
- Climatology Research Group, School of Geo- and Spatial Science, Unit for Environmental Science and Management, North-West University, Potchefstroom 2520, South Africa
| | - R Burger
- Climatology Research Group, School of Geo- and Spatial Science, Unit for Environmental Science and Management, North-West University, Potchefstroom 2520, South Africa
| | - B Language
- Climatology Research Group, School of Geo- and Spatial Science, Unit for Environmental Science and Management, North-West University, Potchefstroom 2520, South Africa
| | - G Mkhatshwa
- Eskom, Air Quality, Climate Change, and Ecosystem Management Research, Research Testing, and Development, Cleveland, 2022, South Africa
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21
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Wiseman V, Lagarde M, Kovacs R, Wulandari LPL, Powell-Jackson T, King J, Goodman C, Hanson K, Miller R, Xu D, Liverani M, Yeung S, Hompashe D, Khan M, Burger R, Christian CS, Blaauw D. Using unannounced standardised patients to obtain data on quality of care in low-income and middle-income countries: key challenges and opportunities. BMJ Glob Health 2019; 4:e001908. [PMID: 31565422 PMCID: PMC6747897 DOI: 10.1136/bmjgh-2019-001908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 08/13/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Virginia Wiseman
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mylene Lagarde
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Roxanne Kovacs
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Timothy Powell-Jackson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jessica King
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Catherine Goodman
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Kara Hanson
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rosalind Miller
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Dong Xu
- Sun Yat-sen Global Health Institute, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Marco Liverani
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Shunmay Yeung
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Dumisani Hompashe
- Department of Economics, University of Fort Hare, Alice, South Africa
| | - Mishal Khan
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Matieland, South Africa
| | - Carmen S Christian
- Department of Economics, University of the Western Cape, Cape Town, South Africa
| | - Duane Blaauw
- Centre for Health Policy, University of Witwatersrand, Johannesburg, South Africa
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22
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Rossouw L, Burger RP, Burger R. An Incentive-Based and Community Health Worker Package Intervention to Improve Early Utilization of Antenatal Care: Evidence from a Pilot Randomised Controlled Trial. Matern Child Health J 2019; 23:633-640. [PMID: 30600521 DOI: 10.1007/s10995-018-2677-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives One of the factors linked to South Africa's relatively high maternal mortality ratio is late utilization of antenatal care (ANC). Early utilization is especially important in South Africa due to the high HIV prevalence amongst pregnant women. This study examined the impact of a package intervention, consisting of an incentive called the Thula Baba Box (TBB) and a community health worker (CHW) programme, on early utilization of ANC. Methods A pilot randomised controlled trial consisting of 72 women aged 18 and older was conducted in an urban area in South Africa to evaluate the impact of the package intervention. Women were recruited and randomised into either intervention (n = 39) or control group (n = 33). The intervention group received both the TBB and monthly CHW visits, while the control group followed standard clinical practice. Both groups were interviewed at recruitment and once again after giving birth. The outcomes measured are the timing of first ANC visit and whether they attended more than four times. It is anticipated that the box will also have a beneficial impact on infant health outcomes, but these fall out of the scope of this study. Results Women in the intervention groups sought care on average 1.35 months earlier than the control group. They were also significantly more likely to attend at least four antenatal clinic visits. Conclusions for practice Given the South African context and the importance of early care-seeking behaviour to improve health outcomes of HIV-positive pregnant women, the intervention can help to improve maternal and neonatal health outcomes. Further research is needed to investigate the impact of the two interventions separately, and to see if these findings hold in other communities.
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Affiliation(s)
- Laura Rossouw
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa.
| | - Rulof Petrus Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Private Bag X1, Matieland, 7602, South Africa
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Wagstaff A, van Doorslaer E, Burger R. SMS nudges as a tool to reduce tuberculosis treatment delay and pretreatment loss to follow-up. A randomized controlled trial. PLoS One 2019; 14:e0218527. [PMID: 31220140 PMCID: PMC6586322 DOI: 10.1371/journal.pone.0218527] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/02/2019] [Indexed: 01/05/2023] Open
Abstract
Background TB persists despite being relatively easy to detect and cure because the journey from the onset of symptoms to cure involves a series of steps, with patients being lost to follow-up at each stage and delays occurring among patients not lost to follow-up. One cause of drop-off and delay occurs when patients delay or avoid returning to clinic to get their test results and start treatment. Methods We fielded two SMS interventions in three Cape Town clinics to see their effects on whether people returned to clinic, and how quickly. One was a simple reminder; the other aimed to overcome “optimism bias” by reminding people TB is curable and many millions die unnecessarily from it. Recruits were randomly assigned at the clinic level to a control group or one of the two SMS groups (1:2:2). In addition to estimating effects on the full sample, we also estimated effects on HIV-positive patients. Results SMS recipients were more likely to return to clinic in the requested two days than the control group. The effect was smaller in the intent-to-treat analysis (52/101 or 51.5% vs. 251/405 or 62.0%, p = 0.05) than in the per-protocol analysis (50/97 or 51.5% vs. 204/318 or 64.2%, p = 0.03). The effect was larger among HIV-positives (10/35 or 28.6% vs. 97/149 or 65.1%, p<0.01). The effects of SMS messages diminished as the interval increased: significant effects at the 5% level were found at five and 10 days only among HIV-positives. The second SMS message had larger effects, albeit not significantly larger, likely due in part to lack of statistical power. Conclusions At 2 U.S. cents per message, SMS reminders are an inexpensive option to encourage TB testers to return to clinic, especially when worded to counter optimism bias.
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Affiliation(s)
- Adam Wagstaff
- Development Research Group, World Bank, Washington, DC, United States of America
- * E-mail:
| | - Eddy van Doorslaer
- Erasmus School of Health Policy and Management and Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
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Smith A, Burger R, Black V. Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa. Matern Child Health J 2019; 23:512-521. [PMID: 30600513 DOI: 10.1007/s10995-018-2663-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and < 5 months, and a quarter (26.3%) attended ≥ 5 months. For those attending ≥ 5 months, 51.8% cited late recognition of pregnancy as the major reason for delayed attendance. Supply-side barriers were not identified as large contributing factors to delayed attendance. Late antenatal care access was predominantly associated with demand-side factors. Women who accessed antenatal care ≥ 5 months were more likely to be in the poorest 40% of the wealth-index distribution (p = 0.034) and to not have completed high school (p = 0.006). They were also more likely to report alcohol consumption during pregnancy (p = 0.020) and be multiparous (p = 0.035). Having completed high school was protective of late antenatal care access in stepwise logistic regression analysis (OR 0.403, CI 0.210-0.773, p < 0.01). For women who attended ≥ 3 months, late access was associated with unwanted pregnancy (p = 0.030). Conclusions for Practice Improved access to pregnancy tests could assist in earlier pregnancy identification. Interventions to increase awareness of the importance of early antenatal care attendance among vulnerable women may help.
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Affiliation(s)
- Anja Smith
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa.
| | - Ronelle Burger
- Research on Socio-Economic Policy (ReSEP), Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Vivian Black
- Clinical Microbiology and Infectious Diseases, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa
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Mchenga M, Burger R, von Fintel D. Examining the impact of WHO's Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi: a retrospective study. BMC Health Serv Res 2019; 19:295. [PMID: 31068183 PMCID: PMC6506931 DOI: 10.1186/s12913-019-4130-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 04/29/2019] [Indexed: 12/01/2022] Open
Abstract
Background A variety of antenatal care models have been implemented in low and middle-income countries over the past decades, as proposed by the World Health Organisation (WHO). One such model is the 2001 Focused Antenatal Care (FANC) programme. FANC recommended a minimum of four visits for women with uncomplicated pregnancies and emphasised quality of care to improve both maternal and neonatal outcomes. Malawi adopted FANC in 2003, however, up to now no study has been done to analyse the model’s performance with regards to antenatal care service quality and utilisation patterns. Methods The paper is based on data pooled from three comparable nationally representative Malawi Demographic and Health Survey (MDHS) datasets (2000, 2004 and 2010). The DHS collects data on demographics, socio-economic indicators, antenatal care, and the fertility history of reproductive women aged between 15 and 49. We pooled a sample of 8545 women who had a live birth in the last 5 years prior to each survey. We measure the impact of FANC on early access to care, underutilisation of care and quality of care with interrupted time series analysis. This method enables us to track changes in both levels and the trends of our outcome variables. Results We find that FANC is associated with earlier access to care. However, it has also been associated with unintended increases in underutilisation. We see no change in the quality of ANC services. Conclusion In light of the WHO 2016 ANC guidelines, which recommend an increase of visits to eight, these results are important. Given that we find underutilisation when the benchmark is set at four visits, eight visits are unlikely to be feasible in low-resource settings.
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Affiliation(s)
- Martina Mchenga
- Faculty of Economics and management sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Ronelle Burger
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
| | - Dieter von Fintel
- Economics Department, Stellenbosch University, Stellenbosch, South Africa
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Burger R, Jung M, Becker J, Krominus J, Lampe M, Kleinschmidt J, Kleinschmidt B. Wirkung von Aqua-Cycling als Bewegungstherapie bei der
Diagnose Lipödem. Phlebologie 2019. [DOI: 10.1055/a-0839-6346] [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: 10/27/2022]
Abstract
ZusammenfassungIn der folgenden Übersicht werden die allgemeinen Vorteile von
Bewegungsinterventionen im Wasser innerhalb der physikalischen
Therapiemöglichkeiten sowie bei den Diagnosen Lip- und Lymphödem angesprochen.
Aufgrund von positiven Erfahrungen bei Lymphödempatientinnen werden hier
Einzelfallkasuistiken bzgl. des Einsatzes von Aqua-Cycling bei Lipödem
vorgestellt, die weitere Untersuchungen anstoßen sollten.
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Affiliation(s)
- R. Burger
- Hochschule Bonn-Rhein-Sieg, University of Applied Science
| | - M. Jung
- Hochschule Fresenius, University of Applied Science
| | - J. Becker
- Hochschule Fresenius, University of Applied Science
| | - J. Krominus
- Hochschule Fresenius, University of Applied Science
| | - M. Lampe
- Hochschule Fresenius, University of Applied Science
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Abstract
BACKGROUND The frequent occurrence of medicine stockouts represents a significant obstacle to tuberculosis control in South Africa. Stockouts can lead to treatment alterations or interruptions, which can impact treatment outcomes. This study investigates the determinants and effects of TB drug stockouts and whether poorer districts are disproportionately affected. METHODS TB stockout data, health system indicators and TB treatment outcomes at the district level were extracted from the District Health Barometer for the years 2011, 2012 and 2013. Poverty terciles were constructed using the Census 2011 data to investigate whether stockouts and poor treatment outcomes were more prevalent in more impoverished districts. Fixed-effects regressions were used to estimate the effects of TB stockouts on TB treatment outcomes. RESULTS TB stockouts occurred in all provinces but varied across provinces and years. Regression analysis showed a significant association between district per capita income and stockouts: a 10% rise in income was associated with an 8.50% decline in stockout proportions. In terms of consequences, after controlling for unobserved time invariant heterogeneity between districts, a 10% rise in TB drug stockouts was found to lower the cure rate by 2.10% (p < 0.01) and the success rate by 1.42% (p < 0.01). These effects were found to be larger in poorer districts. CONCLUSIONS The unequal spread of TB drug stockouts adds to the socioeconomic inequality in TB outcomes. Not only are stockouts more prevalent in poorer parts of South Africa, they also have a more severe impact on TB treatment outcomes in poorer districts. This suggests that efforts to cut back TB drug stockouts would not only improve TB treatment outcomes on average, they are also likely to improve equity because a disproportionate share of this burden is currently borne by the poorer districts.
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Affiliation(s)
- L. E. M. Koomen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
| | - R. Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - E. K. A. van Doorslaer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
- Erasmus School of Economics, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, PA 3062 The Netherlands
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28
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Burger R. A promising approach to identifying health system discrimination and bias. Lancet Glob Health 2019; 7:e546-e547. [PMID: 30928340 DOI: 10.1016/s2214-109x(19)30063-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/15/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Ronelle Burger
- Department of Economics, University of Stellenbosch, Stellenbosch, South Africa.
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Christian C, Burger C, Claassens M, Bond V, Burger R. Patient predictors of health-seeking behaviour for persons coughing for more than two weeks in high-burden tuberculosis communities: the case of the Western Cape, South Africa. BMC Health Serv Res 2019; 19:160. [PMID: 30866926 PMCID: PMC6417175 DOI: 10.1186/s12913-019-3992-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 03/06/2019] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to analyse the patient predictors of health-seeking behaviour for persons coughing for more than 2 weeks to better understand this vulnerable and important population. Methods The study analysed data from a cohort study (SOCS - Secondary Outcome Cohort Study) embedded in a community randomised trial ZAMSTAR (Zambia and South Africa TB and AIDS Reduction Study) in eight high-burden TB communities in the Western Cape, South Africa. These datasets are unique as they contain TB-related data as well as data on health, health-seeking behaviour, lifestyle choices, employment, socio-economic status, education and stigma. We use uni- and multivariate logistic regressions to estimate the odds ratios of consulting for a cough (of more than 2 weeks duration) for a range of relevant patient predictors. Results Three hundred and forty persons consulted someone about their cough and this represents 37% of the 922 participants who reported coughing for more than 2 weeks. In the multivariate analysis, respondents of black ethnic origin (OR 1.99, 95% CI 1.28–3.12, P < 0.01), those with higher levels of education (OR 1.05 per year of education, 95% CI 1.00–1.10, P = 0.05), and older respondents (OR 1.02 per year, 95% CI 1.01–1.04, P < 0.01) had a higher likelihood of consulting for their chronic cough. Individuals who smoked (OR 0.63, 95% CI 0.45–0.88, P < 0.01) and those with higher levels of socio-economic status (OR 0.81, 95% CI 0.71–0.92, P < 0.01) were less likely to consult. We find no evidence of stigma playing a role in health-seeking decisions, but caution that this may be due to the difficulty of accurately and reliably capturing stigma due to, amongst other factors, social desirability bias. Conclusions The low levels of consultation for a cough of more than 2 weeks suggest that there are opportunities to improve case-finding. These findings on health-seeking behaviour can assist policymakers in designing TB screening and active case-finding interventions that are targeted to the characteristics of those with a chronic cough who do not seek care. Electronic supplementary material The online version of this article (10.1186/s12913-019-3992-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carmen Christian
- Department of Economics, Stellenbosch University, Matieland, 7602, South Africa. .,Department of Economics, University of the Western Cape, Bellville, 7535, South Africa.
| | - Cobus Burger
- Department of Economics, Stellenbosch University, Matieland, 7602, South Africa
| | - Mareli Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, 7505, South Africa
| | - Virginia Bond
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H9SH, UK.,Zambart, School of Public Health, University of Zambia, PO Box 50697, Lusaka, Zambia
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Matieland, 7602, South Africa
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Booysen MJ, Visser M, Burger R. Temporal case study of household behavioural response to Cape Town's "Day Zero" using smart meter data. Water Res 2019; 149:414-420. [PMID: 30472543 DOI: 10.1016/j.watres.2018.11.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 11/12/2018] [Accepted: 11/13/2018] [Indexed: 05/04/2023]
Abstract
Faced with the threat of "Day Zero", when it was feared that Cape Town's taps could run dry, consumers reduced household water usage from 540 to 280 L per household per day over the 36 months between January 2015 and January 2018. This paper describes the events that prompted this reduction. We look at how changes in water use were affected by official announcements and by public engagement with this news via the social media activity and internet searches. We analysed the water usage of a subset of middle to high income households where smart hot and cold water meters were installed. For hot water usage patterns we compared meter readings with that in another area unaffected by the drought. We further map our cold water smart meter readings against that of the City of Cape Town's municipal data for domestic freestanding households - a sample of more than 400,000 households. We found that the introduction of Level 5 restrictions had a perverse effect on consumption, possibly due to confusing messages. The most dramatic change in behaviour appears to have been instigated by a media storm and consequent user panic after the release of the City's Critical Water Shortages Disaster Plan in October 2017. However, contradictory communication from national and provincial government eroded some of this gain. The paper concludes with recommendations for demand management in a similar future scenario.
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Affiliation(s)
- M J Booysen
- Department of Electrical and Electronic Engineering, Stellenbosch University, South Africa.
| | - M Visser
- School of Economics, University of Cape Town, South Africa
| | - R Burger
- Department of Economics, Stellenbosch University, South Africa
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Thomas R, Burger R, Hauck K. Richer, wiser and in better health? The socioeconomic gradient in hypertension prevalence, unawareness and control in South Africa. Soc Sci Med 2018; 217:18-30. [PMID: 30292072 DOI: 10.1016/j.socscimed.2018.09.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 09/19/2018] [Accepted: 09/20/2018] [Indexed: 10/28/2022]
Abstract
The socioeconomic gradient in chronic conditions is clear in the poorest and wealthiest of countries, but extant evidence on this relationship in low- and middle-income countries is inconclusive. We use data gathered between 2008 and 2012 from a nationally representative sample of over 10,000 South African adults, and objective health measures to analyse the differential effects of education, income and other factors on the prevalence of hypertension, individuals' awareness and control of hypertensive status. Prevalence of hypertension is high at 38% among women and 34% among men. 59% of hypertensive individuals are unaware of their status. We find prevalence and unawareness of hypertension are a public health concern across all income groups in South Africa. Higher income is however associated with effective control amongst men. Completing secondary education is associated with 7 mmHg lower blood pressure only in a small sub-group of women but is associated with 22 percentage point higher likelihood of effective hypertension control amongst women. We conclude that poorer and less educated individuals are particularly at high risk of cardiovascular disease in South Africa.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Health Policy, London School of Economics and Political Science, Cowdray House, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, South Africa
| | - Katharina Hauck
- School of Public Health, Imperial College London, United Kingdom
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Scherf-Clavel M, Samanski L, Burger R, Deckert J, Menke A, Unterecker S. Differences in the pharmacokinetics of psychopharmacological drugs between smokers and nonsmokers. PHARMACOPSYCHIATRY 2018. [DOI: 10.1055/s-0038-1649541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Scherf-Clavel
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
| | - L Samanski
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
| | - R Burger
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
| | - J Deckert
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
| | - A Menke
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
| | - S Unterecker
- Department of Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Germany
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Christian CS, Gerdtham UG, Hompashe D, Smith A, Burger R. Measuring Quality Gaps in TB Screening in South Africa Using Standardised Patient Analysis. Int J Environ Res Public Health 2018; 15:ijerph15040729. [PMID: 29649095 PMCID: PMC5923771 DOI: 10.3390/ijerph15040729] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/29/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022]
Abstract
This is the first multi-district Standardised Patient (SP) study in South Africa. It measures the quality of TB screening at primary healthcare (PHC) facilities. We hypothesise that TB screening protocols and best practices are poorly adhered to at the PHC level. The SP method allows researchers to observe how healthcare providers identify, test and advise presumptive TB patients, and whether this aligns with clinical protocols and best practice. The study was conducted at PHC facilities in two provinces and 143 interactions at 39 facilities were analysed. Only 43% of interactions resulted in SPs receiving a TB sputum test and being offered an HIV test. TB sputum tests were conducted routinely (84%) while HIV tests were offered less frequently (47%). Nurses frequently neglected to ask SPs whether their household contacts had confirmed TB (54%). Antibiotics were prescribed without taking temperatures in 8% of cases. The importance of returning to the facility to receive TB test results was only explained in 28%. The SP method has highlighted gaps in clinical practice, signalling missed opportunities. Early detection of sub-optimal TB care is instrumental in decreasing TB-related morbidity and mortality. The findings provide the rationale for further quality improvement work in TB management.
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Affiliation(s)
- Carmen S Christian
- Department of Economics, University of the Western Cape, Bellville 7535, South Africa.
- Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa.
| | - Ulf-G Gerdtham
- Department of Economics, Lund University, SE-220 07 Lund, Sweden.
- Department of Clinical Science (Malmo), Lund University, SE-202 13 Malmö, Sweden.
| | - Dumisani Hompashe
- Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa.
- Department of Economics, University of Fort Hare, Alice 5700, South Africa.
| | - Anja Smith
- Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch 7602, South Africa.
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Meehan SA, Sloot R, Draper HR, Naidoo P, Burger R, Beyers N. Factors associated with linkage to HIV care and TB treatment at community-based HIV testing services in Cape Town, South Africa. PLoS One 2018; 13:e0195208. [PMID: 29608616 PMCID: PMC5880394 DOI: 10.1371/journal.pone.0195208] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/19/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Diagnosing HIV and/or TB is not sufficient; linkage to care and treatment is conditional to reduce the burden of disease. This study aimed to determine factors associated with linkage to HIV care and TB treatment at community-based services in Cape Town, South Africa. METHODS This retrospective cohort study utilized routinely collected data from clients who utilized stand-alone (fixed site not attached to a health facility) and mobile HIV testing services in eight communities in the City of Cape Town Metropolitan district, between January 2008 and June 2012. Clients were included in the analysis if they were ≥12 years and had a known HIV status. Generalized estimating equations (GEE) logistic regression models were used to assess the association between determinants (sex, age, HIV testing service and co-infection status) and self-reported linkage to HIV care and/or TB treatment. RESULTS Linkage to HIV care was 3 738/5 929 (63.1%). Linkage to HIV care was associated with the type of HIV testing service. Clients diagnosed with HIV at mobile services had a significantly reduced odds of linking to HIV care (aOR 0.7 (CI 95%: 0.6-0.8), p<0.001. Linkage to TB treatment was 210/275 (76.4%). Linkage to TB treatment was not associated with sex and service type, but was associated with age. Clients in older age groups were less likely to link to TB treatment compared to clients in the age group 12-24 years (all, p-value<0.05). CONCLUSION A large proportion of clients diagnosed with HIV at mobile services did not link to care. Almost a quarter of clients diagnosed with TB did not link to treatment. Integrated community-based HIV and TB testing services are efficient in diagnosing HIV and TB, but strategies to improve linkage to care are required to control these epidemics.
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Affiliation(s)
- Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rosa Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Heather R. Draper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Meehan SA, Rossouw L, Sloot R, Burger R, Beyers N. Access to human immunodeficiency virus testing services in Cape Town, South Africa: a user perspective. Public Health Action 2017; 7:251-257. [PMID: 29584798 DOI: 10.5588/pha.17.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
Objective: To compare the availability, affordability and acceptability of two non-governmental organisation (NGO) led human immunodeficiency virus (HIV) testing service (HTS) modalities (mobile and stand-alone) with HTS at a public primary health care facility. Methods: Adult participants who self-referred for HIV testing were enrolled as they exited the HTS modalities. Data collection using an electronic questionnaire took place between November 2014 and February 2015. Logistic regression analysis was used to assess differences in the participants' demographic characteristics and the availability, affordability and acceptability of HTS between modalities. Results: There were 130 participants included in the study. Irrespective of modality, most participants walked to the service provider, had a travel time of <30 min and reported no costs. Participants were less likely to report waiting times of ⩾30 min compared to <15 min at the mobile modality compared to the public facility (aOR < 0.001, 95%CI < 0.001-0.03). Conclusion: Irrespective of modality, HIV testing services were available and affordable in our study. Waiting times were significantly higher at the public facility compared to the NGO modalities. As South Africa moves toward achieving the first UNAIDS target, it is essential not only to make HTS available and affordable, but also to ensure that these services are acceptable, especially to those who have never been tested before.
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Affiliation(s)
- S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - L Rossouw
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - R Sloot
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - R Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - N Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Meehan SA, Draper HR, Burger R, Beyers N. What drives 'first-time testers' to test for HIV at community-based HIV testing services? Public Health Action 2017; 7:304-306. [PMID: 29584797 DOI: 10.5588/pha.17.0064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/12/2017] [Indexed: 12/19/2022] Open
Abstract
Drivers of and barriers to testing are not well understood for those who have never been tested previously and now self-initiate at a community-based human immuno-deficiency virus (HIV) testing service (CB-HTS). This descriptive study enrolled 229 first-time testers. Participants completed an electronic questionnaire. The majority reported fear and (non) accessibility of HTS as barriers to testing (40% and 24%, respectively). Wanting 'to know my status' and the immediate opportunity to test were reported as drivers of testing (41% and 35%, respectively). Addressing fear of testing and providing an easily accessible opportunity to test may go some way to encouraging those previously untested individuals to test.
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Affiliation(s)
- S-A Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - H R Draper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Burger
- Department of Economics, Stellenbosch University, Cape Town, South Africa
| | - N Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Meehan SA, Beyers N, Burger R. Cost analysis of two community-based HIV testing service modalities led by a Non-Governmental Organization in Cape Town, South Africa. BMC Health Serv Res 2017; 17:801. [PMID: 29197386 PMCID: PMC5712171 DOI: 10.1186/s12913-017-2760-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 11/23/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In South Africa, the financing and sustainability of HIV services is a priority. Community-based HIV testing services (CB-HTS) play a vital role in diagnosis and linkage to HIV care for those least likely to utilise government health services. With insufficient estimates of the costs associated with CB-HTS provided by NGOs in South Africa, this cost analysis explored the cost to implement and provide services at two NGO-led CB-HTS modalities and calculated the costs associated with realizing key HIV outputs for each CB-HTS modality. METHODS The study took place in a peri-urban area where CB-HTS were provided from a stand-alone centre and mobile service. Using a service provider (NGO) perspective, all inputs were allocated by HTS modality with shared costs apportioned according to client volume or personnel time. We calculated the total cost of each HTS modality and the cost categories (personnel, capital and recurring goods/services) across each HTS modality. Costs were divided into seven pre-determined project components, used to examine cost drivers. HIV outputs were analysed for each HTS modality and the mean cost for each HIV output was calculated per HTS modality. RESULTS The annual cost of the stand-alone and mobile modalities was $96,616 and $77,764 respectively, with personnel costs accounting for 54% of the total costs at the stand-alone. For project components, overheads and service provision made up the majority of the costs. The mean cost per person tested at stand-alone ($51) was higher than at the mobile ($25). Linkage to care cost at the stand-alone ($1039) was lower than the mobile ($2102). CONCLUSIONS This study provides insight into the cost of an NGO led CB-HTS project providing HIV testing and linkage to care through two CB-HIV testing modalities. The study highlights; (1) the importance of including all applicable costs (including overheads) to ensure an accurate cost estimate that is representative of the full service implementation cost, (2) the direct link between test uptake and mean cost per person tested, and (3) the need for effective linkage to care strategies to increase linkage and thereby reduce the mean cost per person linked to HIV care.
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Affiliation(s)
- Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Ave, Parow, Cape Town, South Africa
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Ave, Parow, Cape Town, South Africa
| | - Ronelle Burger
- Department Economics, Stellenbosch University, Cape Town, South Africa
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Peipp M, Wesch D, Oberg HH, Lutz S, Muskulus A, van de Winkel JGJ, Parren PWHI, Burger R, Humpe A, Kabelitz D, Gramatzki M, Kellner C. CD20-Specific Immunoligands Engaging NKG2D Enhance γδ T Cell-Mediated Lysis of Lymphoma Cells. Scand J Immunol 2017; 86:196-206. [PMID: 28708284 DOI: 10.1111/sji.12581] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/25/2017] [Indexed: 02/02/2023]
Abstract
Human γδ T cells are innate-like T cells which are able to kill a broad range of tumour cells and thus may have potential for cancer immunotherapy. The activating receptor natural killer group 2 member D (NKG2D) plays a key role in regulating immune responses driven by γδ T cells. Here, we explored whether recombinant immunoligands consisting of a CD20 single-chain fragment variable (scFv) linked to a NKG2D ligand, either MHC class I chain-related protein A (MICA) or UL16 binding protein 2 (ULBP2), could be employed to engage γδ T cells for tumour cell killing. The two immunoligands, designated MICA:7D8 and ULBP2:7D8, respectively, enhanced cytotoxicity of ex vivo-expanded γδ T cells against CD20-positive lymphoma cells. Both Vδ1 and Vδ2 γδ T cells were triggered by MICA:7D8 or ULBP2:7D8. Killing of CD20-negative tumour cells was not induced by the immunoligands, indicating their antigen specificity. MICA:7D8 and ULBP2:7D8 acted in a dose-dependent manner and induced cytotoxicity at nanomolar concentrations. Importantly, chronic lymphocytic leukaemia (CLL) cells isolated from patients were sensitized by the two immunoligands for γδ T cell cytotoxicity. In a combination approach, the immunoligands were combined with bromohydrin pyrophosphate (BrHPP), an agonist for Vδ2 γδ T cells, which further enhanced the efficacy in target cell killing. Thus, employing tumour-directed recombinant immunoligands which engage NKG2D may represent an attractive strategy to enhance antitumour cytotoxicity of γδ T cells.
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Affiliation(s)
- M Peipp
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - D Wesch
- Institute of Immunology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - H-H Oberg
- Institute of Immunology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - S Lutz
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - A Muskulus
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - J G J van de Winkel
- Immunotherapy Laboratory, Department of Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.,Genmab, Utrecht, The Netherlands
| | - P W H I Parren
- Genmab, Utrecht, The Netherlands.,Department of Cancer and Inflammation Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - R Burger
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - A Humpe
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - D Kabelitz
- Institute of Immunology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - C Kellner
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University of Kiel, Kiel, Germany
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Thomas R, Burger R, Harper A, Kanema S, Mwenge L, Vanqa N, Bell-Mandla N, Smith PC, Floyd S, Bock P, Ayles H, Beyers N, Donnell D, Fidler S, Hayes R, Hauck K. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial. Lancet Glob Health 2017; 5:e1133-e1141. [PMID: 28964756 PMCID: PMC5640509 DOI: 10.1016/s2214-109x(17)30367-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/14/2017] [Accepted: 08/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The life expectancy of HIV-positive individuals receiving antiretroviral therapy (ART) is approaching that of HIV-negative people. However, little is known about how these populations compare in terms of health-related quality of life (HRQoL). We aimed to compare HRQoL between HIV-positive and HIV-negative people in Zambia and South Africa. METHODS As part of the HPTN 071 (PopART) study, data from adults aged 18-44 years were gathered between Nov 28, 2013, and March 31, 2015, in large cross-sectional surveys of random samples of the general population in 21 communities in Zambia and South Africa. HRQoL data were collected with a standardised generic measure of health across five domains. We used β-distributed multivariable models to analyse differences in HRQoL scores between HIV-negative and HIV-positive individuals who were unaware of their status; aware, but not in HIV care; in HIV care, but who had not initiated ART; on ART for less than 5 years; and on ART for 5 years or more. We included controls for sociodemographic variables, herpes simplex virus type-2 status, and recreational drug use. FINDINGS We obtained data for 19 750 respondents in Zambia and 18 941 respondents in South Africa. Laboratory-confirmed HIV status was available for 19 330 respondents in Zambia and 18 004 respondents in South Africa; 4128 (21%) of these 19 330 respondents in Zambia and 4012 (22%) of 18 004 respondents in South Africa had laboratory-confirmed HIV. We obtained complete HRQoL information for 19 637 respondents in Zambia and 18 429 respondents in South Africa. HRQoL scores did not differ significantly between individuals who had initiated ART more than 5 years previously and HIV-negative individuals, neither in Zambia (change in mean score -0·002, 95% CI -0·01 to 0·001; p=0·219) nor in South Africa (0·000, -0·002 to 0·003; p=0·939). However, scores did differ between HIV-positive individuals who had initiated ART less than 5 years previously and HIV-negative individuals in Zambia (-0·006, 95% CI -0·008 to -0·003; p<0·0001). A large proportion of people with clinically confirmed HIV were unaware of being HIV-positive (1768 [43%] of 4128 people in Zambia and 2026 [50%] of 4012 people in South Africa) and reported good HRQoL, with no significant differences from that of HIV-negative people (change in mean HRQoL score -0·001, 95% CI -0·003 to 0·001, p=0·216; and 0·001, -0·001 to 0·001, p=0·997, respectively). In South Africa, HRQoL scores were lower in HIV-positive individuals who were aware of their status but not enrolled in HIV care (change in mean HRQoL -0·004, 95% CI -0·01 to -0·001; p=0·010) and those in HIV care but not on ART (-0·008, -0·01 to -0·004; p=0·001) than in HIV-negative people, but the magnitudes of difference were small. INTERPRETATION ART is successful in helping to reduce inequalities in HRQoL between HIV-positive and HIV-negative individuals in this general population sample. These findings highlight the importance of improving awareness of HIV status and expanding ART to prevent losses in HRQoL that occur with untreated HIV progression. The gains in HRQoL after individuals initiate ART could be substantial when scaled up to the population level. FUNDING National Institute of Allergy and Infectious Diseases, National Institute on Drug Abuse, National Institute of Mental Health, President's Emergency Plan for AIDS Relief, International Initiative for Impact Evaluation, the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ranjeeta Thomas
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - Abigail Harper
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Kanema
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Lawrence Mwenge
- ZAMBART Project, Ridgeway Campus, University of Zambia, Lusaka, Zambia
| | - Nosivuyile Vanqa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Nomtha Bell-Mandla
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Peter C Smith
- Imperial College Business School, Imperial College London, London, UK
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Helen Ayles
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - Deborah Donnell
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sarah Fidler
- Department of Medicine, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Hauck
- Department of Infectious Disease Epidemiology, Imperial College London, London, UK
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Burger R, Posel D, von Fintel M. The relationship between negative household events and depressive symptoms: Evidence from South African longitudinal data. J Affect Disord 2017; 218:170-175. [PMID: 28477493 DOI: 10.1016/j.jad.2017.04.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/21/2017] [Accepted: 04/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The relationship between negative life events and vulnerability to depression is not well-documented in developing countries, particularly using large-scale, longitudinal data. This study seeks to add to this literature by examining the relationship between negative household events and vulnerability to depression amongst a representative sample of South African adults for the period 2008-2012. METHODS Data from three waves of the longitudinal South African National Income Dynamics Study (NIDS) were analysed to estimate the association between negative household events and adult depressive symptoms using ordinary least squares (OLS) and fixed-effects regression models. RESULTS One in four South Africans reported that they lived in a household where at least one household member had been seriously ill or injured, or where a household member, relative or friend had died within the previous two years. There was a significant association between the serious illness of a household member, or the death of a family member who provided financial assistance, and adult depression scores. LIMITATIONS The study used data collected in a large-scale household survey by field work teams. It is reliant on self-reported depressive symptoms that have not been validated by formal clinical diagnosis. CONCLUSIONS There are high rates of morbidity and mortality in South Africa, and adults living in households where family members are ill or have died are significantly more vulnerable to depression. These findings highlight the importance of providing counselling and psychiatric support not only to those directly affected by negative health events, but also to their family or household members.
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Affiliation(s)
- Ronelle Burger
- Department of Economics, Research on Socio-Economic Policy (ReSEP), Stellenbosch University, Stellenbosch, South Africa.
| | - Dorrit Posel
- School of Economic and Business Sciences, Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa.
| | - Marisa von Fintel
- Department of Economics, Research on Socio-Economic Policy (ReSEP), Stellenbosch University, Stellenbosch, South Africa.
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Moringlane RB, Keric N, Freimann FB, Mielke D, Burger R, Duncker D, Rohde V, Eckardstein KLV. Efficacy and safety of durotomy after decompressive hemicraniectomy in traumatic brain injury. Neurosurg Rev 2017; 40:655-661. [DOI: 10.1007/s10143-017-0823-2] [Citation(s) in RCA: 5] [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] [Received: 10/19/2016] [Revised: 01/17/2017] [Accepted: 01/24/2017] [Indexed: 11/29/2022]
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Smith A, Burger R, Claassens M, Ayles H, Godfrey-Faussett P, Beyers N. Health care workers' gender bias in testing could contribute to missed tuberculosis among women in South Africa. Int J Tuberc Lung Dis 2017; 20:350-6. [PMID: 27046716 DOI: 10.5588/ijtld.15.0312] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Eight communities with high tuberculosis (TB) prevalence, Western Cape, South Africa. OBJECTIVE To identify sex differences in TB health-seeking behaviour and diagnosis in primary health care facilities and how this influences TB diagnosis. DESIGN We used data from a prevalence survey among 30,017 adults conducted in 2010 as part of the Zambia, South Africa Tuberculosis and AIDS Reduction (ZAMSTAR) trial. RESULTS A total of 1670 (5.4%) adults indicated they had a cough of ⩾2 weeks, 950 (56.9%) of whom were women. Women were less likely to report a cough of ⩾2 weeks (5.1% vs. 6.4%, P < 0.001), but were more likely to seek care for their cough (32.6% vs. 26.9%, P = 0.012). Of all adults who sought care, 403 (80.0%) sought care for their cough at a primary health care (PHC) facility (79.0% women vs. 81.4% men, P = 0.511). Women were less likely to be asked for a sputum sample at the PHC facility (63.3% vs. 77.2%, P = 0.003) and less likely to have a positive sputum result (12.6% vs. 20.7%, P = 0.023). CONCLUSION The attainment of sex equity in the provision of TB health services requires adherence to testing protocols. Everyone, irrespective of sex, who seeks care for a cough of ⩾2 weeks should be tested.
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Affiliation(s)
- A Smith
- Department of Economics, Stellenbosch University, Private Bag X1, Matieland 7602, Stellenbosch, South Africa.
| | - R Burger
- Department of Economics, Stellenbosch University, Stellenbosch, South Africa
| | - M Claassens
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - H Ayles
- Zambia AIDS Related Tuberculosis Project, Lusaka, Zambia; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - P Godfrey-Faussett
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - N Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
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Ramjee S, Hauck KD, Burger R, Stewart J. ISQUA16-2820NARROWING THE GAP: HOSPITAL ACCREDITATION AND INEQUALITY IN SOUTH AFRICA. Int J Qual Health Care 2016. [DOI: 10.1093/intqhc/mzw104.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rice TW, Apperson-Hansen C, DiPaola LM, Semple ME, Lerut TEMR, Orringer MB, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, Wijnhoven BPL, Chen KN, Davies AR, D’Journo XB, Kesler KA, Luketich JD, Ferguson MK, Räsänen JV, van Hillegersberg R, Fang W, Durand L, Allum WH, Cecconello I, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Ishwaran H, Blackstone EH. Worldwide Esophageal Cancer Collaboration: clinical staging data. Dis Esophagus 2016; 29:707-714. [PMID: 27731549 PMCID: PMC5591441 DOI: 10.1111/dote.12493] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To address uncertainty of whether clinical stage groupings (cTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for clinically staged patients from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 22,123 clinically staged patients, 8,156 had squamous cell carcinoma, 13,814 adenocarcinoma, 116 adenosquamous carcinoma, and 37 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (18.5-25 mg/kg2 , 47%), little weight loss (2.4 ± 7.8 kg), 0-1 ECOG performance status (67%), and history of smoking (67%). Cancers were cT1 (12%), cT2 (22%), cT3 (56%), cN0 (44%), cM0 (95%), and cG2-G3 (89%); most involved the distal esophagus (73%). Non-risk-adjusted survival for squamous cell carcinoma was not distinctive for early cT or cN; for adenocarcinoma, it was distinctive for early versus advanced cT and for cN0 versus cN+. Patients with early cancers had worse survival and those with advanced cancers better survival than expected from equivalent pathologic categories based on prior WECC pathologic data. Thus, clinical and pathologic categories do not share prognostic implications. This makes clinically based treatment decisions difficult and pre-treatment prognostication inaccurate. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient characteristics, cancer categories, and treatment characteristics and should direct 9th edition data collection.
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Affiliation(s)
| | | | | | | | | | | | - L.-Q. Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - B. M. Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - V. W. Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | - K. A. Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J. D. Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M. K. Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | | | | | - W. Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L. Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - W. H. Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - R. J. Cerfolio
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M. Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | | | - R. Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - J.-F Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - S. Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T. J. Watson
- University of Rochester, Rochester, New York, USA
| | | | - W. J. Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A. Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C. E. Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P. H. Schipper
- Oregon Health and Science University, Portland, Oregon, USA
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Rice TW, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, Wijnhoven BPL, Chen KL, Davies AR, D'Journo XB, Kesler KA, Luketich JD, Ferguson MK, Räsänen JV, van Hillegersberg R, Fang W, Durand L, Cecconello I, Allum WH, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Lerut TEMR, Orringer MB, Ishwaran H, Apperson-Hansen C, DiPaola LM, Semple ME, Blackstone EH. Worldwide Esophageal Cancer Collaboration: pathologic staging data. Dis Esophagus 2016; 29:724-733. [PMID: 27731547 PMCID: PMC5731491 DOI: 10.1111/dote.12520] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/03/2016] [Accepted: 06/04/2016] [Indexed: 02/05/2023]
Abstract
We report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for patients with pathologically staged cancer of the esophagus and esophagogastric junction after resection or ablation with no preoperative therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted de-identified data using standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 13,300 patients, 5,631 had squamous cell carcinoma, 7,558 adenocarcinoma, 85 adenosquamous carcinoma, and 26 undifferentiated carcinoma. Patients were older (62 years) men (80%) with normal body mass index (51%), little weight loss (1.8 kg), 0-2 ECOG performance status (83%), and a history of smoking (70%). Cancers were pT1 (24%), pT2 (15%), pT3 (50%), pN0 (52%), pM0 (93%), and pG2-G3 (78%); most involved distal esophagus (71%). Non-risk-adjusted survival for both squamous cell carcinoma and adenocarcinoma was monotonic and distinctive across pTNM. Survival was more distinctive for adenocarcinoma than squamous cell carcinoma when pT was ordered by pN. Survival for pTis-1 adenocarcinoma was better than for squamous cell carcinoma, although monotonic and distinctive for both. WECC pathologic staging data is improved over that of the 7th edition, with more patients studied and patient and cancer variables collected. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics, and should direct 9th edition data collection. However, the role of pure pathologic staging as the principal point of reference for esophageal cancer staging is waning.
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Affiliation(s)
- T W Rice
- Cleveland Clinic, Cleveland, Ohio, USA.
| | - L-Q Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - W L Hofstetter
- University of Texas MD Anderson Hospital, Houston, Texas, USA
| | - B M Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - V W Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | - K L Chen
- Beijing Cancer Hospital, Beijing, China
| | - A R Davies
- Guy's & St Thomas' Hospitals, London, England
| | | | - K A Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J D Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M K Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | - J V Räsänen
- Helsinki University Hospital, Helsinki, Finland
| | | | - W Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - I Cecconello
- University of São Paulo School of Medicine, São Paulo, Brazil
| | - W H Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | - R J Cerfolio
- Section of Thoracic Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | - S M Griffin
- University of Newcastle upon Tyne, Newcastle, United Kingdom
| | - R Burger
- University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa
| | - J-F Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - M S Allen
- Mayo Clinic, Rochester, Minnesota, USA
| | - S Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T J Watson
- University of Rochester, Rochester, New York, USA
| | - G E Darling
- Toronto General Hospital, Toronto, Ontario, Canada
| | - W J Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C E Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P H Schipper
- Oregon Health & Science University, Portland, Oregon, USA
| | | | - M B Orringer
- University of Michigan, Ann Arbor, Michigan, USA
| | - H Ishwaran
- University of Miami, Miami, Florida, USA
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Rice TW, Lerut TEMR, Orringer MB, Chen LQ, Hofstetter WL, Smithers BM, Rusch VW, van Lanschot J, Chen KN, Davies AR, D’Journo XB, Kesler KA, Luketich JD, Ferguson MK, Rasanen JV, van Hillegersberg R, Fang W, Durand L, Allum WH, Cecconello I, Cerfolio RJ, Pera M, Griffin SM, Burger R, Liu JF, Allen MS, Law S, Watson TJ, Darling GE, Scott WJ, Duranceau A, Denlinger CE, Schipper PH, Ishwaran H, Apperson-Hansen C, DiPaola LM, Semple ME, Blackstone EH. Worldwide Esophageal Cancer Collaboration: neoadjuvant pathologic staging data. Dis Esophagus 2016; 29:715-723. [PMID: 27731548 PMCID: PMC5528175 DOI: 10.1111/dote.12513] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 02/05/2023]
Abstract
To address uncertainty of whether pathologic stage groupings after neoadjuvant therapy (ypTNM) for esophageal cancer share prognostic implications with pathologic groupings after esophagectomy alone (pTNM), we report data-simple descriptions of patient characteristics, cancer categories, and non-risk-adjusted survival-for pathologically staged cancers after neoadjuvant therapy from the Worldwide Esophageal Cancer Collaboration (WECC). Thirty-three institutions from six continents submitted data using variables with standard definitions: demographics, comorbidities, clinical cancer categories, and all-cause mortality from first management decision. Of 7,773 pathologically staged neoadjuvant patients, 2,045 had squamous cell carcinoma, 5,686 adenocarcinoma, 31 adenosquamous carcinoma, and 11 undifferentiated carcinoma. Patients were older (61 years) men (83%) with normal (40%) or overweight (35%) body mass index, 0-1 Eastern Cooperative Oncology Group performance status (96%), and a history of smoking (69%). Cancers were ypT0 (20%), ypT1 (13%), ypT2 (18%), ypT3 (44%), ypN0 (55%), ypM0 (94%), and G2-G3 (72%); most involved the distal esophagus (80%). Non-risk-adjusted survival for yp categories was unequally depressed, more for earlier categories than later, compared with equivalent categories from prior WECC data for esophagectomy-alone patients. Thus, survival of patients with ypT0-2N0M0 cancers was intermediate and similar regardless of ypT; survival for ypN+ cancers was poor. Because prognoses for ypTNM and pTNM categories are dissimilar, prognostication should be based on separate ypTNM categories and groupings. These data will be the basis for the 8th edition cancer staging manuals following risk adjustment for patient, cancer, and treatment characteristics and should direct 9th edition data collection.
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Affiliation(s)
| | | | | | - L.-Q. Chen
- West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | | | - B. M. Smithers
- University of Queensland, Princess Alexandra Hospital, Brisbane, Australia
| | - V. W. Rusch
- Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | | - K. A. Kesler
- Indiana University Medical Center, Indianapolis, Indiana, USA
| | - J. D. Luketich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - M. K. Ferguson
- Department of Surgery, The University of Chicago, Chicago, Illinois, USA
| | | | | | - W. Fang
- Shanghai Chest Hospital, Shanghai, China
| | - L. Durand
- Hospital de Clinicas, University of Buenos Aires, Buenos Aires, Argentina
| | - W. H. Allum
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - R. J. Cerfolio
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - M. Pera
- Hospital Universitario del Mar, Barcelona, Spain
| | | | - R. Burger
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - J.-F. Liu
- Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | | | - S. Law
- University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, China
| | - T. J. Watson
- University of Rochester, Rochester, New York, USA
| | | | - W. J. Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
| | - A. Duranceau
- University of Montreal, Montreal, Quebec, Canada
| | - C. E. Denlinger
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - P. H. Schipper
- Oregon Health & Science University, Portland, Oregon, USA
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Meehan SA, Leon N, Naidoo P, Jennings K, Burger R, Beyers N. Availability and acceptability of HIV counselling and testing services. A qualitative study comparing clients' experiences of accessing HIV testing at public sector primary health care facilities or non-governmental mobile services in Cape Town, South Africa. BMC Public Health 2015; 15:845. [PMID: 26329262 PMCID: PMC4557635 DOI: 10.1186/s12889-015-2173-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The South African government is striving for universal access to HIV counselling and testing (HCT), a fundamental component of HIV care and prevention. In the Cape Town district, Western Cape Province of South Africa, HCT is provided free of charge at publically funded primary health care (PHC) facilities and through non-governmental organizations (NGOs). This study investigated the availability and accessibility of HCT services; comparing health seeking behaviour and client experiences of HCT across public PHC facilities (fixed sites) and NGO mobile services. METHODS This qualitative study used semi-structured interviews. Systematic sampling was used to select 16 participants who accessed HCT in either a PHC facility (8) or a NGO mobile service (8). Interviews, conducted between March and June 2011, were digitally recorded, transcribed and where required, translated into English. Constant comparative and thematic analysis was used to identify common and divergent responses and themes in relation to the key questions (reasons for testing, choice of service provider and experience of HCT). RESULTS The sample consisted of 12 females and 4 males with an age range of 19-60 years (median age 28 years). Motivations for accessing health facilities and NGO services were similar; opportunity to test, being affected by HIV and a perceived personal risk for contracting HIV. Participants chose a particular service provider based on accessibility, familiarity with and acceptability of that service. Experiences of both services were largely positive, though instances of poor staff attitude and long waiting times were reported at PHC facilities. Those attending NGO services reported shorter waiting times and overall positive testing experiences. Concerns about lack of adequate privacy and associated stigma were expressed about both services. CONCLUSIONS Realised access to HCT is dependent on availability and acceptability of HCT services. Those who utilised either a NGO mobile service or a public PHC facility perceived both service types as available and acceptable. Mobile NGO services provided an accessible opportunity for those who would otherwise not have tested at that time. Policy makers should consider the perceptions and experiences of those accessing HCT services when increasing access to HCT.
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Affiliation(s)
- Sue-Ann Meehan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Ave, Parow, Cape Town, South Africa.
| | - Natalie Leon
- Health Research Unit, South African Medical Research Council, Francie van Zijl Ave, Parow, Cape Town, South Africa.
| | - Pren Naidoo
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Ave, Parow, Cape Town, South Africa.
| | - Karen Jennings
- City of Cape Town Health Directorate, Cape Town, South Africa.
| | - Ronelle Burger
- Department of Economics, Stellenbosch University, Stellenbosch, Cape Town, South Africa.
| | - Nulda Beyers
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Ave, Parow, Cape Town, South Africa.
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Burger R, Kurzbuch D, Gorkin R, Kijanka G, Glynn M, McDonagh C, Ducrée J. An integrated centrifugo-opto-microfluidic platform for arraying, analysis, identification and manipulation of individual cells. Lab Chip 2015; 15:378-81. [PMID: 25407668 DOI: 10.1039/c4lc01002g] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
In this work we present a centrifugal microfluidic system enabling highly efficient collective trapping and alignment of particles such as microbeads and cells, their multi-colour fluorescent detection and subsequent manipulation by optical tweezers. We demonstrate array-based capture and imaging followed by "cherry-picking" of individual particles, first for fluorescently labelled polystyrene (PS) beads and then for cells. Different cell lines are discriminated based on intracellular as well as surface-based markers.
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Affiliation(s)
- R Burger
- Biomedical Diagnostics Institute, National Centre for Sensor Research, School of Physical Sciences, Dublin City University, Ireland.
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Hersey SP, Garland RM, Crosbie E, Shingler T, Sorooshian A, Piketh S, Burger R. An overview of regional and local characteristics of aerosols in South Africa using satellite, ground, and modeling data. Atmos Chem Phys 2015; 15:4259-4278. [PMID: 26312061 PMCID: PMC4547400 DOI: 10.5194/acp-15-4259-2015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We present a comprehensive overview of particulate air quality across the five major metropolitan areas of South Africa (Cape Town, Bloemfontein, Johannesburg and Tshwane (Gauteng Province), the Industrial Highveld Air Quality Priority Area (HVAPA), and Durban), based on a decadal (1 January 2000 to 31 December 2009) aerosol climatology from multiple satellite platforms and detailed analysis of ground-based data from 19 sites throughout Gauteng Province. Satellite analysis was based on aerosol optical depth (AOD) from MODIS Aqua and Terra (550 nm) and MISR (555 nm) platforms, Ångström Exponent (α) from MODIS Aqua (550/865 nm) and Terra (470/660 nm), ultraviolet aerosol index (UVAI) from TOMS, and results from the Goddard Ozone Chemistry Aerosol Radiation and Transport (GOCART) model. At continentally influenced sites, AOD, α, and UVAI reach maxima (0.12-0.20, 1.0-1.8, and 1.0-1.2, respectively) during austral spring (September-October), coinciding with a period of enhanced dust generation and the maximum integrated intensity of close-proximity and subtropical fires identified by MODIS Fire Information for Resource Management System (FIRMS). Minima in AOD, α, and UVAI occur during winter. Results from ground monitoring indicate that low-income township sites experience by far the worst particulate air quality in South Africa, with seasonally averaged PM10 concentrations as much as 136 % higher in townships that in industrial areas. We report poor agreement between satellite and ground aerosol measurements, with maximum surface aerosol concentrations coinciding with minima in AOD, α, and UVAI. This result suggests that remotely sensed data are not an appropriate surrogate for ground air quality in metropolitan South Africa.
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Affiliation(s)
- S. P. Hersey
- Department of Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
- Now at Franklin W. Olin College of Engineering, Needham, MA, USA
| | - R. M. Garland
- Now at Franklin W. Olin College of Engineering, Needham, MA, USA
- Council for Scientific and Industrial Research (CSIR), Pretoria, South Africa
| | - E. Crosbie
- Department of Atmospheric Sciences, University of Arizona, Tucson, AZ, USA
| | - T. Shingler
- Department of Atmospheric Sciences, University of Arizona, Tucson, AZ, USA
| | - A. Sorooshian
- Department of Atmospheric Sciences, University of Arizona, Tucson, AZ, USA
- Department of Chemical and Environmental Engineering, University of Arizona, Tucson, AZ, USA
| | - S. Piketh
- Department of Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
| | - R. Burger
- Department of Environmental Sciences and Management, North-West University, Potchefstroom, South Africa
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Staudinger M, Glorius P, Burger R, Kellner C, Klausz K, Günther A, Repp R, Klapper W, Gramatzki M, Peipp M. The novel immunotoxin HM1.24-ETA' induces apoptosis in multiple myeloma cells. Blood Cancer J 2014; 4:e219. [PMID: 24927408 PMCID: PMC4080209 DOI: 10.1038/bcj.2014.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 12/02/2013] [Revised: 04/17/2014] [Accepted: 04/30/2014] [Indexed: 11/09/2022] Open
Abstract
Despite new treatment modalities, the clinical outcome in a substantial number of patients with multiple myeloma (MM) has yet to be improved. Antibody-based targeted therapies for myeloma patients could make use of the HM1.24 antigen (CD317), a surface molecule overexpressed on malignant plasma cells and efficiently internalized. Here, a novel immunotoxin, HM1.24-ETA', is described. HM1.24-ETA' was generated by genetic fusion of a CD317-specific single-chain Fv (scFv) antibody and a truncated variant of Pseudomonas aeruginosa exotoxin A (ETA'). HM1.24-ETA' inhibited growth of interleukin 6 (IL-6)-dependent and -independent myeloma cell lines. Half-maximal growth inhibition was observed at concentrations as low as 0.3 nM. Target cell killing occurred via induction of apoptosis and was unaffected in co-culture experiments with bone marrow stromal cells. HM1.24-ETA' efficiently triggered apoptosis of freshly isolated/cryopreserved cells of patients with plasma cell leukemia and MM and was active in a preclinical severe combined immunodeficiency (SCID) mouse xenograft model. Importantly, HM1.24-ETA' was not cytotoxic against CD317-positive cells from healthy tissue (monocytes, human umbilical vein endothelial cells). These results indicate that CD317 may represent a promising target structure for specific and efficient immunotoxin therapy for patients with plasma cell tumors.
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Affiliation(s)
- M Staudinger
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - P Glorius
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - R Burger
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - C Kellner
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - K Klausz
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - A Günther
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - R Repp
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - W Klapper
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
| | - M Peipp
- Division of Stem Cell Transplantation and Immunotherapy, 2nd Department of Medicine, Christian-Albrechts-University Kiel, Kiel, Germany
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