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Mwangala PN, Makandi M, Kerubo A, Nyongesa MK, Abubakar A. A scoping review of the literature on the application and usefulness of the Problem Management Plus (PM+) intervention around the world. BJPsych Open 2024; 10:e91. [PMID: 38650067 PMCID: PMC11060090 DOI: 10.1192/bjo.2024.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/13/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Given the high rates of common mental disorders and limited resources, task-shifting psychosocial interventions are needed to provide adequate care. One such intervention developed by the World Health Organization is Problem Management Plus (PM+). AIMS This review maps the evidence regarding the extent of application and usefulness of the PM+ intervention, i.e. adaptability, feasibility, effectiveness and scalability, since it was introduced in 2016. METHOD We conducted a scoping review of seven literature databases and grey literature from January 2015 to February 2024, to identify peer-reviewed and grey literature on PM+ around the world. RESULTS Out of 6739 potential records, 42 met the inclusion criteria. About 60% of the included studies were from low- and middle-income countries. Findings from pilot/feasibility trials demonstrated that PM+ is feasible, acceptable and safe. Results from definitive randomised controlled trials at short-term follow-up also suggested that PM+ is effective, with overall moderate-to-large effect sizes, in improving symptoms of common mental health problems. Although PM+ was more effective in reducing symptoms of common mental disorders, it was found to be costlier compared to usual care in the only study that evaluated its cost-effectiveness. CONCLUSIONS Our findings indicate that PM+, in its individual and group formats, can be adapted and effectively delivered by trained helpers to target a wide range of common mental health concerns. More effectiveness and implementation evidence is required to understand the long-term impact of PM+, its cost-effectiveness and scalability, and moderators of treatment outcomes such as gender and delivery formats.
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Affiliation(s)
- Patrick N. Mwangala
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and School of Public Health, University of the Witwatersrand, South Africa
| | | | - Anita Kerubo
- Institute for Human Development, Aga Khan University, Kenya
| | | | - Amina Abubakar
- Institute for Human Development, Aga Khan University, Kenya; Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya; and Department of Psychiatry, University of Oxford, UK
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Memon Z, Mian A, Ahmed W, Jawwad M, Muhammad S, Noorani AQ, Bhutta Z, Soltani H. Predictors of voluntary uptake of modern contraceptive methods in rural Sindh, Pakistan. PLOS Glob Public Health 2024; 4:e0002419. [PMID: 38574040 PMCID: PMC10994370 DOI: 10.1371/journal.pgph.0002419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
The use of modern contraceptive methods (MCMs) has been stagnant for the last decade in Pakistan. The second most populous province, Sindh reports 25% of MCMs use. Various factors including demographics and health services utilization are associated with the uptake of family planning services. This research aimed to identify and assess specific predictors of MCMs among women aged 15-49 in two districts of Sindh-Matiari and Badin. A cross-sectional household survey was conducted from October 2020- December 2020. In total, 1684 Married Women of Reproductive Age (MWRA) 15-49 years were interviewed. For the selection of eligible respondents, a two-stage stratified cluster sampling strategy was used. Univariate and multivariable logistic regression was used to determine the predictors for the use of MCM. Use of modern methods of contraceptive was 26.1% (n = 441). Statistically significant socio demographic predictors of MCM included: number of children 4 or more (AOR: 5.23; 95%CI: 2.78-9.84), mother having primary education (AOR: 1.73; 95% CI: 1.26-2.36), and husband having middle education (AOR: 1.69; 95% CI: 1.03-2.76). Maternal health services indicators included: postnatal care of mother (AOR: 1.46; 95% CI: 1.09-2.05); women who were visited by Lady Health Workers in their postnatal period and were counselled on family planning (AOR: 1.83; 95% CI: 1.38-2.42). Since the primary purpose of using modern contraceptive methods is for limiting pregnancies, there is a potential to promote awareness about the benefits of birth spacing as part of implementing a more integrated approach to family planning. The integration of family planning services within maternal and newborn child healthcare services effectively promote the voluntary adoption of modern contraceptive methods. The role of Lady Health Workers in family planning counseling and service provision and uptake is important in the context of Sindh and should be fostered further by opportunities for capacity building and their empowerment.
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Affiliation(s)
| | | | | | | | | | | | | | - Hora Soltani
- Sheffield Hallam University, Sheffield, England, United Kingdom
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Batist CH, Dufourq E, Jeantet L, Razafindraibe MN, Randriamanantena F, Baden AL. An integrated passive acoustic monitoring and deep learning pipeline for black-and-white ruffed lemurs (Varecia variegata) in Ranomafana National Park, Madagascar. Am J Primatol 2024; 86:e23599. [PMID: 38244194 DOI: 10.1002/ajp.23599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
The urgent need for effective wildlife monitoring solutions in the face of global biodiversity loss has resulted in the emergence of conservation technologies such as passive acoustic monitoring (PAM). While PAM has been extensively used for marine mammals, birds, and bats, its application to primates is limited. Black-and-white ruffed lemurs (Varecia variegata) are a promising species to test PAM with due to their distinctive and loud roar-shrieks. Furthermore, these lemurs are challenging to monitor via traditional methods due to their fragmented and often unpredictable distribution in Madagascar's dense eastern rainforests. Our goal in this study was to develop a machine learning pipeline for automated call detection from PAM data, compare the effectiveness of PAM versus in-person observations, and investigate diel patterns in lemur vocal behavior. We did this study at Mangevo, Ranomafana National Park by concurrently conducting focal follows and deploying autonomous recorders in May-July 2019. We used transfer learning to build a convolutional neural network (optimized for recall) that automated the detection of lemur calls (57-h runtime; recall = 0.94, F1 = 0.70). We found that PAM outperformed in-person observations, saving time, money, and labor while also providing re-analyzable data. Using PAM yielded novel insights into V. variegata diel vocal patterns; we present the first published evidence of nocturnal calling. We developed a graphic user interface and open-sourced data and code, to serve as a resource for primatologists interested in implementing PAM and machine learning. By leveraging the potential of this pipeline, we can address the urgent need for effective primate population surveys to inform conservation strategies.
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Affiliation(s)
- Carly H Batist
- Department of Anthropology, City University of New York (CUNY) Graduate Center, New York, New York, USA
- New York Consortium in Evolutionary Primatology (NYCEP), New York, New York, USA
- Rainforest Connection (RFCx), Katy, Texas, USA
| | - Emmanuel Dufourq
- African Institute for Mathematical Sciences, Muizenberg, South Africa
- Department of Mathematical Sciences, Stellenbosch University, Stellenbosch, South Africa
- National Institute for Theoretical & Computational Sciences, Stellenbosch, South Africa
- African Institute for Mathematical Sciences, Research and Innovation Centre, Kigali, Rwanda
| | - Lorène Jeantet
- African Institute for Mathematical Sciences, Muizenberg, South Africa
- Department of Mathematical Sciences, Stellenbosch University, Stellenbosch, South Africa
- National Institute for Theoretical & Computational Sciences, Stellenbosch, South Africa
| | - Mendrika N Razafindraibe
- Department of Animal Biology, University of Antananarivo, Antananarivo, Madagascar
- Institut International de Science Sociale, Antananarivo, Madagascar
| | | | - Andrea L Baden
- Department of Anthropology, City University of New York (CUNY) Graduate Center, New York, New York, USA
- New York Consortium in Evolutionary Primatology (NYCEP), New York, New York, USA
- Department of Anthropology, Hunter College of City University of New York (CUNY), New York, New York, USA
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Uwamahoro NS, Forsyth J, Andre F, Mandlate DA, Gilmore B, Muhajarine N. Realist evaluation of maternity waiting home intervention models in Inhambane, Mozambique: protocol for a comparative embedded case study, the Mozambique-Canada Maternal Health Project. BMJ Open 2024; 14:e075681. [PMID: 38521527 PMCID: PMC10961506 DOI: 10.1136/bmjopen-2023-075681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/28/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION This is a study protocol that tests and refines realist theories regarding the uptake and scale-up of the linked maternity waiting home (hereafter MWH) and facility birth intervention in the Mozambican context. The theories were developed through a realist review of MWH-facility birth literature from low-income and middle-income countries. The aim of the proposed study is to contribute to a contextually refined understanding of the causal chains underlying MWH-facility birth adoption by pregnant women and their families, communities, the health system and donors. METHODS AND ANALYSIS The overarching methodology is mixed-methods realist evaluation. The study will adopt a comparative embedded case study design comparing three new masonry MWHs built by the Mozambique-Canada Maternal Health Project in Inhambane province with three older MWHs selected based on variation in the built environment. Baseline data on participating MWH-facility birth interventions will be collected through observations, reviews of routine data and analysis of statistics and reports from provincial and district health authorities and the Mozambique-Canada Maternal Health project. Realist interviews will be conducted with MWH users and non-users, companions of MWH users and non-users, partners of MWH users and non-users, and stakeholders within the health system and the non-governmental organisation sector. Realist focus groups will be used to collect data from community-level implementers. The analysis will be retroductive and use the context-mechanism-outcome configuration heuristic tool to represent generative causation. We will analyse data from intervention and comparator MWHs independently and compare the resulting refined programme theories. Data analysis will be done in NVivo 12. ETHICS AND DISSEMINATION Ethics approval for the project has been obtained from the Mozambique National Bioethics Committee (CNBS-Comité Nacional de Bioética para a Saúde) and the University of Saskatchewan Bioethical Research Ethics Board. The evaluation will adhere to the International Ethical Guidelines for Biomedical Research Involving Human Subjects and the African adaptation of evaluation ethics and principles. Evaluation results will be disseminated to stakeholders' practice audiences through peer-reviewed publications, plain-language briefs, theory validation/feedback meetings and conference presentations.
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Affiliation(s)
- Nadege Sandrine Uwamahoro
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Mozambique-Canada Maternal Health Project, Inhambane, Mozambique
| | - Jessie Forsyth
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Mozambique-Canada Maternal Health Project, Inhambane, Mozambique
| | - Fernanda Andre
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Mozambique-Canada Maternal Health Project, Inhambane, Mozambique
| | | | - Brynne Gilmore
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems, University College Dublin, Dublin, Ireland
| | - Nazeem Muhajarine
- Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Mozambique-Canada Maternal Health Project, Inhambane, Mozambique
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Decelles S, Nardocci M, Mildon A, Salameh B, Sebai I, Arasimowicz S, Batal M. Determinants of continued breastfeeding in children aged 12-23 months in three regions of Haiti. Rev Panam Salud Publica 2024; 48:e6. [PMID: 38464872 PMCID: PMC10921905 DOI: 10.26633/rpsp.2024.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 03/12/2024] Open
Abstract
Objectives To identify the prevalence and determinants of continued breastfeeding in Haitian children aged 12-23 months. Methods Three cross-sectional surveys were conducted yearly during the summers of 2017 to 2019 as part of a 4-year (2016-2020) multisectoral maternal and infant health initiative in the regions of Les Cayes, Jérémie, and Anse d'Hainault in Haiti. A total of 455 children 12-23 months of age and their mothers participated in the study. A child was considered to be continuing breastfeeding if the mother reported giving breast milk in the 24-hour dietary recall. Unadjusted and adjusted prevalence ratios were estimated, and associations were assessed between continued breastfeeding and explanatory factors related to sociodemographic characteristics, household food security, maternal nutrition, and breastfeeding knowledge and practices. Results The prevalence of continued breastfeeding was 45.8%. Continued breastfeeding was significantly more prevalent among younger children, children who did not have a younger sibling, children whose mother was not pregnant, those living in the Jérémie region, children who had been exclusively breastfed for less than 1 month, and children whose mother knew the World Health Organization's recommendation for continued breastfeeding up to 2 years or beyond. Conclusions The study results highlight the need for geographically equitable access to tailored and adequate health services and education that support breastfeeding in a way that is compatible with the local context.
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Affiliation(s)
- Stéphane Decelles
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Milena Nardocci
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Alison Mildon
- Independent consultantTorontoCanadaIndependent consultant, Toronto, Canada.
| | - Bana Salameh
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Ines Sebai
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Sabrina Arasimowicz
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
| | - Malek Batal
- Université de MontréalMontrealCanadaUniversité de Montréal, Montreal, Canada.
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Capasso A, Colomar M, Ramírez D, Serruya S, de Mucio B. Digital health and the promise of equity in maternity care: A mixed methods multi-country assessment on the use of information and communication technologies in healthcare facilities in Latin America and the Caribbean. PLoS One 2024; 19:e0298902. [PMID: 38412170 PMCID: PMC10898739 DOI: 10.1371/journal.pone.0298902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/31/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Timely access to maternity care is critical to saving lives. Digital health may serve to bridge the care chasm and advance health equity. Conducted in the aftermath of the COVID-19 pandemic, this cross-sectional mixed-methods study assessed the use of information and communication technologies (ICTs) in healthcare facilities in nine Latin American and Caribbean countries to understand the landscape of ICT use in maternity care and the barriers and facilitators to its adoption. MATERIALS AND METHODS Between April 2021 and September 2022, we disseminated an online survey in English and Spanish among, mainly public, healthcare institutions that provided maternity care in Argentina, Bolivia, Colombia, the Dominican Republic, Ecuador, Guyana, Honduras, Paraguay and Peru. We also interviewed 27 administrators and providers in ministries of health and healthcare institutions. RESULTS Most of the 1877 institutions that answered the survey reported using ICTs in maternity care (N = 1536, 82%), ranging from 96% in Peru to 64% in the Dominican Republic. Of institutions that used ICTs, 59% reported using them more than before or for the first time since the pandemic began. ICTs were most commonly used to provide family planning (64%) and breastfeeding (58%) counseling, mainly by phone (82%). At the facility level, availability of equipment and internet coverage, coupled with skilled human resources, were the main factors associated with ICT use. At country level, government-led initiatives to develop digital health platforms, alongside national investments in the digital infrastructure, were the determining factors in the adoption of ICTs in healthcare provision. CONCLUSION Digital health for maternity care provision relied on commonly available technology and did not necessitate highly sophisticated systems, making it a sustainable and replicable strategy. However, disparities in access to digital health remain and many facilities in rural and remote areas lacked connectivity. Use of ICTs in maternity care depended on countries' long-term commitments to achieving universal health and digital coverage.
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Affiliation(s)
- Ariadna Capasso
- Health Resources in Action, Boston, MA, United States of America
- New York University, New York, NY, United States of America
| | - Mercedes Colomar
- Pan American Health Organization/World Health Organization, Montevideo, Uruguay
| | | | - Suzanne Serruya
- Pan American Health Organization/World Health Organization, Montevideo, Uruguay
| | - Bremen de Mucio
- Pan American Health Organization/World Health Organization, Montevideo, Uruguay
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Vepachedu S, Nurzenska A, Lohiniva AL, Hudi AH, Deku S, Birungi J, Greiner K, Sherlock J, Campbell C, Foster L. Understanding COVID-19 vaccination behaviors and intentions in Ghana: A Behavioral Insights (BI) study. PLoS One 2024; 19:e0292532. [PMID: 38335165 PMCID: PMC10857727 DOI: 10.1371/journal.pone.0292532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/21/2023] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Vaccine uptake is influenced by a variety of factors. Behavioral Insights (BI) can be used to address vaccine hesitancy to understand the factors that influence the decision to take or refuse a vaccine. METHODOLOGY This two-part study consisted of a survey designed to identify the influence of various drivers of people's COVID-19 vaccination status and their intention to take the vaccine in Ghana, as well as an experiment to test which of several behaviorally informed message frames had the greatest effect on vaccine acceptance. Data was collected from a total of 1494 participants; 1089 respondents (73%) reported already being vaccinated and 405 respondents (27%) reported not being vaccinated yet. The mobile phone-based surveys were conducted between December 2021 and January 2022 using Random Digit Dialing (RDD) to recruit study participants. Data analysis included regression models, relative weights analyses, and ANOVAs. RESULTS The findings indicated that vaccine uptake in Ghana is influenced more by social factors (what others think) than by practical factors such as ease of vaccination. Respondents' perceptions of their family's and religious leaders' attitudes towards the vaccine were among the most influential drivers. Unexpectedly, healthcare providers' positive attitudes about the COVID-19 vaccine had a significant negative relationship with respondents' vaccination behavior. Vaccine intention was positively predicted by risk perception, ease of vaccination, and the degree to which respondents considered the vaccine effective. Perceptions of religious leaders' attitudes also significantly and positively predicted respondents' intention to get vaccinated. Although perceptions of religious leaders' views about the vaccine are an important driver of vaccine acceptance, results asking respondents to rank-order who influences them suggest that people may not be consciously aware-or do not want to admit-the degree to which they are affected by what religious leaders think. Message frames that included fear, altruism, social norms were all followed by positive responses toward the vaccine, as were messages with three distinct messengers: Ghana Health Services, a doctor, and religious leaders. CONCLUSIONS What drives COVID-19 vaccine intentions does not necessarily drive behaviors. The results of this study can be used to develop appropriate COVID-19 vaccine uptake strategies targeting the most important drivers of COVID-19 vaccine acceptance, using effective message frames.
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Affiliation(s)
- Swathi Vepachedu
- Center for Advanced Hindsight, Duke University, Durham, NC, United States of America
- Department of Psychology, North Carolina State University, Raleigh, NC, United States of America
| | | | | | | | | | | | - Karen Greiner
- UNICEF Regional Office Central and West Africa, Dakar, Senegal
| | - Joseph Sherlock
- Center for Advanced Hindsight, Duke University, Durham, NC, United States of America
| | - Chelsi Campbell
- Center for Advanced Hindsight, Duke University, Durham, NC, United States of America
- Department of Psychology, North Carolina State University, Raleigh, NC, United States of America
| | - Lori Foster
- Department of Psychology, North Carolina State University, Raleigh, NC, United States of America
- School of Management Studies, University of Cape Town, Cape Town, South Africa
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Hefez J, Mulunda JC, Tumba AM, Mpoyi M, Dabash R. Domestication of the Maputo Protocol in the Democratic Republic of Congo: Leveraging regional human rights commitments for abortion decriminalization and access. Int J Gynaecol Obstet 2024; 164 Suppl 1:12-20. [PMID: 38360032 DOI: 10.1002/ijgo.15332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The Maputo Protocol, adopted over 20 years ago, is a promising regional treaty for advancing gender equity and sexual and reproductive health and rights. This instrument has driven progress in women's health and rights across Africa, with much remaining to achieve to realize its full potential for women and girls, including access to safe abortion. The present paper shares the strategies and lessons from the Democratic Republic of Congo's (DRC) reform centered on the domestication of the Protocol, specifically applying its commitments on abortion decriminalization and access. With a vision of addressing maternal mortality and rectifying the impacts of widespread sexual violence against women during war, abortion as a human right and health imperative was at the heart of the DRC's reform. Governmental commitment, broad coalition building, evidence generation, and an intersectional advocacy agenda were critical to overcoming opposition, stigma, and other challenges. This paper shares key learnings from the DRC's complex yet collaborative reform strategies and its processes. The strategy prioritized domestication of the Protocol for numerous reforms, including paving the path to legal abortion on the broad grounds of rape or incest, and saving women's health and/or life. With a commitment to maximizing quality, access, task sharing, and equity, progressive national comprehensive abortion guidelines were created alongside an implementation roadmap for accountability. The DRC's experience leveraging the Maputo Protocol's obligations to advance abortion rights and access offers valuable insights for consideration globally.
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Affiliation(s)
| | | | - Anne-Marie Tumba
- National Reproductive Health Program (PNSR), Kinshasa, Democratic Republic of Congo
| | - Mike Mpoyi
- Ipas, Kinshasa, Democratic Republic of Congo
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Halidou Doudou M, Ouedraogo O, Cruz S, Dieudonné D, Levrac M. Enabling environment and challenges for UN joint programming to strengthen nutrition: A multi-country survey in Burkina Faso, Mali, and Senegal. Int J Health Plann Manage 2024. [PMID: 38243898 DOI: 10.1002/hpm.3759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
The United Nations plays an important role in supporting governments to implement nutrition policies and accelerate progress. The development of a common UN nutrition agenda and joint programming are two crucial aspects to improve complementarities and synergies to maximize the nutritional impact. The objective was to identify the success factors and challenges during the planning process of the UN common nutrition agenda in three different contexts. This is a qualitative study, conducted in Burkina Faso, Mali and Senegal between 2016 and 2018. The data was collected using an orientation kit developed by the UN Network which includes an inventory of UN nutrition actions, individual interviews, and consensus workshops. A total of 32 nutrition focal points from UN agencies participated in the study. In all countries, UN nutrition interventions were concentrated in areas with the highest number of stunted. Most of these actions were aligned with the priorities of nutrition policies and were complementary. Governance actions were mainly oriented towards sector governance. Key success of joint nutrition programming by UN includes commitment of country director and technicians, functional UN Network, participation of field-level stakeholders and strengthening of information between UN agencies. Certain prerequisites such as the existence of nutrition policy, stakeholder and action mapping, inventory of UN nutrition actions, situation analysis contributed to the formulation of a common nutrition agenda at country level. Among the challenges, we note effective implementation of joint programs to strengthen complementarity; diversity of beneficiary targeting strategies between sectors; low mobilization of resources; lack of coordination intra and inter agencies; understaffing; strengthening partnership and multisectoral accountability; ownership of the common nutrition agenda by all agencies. The development of common nutrition agenda and joint programs would maximize the nutritional impact in the country level.
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Affiliation(s)
- Maimouna Halidou Doudou
- Université Privée Africaine pour le Développement (UPAD), Niamey, Niger
- Programme Alimentaire Mondial (PAM), N'Djamena, Tchad
| | - Ousmane Ouedraogo
- Fonds des Nations Unies pour l'Enfance (UNICEF), Ouagadougou, Burkina Faso
| | - Sarah Cruz
- Programme Alimentaire Mondial (PAM), Kigali, Rwanda
| | - Diasso Dieudonné
- Comité Permanent Inter-Etats de Lutte Contre la Sécheresse dans le Sahel (CILSS), Ouagadougou, Burkina Faso
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Sequeira Dmello B, John TW, Housseine N, Meyrowitsch DW, van Roosmalen J, van den Akker T, Kujabi ML, Festo C, Nkungu D, Muniro Z, Kabanda I, Msumi R, Maembe L, Sangalala M, Hyera E, Lema J, Bayongo S, Mshiu J, Kidanto HL, Maaløe N. Incidence and determinants of perinatal mortality in five urban hospitals in Dar es Salaam, Tanzania: a cohort study with an embedded case-control analysis. BMC Pregnancy Childbirth 2024; 24:62. [PMID: 38218766 PMCID: PMC10787400 DOI: 10.1186/s12884-023-06096-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/30/2023] [Indexed: 01/15/2024] Open
Abstract
INTRODUCTION Tanzania has one of the highest burdens of perinatal mortality, with a higher risk among urban versus rural women. To understand the characteristics of perinatal mortality in urban health facilities, study objectives were: I. To assess the incidence of perinatal deaths in public health facilities in Dar es Salaam and classify these into a) pre-facility stillbirths (absence of fetal heart tones on admission to the study health facilities) and b) intra-facility perinatal deaths before discharge; and II. To identify determinants of perinatal deaths by comparing each of the two groups of perinatal deaths with healthy newborns. METHODS This was a retrospective cohort study among women who gave birth in five urban, public health facilities in Dar es Salaam. I. Incidence of perinatal death in the year 2020 was calculated based on routinely collected health facility records and the Perinatal Problem Identification Database. II. An embedded case-control study was conducted within a sub-population of singletons with birthweight ≥ 2000 g (excluding newborns with congenital malformations); pre-facility stillbirths and intra-facility perinatal deaths were compared with 'healthy newborns' (Apgar score ≥ 8 at one and ≥ 9 at five minutes and discharged home alive). Descriptive and logistic regression analyses were performed to explore the determinants of deaths. RESULTS A total of 37,787 births were recorded in 2020. The pre-discharge perinatal death rate was 38.3 per 1,000 total births: a stillbirth rate of 27.7 per 1,000 total births and an intra-facility neonatal death rate of 10.9 per 1,000 live births. Pre-facility stillbirths accounted for 88.4% of the stillbirths. The case-control study included 2,224 women (452 pre-facility stillbirths; 287 intra-facility perinatal deaths and 1,485 controls), 99% of whom attended antenatal clinic (75% with more than three visits). Pre-facility stillbirths were associated with low birth weight (cOR 4.40; (95% CI: 3.13-6.18) and with maternal hypertension (cOR 4.72; 95% CI: 3.30-6.76). Intra-facility perinatal deaths were associated with breech presentation (aOR 40.3; 95% CI: 8.75-185.61), complications in the second stage (aOR 20.04; 95% CI: 12.02-33.41), low birth weight (aOR 5.57; 95% CI: 2.62-11.84), cervical dilation crossing the partograph's action line (aOR 4.16; 95% CI:2.29-7.56), and hypertension during intrapartum care (aOR 2.9; 95% CI 1.03-8.14), among other factors. CONCLUSION: The perinatal death rate in the five urban hospitals was linked to gaps in the quality of antenatal and intrapartum care, in the study health facilities and in lower-level referral clinics. Urgent action is required to implement context-specific interventions and conduct implementation research to strengthen the urban referral system across the entire continuum of care from pregnancy onset to postpartum. The role of hypertensive disorders in pregnancy as a crucial determinant of perinatal deaths emphasizes the complexities of maternal-perinatal health within urban settings.
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Affiliation(s)
- Brenda Sequeira Dmello
- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT), P. O Box 23310, Dar Es Salaam, Tanzania.
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania.
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark.
| | - Thomas Wiswa John
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College, East Africa, Aga Khan University, Dar es Salaam, Tanzania
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Dan Wolf Meyrowitsch
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Leiden, the Netherlands
| | - Monica Lauridsen Kujabi
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
| | | | - Daniel Nkungu
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Zainab Muniro
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Idrissa Kabanda
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Rukia Msumi
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Luzango Maembe
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Mtingele Sangalala
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Ester Hyera
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Joyce Lema
- Presidents Office, Regional and Local Government, Municipal Maternity Hospitals Ubungo and Temeke, Dar es Salaam, Tanzania
| | - Scolastica Bayongo
- Regional Referral Hospital Dar Es Salaam, Ministry of Health, Dar es Salaam, Tanzania
| | - Johnson Mshiu
- Muhimbili Medical Research Center, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | - Nanna Maaløe
- Department of Public Health, Global Health Section, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
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Ansari U, Omer K, Aziz A, Gidado Y, Mudi H, Jamaare IS, Andersson N, Cockcroft A. Added value of video edutainment on android handsets in home visits to improve maternal and child health in Bauchi State, Nigeria: Secondary analysis from a cluster randomised controlled trial. Digit Health 2024; 10:20552076241228408. [PMID: 38357586 PMCID: PMC10865940 DOI: 10.1177/20552076241228408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Objective A trial of evidence-based health promotion home visits to pregnant women and their spouses in northern Nigeria found significant improvements in maternal and child health outcomes. This study tested the added value for these outcomes of including video edutainment in the visits. Methods In total, 19,718 households in three randomly allocated intervention wards (administrative areas) received home visits including short videos on android handsets to spark discussion about local risk factors for maternal and child health; 16,751 households in three control wards received visits with only verbal discussion about risk factors. We compared outcomes between wards with and without videos in the visits, calculating the odds ratio (OR) and 95% confidence interval (95%CI) of differences, in bivariate and then multivariate analysis adjusting for socio-economic differences between the video and non-video wards. Results Pregnant women from video wards were more likely than those from non-video wards to have discussed pregnancy and childbirth often with their husbands (OR 2.22, 95%CI 1.07-4.59). Male spouses in video wards were more likely to know to give more fluids and continued feeding to a child with diarrhoea (OR 1.61, 95%CI 1.21-2.13). For most outcomes there was no significant difference between video and non-video wards. The home visitors who shared videos considered they helped pregnant women and their spouses to appreciate the information about risk factors. Conclusion The lack of added value of the videos in the context of a research study may reflect the intensive training of home visitors and the effective evidence-based discussions included in all the visits. Further research could rollout routine home visits with and without videos and test the impact of video edutainment added to home visits carried out in a routine service context.
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Affiliation(s)
- Umaira Ansari
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Amar Aziz
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women's Association of Nigeria, Bauchi, Nigeria
| | - Hadiza Mudi
- Federation of Muslim Women's Association of Nigeria, Bauchi, Nigeria
| | | | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Cockcroft
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Mexico
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Canada
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Breyer GM, Rocha Jacques da Silva ME, Slaviero M, Albuquerque de Almeida B, Machado Sousa da Silva E, de Queiroz Schmidt VR, Alievi M, Maboni G, Petinatti Pavarini S, Maboni Siqueira F. Genotypic characterization of Streptococcus didelphis causative of fatal infection in white-eared opossums. Lett Appl Microbiol 2023; 76:ovad131. [PMID: 37968138 DOI: 10.1093/lambio/ovad131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 11/17/2023]
Abstract
Streptococcus didelphis was once reported as related to severe infections in opossums. Thus, we present the first comprehensive whole-genome characterization of clinical S. didelphis strains isolated from white-eared opossums (Didelphis albiventris). Long-read whole-genome sequencing was performed using the MinION platform, which allowed the prediction of several genomic features. We observed that S. didelphis genomes harbor a cluster for streptolysin biosynthesis and a conserved genomic island with genes involved in transcriptional regulation (arlR) and transmembrane transport (bcrA). Antimicrobial resistance genes for several drug classes were found, including beta-lactam, which is the main antimicrobial class used in Streptococcus spp. infections; however, no phenotypical resistance was observed. In addition, we predicted the presence of 33 virulence factors in the analyzed genomes. High phylogenetic similarity was observed between clinical and reference strains, yet no clonality was suggested. We also proposed dnaN, gki, pros, and xpt as housekeeping candidates to be used in S. didelphis sequence typing. This is the first whole-genome characterization of S. didelphis, whose data provide important insights into its pathogenicity.
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Affiliation(s)
- Gabriela Merker Breyer
- Laboratório de Bacteriologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Maria Eduarda Rocha Jacques da Silva
- Laboratório de Bacteriologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Mônica Slaviero
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Laboratório de Patologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Bruno Albuquerque de Almeida
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Laboratório de Patologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Emanoelly Machado Sousa da Silva
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Laboratório de Patologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Victória Regina de Queiroz Schmidt
- Preservas-Núcleo de Conservação e Reabilitação de Animais Silvestres, Hospital de Clínicas Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Marcelo Alievi
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Preservas-Núcleo de Conservação e Reabilitação de Animais Silvestres, Hospital de Clínicas Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Grazieli Maboni
- Department of Pathobiology, University of Guelph, 50 Stone Road East, NIG 2W1 - Guelph/ON, Canada
| | - Saulo Petinatti Pavarini
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Laboratório de Patologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
| | - Franciele Maboni Siqueira
- Laboratório de Bacteriologia Veterinária, Departamento de Patologia Veterinária, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
- Programa de Pós-Graduação em Ciências Veterinárias, Universidade Federal do Rio Grande do Sul, 9090 Bento Gonçalves Avenue, 91540-000 - Porto Alegre/RS, Brazil
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Oladeji BD, Ayinde OO, Bello T, Kola L, Faregh N, Abdulmalik J, Zelkowitz P, Seedat S, Gureje O. Cascade training for scaling up care for perinatal depression in primary care in Nigeria. Int J Ment Health Syst 2023; 17:41. [PMID: 37986025 PMCID: PMC10658820 DOI: 10.1186/s13033-023-00607-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/06/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Task-shared care is a demonstrated approach for integrating mental health into maternal and child healthcare (MCH) services. Training and continued support for frontline providers is key to the success of task sharing initiatives. In most settings this is provided by mental health specialists. However, in resource constrained settings where specialists are in short supply, there is a need to explore alternative models for providing training and supportive supervision to frontline maternal care providers. This paper reports on the impact of a cascade training (train-the-trainers) approach in improving the knowledge and attitudes of primary healthcare workers (PHCW) to perinatal depression. METHODS Senior primary health care providers selected from across participating local government areas were trained to provide training to other PHCWs. The training sessions facilitated by these trainers were observed and rated for fidelity by specialist trainers, while the trainees provided their impression of and satisfaction with the training sessions using predesigned assessment forms. Training outcomes assessed included knowledge of depression (using mhGAP training questions and knowledge of depression questionnaire) and attitude towards providing care for depression (revised depression attitude questionnaire (R-DAQ)) measured pre and post training as well as six months after training. RESULTS Trainees were 198 PHCWs (94.4% female), who routinely provide MCH services in 28 selected primary care clinics and had between 6- and 34-years' experience. Training was provided by 11 trained trainers who were general physicians or senior nurses. Training sessions were rated high in fidelity and on training style. Sessions were rated excellent by 77.8% of the trainees with the trainers described as knowledgeable, effective and engaging. Knowledge of depression mean score improved from a pre-training level of 12.3 ± 3.5 to 15.4 ± 3.7, immediately post-training and 14.7 ± 3.2, six months post-training (both comparisons: p < 0.001). The proportion of PHCW workers endorsing statements indicative of positive attitudes on the professional confidence and the generalist perspective modules of the R-DAQ also increased with training. CONCLUSION Our findings suggest that cascade training can be an effective model for rapidly providing training and upskilling frontline PHCWs to deliver care for women with perinatal depression in resource limited settings. TRIAL REGISTRATION This study was retrospectively registered 03 December 2019. https://doi.org/10.1186/ISRCTN 94,230,307.
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Affiliation(s)
- Bibilola D Oladeji
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Olatunde O Ayinde
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Toyin Bello
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lola Kola
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Jibril Abdulmalik
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Oye Gureje
- Department of Psychiatry of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
- WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Carey M, Arju T, Cotton JA, Alam M, Kabir M, Faruque ASG, Haque R, Petri WA, Gilchrist CA. Genomic Heterogeneity of Cryptosporidium parvum Isolates From Children in Bangladesh: Implications for Parasite Biology and Human Infection. J Infect Dis 2023; 228:1292-1298. [PMID: 37832036 PMCID: PMC10629705 DOI: 10.1093/infdis/jiad257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Indexed: 10/15/2023] Open
Abstract
Cryptosporidium species are a major cause of diarrhea and associated with growth failure. There is currently only limited knowledge of the parasite's genomic variability. We report a genomic analysis of Cryptosporidium parvum isolated from Bangladeshi infants and reanalysis of sequences from the United Kingdom. Human isolates from both locations shared 154 variants not present in the cattle-derived reference genome, suggesting host-specific adaptation of the parasite. Remarkably 34.6% of single-nucleotide polymorphisms unique to human isolates were nonsynonymous and 8.2% of these were in secreted proteins. Linkage disequilibrium decay indicated frequent recombination. The genetic diversity of C. parvum has potential implications for vaccine and therapeutic design. Clinical Trials Registration. NCT02764918.
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Affiliation(s)
- Maureen Carey
- Departments of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Tuhinur Arju
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | | | - Masud Alam
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Mamun Kabir
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Abu S G Faruque
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Diseases Research, Dhaka, Bangladesh
| | - William A Petri
- Departments of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Carol A Gilchrist
- Departments of Medicine, University of Virginia, Charlottesville, Virginia, USA
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15
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Amamou O, Denis JP, Heinen É, Boubaker T, Cardinal S. A New and Rapid HPLC Method to Determine the Degree of Deacetylation of Glutaraldehyde-Cross-Linked Chitosan. Molecules 2023; 28:7294. [PMID: 37959714 PMCID: PMC10647662 DOI: 10.3390/molecules28217294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023] Open
Abstract
Chitosan is a linear biopolymer composed of D-glucosamine and N-acetylglucosamine units. The percentage of D-glucosamine in the polymeric chain can vary from one sample to another and is expressed as the degree of deacetylation (DDA). Since this parameter has an impact on many properties, its determination is often critical, and potentiometric titration is a common analytical technique to measure the DDA. Cross-linking with glutaraldehyde is one of the most explored modifications of chitosan; however, the determination of the DDA for the resulting reticulated chitosan resins can be challenging. In this paper, we report a new, rapid, and efficient method to determine the DDA of glutaraldehyde-cross-linked chitosan resins via HPLC. This method relies on the use of 2,4-dinitrophenylhydrazine (DNPH) as a derivatizing agent to measure the level of reticulation of the polymer (LR) after the reticulation step. In this study, we prepare three calibration curves (with an R2 value over 0.92) for three series of reticulated polymers covering a large range of reticulation levels to demonstrate that a correlation can be established between the LR established via HPLC and the DDA obtained via titration. The polymers are derived from three different chitosan starting materials. These standard calibration curves are now used on a routine basis in our lab, and the HPLC method has allowed us to change our DDA analysis time from 20 h to 5 min.
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Affiliation(s)
- Ons Amamou
- Département de Biologie, Chimie et Géographie, Université du Québec à Rimouski, Rimouski, QC G5L 3A1, Canada
- Laboratoire de Chimie Hétérocyclique, Produits Naturels et Réactivité (LR11S39), Faculté des Sciences, Université de Monastir, Monastir 5000, Tunisia
| | - Jean-Philippe Denis
- Département de Biologie, Chimie et Géographie, Université du Québec à Rimouski, Rimouski, QC G5L 3A1, Canada
| | - Élise Heinen
- Département de Biologie, Chimie et Géographie, Université du Québec à Rimouski, Rimouski, QC G5L 3A1, Canada
| | - Taoufik Boubaker
- Laboratoire de Chimie Hétérocyclique, Produits Naturels et Réactivité (LR11S39), Faculté des Sciences, Université de Monastir, Monastir 5000, Tunisia
| | - Sébastien Cardinal
- Département de Biologie, Chimie et Géographie, Université du Québec à Rimouski, Rimouski, QC G5L 3A1, Canada
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Kirkby K, Bergen N, Baptista A, Schlotheuber A, Hosseinpoor AR. Data Resource Profile: World Health Organization Health Inequality Data Repository. Int J Epidemiol 2023; 52:e253-e262. [PMID: 37322565 PMCID: PMC10555845 DOI: 10.1093/ije/dyad078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 05/30/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Katherine Kirkby
- Department of Data and Analytics, Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Nicole Bergen
- Department of Data and Analytics, Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Andreia Baptista
- Department of Data and Analytics, Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Anne Schlotheuber
- Department of Data and Analytics, Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
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17
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Headey D, Ruel M. Food inflation and child undernutrition in low and middle income countries. Nat Commun 2023; 14:5761. [PMID: 37717010 PMCID: PMC10505228 DOI: 10.1038/s41467-023-41543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/06/2023] [Indexed: 09/18/2023] Open
Abstract
The 21st Century has been marked by increased volatility in food prices, with global price spikes in 2007-08, 2010-11, and again in 2021-22. The impact of food inflation on the risk of child undernutrition is not well understood, however. This study explores the potential impacts of food inflation on wasting and stunting among 1.27 million pre-school children from 44 developing countries. On average, a 5 percent increase in the real price of food increases the risk of wasting by 9 percent and severe wasting by 14 percent. These risks apply to young infants, suggesting a prenatal pathway, as well as to older children who typically experience a deterioration in diet quality in the wake of food inflation. Male children and children from poor and rural landless households are more severely impacted. Food inflation during pregnancy and the first year after birth also increases the risk of stunting for children 2-5 years of age. This evidence provides a strong rationale for interventions to prevent food inflation and mitigate its impacts on vulnerable children and their mothers.
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Affiliation(s)
- Derek Headey
- Senior Research Fellow, The International Food Policy Research Institute (IFPRI), Colombo, Sri Lanka.
| | - Marie Ruel
- Senior Research Fellow, The International Food Policy Research Institute (IFPRI), Washington, DC, USA
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18
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Diasso D, Halidou Doudou M, Cruz S, Tonnoir F, Compaoré-Sérémé D, Zongo U, Savadogo A. Capacity needs assessment and challenges for multisectoral implementation of nutrition in Burkina Faso: A guide for the formulation of a capacity development plan. Int J Health Plann Manage 2023; 38:1520-1538. [PMID: 37464724 DOI: 10.1002/hpm.3685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/24/2022] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Achieving nutritional goals depends on individual, organisational and environmental capacities. The aim of this study was to analyse and identify capacity gaps among the coordination platforms and networks, and the key technical institutions related to nutrition in Burkina Faso for a capacity development plan formulation. METHODS Using the new Nutrition Capacity Framework developed by the United Nations Network, information were collected using the Nutrition Stakeholder Mapping and Analysis tool, and the Checklist for Capacity Areas. Capacity needs were analysed in terms of Human resource and infrastructure, functional, organisational, coordination and partnership, and financial and resource mobilisation. RESULTS Limited human resource capacity in nutrition was highlighted in most cases by the structures, and the nutrition coordination structure and more than 4/5 of the technical structures are faced with the unavailability of working materials, tools and basic Internet connection. Only 10 among the 30 structures have a unit or service for exchange on nutrition, and only three of them have integrated nutrition actions. Shortfalls were noted in terms of functional, facilitation, communication and advocacy skills, as well as a weak diversification of resource mobilisation strategies. CONCLUSION The use of the analytical framework helped to identify the gaps and to propose paths for capacity development. Efforts need to be strengthened, intensified, coordinated, monitored, evaluated and funded.
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Affiliation(s)
- Dieudonné Diasso
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Maimouna Halidou Doudou
- Epidemiology, Bio-Statistics and Clinical Research Center, School of Public Health, Brussels, Belgium
| | - Sarah Cruz
- UN Network for SUN/REACH Secretariat, World Food Programme (WFP), Rome, Italy
| | - Florence Tonnoir
- UN Network for SUN/REACH Secretariat, World Food Programme (WFP), Rome, Italy
| | - Diarra Compaoré-Sérémé
- Department of Food Technology, Institute for Sciences and Technologies Applied Research, National Center for Scientific and Technological Research, Ouagadougou, Burkina Faso
| | - Urbain Zongo
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
| | - Aly Savadogo
- Laboratory of Applied Biochemistry and Immunology, Center for Research in Biological Sciences of Food and Nutrition, Department of Biochemistry and Microbiology, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso
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Das S, Rasul MG, Khan AR, Fahim SM, Sanin KI, Ahmed T. Success of health cell approach in improving knowledge, attitude and practice related to COVID-19: difference-in-differences analyses of a community-based quasi-experimental trial. BMJ Open 2023; 13:e067096. [PMID: 37604628 PMCID: PMC10445378 DOI: 10.1136/bmjopen-2022-067096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVES There remain hesitations and miscommunication regarding appropriate public health behaviours and conceptions related to COVID-19. We tested the effectiveness of the community-based health cell approach in improving knowledge, attitude and practice (KAP) related to COVID-19. SETTING Households of the Bauniabadh slum area in Mirpur, Dhaka, Bangladesh. PARTICIPANTS Household heads (HHs) and homemakers (HMs) of intervention (n=211) and comparison households (n=209). INTERVENTIONS Behaviour change communication delivered at the community level in a quasi-experimental manner through small-scale community meetings and home visits. OUTCOME VARIABLES AND METHODS The outcomes of interest were before-after mean and per cent changes in KAP scores. Data were collected from HHs and HMs before and after the intervention and difference-in-differences (DID) analysis technique was applied. RESULTS We found statistically significant (p<0.05) before-after differences in the responses to the KAP questions made by the intervention groups. The DID models estimated the improvements in COVID-19-related KAP of HHs by 16.58 (95% CI: 14.05, 19.12), 20.92 (95% CI: 18.17, 23.67) and 28.45 (95% CI: 23.84, 33.07) per cent points, respectively. The DID estimates of KAP in HMs were 17.8 (95% CI: 15.09, 20.51), 22.33 (95% CI: 19.47, 25.19) and 28.06 (95% CI: 23.18, 32.93) per cent points, respectively. Overall, 20.91 (95% CI: 18.87, 22.94) and 21.81 (95% CI: 19.68, 23.94) per cent points of improvement were observed among HHs and HMs, respectively. The DID estimates of before-after mean changes in different KAP domains ranged from 2.24 to 2.68 units and the overall changes in KAP scores among HHs and HMs were 7.11 (95% CI: 6.42, 7.8) and 7.42 (95% CI: 6.69, 8.14) units. CONCLUSION Scientifically valid information disseminated at the community level using the health cell approach could bring positive changes in KAP related to COVID-19.
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Affiliation(s)
- Subhasish Das
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Md Golam Rasul
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Ar-Rafi Khan
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Shah Mohammad Fahim
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Kazi Ishtiaque Sanin
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition Research Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Guzman K, Crowder R, Leddy A, Maraba N, Jennings L, Ahmed S, Sultana S, Onjare B, Shilugu L, Alacapa J, Levy J, Katamba A, Kityamuwesi A, Bogdanov A, Gamazina K, Cattamanchi A, Khan A. Acceptability and feasibility of digital adherence technologies for drug-susceptible tuberculosis treatment supervision: A meta-analysis of implementation feedback. PLOS Digit Health 2023; 2:e0000322. [PMID: 37582066 PMCID: PMC10426983 DOI: 10.1371/journal.pdig.0000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/10/2023] [Indexed: 08/17/2023]
Abstract
Digital adherence technologies (DATs) have emerged as an alternative to directly observed therapy (DOT) for supervisions of tuberculosis (TB) treatment. We conducted a meta-analysis of implementation feedback obtained from people with TB and health care workers (HCWs) involved in TB REACH Wave 6-funded DAT evaluation projects. Projects administered standardized post-implementation surveys based on the Capability, Opportunity, Motivation, Behavior (COM-B) model to people with TB and their health care workers. The surveys included questions on demographics and technology use, Likert scale questions to assess capability, opportunity, and motivation to use DAT and open-ended feedback. We summarized demographic and technology use data descriptively, generated pooled estimates of responses to Likert scale questions within each COM-B category for people with TB and health care workers using random effects models, and performed qualitative analysis of open-ended feedback using a modified framework analysis approach. The analysis included surveys administered to 1290 people with TB and 90 HCWs across 6 TB REACH-funded projects. People with TB and HCWs had an overall positive impression of DATs with pooled estimates between 4·0 to 4·8 out of 5 across COM-B categories. However, 44% of people with TB reported taking TB medications without reporting dosing via DATs and 23% reported missing a dose of medication. Common reasons included problems with electricity, network coverage, and technical issues with the DAT platform. DATs were overall perceived to reduce visits to clinics, decrease cost, increase social support, and decrease workload of HCWs. DATs were acceptable in a wide variety of settings. However, there were challenges related to the feasibility of using current DAT platforms. Implementation efforts should concentrate on ensuring access, anticipating, and addressing technical challenges, and minimizing additional cost to people with TB.
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Affiliation(s)
- Kevin Guzman
- University of California, San Francisco, United States of America
| | - Rebecca Crowder
- University of California, San Francisco, United States of America
| | - Anna Leddy
- University of California, San Francisco, United States of America
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Amera Khan
- Stop TB Partnership/TB REACH, Geneva, Switzerland
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François-Étienne S, Nicolas L, Eric N, Jaqueline C, Pierre-Luc M, Sidki B, Aleicia H, Danilo B, Luis VA, Nicolas D. Important role of endogenous microbial symbionts of fish gills in the challenging but highly biodiverse Amazonian blackwaters. Nat Commun 2023; 14:3903. [PMID: 37414754 PMCID: PMC10326040 DOI: 10.1038/s41467-023-39461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/09/2023] [Indexed: 07/08/2023] Open
Abstract
Amazonian blackwaters are extremely biodiverse systems containing some of Earth's most naturally acidic, dissolved organic carbon -rich and ion-poor waters. Physiological adaptations of fish facing these ionoregulatory challenges are unresolved but could involve microbially-mediated processes. Here, we characterize the physiological response of 964 fish-microbe systems from four blackwater Teleost species along a natural hydrochemical gradient, using dual RNA-Seq and 16 S rRNA of gill samples. We find that host transcriptional responses to blackwaters are species-specific, but occasionally include the overexpression of Toll-receptors and integrins associated to interkingdom communication. Blackwater gill microbiomes are characterized by a transcriptionally-active betaproteobacterial cluster potentially interfering with epithelial permeability. We explore further blackwater fish-microbe interactions by analyzing transcriptomes of axenic zebrafish larvae exposed to sterile, non-sterile and inverted (non-native bacterioplankton) blackwater. We find that axenic zebrafish survive poorly when exposed to sterile/inverted blackwater. Overall, our results suggest a critical role for endogenous symbionts in blackwater fish physiology.
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Affiliation(s)
- Sylvain François-Étienne
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada.
- Fisheries and Oceans, Gulf Fisheries Center, 343 University Ave, Moncton, NB, E1C 5K4, Canada.
| | - Leroux Nicolas
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada
| | - Normandeau Eric
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada
| | - Custodio Jaqueline
- Instituto Nacional de Pesquisas da Amazônia (INPA), Laboratório de Ecofisiologia e Evolução Molecular, Manaus, AM, 69067-375, Brazil
| | - Mercier Pierre-Luc
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada
| | - Bouslama Sidki
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada
| | - Holland Aleicia
- La Trobe University, School of Agriculture, Biomedicine and Environment, Department of Environment and Genetics, Centre for Freshwater Ecosystems, Albury/Wodonga Campus, Vic, Australia
| | - Barroso Danilo
- Instituto Nacional de Pesquisas da Amazônia (INPA), Laboratório de Ecofisiologia e Evolução Molecular, Manaus, AM, 69067-375, Brazil
| | - Val Adalberto Luis
- Instituto Nacional de Pesquisas da Amazônia (INPA), Laboratório de Ecofisiologia e Evolução Molecular, Manaus, AM, 69067-375, Brazil
| | - Derome Nicolas
- Institut de Biologie Intégrative et des Systèmes, Université Laval, 1030 avenue de la Médecine, Québec (QC), G1V 0A6, Canada
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22
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van Braam EJ, McRae DN, Portela AG, Stekelenburg J, Penn-Kekana L. Stakeholders' perspectives on the acceptability and feasibility of maternity waiting homes: a qualitative synthesis. Reprod Health 2023; 20:101. [PMID: 37407983 PMCID: PMC10324180 DOI: 10.1186/s12978-023-01615-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Maternity waiting homes (MHWs) are recommended to help bridge the geographical gap to accessing maternity services. This study aimed to provide an analysis of stakeholders' perspectives (women, families, communities and health workers) on the acceptability and feasibility of MWHs. METHODS A qualitative evidence synthesis was conducted. Studies that were published between January 1990 and July 2020, containing qualitative data on the perspectives of the stakeholder groups were included. A combination of inductive and deductive coding and thematic synthesis was used to capture the main perspectives in a thematic framework. RESULTS Out of 4,532 papers that were found in the initial search, a total of 38 studies were included for the thematic analysis. Six themes emerged: (1) individual factors, such as perceived benefits, awareness and knowledge of the MWH; (2) interpersonal factors and domestic responsibilities, such as household and childcare responsibilities, decision-making processes and social support; (3) MWH characteristics, such as basic services and food provision, state of MWH infrastructure; (4) financial and geographical accessibility, such as transport availability, costs for MWH attendance and loss of income opportunity; (5) perceived quality of care in the MWH and the adjacent health facility, including regular check-ups by health workers and respectful care; and (6) Organization and advocacy, for example funding, community engagement, governmental involvement. The decision-making process of women and their families for using an MWH involves balancing out the gains and losses, associated with all six themes. CONCLUSION This systematic synthesis of qualitative literature provides in-depth insights of interrelating factors that influence acceptability and feasibility of MWHs according to different stakeholders. The findings highlight the potential of MWHs as important links in the maternal and neonatal health (MNH) care delivery system. The complexity and scope of these determinants of utilization underlines the need for MWH implementation strategy to be guided by context. Better documentation of MWH implementation, is needed to understand which type of MWH is most effective in which setting, and to ensure that those who most need the MWH will use it and receive quality services. These results can be of interest for stakeholders, implementers of health interventions, and governmental parties that are responsible for MNH policy development to implement acceptable and feasible MWHs that provide the greatest benefits for its users. Trial registration Systematic review registration number: PROSPERO 2020, CRD42020192219.
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Affiliation(s)
| | - Daphne N McRae
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anayda G Portela
- Department of Maternal, Newborn, Child, and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Jelle Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Centre Groningen/University of Groningen, Groningen, The Netherlands
- Department Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - Loveday Penn-Kekana
- Department of Maternal Health and Health Systems, London School of Hygiene and Tropical Medicine, London, UK
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23
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Elnakib S, Paina L, Attal B, Akter R, Khoury G, Karim L, Barkat HH, Tamang A, Yenokyan G, Metzler J, Robinson C. Incidence of child marriage among refugees and internally displaced persons in the Middle East and South Asia: evidence from six cross-sectional surveys. BMJ Open 2023; 13:e070056. [PMID: 37321808 PMCID: PMC10277033 DOI: 10.1136/bmjopen-2022-070056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/28/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To examine incidence of child marriage among displaced and host populations in humanitarian settings. DESIGN Cross-sectional surveys. SETTING Data were collected in Djibouti, Yemen, Lebanon and Iraq in the Middle East and in Bangladesh and Nepal in South Asia. PARTICIPANTS Adolescent girls aged 10-19 in the six settings and age cohort comparators. OUTCOME MEASURES Cumulative incidence of marriage by age 18. RESULTS In Bangladesh and Iraq, the hazard of child marriage did not differ between internally displaced populations (IDPs) and hosts (p value=0.25 and 0.081, respectively). In Yemen, IDPs had a higher hazard of child marriage compared with hosts (p value<0.001). In Djibouti, refugees had a lower hazard of child marriage compared with hosts (p value<0.001). In pooled data, the average hazard of child marriage was significantly higher among displaced compared with host populations (adjusted HR (aHR) 1.3; 95% CI 1.04 to 1.61).In age cohort comparisons, there was no significant difference between child marriage hazard across age cohorts in Bangladesh (p value=0.446), while in Lebanon and Nepal, younger cohorts were less likely to transition to child marriage compared with older comparators (p value<0.001). Only in Yemen were younger cohorts more likely to transition to child marriage, indicating an increase in child marriage rates after conflict (p value=0.034). Pooled data showed a downward trend, where younger age cohorts had, on average, a lower hazard of child marriage compared with older cohorts (aHR 0.36; 95% CI 0.29 to 0.4). CONCLUSIONS We did not find conclusive evidence that humanitarian crises are associated with universal increases in child marriage rates. Our findings indicate that decision-making about investments in child marriage prevention and response must be attuned to the local context and grounded in data on past and current trends in child marriage among communities impacted by crisis.
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Affiliation(s)
- Shatha Elnakib
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ligia Paina
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bothaina Attal
- Centre for Business Research, Cambridge Judge Business School, Cambridge, UK
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Rumana Akter
- Community Partners International, Cox's Bazar, Bangladesh
| | - Ghada Khoury
- School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | | | | | - Anand Tamang
- Center for Research on Environment Health and Population Activities, Kathmandu, Nepal
| | - Gayane Yenokyan
- Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Courtland Robinson
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Bagambe PG, Nyirazinyoye L, Floyd Cechetto D, Luginaah I. Perceptions of male partners on maternal near-miss events experienced by their female partners in Rwanda. PLoS One 2023; 18:e0286702. [PMID: 37294814 PMCID: PMC10256223 DOI: 10.1371/journal.pone.0286702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 05/22/2023] [Indexed: 06/11/2023] Open
Abstract
BACKGROUND Maternal near-miss refers to women who survive death from life-threatening obstetric complications and has various social, financial, physical, and psychological impacts on families. OBJECTIVE To explore male partners' perceptions of maternal near-miss experienced by their female partners and the associated psychosocial impacts on their families in Rwanda. METHODS This was a qualitative study involving 27 semi-structured in-depth interviews with male partners whose spouses experienced a maternal near-miss event. Data were analyzed using a thematic coding to generate themes from participants' responses. RESULTS Six key themes that emerged were: male partner's support during wife's pregnancy and during maternal near-miss hospitalization, getting the initial information about the spouse's near-miss event, psychosocial impacts of spouse's near-miss, socio-economic impact of spouse's near-miss, post- maternal near-miss family dynamics, and perceived strategies to minimize the impacts of near-miss. Male partners reported emotional, social, and economic impacts as a result of their traumatic experiences. CONCLUSIONS The impact of maternal near-miss among families in Rwanda remains an area that needs healthcare attention. The residual emotional, financial, and social consequences not only affect females, but also their male partners and their relatives. Male partners should be involved and be well-informed about their partners' conditions and the expected long-term effects of near-miss. Also, medical and psychological follow-up for both spouses is necessary for the enhancement of the health and well-being of affected households.
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Affiliation(s)
- Patrick Gatsinzi Bagambe
- Department of Obstetrics and Gynecology, School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | - David Floyd Cechetto
- Department of Anatomy and Cell Biology, University of Western Ontario, London, Ontario, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Ontario, Canada
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25
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Correction to: Development and testing of methods for detecting off-wrist in actimetry recordings. Sleep 2023:zsad137. [PMID: 37265012 DOI: 10.1093/sleep/zsad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
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Brooks MB, Hussain H, Siddiqui S, Ahmed JF, Jaswal M, Amanullah F, Becerra M, Malik AA. Two Clinical Prediction Tools to Inform Rapid Tuberculosis Treatment Decision-making in Children. Open Forum Infect Dis 2023; 10:ofad245. [PMID: 37351457 PMCID: PMC10284336 DOI: 10.1093/ofid/ofad245] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Background In the absence of bacteriologic confirmation to diagnose tuberculosis (TB) in children, it is suggested that treatment should be initiated when sufficient clinical evidence of disease is available. However, it is unclear what clinical evidence is sufficient to make this decision. To identify children who would benefit from rapid initiation of TB treatment, we developed 2 clinical prediction tools. Methods We conducted a secondary analysis of a prospective intensified TB patient-finding intervention conducted in Pakistan in 2014-2016. TB disease was determined through either bacteriologic confirmation or a clinical diagnosis. We derived 2 tools: 1 uses classification and regression tree (CART) analysis to develop decision trees, while the second uses multivariable logistic regression to calculate a risk score. Results Of the 5162 and 5074 children included in the CART and prediction score, respectively, 1417 (27.5%) and 1365 (26.9%) were eligible for TB treatment. CART identified abnormal chest radiographs and family history of TB as the most important predictors (area under the receiver operating characteristic curve [AUC], 0.949). The final prediction score model included age group (0-4, 5-9, 10-14), weight <5th percentile, cough, fever, weight loss, chest radiograph suggestive of TB disease, and family history of TB; the identified best cutoff score was 9 (AUC, 0.985%). Conclusions Use of clinical evidence was sufficient to accurately identify children who would benefit from treatment initiation. Our tools performed well compared with existing algorithms, though these results need to be externally validated before operationalization.
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Affiliation(s)
- Meredith B Brooks
- Correspondence: Meredith B. Brooks, PhD, MPH, Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 (); or Amyn A. Malik, PhD, Interactive Research and Development Global, One George Street, Level 10, Singapore 049145 ()
| | | | - Sara Siddiqui
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Junaid F Ahmed
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | - Maria Jaswal
- Interactive Research and Development Global, Singapore
| | - Farhana Amanullah
- The Indus Hospital and Health Network, Korangi Crossing, Karachi, Pakistan
| | | | - Amyn A Malik
- Correspondence: Meredith B. Brooks, PhD, MPH, Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 (); or Amyn A. Malik, PhD, Interactive Research and Development Global, One George Street, Level 10, Singapore 049145 ()
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González-Barrios FJ, Estrada-Saldívar N, Pérez-Cervantes E, Secaira-Fajardo F, Álvarez-Filip L. Legacy effects of anthropogenic disturbances modulate dynamics in the world's coral reefs. Glob Chang Biol 2023; 29:3285-3303. [PMID: 36932916 DOI: 10.1111/gcb.16686] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 05/16/2023]
Abstract
Rapidly changing conditions alter disturbance patterns, highlighting the need to better understand how the transition from pulse disturbances to more persistent stress will impact ecosystem dynamics. We conducted a global analysis of the impacts of 11 types of disturbances on reef integrity using the rate of change of coral cover as a measure of damage. Then, we evaluated how the magnitude of the damage due to thermal stress, cyclones, and diseases varied among tropical Atlantic and Indo-Pacific reefs and whether the cumulative impact of thermal stress and cyclones was able to modulate the responses of reefs to future events. We found that reef damage largely depends on the condition of a reef before a disturbance, disturbance intensity, and biogeographic region, regardless of the type of disturbance. Changes in coral cover after thermal stress events were largely influenced by the cumulative stress of past disturbances and did not depend on disturbance intensity or initial coral cover, which suggests that an ecological memory is present within coral communities. In contrast, the effect of cyclones (and likely other physical impacts) was primarily modulated by the initial reef condition and did not appear to be influenced by previous impacts. Our findings also underscore that coral reefs can recover if stressful conditions decrease, yet the lack of action to reduce anthropogenic impacts and greenhouse gas emissions continues to trigger reef degradation. We uphold that evidence-based strategies can guide managers to make better decisions to prepare for future disturbances.
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Affiliation(s)
- F Javier González-Barrios
- Biodiversity and Reef Conservation Laboratory, Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - Nuria Estrada-Saldívar
- Biodiversity and Reef Conservation Laboratory, Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | - Esmeralda Pérez-Cervantes
- Biodiversity and Reef Conservation Laboratory, Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
| | | | - Lorenzo Álvarez-Filip
- Biodiversity and Reef Conservation Laboratory, Unidad Académica de Sistemas Arrecifales, Instituto de Ciencias del Mar y Limnología, Universidad Nacional Autónoma de México, Puerto Morelos, Mexico
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Salehi R, de Young S, Asamoah A, Aryee SE, Eli R, Couper B, Smith B, Djokoto C, Agyeman YN, Zakaria AFS, Butt N, Boadu A, Nyante F, Merdiemah G, Oliver-Commey J, Ofori-Boadu L, Akoriyea SK, Parry M, Fiore C, Okae F, Adams A, Acquah H. Evaluation of a continuing professional development strategy on COVID-19 for 10 000 health workers in Ghana: a two-pronged approach. Hum Resour Health 2023; 21:18. [PMID: 36879262 PMCID: PMC9987385 DOI: 10.1186/s12960-023-00804-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND COVID-19 has created unprecedented challenges for health systems worldwide. Since the confirmation of the first COVID-19 case in Ghana in March 2020 Ghanian health workers have reported fear, stress, and low perceived preparedness to respond to COVID-19, with those who had not received adequate training at highest risk. Accordingly, the Paediatric Nursing Education Partnership COVID-19 Response project designed, implemented, and evaluated four open-access continuing professional development courses related to the pandemic, delivered through a two-pronged approach: e-learning and in-person. METHODS This manuscript presents an evaluation of the project's implementation and outcomes using data for a subset of Ghanaian health workers (n = 9966) who have taken the courses. Two questions were answered: first, the extent to which the design and implementation of this two-pronged strategy was successful and, second, outcomes associated with strengthening the capacity of health workers to respond to COVID-19. The methodology involved quantitative and qualitative survey data analysis and ongoing stakeholder consultation to interpret the results. RESULTS Judged against the success criteria (reach, relevance, and efficiency) the implementation of the strategy was successful. The e-learning component reached 9250 health workers in 6 months. The in-person component took considerably more resources than e-learning but provided hands-on learning to 716 health workers who were more likely to experience barriers to accessing e-learning due to challenges around internet connectivity, or institutional capacity to offer training. After taking the courses, health workers' capacities (addressing misinformation, supporting individuals experiencing effects of the virus, recommending the vaccine, course-specific knowledge, and comfort with e-learning) improved. The effect size, however, varied depending on the course and the variable measured. Overall, participants were satisfied with the courses and found them relevant to their well-being and profession. An area for improvement was refining the content-to-delivery time ratio of the in-person course. Unstable internet connectivity and the high upfront cost of data to access and complete the course online were identified as barriers to e-learning. CONCLUSIONS A two-pronged delivery approach leveraged distinct strengths of respective e-learning and in-person strategies to contribute to a successful continuing professional development initiative in the context of COVID-19.
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Affiliation(s)
- Roxana Salehi
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Stephanie de Young
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | | | - Raymond Eli
- Ghana College of Nurses and Midwives, Accra, Ghana
| | - Barbara Couper
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Brian Smith
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | | | | | - Nancy Butt
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | | | - Felix Nyante
- Nursing and Midwifery Council of Ghana, Accra, Ghana
| | | | | | | | | | - Megan Parry
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
| | - Cindy Fiore
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, Canada
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Lusambili AM, Wisofschi S, Wade TJ, Temmerman M, Obure J. A qualitative enquiry of health care workers' narratives on knowledge and sources of information on principles of Respectful Maternity Care (RMC). PLOS Glob Public Health 2023; 3:e0000157. [PMID: 36962732 PMCID: PMC10021807 DOI: 10.1371/journal.pgph.0000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
Research from sub-Saharan Africa indicate that many women experience varied forms of disrespectful maternity care, which amount to a violation of their rights and dignity. Notably, there is little research that sheds light on health care workers (HCWs) training and knowledge of principles of respectful maternity care (RMC). Formulating appropriate interventional strategies to promote the respectful provision of services for women during pregnancy, childbirth, and postpartum period requires an understanding of the current state of knowledge and sources of information on respectful maternity care among HCWs. This paper reports findings from a qualitative study that examined the knowledge and sources of information on the Respectful Maternity Care Charter among HCWs in rural Kisii and Kilifi counties in Kenya. Between January and March 2020, we conducted 24 in-depth interviews among HCWs in rural Kisii and Kilifi health facilities. Data were analyzed using a mixed deductive and inductive thematic analysis guided by Braun's [2006] six stages of analysis. We found that from the seven globally accepted principles of respectful maternity care, at least half of the HCWs were aware of patients right to consented care, confidentiality and privacy, and the right to non-discriminatory care based on specific attributes. Knowledge of the right to no physical and emotional abuse, abandonment of care, and detentions in the facilities was limited to a minority of health care workers but only after prompting. Sources of information on respectful maternity care were largely limited to continuous medical and professional training and clinical mentorship. The existing gap shows the need for training and mentorship of HCWs on the Respectful Maternity Care Charter as part of pre-service medical and nursing curricula and continuing clinical education to bridge this gap. At the policy level, strategies are necessary to support the integration of respectful maternity care into pre-service training curricula.
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Affiliation(s)
- Adelaide M. Lusambili
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- School of Business, African International University, Nairobi, Kenya
| | - Stefania Wisofschi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Terrance J. Wade
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Health Sciences, Brock University, St. Catharines, Canada
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Medical College, Aga Khan University, Nairobi, Kenya
| | - Jerim Obure
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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Goh YE, Marquis GS, Colecraft EK, Aryeetey R. Participating in a Nutrition-Sensitive Agriculture Intervention Is Not Associated with Less Maternal Time for Care in a Rural Ghanaian District. Curr Dev Nutr 2022; 6:nzac145. [PMID: 36475016 PMCID: PMC9718649 DOI: 10.1093/cdn/nzac145] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 08/07/2022] [Accepted: 09/26/2022] [Indexed: 04/22/2024] Open
Abstract
Background Nutrition-sensitive agriculture (NSA) interventions may increase farm-related work for mothers, with consequences for child nutrition. The Nutrition Links (NL) intervention provided mothers with poultry, gardening inputs, technical support, and education to improve livelihoods and child nutrition outcomes in rural Ghana. Objectives Our objective was to compare time allocated to child care by a cross-section of mothers in the intervention group of the NL intervention with the control group (NCT01985243). Methods A cross-section of NL mother-child pairs was included in a time allocation substudy [intervention (NL-I) n = 74 and control (NL-C) n = 69]. In-home observations of the mother-child pair were conducted for 1 min, every 5 min, for 6 h. Observations were categorized into 4 nonoverlapping binary variables as follows: 1) maternal direct care, 2) maternal supervisory care, 3) allocare, and 4) no direct supervision. Allocare was defined as care by another person in the presence or absence of the mother. Any care was defined as the observation of maternal direct care, maternal supervisory care, or allocare. Generalized linear mixed models with binomial data distribution were used to compare the child care categories by group, adjusting for known covariates. Results Maternal direct care (OR = 1.07; 95% CI: 0.89, 1.28) and any care (OR = 1.56; 95% CI: 0.91, 2.67) did not differ by intervention group. However, there was a higher odds of allocare (OR = 1.36; 95% CI: 1.04, 1.79) in NL-I than in NL-C women. Conclusions Maternal participation in an NSA intervention was not associated with a decrease in time spent directly on child care but was associated with an increase in care from other household and community members.The clinicaltrials.gov number provided is for the main NL intervention and not this current substudy.
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Affiliation(s)
- Yvonne E Goh
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Grace S Marquis
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Esi K Colecraft
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
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Gomes I, Dong C, Vandewalle P, Khan A, Creswell J, Dowdy D, Sohn H. Comparative assessment of the cost-effectiveness of Tuberculosis (TB) active case-finding interventions: A systematic analysis of TB REACH wave 5 projects. PLoS One 2022; 17:e0270816. [PMID: 36156080 PMCID: PMC9512197 DOI: 10.1371/journal.pone.0270816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Interventions that can help streamline and reduce gaps in the tuberculosis (TB) care cascade can play crucial roles in TB prevention and care, but are often operationally complex and resource intensive, given the heterogenous settings in which they are implemented. In this study, we present a comparative analysis on cost-effectiveness of TB REACH Wave 5 projects with diverse programmatic objectives to inform future decisions regarding funding, strategic adoption, and scale-up. Methods We comprehensively reviewed project reports and financial statements from TB REACH Wave 5, a funding mechanism for interventions that aimed to strengthen the TB care cascade in diverse settings. Two independent reviewers abstracted cost (in 2017 US dollars) and key programmatic data, including project type (case-finding only; case-finding and linkage-to-care; or case-finding, linkage-to-care and patient support), operational setting (urban or rural), and project outputs (numbers of people with TB diagnosed, started on treatment, and successfully completing treatment). Cost-effectiveness ratios for each project were calculated as ratios of apportioned programmatic expenditures to corresponding project outputs. Results Of 32 case finding and patient support projects funded through TB REACH Wave 5, 29 were included for analysis (11 case-finding only; 9 case-finding and linkage-to-care; and 9 case-finding, linkage-to-care and patient support). 21 projects (72%) were implemented in either Africa or Southeast Asia, and 19 (66%) focused on serving urban areas. Average cost-effectiveness was $184 per case diagnosed (range: $30-$10,497), $332 per diagnosis and treatment initiation ($123-$10,608), and $40 per patient treatment supported ($8-$160). Cost per case diagnosed was lower for case-finding-only projects ($132) than projects including linkage-to-care ($342) or linkage-to-care and patient support ($254), and generally increased with the corresponding country’s per-capita GDP ($543 per $1000 increase, 95% confidence interval: -$53, $1138). Conclusion The costs and cost-effectiveness of interventions to strengthen the TB care cascade were heterogenous, reflecting differences in context and programmatic objective. Nevertheless, many such interventions are likely to offer good value for money. Systematic collection and analysis of cost-effectiveness data can help improve comparability, monitoring, and evaluation.
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Affiliation(s)
- Isabella Gomes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Chaoran Dong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Amera Khan
- Stop TB Partnership, TB REACH Initiative, Geneva, Switzerland
| | - Jacob Creswell
- Stop TB Partnership, TB REACH Initiative, Geneva, Switzerland
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hojoon Sohn
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Nyamtema AS, LeBlanc JC, Mtey G, Tomblin Murphy G, Kweyamba E, Bulemela J, Shayo A, Abel Z, Kilume O, Scott H, Rigby J. Scale up and strengthening of comprehensive emergency obstetric and newborn care in Tanzania. PLoS One 2022; 17:e0271282. [PMID: 35802730 PMCID: PMC9269945 DOI: 10.1371/journal.pone.0271282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 06/28/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction In Tanzania, inadequate access to comprehensive emergency obstetric and newborn care (CEmONC) services is the major bottleneck for perinatal care and results in high maternal and perinatal mortality. From 2015 to 2019, the Accessing Safe Deliveries in Tanzania project was implemented to study how to improve access to CEmONC services in underserved rural areas. Methods A five-year longitudinal cohort study was implemented in seven health centres (HCs) and 21 satellite dispensaries in Morogoro region. Five of the health centres received CEmONC interventions and two served as controls. Forty-two associate clinicians from the intervention HCs were trained in teams for three months in CEmONC and anaesthesia. Managers of 20 intervention facilities, members of the district and regional health management teams were trained in leadership and management. Regular supportive supervision was conducted. Results Interventions resulted in improved responsibility and accountability among managers. In intervention HCs, the mean monthly deliveries increased from 183 (95% CI 174–191) at baseline (July 2014 –June 2016) to 358 (95% CI 328–390) during the intervention period (July 2016 –June 2019). The referral rate to district hospitals in intervention HCs decreased from 6.0% (262/4,392) with 95% CI 5.3–6.7 at baseline to 4.0% (516/12,918) with 95% CI 3.7–4.3 during the intervention period while it increased in the control group from 0.8% (48/5,709) to 1.5% (168/11,233). The obstetric case fatality rate decreased slightly from 1.5% (95% CI 0.6–3.1) at baseline to 1.1% (95% CI 0.7–1.6) during the intervention period (not statistically significant). Active engagement strategies and training in leadership and management resulted in uptake and improvement of CEmONC and anaesthesia curricula, and contributed to scale up of CEmONC at health centre level in the country. Conclusions Integration of leadership and managerial capacity building, with CEmONC-specific interventions was associated with health systems strengthening and improved quality of services.
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Affiliation(s)
- Angelo S. Nyamtema
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
- St. Francis University College for Health and Allied Sciences, Ifakara, Tanzania
- * E-mail:
| | | | - Godfrey Mtey
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Gail Tomblin Murphy
- WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Elias Kweyamba
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
- St. Francis University College for Health and Allied Sciences, Ifakara, Tanzania
| | - Janet Bulemela
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
- St. Francis University College for Health and Allied Sciences, Ifakara, Tanzania
| | - Allan Shayo
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Zabron Abel
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
| | - Omary Kilume
- Tanzanian Training Centre for International Health, Ifakara, Tanzania
- St. Francis University College for Health and Allied Sciences, Ifakara, Tanzania
| | | | - Janet Rigby
- WHO/PAHO Collaborating Centre on Health Workforce Planning & Research, Dalhousie University and Nova Scotia Health, Halifax, Nova Scotia, Canada
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Qin ZZ, Barrett R, Ahmed S, Sarker MS, Paul K, Adel ASS, Banu S, Creswell J. Comparing different versions of computer-aided detection products when reading chest X-rays for tuberculosis. PLOS Digit Health 2022; 1:e0000067. [PMID: 36812562 PMCID: PMC9931298 DOI: 10.1371/journal.pdig.0000067] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/15/2022] [Indexed: 06/18/2023]
Abstract
Computer-aided detection (CAD) was recently recommended by the WHO for TB screening and triage based on several evaluations, but unlike traditional diagnostic tests, software versions are updated frequently and require constant evaluation. Since then, newer versions of two of the evaluated products have already been released. We used a case control sample of 12,890 chest X-rays to compare performance and model the programmatic effect of upgrading to newer versions of CAD4TB and qXR. We compared the area under the receiver operating characteristic curve (AUC), overall, and with data stratified by age, TB history, gender, and patient source. All versions were compared against radiologist readings and WHO's Target Product Profile (TPP) for a TB triage test. Both newer versions significantly outperformed their predecessors in terms of AUC: CAD4TB version 6 (0.823 [0.816-0.830]), version 7 (0.903 [0.897-0.908]) and qXR version 2 (0.872 [0.866-0.878]), version 3 (0.906 [0.901-0.911]). Newer versions met WHO TPP values, older versions did not. All products equalled or surpassed the human radiologist performance with improvements in triage ability in newer versions. Humans and CAD performed worse in older age groups and among those with TB history. New versions of CAD outperform their predecessors. Prior to implementation CAD should be evaluated using local data because underlying neural networks can differ significantly. An independent rapid evaluation centre is necessitated to provide implementers with performance data on new versions of CAD products as they are developed.
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Affiliation(s)
- Zhi Zhen Qin
- Stop TB Partnership, Le Grand-Saconnex, Geneva, Switzerland
| | | | - Shahriar Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Kishor Paul
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jacob Creswell
- Stop TB Partnership, Le Grand-Saconnex, Geneva, Switzerland
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Raqib R, Sarker P, Akhtar E, Nurul Huda TM, Haq MA, Roy AK, Hosen MB, Haque F, Chowdhury MR, Reidpath DD, Emdadul Hoque DM, Islam Z, Ahmed S, Ahmed T, Tofail F, Razzaque A. Seroprevalence of SARS-CoV-2 infection and associated factors among Bangladeshi slum and non-slum dwellers in pre-COVID-19 vaccination era: October 2020 to February 2021. PLoS One 2022; 17:e0268093. [PMID: 35604947 PMCID: PMC9126397 DOI: 10.1371/journal.pone.0268093] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 04/21/2022] [Indexed: 11/18/2022] Open
Abstract
Background Seroprevalence studies have been carried out in many developed and developing countries to evaluate ongoing and past infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Data on this infection in marginalized populations in urban slums are limited, which may offer crucial information to update prevention and mitigation policies and strategies. We aimed to determine the seroprevalence of SARS-CoV-2 infection and factors associated with seropositivity in slum and non-slum communities in two large cities in Bangladesh. Methods A cross-sectional study was carried out among the target population in Dhaka and Chattogram cities between October 2020 and February 2021. Questionnaire-based data, anthropometric and blood pressure measurements and blood were obtained. SARS-CoV-2 serology was assessed by Roche Elecsys® Anti-SARS-CoV-2 immunoassay. Results Among the 3220 participants (2444 adults, ≥18 years; 776 children, 10–17 years), the overall weighted seroprevalence was 67.3% (95% confidence intervals (CI) = 65.2, 69.3) with 71.0% in slum (95% CI = 68.7, 72.2) and 62.2% in non-slum (95% CI = 58.5, 65.8). The weighted seroprevalence was 72.9% in Dhaka and 54.2% in Chattogram. Seroprevalence was positively associated with limited years of formal education (adjusted odds ratio [aOR] = 1.61; 95% CI = 1.43, 1.82), lower income (aOR = 1.23; 95% CI = 1.03, 1.46), overweight (aOR = 1.2835; 95% CI = 1.26, 1.97), diabetes (aOR = 1.67; 95% CI = 1.21, 2.32) and heart disease (aOR = 1.38; 95% CI = 1.03, 1.86). Contrarily, negative associations were found between seropositivity and regular wearing of masks and washing hands, and prior BCG vaccination. About 63% of the population had asymptomatic infection; only 33% slum and 49% non-slum population showed symptomatic infection. Conclusion The estimated seroprevalence of SARS-CoV-2 was more prominent in impoverished informal settlements than in the adjacent middle-income non-slum areas. Additional factors associated with seropositivity included limited education, low income, overweight and pre-existing chronic conditions. Behavioral factors such as regular wearing of masks and washing hands were associated with lower probability of seropositivity.
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Affiliation(s)
- Rubhana Raqib
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
- * E-mail:
| | - Protim Sarker
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | - Evana Akhtar
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | | | | | | | - Farjana Haque
- Infectious Diseases Division, icddrb, Dhaka, Bangladesh
| | | | - Daniel D. Reidpath
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
| | | | | | - Shehlina Ahmed
- Foreign, Commonwealth & Development Office (FCDO), Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, icddrb, Dhaka, Bangladesh
| | - Abdur Razzaque
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
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Kay AW, Sandoval M, Mtetwa G, Mkhabela M, Ndlovu B, Devezin T, Sikhondze W, Vambe D, Sibanda J, Dube GS, Stevens RH, Lukhele B, Mandalakas AM. Vikela Ekhaya: A Novel, Community-based, Tuberculosis Contact Management Program in a High Burden Setting. Clin Infect Dis 2022; 74:1631-1638. [PMID: 34302733 PMCID: PMC9070808 DOI: 10.1093/cid/ciab652] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The prevention of tuberculosis (TB) in child contacts of TB cases and people living with human immunodeficiency virus (HIV) is a public health priority, but global access to TB preventive therapy (TPT) remains low. In 2019, we implemented Vikela Ekhaya, a novel community-based TB contact management program in Eswatini designed to reduce barriers to accessing TPT. METHODS Vikela Ekhaya offered differentiated TB and HIV testing for household contacts of TB cases by using mobile contact management teams to screen contacts, assess their TPT eligibility, and initiate and monitor TPT adherence in participants' homes. RESULTS In total, 945 contacts from 244 households were screened for TB symptoms; 72 (8%) contacts reported TB symptoms, and 5 contacts (0.5%) were diagnosed with prevalent TB. A total of 322 of 330 (98%) eligible asymptomatic household contacts initiated TPT. Of 322 contacts initiating TPT, 248 children initiated 3 months of isoniazid and rifampicin and 74 children and adults living with HIV initiated 6 months of isoniazid; 298 (93%) completed TPT. In clustered logistic regression analyses, unknown HIV status (adjusted odds ratio [aOR] 5.7, P = .023), positive HIV status (aOR 21.1, P = .001), urban setting (aOR 5.6, P = .006), and low income (aOR 5.9, P = .001) predicted loss from the cascade of care among TPT-eligible contacts. CONCLUSION Vikela Ekhaya demonstrated that community-based TB household contact management is a feasible, acceptable, and successful strategy for TB screening and TPT delivery. The results of this study support the development of novel, differentiated, community-based interventions for TB prevention and control.
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Affiliation(s)
- Alexander W Kay
- The Global Tuberculosis Program, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
- Baylor College of Medicine Children’s Foundation-Eswatini, Mbabane, Eswatini
| | - Micaela Sandoval
- The Global Tuberculosis Program, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
- UTHealth School of Public Health, Houston, Texas, USA
| | - Godwin Mtetwa
- Baylor College of Medicine Children’s Foundation-Eswatini, Mbabane, Eswatini
| | - Musa Mkhabela
- Baylor College of Medicine Children’s Foundation-Eswatini, Mbabane, Eswatini
| | - Banele Ndlovu
- Baylor College of Medicine Children’s Foundation-Eswatini, Mbabane, Eswatini
| | - Tara Devezin
- The Global Tuberculosis Program, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Welile Sikhondze
- Eswatini National Tuberculosis Control Program, Manzini, Eswatini
| | - Debrah Vambe
- Eswatini National Tuberculosis Control Program, Manzini, Eswatini
| | - Joyce Sibanda
- Eswatini National Tuberculosis Control Program, Manzini, Eswatini
| | - Gloria S Dube
- Eswatini National Tuberculosis Control Program, Manzini, Eswatini
| | - Robert H Stevens
- Independent Consultant to StopTB Partnership, Geneva, Switzerland
| | - Bhekumusa Lukhele
- The Global Tuberculosis Program, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
- Baylor College of Medicine Children’s Foundation-Eswatini, Mbabane, Eswatini
| | - Anna M Mandalakas
- The Global Tuberculosis Program, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
- UTHealth School of Public Health, Houston, Texas, USA
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Dallmann D, Marquis GS, Colecraft EK, Kanlisi R, Aidam BA. Maternal Participation Level in a Nutrition-Sensitive Agriculture Intervention Matters for Child Diet and Growth Outcomes in Rural Ghana. Curr Dev Nutr 2022; 6:nzac017. [PMID: 35295712 PMCID: PMC8921653 DOI: 10.1093/cdn/nzac017] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 12/02/2021] [Accepted: 01/27/2022] [Indexed: 11/27/2022] Open
Abstract
Background Little is known about how the level of program participation affects child nutrition in rural interventions. Objectives This study examined the association between participation level in a nutrition-sensitive agriculture intervention and children's diet and anthropometric outcomes in rural Ghana. Methods Nutrition Links was a cluster randomized controlled trial (clinicaltrials.gov NCT01985243), which enrolled caregivers with children (aged less than 2 mo in 2014-2015 and less than 18 mo in 2016-2017). Of the 287 caregivers in 19 intervention communities who enrolled, 233 adopted the intervention and received layer poultry, garden inputs, and weekly child feeding education. The egg production and repayment of poultry were monitored, and feed was sold at the weekly meetings. After endline, the nutrition educators rated each woman who adopted the intervention on a scale [very poor (1) to excellent (5)] for: 1) meeting attendance, 2) egg productivity, 3) feed and poultry loan payment, 4) contributions during meetings, and 5) attentiveness towards group members. Participation level was classified as high, medium, and low by dividing the sum of these 5 items into tertiles; 54 women who did not adopt the intervention were classified as "no participation." Generalized mixed linear models tested the difference in changes in children's diet and anthropometric indices between the participation levels and the control category - 213 caregiver-child dyads in 20 communities who received standard-of-care health and agricultural services. Results Compared with the control category, only high participation was associated with egg consumption [adjusted OR (aOR) = 3.03; 95% CI: 1.15, 7.94]. Both medium and high participation levels were associated with length-for-age z-scores (LAZ)/height-for-age z-scores (HAZ) [adjusted β-coefficients (aβ) = 0.44; 95% CI: 0.16, 0.72 and 0.40; 95% CI: 0.12, 0.67, respectively]. Conclusion These results highlight the importance of promoting and monitoring the level of beneficiary participation to estimate the full potential of nutrition-sensitive agriculture interventions to improve nutritional outcomes.
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Affiliation(s)
- Diana Dallmann
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Grace S Marquis
- School of Human Nutrition, McGill University, Montreal, Quebec, Canada
| | - Esi K Colecraft
- Department of Nutrition and Food Science, University of Ghana, Legon, Ghana
| | - Roland Kanlisi
- Animal Science Department of the University of Ghana, Legon, Ghana
| | - Bridget A Aidam
- Technical Services and Innovation, Action Against Hunger, NY, USA
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Duncan E, Ashton L, Abdulai AR, Sawadogo-Lewis T, King SE, Fraser EDG, Vosti S, Haines J, Knight F, Roberton T. Connecting the food and agriculture sector to nutrition interventions for improved health outcomes. Food Secur 2022; 14:657-675. [PMID: 35126795 PMCID: PMC8804081 DOI: 10.1007/s12571-022-01262-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/16/2022] [Indexed: 11/28/2022]
Abstract
To achieve the Sustainable Development Goal of zero hunger, multi-sectoral strategies to improve nutrition are necessary. Building towards this goal, the food and agriculture sector must be considered when designing nutritional interventions. Nevertheless, most frameworks designed to guide nutritional interventions do not adequately capture opportunities for integrating nutrition interventions within the food and agriculture sector. This paper aims to highlight how deeply connected the food and agriculture sector is to underlying causes of malnutrition and identify opportunities to better integrate the food and agriculture sector and nutrition in low and middle income countries. In particular, this paper: (1) expands on the UNICEF conceptual framework for undernutrition to integrate the food and agriculture sector and nutrition outcomes, (2) identifies how nutritional outcomes and agriculture are linked in six important ways by defining evidence-based food and agriculture system components within these pathways: as a source of food, as a source of income, through food prices, women’s empowerment, women’s utilization of time, and women’s health and nutritional status, and (3) shows that the food and agriculture sector facilitates interventions through production, processing and consumption, as well as through farmer practices and behavior. Current frameworks used to guide nutrition interventions are designed from a health sector paradigm, leaving agricultural aspects not sufficiently leveraged. This paper concludes by proposing intervention opportunities to rectify the missed opportunities generated by this approach. Program design should consider the ways that the food and agriculture sector is linked to other critical sectors to comprehensively address malnutrition. This framework is designed to help the user to begin to identify intervention sites that may be considered when planning and implementing multi-sectoral nutrition programs.
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Affiliation(s)
- E. Duncan
- University of Guelph, Guelph, ON Canada
| | - L. Ashton
- University of Guelph, Guelph, ON Canada
| | | | | | | | | | - S. Vosti
- University of Guelph, Guelph, ON Canada
| | - J. Haines
- University of Guelph, Guelph, ON Canada
| | - F. Knight
- University of Guelph, Guelph, ON Canada
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Rahman S, Rahman MM, Miah M, Begum MN, Sarmin M, Mahfuz M, Hossain ME, Rahman MZ, Chisti MJ, Ahmed T, Arifeen SE, Rahman M. COVID-19 reinfections among naturally infected and vaccinated individuals. Sci Rep 2022; 12:1438. [PMID: 35082344 PMCID: PMC8792012 DOI: 10.1038/s41598-022-05325-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022] Open
Abstract
The protection against emerging SARS-CoV-2 variants by pre-existing antibodies elicited due to the current vaccination or natural infection is a global concern. We aimed to investigate the rate of SARS-CoV-2 infection and its clinical features among infection-naïve, infected, vaccinated, and post-infection-vaccinated individuals. A cohort was designed among icddr,b staff registered for COVID-19 testing by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR). Reinfection cases were confirmed by whole-genome sequencing. From 19 March 2020 to 31 March 2021, 1644 (mean age, 38.4 years and 57% male) participants were enrolled; where 1080 (65.7%) were tested negative and added to the negative cohort. The positive cohort included 750 positive patients (564 from baseline and 186 from negative cohort follow-up), of whom 27.6% were hospitalized and 2.5% died. Among hospitalized patients, 45.9% had severe to critical disease and 42.5% required oxygen support. Hypertension and diabetes mellitus were found significantly higher among the hospitalised patients compared to out-patients; risk ratio 1.3 and 1.6 respectively. The risk of infection among positive cohort was 80.2% lower than negative cohort (95% CI 72.6-85.7%; p < 0.001). Genome sequences showed that genetically distinct SARS-CoV-2 strains were responsible for reinfections. Naturally infected populations were less likely to be reinfected by SARS-CoV-2 than the infection-naïve and vaccinated individuals. Although, reinfected individuals did not suffer severe disease, a remarkable proportion of naturally infected or vaccinated individuals were (re)-infected by the emerging variants.
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Affiliation(s)
- Sezanur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Mahfuzur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mojnu Miah
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mst Noorjahan Begum
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Monira Sarmin
- Nutrition and Clinical Services Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mustafa Mahfuz
- Nutrition and Clinical Services Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Enayet Hossain
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammed Ziaur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammod Jobayer Chisti
- Nutrition and Clinical Services Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shams El Arifeen
- Maternal and Child Health Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mustafizur Rahman
- Virology Laboratory, Infectious Diseases Division, icddr,b: International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
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de Marins Costa J, Swatuk LA, Ferreira Lopes A. Identifying stakeholders and discussing a strategy for the participatory management of a protected area: the case of Engenho Pequeno, in Rio de Janeiro State, Brazil. Environ Dev Sustain 2022; 24:13260-13281. [PMID: 35002480 PMCID: PMC8723810 DOI: 10.1007/s10668-021-01989-7] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/19/2021] [Indexed: 06/14/2023]
Abstract
This paper identifies the potential main social actors involved in and affected by the conservation and use of the Environmental Protection Area (EPA) of Engenho Pequeno, in Rio de Janeiro State, Brazil, and discusses how environmental education can be shaped to engage them in participatory, socially progressive and environmentally sustainable management for that area. Therefore, semi-structured interviews were conducted with individuals and entities related to the EPA. The snowball method complemented the mapping of non-official social actors. The discussion was based on the critical approach of environmental education, polycentric governance, adaptive management, environmental advocacy and case studies about education in protected areas. Results showed nine key stakeholders to be considered in a network program for the EPA's participatory management, including government, schools, local and nearby residents and religious groups. In the end, we recommend the hosting of a one day workshop, built around existing local and national environmental goals, as an entry point for trust building and the search for shared interests.
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Affiliation(s)
- Júlia de Marins Costa
- Master in Sustainable Development Practice, Researcher at the Sustainable Development Practice Graduate Program (PPGPDS), Federal Rural University of Rio de Janeiro (UFRRJ), Belo Horizonte, MG Brazil
| | - Larry A. Swatuk
- PhD in Political Science & International Relations, Professor at the School of Environment, Enterprise and Development (SEED), University of Waterloo (UW), Waterloo, ON Canada
| | - Alexandre Ferreira Lopes
- PhD in Ecology, Professor at the Sustainable Development Practice Graduate Program (PPGPDS), Federal Rural University of Rio de Janeiro (UFRRJ), Rio de Janeiro, RJ Brazil
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Belaid L, Ansari U, Omer K, Gidado Y, Baba MC, Daniel LE, Andersson N, Cockcroft A. "I had to change my attitude": narratives of most significant change explore the experience of universal home visits to pregnant women and their spouses in Bauchi State, Nigeria. Arch Public Health 2021; 79:202. [PMID: 34794488 PMCID: PMC8600880 DOI: 10.1186/s13690-021-00735-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 11/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Universal home visits to pregnant women and their spouses in Bauchi State, northern Nigeria, discussed local evidence about maternal and child health risks actionable by households. The expected results chain for improved health behaviours resulting from the visits was based on the CASCADA model, which includes Conscious knowledge, Attitudes, Subjective norms, intention to Change, Agency to change, Discussion of options, and Action to change. Previous quantitative analysis confirmed the impact of the visits on maternal and child outcomes. To explore the mechanisms of the quantitative improvements, we analysed participants' narratives of changes in their lives they attributed to the visits. METHODS Local researchers collected stories of change from 23 women and 21 men in households who had received home visits, from eight male and eight female home visitors, and from four government officers attached to the home visits program. We used a deductive thematic analysis based on the CASCADA results chain to analyze stories from women and men in households, and an inductive thematic approach to analyze stories from home visitors and government officials. RESULTS The stories from the visited women and men illustrated all steps in the CASCADA results chain. Almost all stories described increases in knowledge. Stories also described marked changes in attitudes and positive deviations from harmful subjective norms. Most stories recounted a change in behaviour attributed to the home visits, and many went on to mention a beneficial outcome of the behaviour change. Men, as well as women, described significant changes. The home visitors' stories described increases in knowledge, increased self-confidence and status in the community, and, among women, financial empowerment. CONCLUSIONS The narratives of change gave insights into likely mechanisms of impact of the home visits, at least in the Bauchi setting. The compatibility of our findings with the CASCADA results chain supports the use of this model in designing and analysing similar interventions in other settings. The indication that the home visits changed male engagement has broader relevance and contributes to the ongoing debate about how to increase male involvement in reproductive health.
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Affiliation(s)
- Loubna Belaid
- Department of Family Medicine, McGill University, Participatory Research at McGill (PRAM), 5858 Cote des Neiges, suite 300, Montreal, Quebec, Canada.
| | - Umaira Ansari
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Khalid Omer
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Yagana Gidado
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi Chapter, Bauchi, Nigeria
| | - Muhammed Chadi Baba
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi Chapter, Bauchi, Nigeria
| | | | - Neil Andersson
- Department of Family Medicine, McGill University, Participatory Research at McGill (PRAM), 5858 Cote des Neiges, suite 300, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Participatory Research at McGill (PRAM), 5858 Cote des Neiges, suite 300, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Mexico
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Pattnaik A, Mohan D, Tsui A, Chipokosa S, Katengeza H, Ndawala J, Marx MA. The aggregate effect of implementation strength of family planning programs on modern contraceptive use at the health systems level in rural Malawi. PLoS One 2021; 16:e0232504. [PMID: 34780507 PMCID: PMC8592450 DOI: 10.1371/journal.pone.0232504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/29/2021] [Indexed: 11/20/2022] Open
Abstract
To explore the association between the strength of implementation of family planning (FP) programs on the use of modern contraceptives. Specifically, how strongly these programs are being implemented across a health facility's catchment area in Malawi and the odds of a woman in that catchment area is using modern contraceptives. This information can be used to assess whether the combined impact of multiple large-scale FP programs is leading to change in the health outcomes they aim to improve. We used data from the 2017 Implementation Strength Assessment (ISA) that quantified how much of family planning programs at the health facility and community health worker levels were being implemented across every district of Malawi. We used a summary measure developed in a previous study that employs quantitative methods to combine data across FP domains and health system levels. We tested the association of this summary measure for implementation strength with household data from the 2015 Malawi Demographic Health Survey (DHS). We found that areas with stronger implementation of FP programs had higher odds of women using modern contraceptives compared with areas with weaker implementation. The association of ISA with use of modern contraception was different by education, marital status, and geography. After controlling for these factors, we found that the adjusted odds of using a modern contraceptive was three times higher in catchment areas with high implementation strength compared to those with lower strength. Metrics that summarize how strongly FP programs are being implemented were used to show a statistically significantly positive relationship between increasing implementation strength and higher rates of modern contraceptive use. Decisionmakers at the various levels of health authority can use this type of summary measure to better understand the combined impact of their diverse FP programming and inform future programmatic and policy decisions. The findings also reinforce the idea that having a well-supported and supplied cadre of community health workers supplementing FP provision at the health facility can be an important health systems mechanism, especially in rural settings and to target youth populations.
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Affiliation(s)
- Anooj Pattnaik
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Amy Tsui
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Hans Katengeza
- Reproductive Health Directorate, Ministry of Health, Lilongwe, Malawi
| | | | - Melissa A. Marx
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Dumigan CR, Muileboom J, Gregory J, Shrestha A, Hewedy OA, Raizada MN. Ancient Relatives of Modern Maize From the Center of Maize Domestication and Diversification Host Endophytic Bacteria That Confer Tolerance to Nitrogen Starvation. Front Plant Sci 2021; 12:660673. [PMID: 34603345 PMCID: PMC8485183 DOI: 10.3389/fpls.2021.660673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/12/2021] [Indexed: 06/13/2023]
Abstract
Plants can adapt to their surroundings by hosting beneficial bacteria that confer a selective advantage in stressful conditions. Endophytes are a class of beneficial bacteria that exist within the internal spaces of plants and many species can improve plant nitrogen use efficiency. Nitrogen is an essential plant macronutrient, and is often a limiting factor to plant growth, especially in cereal crops such as maize. Every year farmers apply over 100 million metric tonnes of synthetic nitrogen fertilizer to meet the growing demand for stable food crops. Breeding efforts in maize over the past several decades has focused heavily on yield in response to nitrogen inputs, and so may have selected against adaptations that allow plants to survive in nitrogen stressed conditions. Data suggests that our heavy dependence on synthetic nitrogen fertilizer is not sustainable in the long term, and so there is on-going research efforts to reduce and replace this currently essential part of modern agriculture. Bacteria that improve plant tolerance to nitrogen stressed environments would allow farmers to reduce the amount of fertilizer they apply. The selection of maize under high nitrogen conditions to create modern varieties may have caused the plant to lose these beneficial bacteria that allowed wild maize ancestors to thrive in low nitrogen soil. Here in this study, we examine the root and shoot microbiomes of the wild ancestor of all maize, Parviglumis, and an ancient Mexican landrace (Mixteco) from Oaxaca, the area of early maize diversification. Both of these maize genotypes have thrived for thousands of years with little to no nitrogen inputs and so we hypothesized that they host beneficial bacteria that allow them to thrive in nitrogen stressed conditions. We identified multiple root endophyte species from each ancient maize relative that increased the growth of annual ryegrass (model maize relative) under nitrogen starvation. Furthermore, research infers these strains were vertically transmitted to new generations of plants, potentially through seed, indicating selection pressure for Parviglumis and Mixteco to maintain them in their microbiome.
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Affiliation(s)
| | | | | | | | | | - Manish N. Raizada
- Department of Plant Agriculture, University of Guelph, Guelph, ON, Canada
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Vo LNQ, Codlin A, Ngo TD, Dao TP, Dong TTT, Mo HTL, Forse R, Nguyen TT, Cung CV, Nguyen HB, Nguyen NV, Nguyen VV, Tran NT, Nguyen GH, Qin ZZ, Creswell J. Early Evaluation of an Ultra-Portable X-ray System for Tuberculosis Active Case Finding. Trop Med Infect Dis 2021; 6:163. [PMID: 34564547 PMCID: PMC8482270 DOI: 10.3390/tropicalmed6030163] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/20/2022] Open
Abstract
X-ray screening is an important tool in tuberculosis (TB) prevention and care, but access has historically been restricted by its immobile nature. As recent advancements have improved the portability of modern X-ray systems, this study represents an early evaluation of the safety, image quality and yield of using an ultra-portable X-ray system for active case finding (ACF). We reported operational and radiological performance characteristics and compared image quality between the ultra-portable and two reference systems. Image quality was rated by three human readers and by an artificial intelligence (AI) software. We deployed the ultra-portable X-ray alongside the reference system for community-based ACF and described TB care cascades for each system. The ultra-portable system operated within advertised specifications and radiologic tolerances, except on X-ray capture capacity, which was 58% lower than the reported maximum of 100 exposures per charge. The mean image quality rating from radiologists for the ultra-portable system was significantly lower than the reference (3.71 vs. 3.99, p < 0.001). However, we detected no significant differences in TB abnormality scores using the AI software (p = 0.571), nor in any of the steps along the TB care cascade during our ACF campaign. Despite some shortcomings, ultra-portable X-ray systems have significant potential to improve case detection and equitable access to high-quality TB care.
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Affiliation(s)
- Luan Nguyen Quang Vo
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Andrew Codlin
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Thuc Doan Ngo
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Thang Phuoc Dao
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Thuy Thi Thu Dong
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | - Huong Thi Lan Mo
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Rachel Forse
- Friends for International TB Relief, Ha Noi 100000, Vietnam; (A.C.); (T.T.T.D.); (R.F.)
| | | | - Cong Van Cung
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | - Hoa Binh Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | - Nhung Viet Nguyen
- National Lung Hospital, Ha Noi 100000, Vietnam; (C.V.C.); (H.B.N.); (N.V.N.)
| | | | - Ngan Thi Tran
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Giang Hoai Nguyen
- IRD VN, Ho Chi Minh City 700000, Vietnam; (T.D.N.); (T.P.D.); (H.T.L.M.); (N.T.T.); (G.H.N.)
| | - Zhi Zhen Qin
- Stop TB Partnership, 1218 Geneva, Switzerland; (Z.Z.Q.); (J.C.)
| | - Jacob Creswell
- Stop TB Partnership, 1218 Geneva, Switzerland; (Z.Z.Q.); (J.C.)
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Chowdhury R, McKague K, Krause H. How workers respond to social rewards: evidence from community health workers in Uganda. Health Policy Plan 2021; 36:239-248. [PMID: 33881139 PMCID: PMC8058949 DOI: 10.1093/heapol/czaa162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2020] [Indexed: 11/14/2022] Open
Abstract
This paper investigates the effect of a non-financial incentive-a competitive annual award-on community health workers' (CHWs) performance, an issue in the public health literature that has not been explored to its potential. Combining data on a competitive social 'Best CHW' award with the monthly performance of 4050 CHWs across Uganda, we examined if introducing social recognition awards improved the performance of CHWs. In contrast to predominant explanations about the effect of awards on motivation, our first multilevel mixed-effect models found that an award within a branch (consisting of ∼30 CHWs) was negatively associated with the performance of the local peers of the winning CHW. Models focused on non-winning branch offices revealed two additional findings. First, a branch showed underperformance if a CHW from any of the three neighbouring branches won an award in the previous year, with average monthly performance scores dropping by 27 percentage points. Second, this negative association was seen only in the top 50th percentile of CHWs. The bottom 50th percentile of CHWs exhibited increased performance by 13 percentage points. These counter-intuitive results suggest that the negative response from high performers might be explained by their frustration of not winning the award or by emotions such as envy and jealousy generated by negative social comparisons. Our results suggest that more fine-grained examination of data pertaining to motivators for CHWs in low-income countries is needed. Motivational incentives like awards may need to be customized for higher- and lower-performing CHWs.
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Affiliation(s)
- Reajul Chowdhury
- Corresponding author. Agriculture and Consumer Economics, University of Illinois, Urbana – Champaign, 59 Mumford Hall, 1301 W. Gregory Drive Urbana, IL 61801, USA. E-mail:
| | - Kevin McKague
- Shannon School of Business, Cape Breton University, Sydney, Nova Scotia B1M 1A2, Canada
| | - Heather Krause
- Principal Data Scientist, Datassist, Toronto, ON M4Y 3E1, Canada
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Vasconcelos Gioia G, Lamielle G, Aguanno R, ElMasry I, Mouillé B, De Battisti C, Angot A, Ewann F, Sivignon A, Donachie D, Rozov O, Bonbon É, Poudevigne F, VonDobschuetz S, Plée L, Kalpravidh W, Sumption K. Informing resilience building: FAO's Surveillance Evaluation Tool (SET) Biothreat Detection Module will help assess national capacities to detect agro-terrorism and agro-crime. One Health Outlook 2021; 3:14. [PMID: 34275496 PMCID: PMC8286858 DOI: 10.1186/s42522-021-00045-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
Attacks using animal pathogens can have devastating socioeconomic, public health and national security consequences. The livestock sector has some inherent vulnerabilities which put it at risk to the deliberate or accidental spread of disease. The growing concern of countries about the risks of agro-terrorism and agro-crime has led to efforts to prepare against potential attacks. One recent international effort is the launch of a joint OIE, FAO and INTERPOL project in 2019 to build resilience against agro-terrorism and agro-crime targeting animal health with the financial support of the Weapons Threat Reduction Programme of Global Affairs Canada. Given the importance of strong animal health surveillance systems for the early and effective response to agro-terrorism and agro-crime, the project will use the FAO Surveillance Evaluation Tool (SET) and its new Biothreat Detection Module to evaluate beneficiary countries' capacities to detect criminal or terrorist animal health events. This paper presents the development of the new SET Biothreat Detection Module and how it will be used to evaluate surveillance for agro-terrorism and agro-crime animal disease threats. The module will be piloted in early 2021 and, once finalized, will be used by beneficiary countries of the joint OIE-FAO-INTERPOL project. Results from evaluations using SET and its Biothreat Detection Module are expected to provide a baseline from which countries can build targeted capacity for animal disease surveillance including early detection and investigation of potential terrorist or criminal events involving zoonotic and non-zoonotic animal pathogens.
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Affiliation(s)
| | - Gaël Lamielle
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Ryan Aguanno
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Ihab ElMasry
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Béatrice Mouillé
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | | | - Angélique Angot
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Fanny Ewann
- International Criminal Police Organization (INTERPOL), Lyon, France
| | - Adrien Sivignon
- International Criminal Police Organization (INTERPOL), Lyon, France
| | | | - Orr Rozov
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | - Étienne Bonbon
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | | | | | - Ludovic Plée
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
| | | | - Keith Sumption
- Food and Agriculture Organization of the United Nations (FAO), Rome, Italy
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Dyke E, Pénicaud S, Hatchard J, Dawson AM, Munishi O, Jalal C. Girl-Powered Nutrition Program: Key Themes from a Formative Evaluation of a Nutrition Program Co-designed and Implemented by Adolescent Girls in Low- and Middle-Income Countries. Curr Dev Nutr 2021; 5:nzab083. [PMID: 34286176 PMCID: PMC8282357 DOI: 10.1093/cdn/nzab083] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/07/2021] [Accepted: 05/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To improve nutritional knowledge and attitudes of girls and young women, Nutrition International (NI) partnered with the World Association of Girl Guides and Girl Scouts (WAGGGS) to pilot the Girl-Powered Nutrition (GPN) program from 2018 to 2020 in 4 countries (Madagascar, the Philippines, Sri Lanka, and Tanzania). OBJECTIVE The aim was to share adolescent girls' and programmers' experiences with co-designing and implementing the GPN program in low- and middle-income countries (LMICs). METHODS A formative evaluation of the GPN program was commissioned by NI and undertaken by Universalia Management Group (Universalia). The evaluation was largely qualitative (employing focus groups, interviews, and document analysis). Based on the results of the formative evaluation, themes related to working with adolescent girls were identified. RESULTS The involvement of adolescents in the design, implementation, and evaluation of nutrition programming that targets them is essential for meaningful uptake. Sufficient time and respect must be given to the co-design process, including clearly defining adolescents' roles, ensuring transparency and clear communication, and managing adolescents' expectations. Ensuring adequate exposure and suitable timing for adolescent nutrition programming from adequately trained staff were identified as good practices from the evaluation. Program curriculum and activities must be appropriately tailored to adolescent age and stage, target adolescents and their gatekeepers and duty-bearers, and address the underlying issues of poverty, gender inequality, and structural norms that negatively impact adolescents' agency and nutrition. CONCLUSIONS This research supports and elaborates on several documented and accepted good practices for working with adolescents to improve nutrition knowledge and attitudes. Similar programs with key features such as co-design, suitable timing, curriculum, and exposure of programs by age group, addressing underlying structural issues, the involvement of gatekeepers and duty-bearers, and confidence-building can increase adolescent girls' nutrition knowledge and attitudes.
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Affiliation(s)
- Elizabeth Dyke
- Universalia Management Group, Westmount, Montreal, Quebec, Canada
| | - Sophie Pénicaud
- Universalia Management Group, Westmount, Montreal, Quebec, Canada
| | | | | | - Oresto Munishi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Abstract
Among livestock species, poultry and small ruminants are of particular importance to rural women in low- and middle-income countries, as means to generate income, provide nutritious food for the family, accumulate wealth, and confer social status. Newcastle disease (ND) and Peste des Petits Ruminants (PPR) are widespread livestock diseases of poultry and small ruminants, respectively. While both diseases are vaccine preventable, numerous constraints limit the availability of and access to livestock vaccines, especially among the most vulnerable populations in developing countries. The literature on equity and effectiveness of livestock vaccine distribution systems has emphasized many of these constraints, however a gendered analysis and deeper understanding of the vaccine system remain insufficient. This paper applies a gendered and intersectional transformational approach, or GITA, to highlight how gender and other social factors affect the provision and utilization of vaccines for ND and PPR diseases in the region of Kaffrine, Senegal. We first articulate and describe the vaccine value chains (VVCs) for these diseases in Kaffrine, and then analyze the gendered and intersectional dynamics at different nodes of the VVCs, including actors at the national level, through the regional and district levels, down to providers of animal health at community level and the livestock keepers themselves. Our findings indicate that actors’ various experiences are shaped and defined mainly by rigid gender norms, location and remoteness, and to a lesser degree by other social stratifications of age, ethnicity, and livelihood. Given the significant role that gender norms play in the livestock vaccine value chains, differences according to the livestock species, regulation of vaccine administration, and vaccine distribution systems emerge as highly relevant for understanding barriers that women specifically face within the livestock vaccination system.
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Affiliation(s)
- Sarah McKune
- Department of Environmental and Global Health and Center for African Studies, University of Florida, Gainesville, FL, United States of America
| | - Renata Serra
- Center for African Studies, University of Florida, Gainesville, FL, United States of America
- * E-mail:
| | - Alioune Touré
- Department of Livestock Science & Technology, Université du Sine Saloum El Hadj Ibrahima Niass, Kaffrine, Senegal
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Goulart CM, Purewal A, Nakhuda H, Ampadu A, Giancola A, Kortenaar JL, Bassani DG. Tools for measuring gender equality and women's empowerment (GEWE) indicators in humanitarian settings. Confl Health 2021; 15:39. [PMID: 34001201 PMCID: PMC8127307 DOI: 10.1186/s13031-021-00373-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/27/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Effective measurement of Gender Equality and Women's Empowerment (GEWE) is challenging in low and middle-income countries (LMICs), and even more so in humanitarian settings. Conflict, natural disasters, and epidemics may increase gender inequities, but also present an opportunity to address them. This scoping review describes and identifies gaps in the measurement tools, methods, and indicators used to measure GEWE in humanitarian settings, and presents a dashboard that can be used by researchers, organizations and governments to identify GEWE measurement tools. METHODS Scientific articles published between January 2004 and November 2019 were identified using Embase, Medline, PsycInfo, CINAHL, Scopus, and PAIS index. Relevant non peer-reviewed literature was downloaded from the websites of humanitarian organizations. Publications on women and/or girls impacted by a humanitarian crisis in a LMIC, within 5 years of data collection, were included. Publications were double-screened in the title/abstract and full-text stages. We used a machine learning software during the title/abstract screening to increase the efficiency of the process. Measurement tools, sampling and data collection methods, gap areas (geographical, topical and contextual), and indicators were catalogued for easy access in an interactive Tableau dashboard. RESULTS Our search yielded 27,197 publications and 2396 non peer-reviewed literature reports. One hundred and seventy publications were included in the final review. Extracted indicators were categorized into seven domains: economic, health, human development, leadership, psychological, security and justice, and sociocultural. The vast majority of studies were observational, and over 70% utilized a cross-sectional study design. Thirty-eight toolkits and questionnaires were identified in this review, of which 19 (50%) were designed specifically for humanitarian settings. Sociocultural was the largest domain in number of studies and indicators in this review, with gender-based violence indicators reported in 66% of studies. Indicators of economic, human development and leadership were uncommon in the peer-reviewed literature. DISCUSSION While there has been some effort to measure GEWE in conflict-affected and other humanitarian settings, measurement has largely focused on violence and security issues. A more comprehensive framework for measuring GEWE in these settings is needed; objective measurement of women's empowerment and gender equality should be prioritized by organizations providing humanitarian aid.
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Affiliation(s)
- Céline M Goulart
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
| | - Amber Purewal
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Humaira Nakhuda
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Anita Ampadu
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Amanda Giancola
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Jean-Luc Kortenaar
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
| | - Diego G Bassani
- The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada
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Nguyen LH, Tran PTM, Dam TA, Forse RJ, Codlin AJ, Huynh HB, Dong TTT, Nguyen GH, Truong VV, Dang HTM, Nguyen TD, Nguyen HB, Nguyen NV, Khan A, Creswell J, Vo LNQ. Assessing private provider perceptions and the acceptability of video observed treatment technology for tuberculosis treatment adherence in three cities across Viet Nam. PLoS One 2021; 16:e0250644. [PMID: 33961645 PMCID: PMC8104441 DOI: 10.1371/journal.pone.0250644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 04/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The World Health Organization recently recommended Video Observed Therapy (VOT) as one option for monitoring tuberculosis (TB) treatment adherence. There is evidence that private sector TB treatment has substandard treatment follow-up, which could be improved using VOT. However, acceptability of VOT in the private sector has not yet been evaluated. Methods We conducted a cross-sectional survey employing a theoretical framework for healthcare intervention acceptability to measure private provider perceptions of VOT across seven constructs in three cities of Viet Nam: Ha Noi, Ho Chi Minh City, and Hai Phong. We investigated the differences in private providers’ attitudes and perceptions of VOT using mixed ordinal models to test for significant differences in responses between groups of providers stratified by their willingness to use VOT. Results A total of 79 private providers completed the survey. Sixty-two providers (75%) indicated they would use VOT if given the opportunity. Between private providers who would and would not use VOT, there were statistically significant differences (p≤0.001) in the providers’ beliefs that VOT would help identify side effects faster and in their confidence to monitor treatment and provide differentiated care with VOT. There were also significant differences in providers’ beliefs that VOT would save them time and money, address problems faced by their patients, benefit their practice and patients, and be relevant for all their patients. Conclusion Private providers who completed the survey have positive views towards using VOT and specific subpopulations acknowledge the value of integrating VOT into their practice. Future VOT implementation in the private sector should focus on emphasizing the benefits and relevance of VOT during recruitment and provide programmatic support for implementing differentiated care with the technology.
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Affiliation(s)
| | | | - Thu Anh Dam
- Friends for International TB Relief, Hanoi, Viet Nam
| | | | | | - Huy Ba Huynh
- Friends for International TB Relief, Hanoi, Viet Nam
| | | | | | | | | | | | | | | | - Amera Khan
- Stop TB Partnership, Geneva, Switzerland
| | | | - Luan Nguyen Quang Vo
- Friends for International TB Relief, Hanoi, Viet Nam
- IRD VN, Hanoi, Viet Nam
- * E-mail:
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Kumar P, Gruzd A, Mai P. Mapping out Violence Against Women of Influence on Twitter Using the Cyber-Lifestyle Routine Activity Theory. Am Behav Sci 2021; 65:689-711. [PMID: 33896942 PMCID: PMC8044621 DOI: 10.1177/0002764221989777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The study applies and expands the routine activity theory to examine the dynamics of online harassment and violence against women on Twitter in India. We collected 931,363 public tweets (original posts and replies) over a period of 1 month that mentioned at least one of 101 influential women in India. By undertaking both manual and automated text analysis of "hateful" tweets, we identified three broad types of violence experienced by women of influence on Twitter: dismissive insults, ethnoreligious slurs, and gendered sexual harassment. The analysis also revealed different types of individually motivated offenders: "news junkies," "Bollywood fanatics," and "lone-wolves", who do not characteristically engage in direct targeted attacks against a single person. Finally, we question the effectiveness of Twitter's form of "guardianship" against online violence against women, as we found that a year after our initial data collection in 2017, only 22% of hostile posts with explicit forms of harassment have been deleted. We conclude that in the social media age, online and offline public spheres overlap and intertwine, requiring improved regulatory approaches, policies, and moderation tools of "capable" guardianship that empower women to actively participate in public life.
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Affiliation(s)
- Priya Kumar
- Ryerson University, Toronto, Ontario, Canada
| | | | - Philip Mai
- Ryerson University, Toronto, Ontario, Canada
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