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Majeed T, Hopkin G, Wang K, Nepal S, Votruba N, Gronholm P, Gurung D, Semrau M, Bagade T, Farina N, Musyimi C, Pingani L, Breuer E, Lund C, Thornicroft G, Evans-Lacko S. Anti-stigma interventions in low-income and middle-income countries: a systematic review. EClinicalMedicine 2024; 72:102612. [PMID: 38707913 PMCID: PMC11066569 DOI: 10.1016/j.eclinm.2024.102612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/31/2024] [Accepted: 04/09/2024] [Indexed: 05/07/2024] Open
Abstract
Background Stigma exacerbates power imbalances and societal disparities, significantly impacting diverse identities and health conditions, particularly for low and middle-income countries (LMICs). Though crucial for dismantling harmful stereotypes, and enhancing healthcare utilisation, existing research on anti-stigma interventions is limited with its condition-focused approach. We aimed to thoroughly evaluate peer-reviewed and non-peer-reviewed literature for a comprehensive review of anti-stigma interventions for diverse identities and all health conditions in LMICs. Methods This review systematically explored peer-reviewed and non-peer-reviewed literature, in ten electronic databases up to January 30, 2024, covering all anti-stigma interventions across various stigmatised identities and health conditions in LMICs. Quality assessment for this systematic review was conducted as per Cochrane Collaboration's suggested inclusions. The review was registered with PROSPERO (Registration: 2017 CRD42017064283). Findings Systematic synthesis of the 192 included studies highlights regional imbalances, while providing valuable insights on robustness and reliability of anti-stigma research. Most studies used quasi-experimental design, and most centred on HIV/AIDS or mental health related stigma, with very little work on other issues. Certain high-population LMICs had no/little representation. Interpretation The interventions targeted diverse segments of populations and consequently yielded a multitude of stigma-related outcomes. However, despite the heterogeneity of studies, most reported positive outcomes underscoring the effectiveness of existing interventions to reduce stigma. Funding This study is supported by the UK Medical Research Council Indigo Partnership (MR/R023697/1) award.
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Affiliation(s)
- Tazeen Majeed
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Gareth Hopkin
- National Institute for Health and Care Excellence, United Kingdom
| | - Katie Wang
- Department of Social and Behavioral Sciences, Yale School of Public Health, United Kingdom
| | | | - Nicole Votruba
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Petra Gronholm
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Dristy Gurung
- Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Transcultural Psychosocial Organization, Kathmandu, Nepal
| | - Maya Semrau
- Centre of Excellence for Global Health Research, Brighton & Sussex Medical School, Brighton, UK
| | - Tanmay Bagade
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Nick Farina
- Faculty of Health, University of Plymouth, Plymouth, UK
| | | | - Luca Pingani
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Dipartimento ad Attività Integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Erica Breuer
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Crick Lund
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Alan J Fisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Graham Thornicroft
- Centre for Implementation Science and Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, United Kingdom
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Gaviola GC, McCarville M, Shendale S, Goodman T, Lomazzi M, Desai S. A review of health worker vaccination programs in low, middle and upper middle-income countries. Public Health Pract (Oxf) 2023; 6:100415. [PMID: 37547811 PMCID: PMC10400463 DOI: 10.1016/j.puhip.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Study design A PubMed Literature search. Methods A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Results The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW. Conclusions The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.
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Affiliation(s)
- Gabriel C. Gaviola
- Department of Occupational Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Maddison McCarville
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- World Federation of Public Health Associations, Geneva, Switzerland
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marta Lomazzi
- World Federation of Public Health Associations, Geneva, Switzerland
- University of Geneva, Institute of Global Health, Geneva, Switzerland
| | - Shalini Desai
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
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Shakir M, Altaf A, Irshad HA, Hussain N, Pirzada S, Tariq M, Trillo-Ordonez Y, Enam SA. Factors Delaying the Continuum of Care for the Management of Traumatic Brain Injury in Low- and Middle-Income Countries: A Systematic Review. World Neurosurg 2023; 180:169-193.e3. [PMID: 37689356 DOI: 10.1016/j.wneu.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Considering the disproportionate burden of delayed traumatic brain injury (TBI) management in low- and middle-income countries (LMICs), there is pressing demand for investigations. Therefore, our study aims to evaluate factors delaying the continuum of care for the management of TBIs in LMICs. METHODS A systematic review was conducted with PubMed, Scopus, Google Scholar and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Observational studies with TBI patients in LMIC were included. The factors affecting management of TBI were extracted and analyzed descriptively. RESULTS A total of 55 articles were included consisting of 60,603 TBI cases from 18 LMICs. Road traffic accidents (58.7%) were the most common cause of injury. Among included studies, factors contributing to prehospital delays included a poor referral system and lack of an organized system of referral (14%), long travel distances (11%), inadequacy of emergency medical services (16.6%), and self-treatment practices (2.38%). For in-hospital delays, factors such as lack of trained physicians (10%), improper triage systems (20%), and absence of imaging protocols (10%), lack of in-house computed tomography scanners (35%), malfunctioning computed tomography scanners (10%), and a lack of invasive monitoring of intracranial pressure (5%), limited theater space (28%), lack of in-house neurosurgical facilities (28%), absence of in-house neurosurgeons (28%), and financial constraints (14%) were identified. CONCLUSIONS Several factors, both before and during hospitalization contribute to delays in the management of TBIs in LMICs. Strategically addressing these factors can help overcome delays and improve TBI management in LMICs.
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Affiliation(s)
- Muhammad Shakir
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
| | - Ahmed Altaf
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Nowal Hussain
- Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sonia Pirzada
- Medical College, Aga Khan University, Karachi, Pakistan
| | - Mahnoor Tariq
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Yesel Trillo-Ordonez
- Duke University Division of Global Neurosurgery and Neurology, Durham, North Carolina, USA
| | - Syed Ather Enam
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Matthews S, Coates MM, Bukhman A, Trujillo C, Ferrari G, Dagnaw WW, Fénelon DL, Getachew T, Karmacharya B, Larco NC, Lulebo AM, Mayige MT, Mbaye MN, Tarekegn G, Gupta N, Adler A, Bukhman G. Health system capacity to manage diabetic ketoacidosis in nine low-income and lower-middle income countries: A cross-sectional analysis of nationally representative survey data. EClinicalMedicine 2023; 55:101759. [PMID: 36471690 PMCID: PMC9718963 DOI: 10.1016/j.eclinm.2022.101759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There has been increasing awareness about the importance of type 1 diabetes (T1D) globally. Diabetic ketoacidosis (DKA) is a life-threatening complication of T1D in low-income settings. Little is known about health system capacity to manage DKA in low- and lower-middle income countries (LLMICs). As such, we describe health system capacity to diagnose and manage DKA across nine LLMICs using data from Service Provision Assessments. METHODS In this cross-sectional study, we used data from Service Provision Assessment (SPA) surveys, which are part of the Demographic and Health Survey (DHS) Program. We defined an item set to diagnose and manage DKA in higher-level (tertiary or secondary) facilities, and a set to assess and refer patients presenting to lower-level (primary) facilities. We quantified each item's availability by service level in Bangladesh (Survey 1: May 22 2014-Jul 20 2014; Survey 2: Jul 2017-Oct 2017), the Democratic Republic of the Congo (DRC) (Oct 16 2017-Nov 24 2017 in Kinshasha; Aug 08 2018-Apr 20 2018 in rest of country), Haiti (Survey 1: Mar 05 2013-Jul 2013; Survey 2: Dec 16 2017-May 09 2018), Ethiopia (Feb 06 2014-Mar 09 2014), Malawi (Phase 1: Jun 11 2013-Aug 20 2013; Phase 2: Nov 13 2013-Feb 7 2014), Nepal (Phase 1: Apr 20 2015-Apr 25 2015; Phase 2: Jun 04 2015-Nov 05 2015), Senegal (Survey 1: Jan 2014-Oct 2014; Survey 2: Feb 09 2015-Nov 10 2015; Survey 3: Feb 2016-Nov 2016; Survey 4: Mar 13 2017-Dec 15 2017; Survey 5: Apr 15 2018-Dec 31 2018; Survey 6: Apr 15 2019-Feb 28 2020), Tanzania (Oct 20 2014-Feb 21 2015), and Afghanistan (Nov 1 2018-Jan 20 2019). Variation in secondary facilities' capacity and trends over time were also explored. FINDINGS We examined data from 2028 higher-level and 7534 lower-level facilities. Of these, 1874 higher-level and 6636 lower-level facilities' data were eligible for analysis. Availability of all item sets were low at higher-level facilities, where less than 50% had the minimal set of supplies, less than 20% had the full minimal set, and less than 15% had the ideal set needed to diagnose and manage DKA. Across countries in lower-level facilities, less than 14% had the minimal set of supplies and less than 9% the full set of supplies for diagnosis and transfer of DKA patients. No country had more than 20% of facilities with the minimal set of items needed to assess or manage DKA. Where data were available for more than one survey (Bangladesh, Senegal, and Haiti), changes in availability of the minimal set and ideal set of items did not exceed 15%. Tertiary facilities performed best in Haiti, Ethiopia, Malawi, Nepal, Senegal, Tanzania, and Afghanistan. Secondary facilities that were rural, public, and had fewer staff had lower capacity. INTERPRETATION Health system capacity to manage DKA was low across these nine LLMICs. Although efforts are underway to strengthen health systems, a specific focus on DKA management is still needed. FUNDING Leona M. and Harry B. Helmsley Charitable Trust, and Juvenile Diabetes Research Foundation Ltd.
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Affiliation(s)
- Sarah Matthews
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Matthew M. Coates
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Alice Bukhman
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Celina Trujillo
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
| | - Gina Ferrari
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
| | - Wubaye Walelgne Dagnaw
- NCD Synergies Project, Partners In Health, Boston, MA, USA
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
| | | | - Theodros Getachew
- Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Biraj Karmacharya
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Kathmandu, Nepal
| | - Nancy Charles Larco
- Haitian Foundation for Diabetes and Cardiovascular Diseases (FHADIMAC), Port-au-Prince, Haiti
| | - Aimée M. Lulebo
- Kinshasa School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | | | | | - Getahun Tarekegn
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Neil Gupta
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Alma Adler
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Gene Bukhman
- Center for Integration Science, Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- NCD Synergies Project, Partners In Health, Boston, MA, USA
- Program in Global Noncommunicable Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Corresponding author. Center for Integration Science, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
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Thomas Mori A, Christopher Bulula N, Magodi R, Mwengee W. Domestic funding opportunities for Tanzania as five new Middle-Income countries brace for reduced Gavi support for immunization. Vaccine 2022; 40:3278-85. [PMID: 35527062 DOI: 10.1016/j.vaccine.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/11/2022] [Accepted: 04/15/2022] [Indexed: 01/13/2023]
Abstract
Vaccines have produced remarkable impact in reducing the global burden of disease. Thanks to Gavi-the Vaccine Alliance, which supports eligible countries to increase access to the new and underused vaccines. Gavi support depends on economic growth, whereby low-income countries contribute 0.2 USD per dose of supported vaccines, while middle-income countries contribute by price fraction that increases gradually by 15% annually. A country must become fully self-financing within five years when its economy reaches 1,630 USD GNI per capita. Recently, Tanzania, Benin, Haiti, Nepal, and Tajikistan became middle-income countries triggering gradual reduction in Gavi support. This paper first compares the socio-demographic characteristics, immunization program performance, and health financing strategies of these countries and second, explores domestic financing strategies that Tanzania can use to close the funding gap. Although the five countries are similar economically, they vary in demography, health financing strategies, extent of donor dependency, and strength of immunization programs. Some health indicators are not any better than those in low-income countries. Tanzania receives the largest financial support from Gavi and is projected to be fully self-financing by 2043. The potential domestic funding opportunities include to increase Government budget, use of innovative financing strategies, and health insurance, complemented with enhanced program efficiency.
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Kumar P, Hama S, Abbass RA, Nogueira T, Brand VS, Wu HW, Abulude FO, Adelodun AA, Anand P, Andrade MDF, Apondo W, Asfaw A, Aziz KH, Cao SJ, El-Gendy A, Indu G, Kehbila AG, Ketzel M, Khare M, Kota SH, Mamo T, Manyozo S, Martinez J, McNabola A, Morawska L, Mustafa F, Muula AS, Nahian S, Nardocci AC, Nelson W, Ngowi AV, Njoroge G, Olaya Y, Omer K, Osano P, Sarkar Pavel MR, Salam A, Santos ELC, Sitati C, Shiva Nagendra SM. In-kitchen aerosol exposure in twelve cities across the globe. Environ Int 2022; 162:107155. [PMID: 35278800 DOI: 10.1016/j.envint.2022.107155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/13/2022] [Accepted: 02/18/2022] [Indexed: 06/14/2023]
Abstract
Poor ventilation and polluting cooking fuels in low-income homes cause high exposure, yet relevant global studies are limited. We assessed exposure to in-kitchen particulate matter (PM2.5 and PM10) employing similar instrumentation in 60 low-income homes across 12 cities: Dhaka (Bangladesh); Chennai (India); Nanjing (China); Medellín (Colombia); São Paulo (Brazil); Cairo (Egypt); Sulaymaniyah (Iraq); Addis Ababa (Ethiopia); Akure (Nigeria); Blantyre (Malawi); Dar-es-Salaam (Tanzania) and Nairobi (Kenya). Exposure profiles of kitchen occupants showed that fuel, kitchen volume, cooking type and ventilation were the most prominent factors affecting in-kitchen exposure. Different cuisines resulted in varying cooking durations and disproportional exposures. Occupants in Dhaka, Nanjing, Dar-es-Salaam and Nairobi spent > 40% of their cooking time frying (the highest particle emitting cooking activity) compared with ∼ 68% of time spent boiling/stewing in Cairo, Sulaymaniyah and Akure. The highest average PM2.5 (PM10) concentrations were in Dhaka 185 ± 48 (220 ± 58) μg m-3 owing to small kitchen volume, extensive frying and prolonged cooking compared with the lowest in Medellín 10 ± 3 (14 ± 2) μg m-3. Dual ventilation (mechanical and natural) in Chennai, Cairo and Sulaymaniyah reduced average in-kitchen PM2.5 and PM10 by 2.3- and 1.8-times compared with natural ventilation (open doors) in Addis Ababa, Dar-es-Salam and Nairobi. Using charcoal during cooking (Addis Ababa, Blantyre and Nairobi) increased PM2.5 levels by 1.3- and 3.1-times compared with using natural gas (Nanjing, Medellin and Cairo) and LPG (Chennai, Sao Paulo and Sulaymaniyah), respectively. Smaller-volume kitchens (<15 m3; Dhaka and Nanjing) increased cooking exposure compared with their larger-volume counterparts (Medellin, Cairo and Sulaymaniyah). Potential exposure doses were highest for Asian, followed by African, Middle-eastern and South American homes. We recommend increased cooking exhaust extraction, cleaner fuels, awareness on improved cooking practices and minimising passive occupancy in kitchens to mitigate harmful cooking emissions.
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Affiliation(s)
- Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; Department of Civil, Structural & Environmental Engineering, Trinity College Dublin, Dublin, Ireland; School of Architecture, Southeast University, Nanjing, China.
| | - Sarkawt Hama
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom
| | - Rana Alaa Abbass
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom
| | - Thiago Nogueira
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; Departamento de Ciências Atmosféricas - Instituto de Astronomia, Geofísica e Ciências Atmosféricas - IAG, Universidade de São Paulo, São Paulo, Brazil
| | - Veronika S Brand
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; Departamento de Ciências Atmosféricas - Instituto de Astronomia, Geofísica e Ciências Atmosféricas - IAG, Universidade de São Paulo, São Paulo, Brazil
| | - Huai-Wen Wu
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; School of Architecture, Southeast University, Nanjing, China
| | | | - Adedeji A Adelodun
- Department of Marine Science and Technology, The Federal University of Technology Akure, 340001, Nigeria
| | - Partibha Anand
- Department of Civil Engineering, Indian Institute of Technology Delhi, India
| | - Maria de Fatima Andrade
- Departamento de Ciências Atmosféricas - Instituto de Astronomia, Geofísica e Ciências Atmosféricas - IAG, Universidade de São Paulo, São Paulo, Brazil
| | | | - Araya Asfaw
- Physics Department, Addis Ababa University, Ethiopia
| | - Kosar Hama Aziz
- Department of Chemistry, College of Science, University of Sulaimani, Kurdistan Region, Iraq
| | - Shi-Jie Cao
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; School of Architecture, Southeast University, Nanjing, China
| | - Ahmed El-Gendy
- Department of Construction Engineering, School of Sciences and Engineering, The American University in Cairo, New Cairo 11835, Egypt
| | - Gopika Indu
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, India
| | | | - Matthias Ketzel
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; Department of Environmental Science, Aarhus University, Roskilde, Denmark
| | - Mukesh Khare
- Department of Civil Engineering, Indian Institute of Technology Delhi, India
| | - Sri Harsha Kota
- Department of Civil Engineering, Indian Institute of Technology Delhi, India
| | - Tesfaye Mamo
- Physics Department, Addis Ababa University, Ethiopia
| | | | | | - Aonghus McNabola
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; Department of Civil, Structural & Environmental Engineering, Trinity College Dublin, Dublin, Ireland
| | - Lidia Morawska
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, Surrey, United Kingdom; International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Australia
| | - Fryad Mustafa
- Department of Chemistry, College of Science, University of Sulaimani, Kurdistan Region, Iraq
| | | | - Samiha Nahian
- Department of Chemistry, Faculty of Science, University of Dhaka, Dhaka 1000, Bangladesh
| | | | - William Nelson
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Aiwerasia V Ngowi
- Department of Environmental and Occupational Health, Muhimbili University of Health and Allied Sciences, Tanzania
| | | | - Yris Olaya
- Universidad Nacional de Colombia, Colombia
| | - Khalid Omer
- Department of Chemistry, College of Science, University of Sulaimani, Kurdistan Region, Iraq
| | | | - Md Riad Sarkar Pavel
- Department of Chemistry, Faculty of Science, University of Dhaka, Dhaka 1000, Bangladesh
| | - Abdus Salam
- Department of Chemistry, Faculty of Science, University of Dhaka, Dhaka 1000, Bangladesh
| | - Erik Luan Costa Santos
- Department of Environmental Health - School of Public Health - University of São Paulo, Brazil
| | | | - S M Shiva Nagendra
- Department of Civil Engineering, Indian Institute of Technology Madras, Chennai, India
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Sharma R, Garg K, Katiyar V, Alam I, Tandon V, Raheja A, Mishra S, Veerabhadraiah P, Suri A, Chandra PS, Kale SS. Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India. World Neurosurg 2021; 152:e635-44. [PMID: 34129979 DOI: 10.1016/j.wneu.2021.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022]
Abstract
Objective We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center. Methods This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on March 25, 2020 to November 30, 2020 with that of same period in the previous year, 2019. Results There were 687 neurosurgery admissions during the study period compared with 2550 admissions in 2019. The total number of surgeries performed in neurosurgery also showed a similar trend, with only 654 surgeries in 2020 compared with 3165 surgeries in 2019. During COVID-19 times, 474 patients were operated on including both trauma and nontrauma cases. Of the 50 patients with suspected/indeterminate COVID-19 who were operated on, 5 turned out to be positive for COVID-19. Significant differences were seen in the mortality (P < 0.01) and morbidity (P < 0.01) among patients with trauma on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (P < 0.001) and morbidity (P < 0.001) in patients who did not have trauma. Conclusions The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.
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Wijeyaratne M, Cassim R, Bradbury A, Hyrin A, Jayawickrema B, Weerasekera A, Hettiarachchi M, Sirimanna C, Galapaththy C. Clinical Outcomes Following Lower Extremity Vein Bypass for Chronic Limb Threatening Ischaemia (CLTI) at the University of Colombo, Sri Lanka. Eur J Vasc Endovasc Surg 2020; 60:560-566. [PMID: 32778492 DOI: 10.1016/j.ejvs.2020.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although high quality epidemiological data are lacking, the global increase in chronic limb threatening ischaemia may be disproportionately affecting low and LMICs. All available data for outcomes from bypass for limb salvage are from high income countries, with none from LMIC settings where the challenge is greatest. This study aimed to assess the clinical outcomes following vein lower extremity bypass for chronic limb threatening ischaemia at the University of Colombo, Sri Lanka, and to compare patients and outcomes with those described in the Society for Vascular Surgery (SVS) Objective Performance Goals (OPG) and United States National Surgical Quality Improvement Program (NSQIP). METHODS Consecutive patients (n = 367) undergoing SVS-OPG eligible lower extremity bypass between 2015 and 2017 were studied. Thirty day major adverse cardiovascular events (MACE), major adverse limb events (MALE), deaths, and amputations are reported, along with one year overall survival, limb salvage, and amputation free survival. RESULTS Patients at University of Colombo had more diabetes mellitus (80% vs. SVS 57% vs. NSQIP 50%, p < .001) and tissue loss (100% vs. SVS 74% vs. NSQIP 59%, p < .001). The 30 day MALE was 7.6%, which is not a statistically significant difference from the SVS (6.1%) or NSQIP (9%). The 30 day MACE was 8.2%, statistically significantly higher than NSQIP (4.2%, p < .001) but not SVS (6.2%, p = .20). At 12 months, the overall survival (82%) was within the OPG threshold, but limb salvage (81.8%) and amputation free survival (64.5%) were just outside. CONCLUSION Outcomes following vein bypass for ischaemic necrosis at the University of Colombo, Sri Lanka, are acceptable and similar to those reported from high income countries despite greater limb threat severity and resource limitations. Further real world data from similar settings on outcomes following revascularisation are required. These data suggest that a vein bypass first strategy for advanced ischaemic necrosis is feasible and effective even in resource limited settings.
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Affiliation(s)
- Mandika Wijeyaratne
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka.
| | - Rezni Cassim
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Andrew Bradbury
- College of Medical and Dental Sciences, University of Birmingham, UK
| | - Arch Hyrin
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Buddima Jayawickrema
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Amila Weerasekera
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Malinatha Hettiarachchi
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Chamendra Sirimanna
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Charith Galapaththy
- Department of Surgery, National Hospital of Sri Lanka, Faculty of Medicine, University of Colombo, Sri Lanka
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Schröders J, Dewi FST, Nilsson M, Nichter M, Sebastian MS. Effects of social network diversity in the disablement process: a comparison of causal inference methods and an outcome-wide approach to the Indonesian Family Life Surveys, 2007-2015. Int J Equity Health 2020; 19:128. [PMID: 32736632 PMCID: PMC7393827 DOI: 10.1186/s12939-020-01238-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks (SN) have been proven to be instrumental for healthy aging and function as important safety nets, particular for older adults in low and middle-income countries (LMICs). Despite the importance of interpreting health outcomes in terms of SN, in many LMICs - including Indonesia - epidemiological studies and policy responses on the health effects of SN for aging populations are still uncommon. Using outcome-wide multi-method approaches to longitudinal panel data, this study aims to outline more clearly the role of SN diversity in the aging process in Indonesia. We explore whether and to what degree there is an association of SN diversity with adult health outcomes and investigate potential gender differences, heterogeneous treatment effects, and effect gradients along disablement processes. METHODS Data came from the fourth and fifth waves of the Indonesian Family Life Survey fielded in 2007-08 and 2014-15. The analytic sample consisted of 3060 adults aged 50+ years. The primary exposure variable was the diversity of respondents' SN at baseline. This was measured through a social network index (SNI), conjoining information about household size together with a range of social ties with whom respondents had active contact across six different types of role relationships. Guided by the disablement process model, a battery of 19 outcomes (8 pathologies, 5 impairments, 4 functional limitations, 2 disabilities) were included into analyses. Evidence for causal effects of SN diversity on health was evaluated using outcome-wide multivariable regression adjustment (RA), propensity score matching (PSM), and instrumental variable (IV) analyses. RESULTS At baseline, 60% of respondents had a low SNI. Results from the RA and PSM models showed greatest concordance and that among women a diverse SN was positively associated with pulmonary outcomes and upper and lower body functions. Both men and women with a high SNI reported less limitations in performing activities of daily living (ADL) and instrumental ADL (IADL) tasks. A high SNI was negatively associated with C-reactive protein levels in women. The IV analyses yielded positive associations with cognitive functions for both men and women. CONCLUSIONS Diverse SN confer a wide range of strong and heterogeneous long-term health effects, particularly for older women. In settings with limited formal welfare protection, intervening in the SN of older adults and safeguarding their access to diverse networks can be an investment in population health, with manifold implications for health and public policy.
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Affiliation(s)
- Julia Schröders
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Fatwa Sari Tetra Dewi
- Department of Health Behaviour, Environment and Social Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maria Nilsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, USA
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Roba AA, Tefera M, Worku T, Dasa TT, Estifanos AS, Assefa N. Application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries: a systematic review and meta-analysis. Matern Health Neonatol Perinatol 2019; 5:16. [PMID: 31641528 PMCID: PMC6796424 DOI: 10.1186/s40748-019-0111-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 09/11/2019] [Indexed: 01/01/2023] Open
Abstract
Abstract There are conflicting results from large randomized controlled trials in different populations regarding the effectiveness of topical application of 4% chlorhexidine to the umbilical stump of newborn infants at reducing neonatal mortality. Meta-analysis and systematic review of trials performed in South Asia and Europe support 4% chlorhexidine application to reduce neonatal mortality, whereas trials performed in Sub-Saharan Africa do not. The aim of this review is to determine the effectiveness of 4% chlorhexidine application to the umbilical stump of newborn infants born in lower income countries in order to reduce neonatal mortality when compared with usual cord care. Our search strategy included randomized trials published between January1st 2000 and September 4th, 2018, that compared 4% chlorhexidine with usual cord care (“dry cord care”). The outcome variable of interest was neonatal mortality. Pooled relative risks (RR) with 95% confidence intervals (CIs) using a random-effects model were calculated. Nine trials were included, from six countries: Zambia, Tanzania, Bangladesh, Nepal, India and Pakistan, with a total of 257,153 participants. Five studies (N = 119,833) reported neonatal mortality. There was a 21% reduction in neonatal mortality among with 4% chlorhexidine application: pooled RR (95% CI) 0.79 (0.69–0.90), P = 0.0005. The incidence of omphalitis was decreased by 35% with 4% chlorhexidine (6 studies, N = 108,263): pooled RR (95% CI) 0.65 (0.56–0.75), P = 0.00001. Chlorhexidine application delayed the umbilical cord separation time (4 studies, N = 28,917): mean difference (95% CI) 2.71 (2.63–2.78) days. In conclusion, this systematic review found that topical application of 4% chlorhexidine to the umbilical cord stump of newborn infants in lower income countries significantly reduces the incidence of neonatal mortality. Chlorhexidine also reduces the incidence of omphalitis, but prolongs umbilical cord separation time. Trial registration Systematic Review Registration: CRD42018109280.
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Affiliation(s)
- Aklilu Abrham Roba
- 1College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Maleda Tefera
- 1College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Teshager Worku
- 1College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | | | - Abiy Seifu Estifanos
- 2Department of Reproductive Health and Health Service Management, School Of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Nega Assefa
- 1College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Gupta R, Gupta VP, Prakash H, Agrawal A, Sharma KK, Deedwania PC. 25-Year trends in hypertension prevalence, awareness, treatment, and control in an Indian urban population: Jaipur Heart Watch. Indian Heart J 2017; 70:802-807. [PMID: 30580848 PMCID: PMC6306304 DOI: 10.1016/j.ihj.2017.11.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/15/2017] [Accepted: 11/13/2017] [Indexed: 02/08/2023] Open
Abstract
Objectives We evaluated trends in hypertension prevalence, awareness, treatment and control in an Indian urban population over 25 years. Trends were projected to year 2030 to determine attainment of World Health Organization (WHO) Global Monitoring Framework targets. Methods Adult participants (n = 7440, men 4237, women 3203) enrolled in successive population based studies in Jaipur, India from years 1991 to 2015 were evaluated for hypertension prevalence, awareness, treatment and control. The studies were performed in years 1991–93 (n = 2212), 1999–01 (n = 1123), 2003–04 (n = 458), 2006–07 (n = 1127), 2009–10 (n = 739) and 2012–15 (n = 1781). Descriptive statistics are reported. We used logarithmic forecasting to year 2030 and compared outcomes to WHO target of 25% lower prevalence and >50% control. Results The age-adjusted hypertension prevalence (%) among adults in successive studies increased from 29.5, 30.2, 36.5, 42.1, 34.4 to 36.1 (R2 = 0.41). Increasing trends were observed for hypertension awareness (13, 44, 49, 44, 49, 56; R2 = 0.63); treatment in all (9, 22, 38, 34, 41, 36; R2 = 0.68) and aware hypertensives (61, 66, 77, 79, 70, 64; R2 = 0.46); and control in all (2, 14, 13, 18, 21, 21; R2 = 0.82), aware (12, 33, 27, 46, 37, 37; R2 = 0.54) and treated (9, 20, 21, 48, 36, 49; R2 = 0.80) hypertensive participants. Projections to year 2030 show increases in prevalence to 44% (95% CI 43–45), awareness to 82% (81–83), treatment to 62% (61–63), and control to 36% (35–37). Conclusion Hypertension prevalence, awareness, treatment and control rates are increasing among urban populations in India. Better awareness is associated with greater control. The rates of increase are off-target for WHO Global Monitoring Framework and UN Sustainable Development Goals.
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Affiliation(s)
- Rajeev Gupta
- Department of Medicine, Eternal Heart Care Centre and Research Institute, Jaipur, India; Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India.
| | - Vijay P Gupta
- Department of Statistics, University of Rajasthan, Jaipur, India
| | - Hari Prakash
- Department of Medicine, Monilek Hospital and Research Centre, Jaipur, India
| | - Aachu Agrawal
- Department of Home Science, University of Rajasthan, Jaipur, India
| | - Krishna K Sharma
- Research Development Unit, Rajasthan University of Health Sciences, Jaipur, India
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Le MTH, Holton S, Nguyen HT, Wolfe R, Fisher J. Victimisation, poly-victimisation and health-related quality of life among high school students in Vietnam: a cross-sectional survey. Health Qual Life Outcomes 2016; 14:155. [PMID: 27814728 PMCID: PMC5097374 DOI: 10.1186/s12955-016-0558-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 10/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background In high and upper-middle income countries poly-victimisation (exposure to multiple forms of victimisation) is associated with worse health-related quality of life (HRQoL) among adolescents. There is a lack of empirical evidence about these associations from low- and lower-middle income countries. The aims of this study were to examine the associations between exposure to 1) individual forms of victimisation and 2) poly-victimisation and the HRQoL of adolescents in Vietnam. Method A cross-sectional, anonymously-completed survey of high school students in Hanoi, Vietnam. Lifetime exposure to eight individual forms of victimisation and poly-victimisation were assessed using the Juvenile Victimisation Questionnaire Revised-2 (JVQ R2). Health-related quality of life was assessed using the Duke Health Profile Adolescent Version (DHP-A). Bi-variate analyses and multiple linear regressions were conducted to assess the associations between individual forms of victimisation, poly-victimisation and HRQoL among girls and boys. Results In total 1616/1745 students (92.6 %) completed the questionnaire. Adolescent girls had significantly worse HRQoL than boys in all domains, except disability. Different forms of victimisation were associated with different HRQoL domains among girls and boys. Cyber victimisation was the most detrimental to girls’ HRQoL while for boys maltreatment was the most detrimental. Experiences of poly-victimisation were associated with worse HRQoL in physical, mental, social and general health, lower levels of self-esteem and increased levels of anxiety, depression and pain domains among both sexes. Conclusions Among Vietnamese adolescents, experiences of individual forms of victimisation were associated with poorer HRQoL in specific domains; the most detrimental forms of victimisation varied for girls and boys. However, it was experiences of poly-victimisation that had the most detrimental impacts on the HRQoL of both sexes. Recognition of violence, including poly-victimisation, is still low in Vietnam. These data indicate that community education, prevention and early intervention programs to reduce violent victimisation and assist adolescents who have experienced it, with attention to gender differences, are needed in Vietnam. Electronic supplementary material The online version of this article (doi:10.1186/s12955-016-0558-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Minh T H Le
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Sara Holton
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Huong T Nguyen
- Faculty of Social Sciences, Behaviours and Health Education, Hanoi School of Public Health, 138 Giang Vo street, Ba Dinh District, Hanoi, Vietnam
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Level 6, the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Jane Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, 6th Floor, the Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia
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13
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Redding LE, Cubas-Delgado F, Sammel MD, Smith G, Galligan DT, Levy MZ, Hennessy S. Comparison of two methods for collecting antibiotic use data on small dairy farms. Prev Vet Med 2014; 114:213-22. [PMID: 24630404 DOI: 10.1016/j.prevetmed.2014.02.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 02/09/2014] [Accepted: 02/11/2014] [Indexed: 11/27/2022]
Abstract
Antibiotics are commonly used in animal agriculture; they can improve animal health and productivity, but their use may also represent a public health threat. Very little is known about antibiotic use on small farms in lower/middle income countries. To understand antibiotic use on these farms and promote the judicious use of these drugs, pharmacoepidemiologic data are necessary. However, acquiring such data can be difficult, as farmers are often illiterate (and therefore cannot participate in written surveys or keep treatment records), antibiotics can be obtained over-the-counter (in which case no prescriptions are generated) and monitoring and surveillance systems for drug use are often non-existent. The goal of this study was to compare two methods of acquiring pharmacoepidemiologic data pertaining to antibiotics that are well-adapted to farms in lower-middle income countries: self-report and the collection of discarded drug packaging. A convenience sample of 20 farmers in Cajamarca, Peru, participated in the study. Farmers placed discarded antibiotic packaging in bins for six months. At the end of the six-month period, farmers were interviewed and asked to recall the antibiotic usage that occurred on their farm over the past month and past six months; these self-reported data were quantitatively and qualitatively compared to the bin contents collected in the last month and previous six months. We found that the agreement between the bins and self-report was relatively poor for both the quantity and types of antibiotics used. The bins appeared to perform better than self-report when bottles and mLs of antibiotics were measured, while self-report appeared to perform better for intra-mammary infusions. The bins also appeared to perform better when data pertaining to an extended time period (six months) were collected. The results of this study will provide guidance to investigators seeking to collect pharmacoepidemiologic data in similar environments.
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Affiliation(s)
- L E Redding
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - F Cubas-Delgado
- Universidad Nacional de Cajamarca, Department of Veterinary Medicine, Peru
| | - M D Sammel
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - G Smith
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - D T Galligan
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - M Z Levy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Hennessy
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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