1
|
Bresnahan BW, Vodicka E, Babigumira JB, Malik AM, Yego F, Lokangaka A, Chitah BM, Bauer Z, Chavez H, Moore JL, Garrison LP, Swanson JO, Swanson D, McClure EM, Goldenberg RL, Esamai F, Garces AL, Chomba E, Saleem S, Tshefu A, Bose CL, Bauserman M, Carlo W, Bucher S, Liechty EA, Nathan RO. Cost estimation alongside a multi-regional, multi-country randomized trial of antenatal ultrasound in five low-and-middle-income countries. BMC Public Health 2021; 21:952. [PMID: 34016085 PMCID: PMC8135981 DOI: 10.1186/s12889-021-10750-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/04/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Improving maternal health has been a primary goal of international health agencies for many years, with the aim of reducing maternal and child deaths and improving access to antenatal care (ANC) services, particularly in low-and-middle-income countries (LMICs). Health interventions with these aims have received more attention from a clinical effectiveness perspective than for cost impact and economic efficiency. METHODS We collected data on resource use and costs as part of a large, multi-country study assessing the use of routine antenatal screening ultrasound (US) with the aim of considering the implications for economic efficiency. We assessed typical antenatal outpatient and hospital-based (facility) care for pregnant women, in general, with selective complication-related data collection in women participating in a large maternal health registry and clinical trial in five LMICs. We estimated average costs from a facility/health system perspective for outpatient and inpatient services. We converted all country-level currency cost estimates to 2015 United States dollars (USD). We compared average costs across countries for ANC visits, deliveries, higher-risk pregnancies, and complications, and conducted sensitivity analyses. RESULTS Our study included sites in five countries representing different regions. Overall, the relative cost of individual ANC and delivery-related healthcare use was consistent among countries, generally corresponding to country-specific income levels. ANC outpatient visit cost estimates per patient among countries ranged from 15 to 30 USD, based on average counts for visits with and without US. Estimates for antenatal screening US visits were more costly than non-US visits. Costs associated with higher-risk pregnancies were influenced by rates of hospital delivery by cesarean section (mean per person delivery cost estimate range: 25-65 USD). CONCLUSIONS Despite substantial differences among countries in infrastructures and health system capacity, there were similarities in resource allocation, delivery location, and country-level challenges. Overall, there was no clear suggestion that adding antenatal screening US would result in either major cost savings or major cost increases. However, antenatal screening US would have higher training and maintenance costs. Given the lack of clinical effectiveness evidence and greater resource constraints of LMICs, it is unlikely that introducing antenatal screening US would be economically efficient in these settings--on the demand side (i.e., patients) or supply side (i.e., healthcare providers). TRIAL REGISTRATION Trial number: NCT01990625 (First posted: November 21, 2013 on https://clinicaltrials.gov ).
Collapse
Affiliation(s)
- B W Bresnahan
- Department of Radiology, University of Washington, Seattle, WA, USA.
| | - E Vodicka
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J B Babigumira
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - A M Malik
- Aga Khan University, Karachi, Pakistan
| | - F Yego
- Moi University, Eldoret, Kenya
| | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | | | - Z Bauer
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - H Chavez
- University of Francisco Marroquin, Guatemala City, Guatemala
| | | | - L P Garrison
- Department of Pharmacy, University of Washington, Seattle, WA, USA
| | - J O Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - D Swanson
- Department of Radiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina, Chapel Hill, NC, USA
| | - W Carlo
- University of Alabama Birmingham, Birmingham, AL, USA
| | - S Bucher
- Indiana University, Indianapolis, IN, USA
| | | | - R O Nathan
- Department of Radiology, University of Washington, Seattle, WA, USA
| |
Collapse
|
2
|
Jessani S, Saleem S, Hoffman MK, Goudar SS, Derman RJ, Moore JL, Garces A, Figueroa L, Krebs NF, Okitawutshu J, Tshefu A, Bose CL, Mwenechanya M, Chomba E, Carlo WA, Das PK, Patel A, Hibberd PL, Esamai F, Liechty EA, Bucher S, Nolen TL, Koso-Thomas M, Miodovnik M, McClure EM, Goldenberg RL. Association of haemoglobin levels in the first trimester and at 26-30 weeks with fetal and neonatal outcomes: a secondary analysis of the Global Network for Women's and Children's Health's ASPIRIN Trial. BJOG 2021; 128:1487-1496. [PMID: 33629490 DOI: 10.1111/1471-0528.16676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Limited data are available from low- and middle-income countries (LMICs) on the relationship of haemoglobin levels to adverse outcomes at different times during pregnancy. We evaluated the association of haemoglobin levels in nulliparous women at two times in pregnancy with pregnancy outcomes. DESIGN ASPIRIN Trial data were used to study the association between haemoglobin levels measured at 6+0 -13+6 weeks and 26+0 -30+0 weeks of gestation with fetal and neonatal outcomes. SETTING Obstetric care facilities in Pakistan, India, Kenya, Zambia, The Democratic Republic of the Congo and Guatemala. POPULATION A total of 11 976 pregnant women. METHODS Generalised linear models were used to obtain adjusted relative risks and 95% CI for adverse outcomes. MAIN OUTCOME MEASURES Preterm birth, stillbirth, neonatal death, small for gestational age (SGA) and birthweight <2500 g. RESULTS The mean haemoglobin levels at 6+0 -13+6 weeks and at 26-30 weeks of gestation were 116 g/l (SD 17) and 107 g/l (SD 15), respectively. In general, pregnancy outcomes were better with increasing haemoglobin. At 6+0 -13+6 weeks of gestation, stillbirth, SGA and birthweight <2500 g, were significantly associated with haemoglobin of 70-89 g/l compared with haemoglobin of 110-129 g/l The relationships of adverse pregnancy outcomes with various haemoglobin levels were more marked at 26-30 weeks of gestation. CONCLUSIONS Both lower and some higher haemoglobin concentrations are associated with adverse fetal and neonatal outcomes at 6+0 -13+6 weeks and at 26-30 weeks of gestation, although the relationship with low haemoglobin levels appears more consistent and generally stronger. TWEETABLE ABSTRACT Both lower and some higher haemoglobin concentrations were associated with adverse fetal and neonatal outcomes at 6-13 weeks and 26-30 weeks of gestation.
Collapse
Affiliation(s)
- S Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - S Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - M K Hoffman
- Department of Obstetrics and Gynecology, Christiana Care, Newark, DE, USA
| | - S S Goudar
- KLE Academy of Higher Education and Research Jawaharlal Nehru Medical College, Belagavi, Karnataka, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
| | - J L Moore
- RTI International, Research Triangle Park, Durham, NC, USA
| | - A Garces
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - L Figueroa
- Instituto de Nutrición de Centroamérica y Panamá, Guatemala City, Guatemala
| | - N F Krebs
- University of Colorado School of Medicine, Denver, CO, USA
| | - J Okitawutshu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - E Chomba
- University Teaching Hospital, Lusaka, Zambia
| | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - P K Das
- Lata Medical Research Foundation, Nagpur, India
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India.,Datta Meghe Institute of Medical Sciences, Wardha, India
| | - P L Hibberd
- Boston University School of Public Health, Boston, MA, USA
| | - F Esamai
- Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya
| | - E A Liechty
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - S Bucher
- School of Medicine, Indiana University, Indianapolis, IN, USA
| | - T L Nolen
- RTI International, Research Triangle Park, Durham, NC, USA
| | - M Koso-Thomas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - M Miodovnik
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - E M McClure
- RTI International, Research Triangle Park, Durham, NC, USA
| | - R L Goldenberg
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| |
Collapse
|
3
|
Goldenberg RL, Nathan RO, Swanson D, Saleem S, Mirza W, Esamai F, Muyodi D, Garces AL, Figueroa L, Chomba E, Chiwala M, Mwenechanya M, Tshefu A, Lokangako A, Bolamba VL, Moore JL, Franklin H, Swanson J, Liechty EA, Bose CL, Krebs NF, Michael Hambidge K, Carlo WA, Kanaiza N, Naqvi F, Pineda IS, López-Gomez W, Hamsumonde D, Harrison MS, Koso-Thomas M, Miodovnik M, Wallace DD, McClure EM. Routine antenatal ultrasound in low- and middle-income countries: first look - a cluster randomised trial. BJOG 2018; 125:1591-1599. [PMID: 29782696 DOI: 10.1111/1471-0528.15287] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Ultrasound is widely regarded as an important adjunct to antenatal care (ANC) to guide practice and reduce perinatal mortality. We assessed the impact of ANC ultrasound use at health centres in resource-limited countries. DESIGN Cluster randomised trial. SETTING Clusters within five countries (Democratic Republic of Congo, Guatemala, Kenya, Pakistan, and Zambia) METHODS: Clusters were randomised to standard ANC or standard care plus two ultrasounds and referral for complications. The study trained providers in intervention clusters to perform basic obstetric ultrasounds. MAIN OUTCOME MEASURES The primary outcome was a composite of maternal mortality, maternal near-miss mortality, stillbirth, and neonatal mortality. RESULTS During the 24-month trial, 28 intervention and 28 control clusters had 24 263 and 23 160 births, respectively; 78% in the intervention clusters received at least one study ultrasound; 60% received two. The prevalence of conditions noted including twins, placenta previa, and abnormal lie was within expected ranges. 9% were referred for an ultrasound-diagnosed condition, and 71% attended the referral. The ANC (RR 1.0 95% CI 1.00, 1.01) and hospital delivery rates for complicated pregnancies (RR 1.03 95% CI 0.89, 1.20) did not differ between intervention and control clusters nor did the composite outcome (RR 1.09 95% CI 0.97, 1.23) or its individual components. CONCLUSIONS Despite availability of ultrasound at ANC in the intervention clusters, neither ANC nor hospital delivery for complicated pregnancies increased. The composite outcome and the individual components were not reduced. TWEETABLE ABSTRACT Antenatal care ultrasound did not improve a composite outcome that included maternal, fetal, and neonatal mortality.
Collapse
Affiliation(s)
| | - R O Nathan
- University of Washington, Seattle, WA, USA
| | - D Swanson
- University of Washington, Seattle, WA, USA
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | - W Mirza
- Aga Khan University, Karachi, Pakistan
| | | | | | | | | | - E Chomba
- University of Zambia, Lusaka, Zambia
| | - M Chiwala
- University of Zambia, Lusaka, Zambia
| | | | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Lokangako
- Kinshasa School of Public Health, Kinshasa, DRC
| | - V L Bolamba
- Kinshasa School of Public Health, Kinshasa, DRC
| | | | | | - J Swanson
- University of Washington, Seattle, WA, USA
| | | | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N F Krebs
- University of Colorado, Denver, CO, USA
| | | | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - F Naqvi
- Aga Khan University, Karachi, Pakistan
| | - I S Pineda
- San Carlos University, Guatemala City, Guatemala
| | | | | | | | | | | | | | | |
Collapse
|
4
|
Pasha O, McClure EM, Saleem S, Tikmani SS, Lokangaka A, Tshefu A, Bose CL, Bauserman M, Mwenechanya M, Chomba E, Carlo WA, Garces AL, Figueroa L, Hambidge KM, Krebs NF, Goudar S, Kodkany BS, Dhaded S, Derman RJ, Patel A, Hibberd PL, Esamai F, Tenge C, Liechty EA, Moore JL, Wallace DD, Koso-Thomas M, Miodovnik M, Goldenberg RL. A prospective cause of death classification system for maternal deaths in low and middle-income countries: results from the Global Network Maternal Newborn Health Registry. BJOG 2018; 125:1137-1143. [PMID: 29094456 DOI: 10.1111/1471-0528.15011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the causes of maternal death in a population-based cohort in six low- and middle-income countries using a standardised, hierarchical, algorithmic cause of death (COD) methodology. DESIGN A population-based, prospective observational study. SETTING Seven sites in six low- to middle-income countries including the Democratic Republic of the Congo (DRC), Guatemala, India (two sites), Kenya, Pakistan and Zambia. POPULATION All deaths among pregnant women resident in the study sites from 2014 to December 2016. METHODS For women who died, we used a standardised questionnaire to collect clinical data regarding maternal conditions present during pregnancy and delivery. These data were analysed using a computer-based algorithm to assign cause of maternal death based on the International Classification of Disease-Maternal Mortality system (trauma, termination of pregnancy-related, eclampsia, haemorrhage, pregnancy-related infection and medical conditions). We also compared the COD results to healthcare-provider-assigned maternal COD. MAIN OUTCOME MEASURES Assigned causes of maternal mortality. RESULTS Among 158 205 women, there were 221 maternal deaths. The most common algorithm-assigned maternal COD were obstetric haemorrhage (38.6%), pregnancy-related infection (26.4%) and pre-eclampsia/eclampsia (18.2%). Agreement between algorithm-assigned COD and COD assigned by healthcare providers ranged from 75% for haemorrhage to 25% for medical causes coincident to pregnancy. CONCLUSIONS The major maternal COD in the Global Network sites were haemorrhage, pregnancy-related infection and pre-eclampsia/eclampsia. This system could allow public health programmes in low- and middle-income countries to generate transparent and comparable data for maternal COD across time or regions. TWEETABLE ABSTRACT An algorithmic system for determining maternal cause of death in low-resource settings is described.
Collapse
Affiliation(s)
- O Pasha
- Aga Khan University, Karachi, Pakistan.,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - S Saleem
- Aga Khan University, Karachi, Pakistan
| | | | - A Lokangaka
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, Democratic Republic of the Congo
| | - C L Bose
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M Bauserman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - E Chomba
- University Teaching Hospital, Lusaka, Zambia
| | - W A Carlo
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - K M Hambidge
- University of Colorado, School of Medicine, Denver, CO, USA
| | - N F Krebs
- University of Colorado, School of Medicine, Denver, CO, USA
| | - S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - S Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - R J Derman
- Thomas Jefferson University, Philadelphia, PA, USA
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | | | | | - C Tenge
- Moi University, Eldoret, Kenya
| | | | | | | | | | | | - R L Goldenberg
- Columbia University School of Medicine, New York, NY, USA
| |
Collapse
|
5
|
Haddad LB, Wall KM, Kilembe W, Vwalika B, Naw HT, Brill I, Chomba E, Tichacek A, Allen S. Hormonal contraception may increase HIV acquisition among Zambian women with bacterial vaginosis. Contraception 2017. [DOI: 10.1016/j.contraception.2017.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
6
|
McClure EM, Garces A, Saleem S, Moore JL, Bose CL, Esamai F, Goudar SS, Chomba E, Mwenechanya M, Pasha O, Tshefu A, Patel A, Dhaded SM, Tenge C, Marete I, Bauserman M, Sunder S, Kodkany BS, Carlo WA, Derman RJ, Hibberd PL, Liechty EA, Hambidge KM, Krebs NF, Koso-Thomas M, Miodovnik M, Wallace DD, Goldenberg RL. Global Network for Women's and Children's Health Research: probable causes of stillbirth in low- and middle-income countries using a prospectively defined classification system. BJOG 2017; 125:131-138. [PMID: 28139875 DOI: 10.1111/1471-0528.14493] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to classify causes of stillbirth for six low-middle-income countries using a prospectively defined algorithm. DESIGN Prospective, observational study. SETTING Communities in India, Pakistan, Guatemala, Democratic Republic of Congo, Zambia and Kenya. POPULATION Pregnant women residing in defined study regions. METHODS Basic data regarding conditions present during pregnancy and delivery were collected. Using these data, a computer-based hierarchal algorithm assigned cause of stillbirth. Causes included birth trauma, congenital anomaly, infection, asphyxia, and preterm birth, based on existing cause of death classifications and included contributing maternal conditions. MAIN OUTCOME MEASURES Primary cause of stillbirth. RESULTS Of 109 911 women who were enrolled and delivered (99% of those screened in pregnancy), 2847 had a stillbirth (a rate of 27.2 per 1000 births). Asphyxia was the cause of 46.6% of the stillbirths, followed by infection (20.8%), congenital anomalies (8.4%) and prematurity (6.6%). Among those caused by asphyxia, 38% had prolonged or obstructed labour, 19% antepartum haemorrhage and 18% pre-eclampsia/eclampsia. About two-thirds (67.4%) of the stillbirths did not have signs of maceration. CONCLUSIONS Our algorithm determined cause of stillbirth from basic data obtained from lay-health providers. The major cause of stillbirth was fetal asphyxia associated with prolonged or obstructed labour, pre-eclampsia and antepartum haemorrhage. In the African sites, infection also was an important contributor to stillbirth. Using this algorithm, we documented cause of stillbirth and its trends to inform public health programs, using consistency, transparency, and comparability across time or regions with minimal burden on the healthcare system. TWEETABLE ABSTRACT Major causes of stillbirth are asphyxia, pre-eclampsia and haemorrhage. Infections are important in Africa.
Collapse
Affiliation(s)
| | - A Garces
- Materno Infantil Unidad de Planificación, INCAP, Guatemala City, Guatemala
| | - S Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - C L Bose
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F Esamai
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - S S Goudar
- KLE University's JN Medical College, Belagavi, India
| | - E Chomba
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - M Mwenechanya
- Department of Paediatrics, University of Zambia, Lusaka, Zambia
| | - O Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - A Tshefu
- Kinshasa School of Public Health, Kinshasa, DRC
| | - A Patel
- Lata Medical Research Foundation, Nagpur, India
| | - S M Dhaded
- KLE University's JN Medical College, Belagavi, India
| | - C Tenge
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - I Marete
- Department of Paediatrics, Moi University College of Health and Sciences, Eldoret, Kenya
| | - M Bauserman
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Sunder
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - B S Kodkany
- KLE University's JN Medical College, Belagavi, India
| | - W A Carlo
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - R J Derman
- Department of Obstetrics, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - E A Liechty
- Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - K M Hambidge
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - N F Krebs
- Department of Pediatrics, University of Colorado, Denver, CO, USA
| | - M Koso-Thomas
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
| | - M Miodovnik
- Perinatology and Pregnancy Branch, NICHD, Bethesda, MD, USA
| | | | | |
Collapse
|
7
|
Lander R, Krebs N, Mazariegos M, Garces A, Westcott J, Goco N, Tshefu A, Pasha O, Chomba E, Hambidge M. Dietary Predictors of Growth in Vulnerable Young Children from Four Low‐Resource Countries: a Longitudinal Study. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.31.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - N Krebs
- UC DenverAuroraCOUnited States
| | | | | | | | - N Goco
- RTI Intl ResearchTriangle ParkNCUnited States
| | - A Tshefu
- Kinshasa Sch Pub Hlth KinshasaThe Democratic Republic of the Congo
| | | | | | | | | |
Collapse
|
8
|
Lindegger G, Quayle M, Singh S, Welsh S, Mark D, Wallace M, Roux S, Bekker L, Mwananyanda L, Kilembe W, Chomba E, Allen S, Priddy F, Fast P. A mixed-methods assessment of understanding (AoU) tool for AIDS vaccine trials in sub-Saharan Africa: results from a pilot study. Retrovirology 2012. [PMCID: PMC3441431 DOI: 10.1186/1742-4690-9-s2-p135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- G Lindegger
- School of Psychology, University of Kwa-Zulu Natal, Pietermaritzburg, South Africa
| | - M Quayle
- School of Psychology, University of Kwa-Zulu Natal, Pietermaritzburg, South Africa
| | - S Singh
- GHAR Consulting Inc, New York, NY, USA
| | - S Welsh
- International AIDS Vaccine Initiative, New York, NY, USA
| | - D Mark
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - M Wallace
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - S Roux
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | - L Bekker
- Desmond Tutu HIV Foundation, University of Cape Town, Cape Town, South Africa
| | | | - W Kilembe
- Zambia-Emory HIV Research Project, Lusaka, Zambia
| | - E Chomba
- Zambia-Emory HIV Reseach Project, Lusaka, Zambia
| | - S Allen
- Emory University, Atlanta, GA, USA
| | - F Priddy
- International AIDS Vaccine Initiative, New York, NY, USA
| | - P Fast
- International AIDS Vaccine Initiative, New York, NY, USA
| |
Collapse
|
9
|
Basu D, Kraft C, Campbell P, Murphy M, Yu T, Hraber P, Chomba E, Mulenga J, Kilembe W, Allen S, Derdeyn C, Hunter E. Intrasubtype C superinfected individuals mount delayed and low-titer autologous neutralizing antibody responses prior to superinfection. Retrovirology 2012. [PMCID: PMC3441906 DOI: 10.1186/1742-4690-9-s2-p159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
10
|
Ngongo BP, Priddy F, Park H, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker L, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries – a case study of ten research centers in Eastern and Southern Africa. Retrovirology 2012. [PMCID: PMC3442024 DOI: 10.1186/1742-4690-9-s2-p117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
11
|
Wall K, Vwalika B, Haddad L, Khu NH, Vwalika C, Kilembe W, Chomba E, Stephenson R, Kleinbaum D, Nizam A, Brill I, Tichacek A, Allen S. Effect of an intervention to promote contraceptive uptake on incident pregnancy: a randomized controlled trial among HIV positive couples in Zambia. Retrovirology 2012. [PMCID: PMC3441569 DOI: 10.1186/1742-4690-9-s2-p211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
12
|
Wall K, Kilembe W, Nizam A, Vwalika C, Kautzman M, Chomba E, Tichacek A, Sardar G, Casanova D, Henderson F, Mulenga J, Kleinbaum D, Allen S. Promotion of couples’ voluntary HIV counseling and testing in Lusaka, Zambia by influence network leaders and agents. Retrovirology 2012. [PMCID: PMC3441942 DOI: 10.1186/1742-4690-9-s2-p210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
13
|
Kvalsund M, Mbewe E, Mulenga J, Atadzhanov M, Haworth A, Chomba E, Birbeck G. Quality Indicators for Epilepsy Care in Zambia: Roadwork for the WHO Mental Health Gap Action Programme (mhGAP) Guidelines (P07.116). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
14
|
Birbeck G, Chomba E, Atadzhanov M, Mbewe E, Haworth A, Kansembe H. The Cost of Implementing a Nationwide Program To Decrease the Epilepsy Treatment Gap in a Low Income, High Gap Country (P01.060). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
15
|
Engmann C, Garces A, Jehan I, Ditekemena J, Phiri M, Thorsten V, Mazariegos M, Chomba E, Pasha O, Tshefu A, Wallace D, McClure EM, Goldenberg RL, Carlo WA, Wright LL, Bose C. Birth attendants as perinatal verbal autopsy respondents in low- and middle-income countries: a viable alternative? Bull World Health Organ 2011; 90:200-8. [PMID: 22461715 DOI: 10.2471/blt.11.092452] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 11/07/2011] [Accepted: 11/09/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To assess the feasibility of using birth attendants instead of bereaved mothers as perinatal verbal autopsy respondents. METHODS Verbal autopsy interviews for early neonatal deaths and stillbirths were conducted separately among mothers (reference standard) and birth attendants in 38 communities in four developing countries. Concordance between maternal and attendant responses was calculated for all questions, for categories of questions and for individual questions. The sensitivity and specificity of individual questions with the birth attendant as respondent were assessed. FINDINGS For early neonatal deaths, concordance across all questions was 94%. Concordance was at least 95% for more than half the questions on maternal medical history, birth attendance and neonate characteristics. Concordance on any given question was never less than 80%. Sensitivity and specificity varied across individual questions, more than 80% of which had a sensitivity of at least 80% and a specificity of at least 90%. For stillbirths, concordance across all questions was 93%. Concordance was 95% or greater more than half the time for questions on birth attendance, site of delivery and stillborn characteristics. Sensitivity and specificity varied across individual questions. Over 60% of the questions had a sensitivity of at least 80% and over 80% of them had a specificity of at least 90%. Overall, the causes of death established through verbal autopsy were similar, regardless of respondent. CONCLUSION Birth attendants can substitute for bereaved mothers as verbal autopsy respondents. The questions in existing harmonized verbal autopsy questionnaires need further refinement, as their sensitivity and specificity differ widely.
Collapse
Affiliation(s)
- C Engmann
- Department of Pediatrics and Maternal and Child Health, University of North Carolina Schools of Medicine and Public Health, UNC Hospitals, UNC-Chapel Hill, Chapel Hill, NC 27599-7596, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Engmann C, Jehan I, Ditekemena J, Garces A, Phiri M, Mazariegos M, Chomba E, Pasha O, Tshefu A, McClure EM, Thorsten V, Chakraborty H, Goldenberg RL, Bose C, Carlo WA, Wright LL. An alternative strategy for perinatal verbal autopsy coding: single versus multiple coders. Trop Med Int Health 2011; 16:18-29. [PMID: 21371206 DOI: 10.1111/j.1365-3156.2010.02679.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine the comparability between cause of death (COD) by a single physician coder and a two-physician panel, using verbal autopsy. METHODS The study was conducted between May 2007 and June 2008. Within a week of a perinatal death in 38 rural remote communities in Guatemala, the Democratic Republic of Congo, Zambia and Pakistan, VA questionnaires were completed. Two independent physicians, unaware of the others decisions, assigned an underlying COD, in accordance with the causes listed in the chapter headings of the International classification diseases and related health problems, 10th revision (ICD-10). Cohen's kappa statistic was used to assess level of agreement between physician coders. RESULTS There were 9461 births during the study period; 252 deaths met study enrolment criteria and underwent verbal autopsy. Physicians assigned the same COD for 75% of stillbirths (SB) (K = 0.69; 95% confidence interval: 0.61-0.78) and 82% early neonatal deaths (END) (K = 0.75; 95% confidence interval: 0.65-0.84). The patterns and proportion of SBs and ENDs determined by the physician coders were very similar compared to causes individually assigned by each physician. Similarly, rank order of the top five causes of SB and END was identical for each physician. CONCLUSION This study raises important questions about the utility of a system of multiple coders that is currently widely accepted and speculates that a single physician coder may be an effective and economical alternative to VA programmes that use traditional two-physician panels to assign COD.
Collapse
Affiliation(s)
- C Engmann
- Department of Pediatrics, University of North Carolina, School of Medicine, Chapel Hill, NC 27599-7596, USA. USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Birbeck GL, Chomba E, Atadzhanov M, Haworth A, Mbewe E, Mpabalwani EM. Evidence-Based Guidelines for EEG Utilization at the University Teaching Hospital (UTH). Med J Zambia 2011; 38:http://www.mjz.co.zm/content/neurological-psychiatric-society-zambias-evidence-based-guidelines-eeg-utilization. [PMID: 25346553 PMCID: PMC4205944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Gretchen L Birbeck
- 1 Chikankata Epilepsy Care Team, Chikankata Mission Hospital, Mazabuka & Michigan State University, Neurologic & Psychiatric Epidemiology Program, East Lansing, MI--USA ; 2 Michigan State University, International Neurologic & Psychiatric Epidemiology Program, East Lansing, MI-USA
| | - E Chomba
- 3 The University of Zambia, Department of Paediatrics and Child Health, Lusaka
| | - M Atadzhanov
- 4 The University of Zambia, Department of Internal Medicine, Lusaka
| | - A Haworth
- 5 The University of Zambia, Department of Psychiatry, Lusaka
| | - E Mbewe
- 6 Chainama College of Health Sciences. Department of Mental Health and Clinical Psychiatry, Lusaka
| | | |
Collapse
|
18
|
Engmann C, Jehan I, Ditekemena J, Garces A, Phiri M, Mazariegos M, Chomba E, Pasha O, Tshefu A, Hemed Y, McClure EM, Thorsten V, Bann C, Goldenberg RL, Bose C, Setel P, Carlo WA, Wright LL. Using verbal autopsy to ascertain perinatal cause of death: are trained non-physicians adequate? Trop Med Int Health 2009; 14:1496-504. [PMID: 19799757 DOI: 10.1111/j.1365-3156.2009.02395.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To develop a standardized verbal autopsy (VA) training program and evaluate whether its implementation resulted in comparable knowledge required to classify perinatal cause of death (COD) by physicians and non-physicians. METHODS Training materials, case studies, and written and mock scenarios for this VA program were developed using conventional VA and ICD-10 guidelines. This program was used to instruct physicians and non-physicians in VA methodology using a train-the-trainer model. Written tests of cognitive and applied knowledge required to classify perinatal COD were administered before and after training to evaluate the effect of the VA training program. RESULTS Fifty-three physicians and non-physicians (nurse-midwives/nurses and Community Health Workers [CHW]) from Pakistan, Zambia, the Democratic Republic of Congo, and Guatemala were trained. Cognitive and applied knowledge mean scores among all trainees improved significantly (12.8 and 28.8% respectively, P < 0.001). Cognitive and applied knowledge post-training test scores of nurse-midwives/nurses were comparable to those of physicians. CHW (high-school graduates with 15 months or less formal health/nursing training) had the largest improvements in post-training applied knowledge with scores comparable to those of physicians and nurse-midwives/nurses. However, CHW cognitive knowledge post-training scores were significantly lower than those of physicians and nurses. CONCLUSIONS With appropriate training in VA, cognitive and applied knowledge required to determine perinatal COD is similar for physicians and nurses-midwives/nurses. This suggests that midwives and nurses may play a useful role in determining COD at the community level, which may be a practical way to improve the accuracy of COD data in rural, remote, geographic areas.
Collapse
Affiliation(s)
- C Engmann
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, North Carolina 27599-7596, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Sitrin D, Clements A, Mwananyanda L, Kilembe W, Kautzman M, Conkling M, Luisi N, Chomba E, Allen S. P06-04. Using referrals from government health centers to expand an HIV discordant couple cohort in Lusaka, Zambia in preparation for vaccine efficacy trials. Retrovirology 2009. [PMCID: PMC2767999 DOI: 10.1186/1742-4690-6-s3-p93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
20
|
Halloran DR, McClure E, Chakraborty H, Chomba E, Wright LL, Carlo WA. Birth asphyxia survivors in a developing country. J Perinatol 2009; 29:243-9. [PMID: 19037228 PMCID: PMC3807866 DOI: 10.1038/jp.2008.192] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2008] [Revised: 08/17/2008] [Accepted: 09/15/2008] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Determine the baseline incidence of birth asphyxia in neonatal intensive care unit (NICU) survivors in a developing country and the early neurodevelopmental outcomes of such infants. STUDY DESIGN This cross-sectional, prospective study collected diagnostic and examination findings on all infants seen in the University of Zambia NICU follow-up clinic over a 4-week period. RESULT Of the 182 infants, 42 (23%) had a clinical diagnosis of birth asphyxia. Of 42 infants with birth asphyxia, 13 (31%) had an abnormal neurologic examination during the clinic visit; in contrast, 13 of 141 infants without birth asphyxia (9%) had an abnormal examination (odds ratio 4.4, 95% confidence interval: 1.8, 10.4). CONCLUSION Birth asphyxia survivors account for almost a quarter of NICU survivors in a developing country and half of those with an abnormal neurologic examination. Studies are necessary to determine the percent of birth asphyxia survivors who have permanent motor and cognitive disabilities.
Collapse
Affiliation(s)
- D R Halloran
- Department of Pediatrics, Saint Louis University, Saint Louis, MO 63104, USA.
| | | | | | | | | | | |
Collapse
|
21
|
Stephenson R, Shutes E, McKenna S, Allen S, Brill I, Kancheya N, Zulu I, Sinkala M, Tichacek A, Chomba E. The impact of project closure on HIV incidence and mortality in a cohort of couples in Lusaka, Zambia. AIDS Care 2008; 20:683-91. [PMID: 18576170 DOI: 10.1080/09540120701593505] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to assess the impact of temporary closure of an HIV research clinic on the health of study participants. Primary data were collected quarterly from couples enrolled in research studies at an established HIV study site. There were 632 participating couples enrolled when the project closed, 475 of whom returned when it re-opened six months later. HIV sero-incidence, mortality rates and risk-taking behaviours were compared before and during the closure. Perceived impact of the closure was measured in returning participants. Demographic data collected at the last pre-closure study visit were used to look at the differences between returning and non-returning study participants. Serologic data from those who returned were compared pre- and post-closure to examine changes in HIV incidence. Mortality rates were estimated from reported deaths, and were compared pre- and during project closure. Perceptions of the impact of the closure among returning participants were examined through an interviewer administered questionnaire. It was found that couples who returned were not demographically different from couples who did not return. Most participants reported no problems with finding alternate sources of condoms and the incidence of HIV did not change significantly during the closure. Eighty-four percent respondents reported that the closure had a negative impact on them, 87% of whom rated loss of medical care as the main impact. The mortality rate among HIV-positive participants doubled from 6.7/100 person years to 12.4/100 person years during the closure (p=0.01). Results indicate that couples voluntary counselling and testing (CVCT) established durable risk-reduction behaviours that persisted during project closure. ThIn ae loss of healthcare was perceived as the most negative impact on participants, reflected in increased mortality rates. Research projects should make transition plans and budget for mechanisms to reduce the negative impact on participants of project closures.
Collapse
Affiliation(s)
- R Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, US.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Stephenson R, Mendenhall E, Muzizi L, Vwalika B, Chomba E, Ahmed Y, Clark L, Roth D, Telfair J, Haworth A, Allen S. The influence of motivational messages on future planning behaviors among HIV concordant positive and discordant couples in Lusaka, Zambia. AIDS Care 2008; 20:150-60. [PMID: 18293123 DOI: 10.1080/09540120701534681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In Zambia the HIV/AIDS epidemic has resulted in many single female-headed households. Strong patriarchal laws and customs prevent widows and children from maintaining economic assets. This study examines the impact of a video-based motivational intervention promoting future planning in 1,504 HIV-infected couples in Lusaka, Zambia. Following a group video session, couples randomized to the motivational arm could choose to write a will, identify a guardian for their children and make financial plans. Desirable behaviours modelled in the motivational video were measured at quarterly intervals for a year and compared in intervention and control arms. Demographic measures including age, income and educational status were not associated with planning behaviours. Participation in the intervention was associated with will writing (23% versus 5%) and naming a guardian (32% versus 17%) but not with other planning behaviours. The study demonstrates the ability of motivational messages integrated into HIV VCT to encourage future planning behaviour and points to the need to expand existing HIV and VCT services to meet other non-health needs of those living with HIV.
Collapse
Affiliation(s)
- R Stephenson
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Stephenson R, Barker J, Cramer R, Hall MA, Karita E, Chomba E, Vwalika C, Allen S. The demographic profile of sero-discordant couples enrolled in clinical research in Rwanda and Zambia. AIDS Care 2008; 20:395-405. [DOI: 10.1080/09540120701593497] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- R. Stephenson
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , US
| | - J. Barker
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , US
- b Rwanda Zambia HIV Research Group, Rollins School of Public Health , Emory University , Atlanta , GA , US
| | - R. Cramer
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , US
- c Project San Francisco , Kigali , Rwanda
| | - M. A. Hall
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , US
- b Rwanda Zambia HIV Research Group, Rollins School of Public Health , Emory University , Atlanta , GA , US
| | - E. Karita
- b Rwanda Zambia HIV Research Group, Rollins School of Public Health , Emory University , Atlanta , GA , US
- c Project San Francisco , Kigali , Rwanda
| | - E. Chomba
- d University Teaching Hospital School of Medicine , University of Zambia , Lusaka , Zambia
| | - C. Vwalika
- b Rwanda Zambia HIV Research Group, Rollins School of Public Health , Emory University , Atlanta , GA , US
- e Zambia Emory HIV Research Project , Lusaka , Zambia
| | - S. Allen
- a Hubert Department of Global Health , Rollins School of Public Health, Emory University , Atlanta , GA , US
- c Project San Francisco , Kigali , Rwanda
| |
Collapse
|
24
|
Abstract
OBJECTIVES To evaluate the effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) course in improving knowledge and skills of nurse midwives in low-risk delivery clinics in a developing country. METHODS The investigators identified the content specifications of the training material, developed both written and performance evaluations and administered the evaluations both before and after training clinical nurse midwives in Zambia. FINDINGS Based on these evaluations, both the knowledge and skills of the nurse midwives improved significantly following the course (from a mean of 65% correct pretraining to 84% correct post-training and from 65% to 77% correct on the performance and written evaluations, respectively). The ENC course written evaluation was validated and both tools allowed evaluation of the ENC course training. CONCLUSIONS We found significant improvements in trainees' knowledge and skills in essential newborn care following the WHO ENC course; however, lack of basic resources may have limited the application of the ENC guidelines. Implementation of the ENC course should be undertaken in consideration with the local conditions available for newborn care.
Collapse
Affiliation(s)
- E M McClure
- Research Triangle Institute, Durham, North Carolina 27709, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Mendenhall E, Muzizi L, Stephenson R, Chomba E, Ahmed Y, Haworth A, Allen S. Property grabbing and will writing in Lusaka, Zambia: an examination of wills of HIV-infected cohabiting couples. AIDS Care 2007; 19:369-74. [PMID: 17453571 DOI: 10.1080/09540120600774362] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
High rates of HIV and poverty place women in a precarious economic situation in Lusaka, Zambia. Mortality from HIV infection is high, leaving many households single headed and creating almost a half a million orphans. One of the most prevalent forms of gender violence that creates poverty in women is when the male's family claims the property of the deceased from the widow and the children. The Zambia-Emory HIV Research Project collected 184 wills from individuals in monogamous unions where one or both of the individuals were HIV-positive. Despite the fact that many wills specifically stated that their extended family was not allowed to tamper with their possessions in the event of death, property grabbing proved to be a prevalent and difficult issue in Lusaka. In order to improve the lives of widowed women in Lusaka, the government and other civic and non-governmental organisations must inform women of their rights to own and protect their land and other assets in the event of their husbands' death, an issue of increasing importance in the area of HIV/AIDS.
Collapse
Affiliation(s)
- E Mendenhall
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
| | | | | | | | | | | | | |
Collapse
|
26
|
Atadzhanov M, Chomba E, Haworth A, Mbewe E, Birbeck GL. Knowledge, attitudes, behaviors, and practices regarding epilepsy among Zambian clerics. Epilepsy Behav 2006; 9:83-8. [PMID: 16713361 DOI: 10.1016/j.yebeh.2006.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 03/17/2006] [Accepted: 03/18/2006] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epilepsy carries a high burden of social morbidity. An understanding of who propagates stigma and the determinants of stigmatizing attitudes is needed to develop effective interventions. Clerics represent an especially influential social group in Africa. Therefore, we conducted a survey of the knowledge, attitudes, behavior, and practices of Zambian clerics with respect to epilepsy. METHODS We studied clerics in one large rural region as well as in the capital city. The rural survey was conducted door-to-door. In the urban areas, central administration for multiple denominations assisted in survey delivery. The survey, adapted from previously published instruments, included cleric-specific questions and demographic data. Composite scores for knowledge and tolerance were developed. Determinants of higher knowledge and tolerance were assessed. RESULTS Almost all Zambian clerics know someone with epilepsy and have witnessed a seizure. More than 40% report having a family member with epilepsy. Unfortunately, this familiarity is not associated with more knowledge or tolerance for the condition. Younger clerics, urban dwellers, those with fewer children, and those with more years of formal education were significantly more tolerant. More knowledgeable clerics are more likely to recommend that a person with epilepsy seek care from a physician rather than a traditional healer. Formal education was the most important factor in determining tolerance toward epilepsy. CONCLUSIONS Zambian clerics are very familiar with epilepsy, yet have relatively little knowledge of the etiology. Many view traditional healers as the appropriate care provider for epilepsy. To decrease stigma and improve the quality of advice offered by clerics to their congregations, educational programs focusing on the biomedical nature of the disorder are needed, particularly in rural regions.
Collapse
|
27
|
|
28
|
Gould SS, Kabamba JD, Amadi B, Chintu C, Chomba E, Baboo KS, Mathewson JJ, DuPont HL, Murphy JR. Latex agglutination v. enzyme-linked immunosorbent assays for detection of antibodies to HIV in plasma from Lusaka, Zambia. S Afr Med J 1998; 88:55-6. [PMID: 9539942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|