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Thekkur P, Thiagesan R, Nair D, Karunakaran N, Khogali M, Zachariah R, Dar Berger S, Satyanarayana S, Kumar AMV, Bochner AF, McClelland A, Ananthakrishnan R, Harries AD. Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India. Int J Tuberc Lung Dis 2024; 28:122-139. [PMID: 38454186 DOI: 10.5588/ijtld.23.0285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a '7-1-7' timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.METHODS This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).RESULTS There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the '7-1-7' period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving '7-1-7' included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.CONCLUSIONS Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management..
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Affiliation(s)
- P Thekkur
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - R Thiagesan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - N Karunakaran
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - M Khogali
- Institute of Public Health, College of Medicine and Health Sciences, University of the United Arab Emirates, Al Ain, UAE
| | - R Zachariah
- United Nations Children Fund, United Nations Development Programme, World Bank Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland
| | - S Dar Berger
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, The Union South-East Asia Office, New Delhi, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | | | | | - R Ananthakrishnan
- Resource Group for Education and Advocacy for Community Health, Chennai, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France;, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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Altijani N, Khogali M, Hinton L, Opondo C, Eljack E, Knight M, Nair M. Trends in birth attendants in Sudan using three consecutive household surveys (from 2006 to 2014). Front Glob Womens Health 2023; 4:1012676. [PMID: 37711966 PMCID: PMC10498120 DOI: 10.3389/fgwh.2023.1012676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/04/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Improving maternal health and survival remains a public health priority for Sudan. Significant investments were made to expand access to maternal health services, such as through the training and deployment of providers with varying skills and competencies to work across the country. This study investigates trends in the coverage of different birth attendants and their relationship with the maternal mortality ratio (MMR). Methods Trend analyses were conducted using data from the 2006, 2010, and 2014 Sudan Household surveys. Three categories of birth attendants were identified: (1) skilled birth attendants (SBA) such as doctors, nurse-midwives, and health visitors, (2) locally certified midwives, and (3) traditional birth attendants (TBA). Multivariable logistic regression models were used to examine trends in SBAs (vs. locally certified midwives and TBAs), locally certified midwives (vs SBAs and TBAs), and SBAs and locally certified midwives by place of birth (health facility and home). The analyses were adjusted for potential confounders. An ecological analysis was conducted to assess the relationship between birth attendants by place of birth and MMR at the state level. Results Births by 15,848 women were analysed. Locally certified midwives attended most births in each survey year, with their contribution increasing from 36.3% in 2006 to 55.5% in 2014. The contributions of SBAs and TBAs decreased over the same period. In 2014 compared with 2006, births were more likely to be attended by a locally certified midwife (aOR: 2.19; 95%CI: 1.82-2.63) but less likely to be attended by a SBA (aOR: 0.46; 95%CI: 0.37-0.56). The decrease in SBA was more substantial for births taking place at home (aOR: 0.17; 95%CI: 0.12-0.23) than for health facility births (aOR: 0.45; 95%CI: 0.31-0.65). In the ecological analysis 2014-2016, the proportion of births attended by SBA in health facilities correlated negatively with MMR at state level (rho -0.55; p: 0.02). Conclusion This analysis suggests that although an improved coverage of maternal health with locally certified midwives has been observed, it has not provided the skill level reached by SBA. SBAs working in facility settings were a key correlating factor to reduced maternal mortality. Urgent action is needed to improve access to SBAs in health facilities, thereby accelerating progress in reducing maternal mortality.
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Affiliation(s)
- Noon Altijani
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mustafa Khogali
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
| | - Lisa Hinton
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, United Kingdom
| | - Charles Opondo
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Eman Eljack
- Health Systems Strengthening and Malaria Program Management Unit, Federal Ministry of Health, Khartoum, Sudan
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Manisha Nair
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Harries AD, Lin Y, Thekkur P, Nair D, Chakaya J, Dongo JP, Luzze H, Chimzizi R, Mubanga A, Timire C, Kavenga F, Satyanarayana S, Kumar AMV, Khogali M, Zachariah R. Why TB programmes should assess for comorbidities, determinants and disability at the start and end of TB treatment. Int J Tuberc Lung Dis 2023; 27:495-498. [PMID: 37353872 DOI: 10.5588/ijtld.23.0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Y Lin
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - P Thekkur
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - D Nair
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - J Chakaya
- Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya, Respiratory Society of Kenya, Nairobi, Kenya
| | - J P Dongo
- The Union-Uganda Office, Kampala, Uganda
| | - H Luzze
- National Leprosy and Tuberculosis Programme, Ministry of Health, Kampala, Uganda
| | - R Chimzizi
- Ministry of Health/USAID STAR Project, Lusaka, Zambia
| | - A Mubanga
- National Tuberculosis Programme, Ministry of Health, Lusaka, Zambia
| | - C Timire
- International Union Against Tuberculosis and Lung Disease, Paris, France, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK, Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - F Kavenga
- Ministry of Health and Child Care, AIDS and TB Department, Harare, Zimbabwe
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, Paris, France, The Union-South East (USEA) Office, New Delhi, India, Yenepoya Medical College, Yenepoya (deemed University), Mangalore, India
| | - M Khogali
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - R Zachariah
- Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Baral P, Hann K, Pokhrel B, Koirala T, Thapa R, Bijukchhe SM, Khogali M. Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study. Public Health Action 2021; 11:52-57. [PMID: 34778016 PMCID: PMC8575388 DOI: 10.5588/pha.21.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
SETTING Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal. OBJECTIVES To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019. DESIGN This was a cross-sectional study. RESULTS Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories. CONCLUSION We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.
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Affiliation(s)
- P Baral
- Department of Pharmacy, Modern Technical College, Sanepa, Lalitpur, Nepal
| | - K Hann
- Sustainable Health System, Freetown, Sierra Leone
| | - B Pokhrel
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - T Koirala
- Dasharathpur Primary Health Centre, Department of Health Services, Ministry of Health and Population, Surkhet, Nepal
| | - R Thapa
- Department of Pharmacy, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - S M Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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5
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Shrestha S, Hann K, Kyaw KWY, Koju P, Khogali M. Surgical antibiotic prophylaxis administration practices. Public Health Action 2021; 11:18-23. [PMID: 34778011 PMCID: PMC8575384 DOI: 10.5588/pha.21.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/07/2021] [Indexed: 01/05/2023] Open
Abstract
SETTING A referral hospital in Kavre, Nepal. OBJECTIVES To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019). DESIGN This was a retrospective cohort analysis. RESULTS The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG. CONCLUSION A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.
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Affiliation(s)
- S Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - K Hann
- Sustainable Health Systems, Freetown, Sierra Leone
| | - K W Y Kyaw
- Department of Operational Research, International Union Against Tuberculosis and Lung Disease (The Union), Mandalay, Myanmar
- Centre for Operational Research, The Union, Paris, France
| | - P Koju
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), WHO, Geneva, Switzerland
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Affiliation(s)
- Maowia M Mukhtar
- Institute of Endemic Diseases, University of Khartoum, Khartoum, Sudan. .,TIBA-Sudan Project, Bioscience Research Institute, Ibn Sina University, Khartoum, Sudan.
| | - Mustafa Khogali
- School of Medicine, Ahfad University for Women, Omdurman, Sudan
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7
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Harries AD, Khogali M, Kumar AMV, Satyanarayana S, Takarinda KC, Karpati A, Olliaro P, Zachariah R. Building the capacity of public health programmes to become data rich, information rich and action rich. Public Health Action 2018; 8:34-36. [PMID: 29946518 DOI: 10.5588/pha.18.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/02/2018] [Indexed: 11/10/2022] Open
Abstract
Good quality, timely data are the cornerstone of health systems, but in many countries these data are not used for evidence-informed decision making and/or for improving public health. The SORT IT (Structured Operational Research and Training Initiative) model has, over 8 years, trained health workers in low- and middle-income countries to use data to answer important public health questions by taking research projects through to completion and publication in national or international journals. The D2P (data to policy) training initiative is relatively new, and it teaches health workers how to apply 'decision analysis' and develop policy briefs for policy makers: this includes description of a problem and the available evidence, quantitative comparisons of policy options that take into account predicted health and economic impacts, and political and feasibility assessments. Policies adopted from evidence-based information generated through the SORT IT and D2P approaches can be evaluated to assess their impact, and the cycle repeated to identify and resolve new public health problems. Ministries of Health could benefit from this twin-training approach to make themselves 'data rich, information rich and action rich', and thereby use routinely collected data in a synergistic manner to improve public health policy making and health care delivery.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,London School of Hygiene & Tropical Medicine, London, UK
| | - M Khogali
- Vital Strategies, New York, New York, USA
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
| | - K C Takarinda
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,AIDS & TB Department, Ministry of Health and Child Care, Harare, Zimbabwe
| | - A Karpati
- Vital Strategies, New York, New York, USA
| | - P Olliaro
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland
| | - R Zachariah
- Special Programme for Research and Training in Tropical Disease, World Health Organization, Geneva, Switzerland.,Operations Research Unit (LuxOR), Médecins sans Frontières, Luxembourg
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Jabbour S, Siddiqi S, Giacaman R, Serag H, Al-Lawati J, Takian A, Ben Romdhane H, Badr E, Abu-Raddad LJ, El-Dawla AS, Najjab S, Moussaoui D, Khogali M, Khader Y, Attal B, Nuwayhid I. New leadership for the WHO Regional Office for the Eastern Mediterranean: exceptional election in an exceptional time. Lancet 2018; 391:1879-1881. [PMID: 29729865 DOI: 10.1016/s0140-6736(18)31029-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 04/26/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Samer Jabbour
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, occupied Palestinian territory
| | - Hani Serag
- Egyptian Foundation for Health For All and Regional Coordination Committee, People's Health Movement, Cairo, Egypt
| | | | - Amirhossein Takian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Laith J Abu-Raddad
- Department of Healthcare Policy and Research, Weill Cornell Medical College-Qatar, Doha, Qatar
| | | | - Salwa Najjab
- Juzoor Foundation for Health and Social Development, Ramallah, occupied Palestinian territory
| | - Driss Moussaoui
- Ibn Rushd University Psychiatric Centre, Casablanca, Morocco
| | - Mustafa Khogali
- School of Medicine, Ahfad University for Women, Khartoum, Sudan
| | - Yousef Khader
- Department of Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Bothaina Attal
- Faculty of Medicine and Health Sciences, Sana'a University, Sana'a, Yemen
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon
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Visagie S, Eide AH, Dyrstad K, Mannan H, Swartz L, Schneider M, Mji G, Munthali A, Khogali M, van Rooy G, Hem KG, MacLachlan M. Factors related to environmental barriers experienced by persons with and without disabilities in diverse African settings. PLoS One 2017; 12:e0186342. [PMID: 29023578 PMCID: PMC5638520 DOI: 10.1371/journal.pone.0186342] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 10/01/2017] [Indexed: 11/18/2022] Open
Abstract
This paper explores differences in experienced environmental barriers between individuals with and without disabilities and the impact of additional factors on experienced environmental barriers. Data was collected in 2011–2012 by means of a two-stage cluster sampling and comprised 400–500 households in different sites in South Africa, Sudan Malawi and Namibia. Data were collected through self-report survey questionnaires. In addition to descriptive statistics and simple statistical tests a structural equation model was developed and tested. The combined file comprised 9,307 participants. The Craig Hospital Inventory of Environmental Factors was used to assess the level of environmental barriers. Transportation, the natural environment and access to health care services created the biggest barriers. An exploratory factor analysis yielded support for a one component solution for environmental barriers. A scale was constructed by adding the items together and dividing by number of items, yielding a range from one to five with five representing the highest level of environmental barriers and one the lowest. An overall mean value of 1.51 was found. Persons with disabilities scored 1.66 and persons without disabilities 1.36 (F = 466.89, p < .001). Bivariate regression analyses revealed environmental barriers to be higher among rural respondents, increasing with age and severity of disability, and lower for those with a higher level of education and with better physical and mental health. Gender had an impact only among persons without disabilities, where women report more barriers than men. Structural equation model analysis showed that socioeconomic status was significantly and negatively associated with environmental barriers. Activity limitation is significantly associated with environmental barriers when controlling for a number of other individual characteristics. Reducing barriers for the general population would go some way to reduce the impact of these for persons with activity limitations, but additional and specific adaptations will be required to ensure an inclusive society.
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Affiliation(s)
- Surona Visagie
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
| | - Arne H. Eide
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
- SINTEF Technology and Society, Oslo, Norway
- * E-mail:
| | | | - Hasheem Mannan
- School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
| | - Leslie Swartz
- Stellenbosch University, Department of Psychology, Stellenbosch, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
| | | | | | | | | | - Malcolm MacLachlan
- Centre for Rehabilitation Studies, Stellenbosch University, Tygerberg, South Africa
- Department of Psychology, Maynooth University, Maynooth, Ireland
- Olomouc University Social Health Institute, Palacky University Olomouc, Olomouc, Czech Republic
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Visagie S, Eide AH, Mannan H, Schneider M, Swartz L, Mji G, Munthali A, Khogali M, van Rooy G, Hem KG, MacLachlan M. A description of assistive technology sources, services and outcomes of use in a number of African settings. Disabil Rehabil Assist Technol 2016; 12:705-712. [DOI: 10.1080/17483107.2016.1244293] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Surona Visagie
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | - Arne H. Eide
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
- SINTEF Technology and Society, Oslo, Norway
| | - Hasheem Mannan
- Centre for Global Health, Trinity University College, Dublin, Ireland
| | - Marguerite Schneider
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, South Africa
| | - Leslie Swartz
- Department of Psycology, Stellenbosch University, Stellenbosch, South Africa
| | - Gubela Mji
- Centre for Rehabilitation studies, Stellenbosch University, Stellenbosch, South Africa
| | | | - Mustafa Khogali
- School of Medicine, Afhad University for Women, Omdurman, Sudan
| | - Gert van Rooy
- Multidisciplinary Research Centre, University of Namibia, Windhoek, Namibia
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11
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Sawadogo M, Ciza F, Nzeyimana SD, Shingiro A, Ndikumana T, Demeulenaere T, Khogali M, Edginton M, Reid AJ, Kumar AMV, Harries AD. Effect of increased ART-CPT uptake on tuberculosis outcomes and associated factors, Burundi, 2009-2013. Public Health Action 2015; 5:214-6. [PMID: 26767173 DOI: 10.5588/pha.15.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 09/06/2015] [Indexed: 11/10/2022] Open
Abstract
We retrospectively examined 3579 records of human immunodeficiency virus infected tuberculosis (TB) patients diagnosed from January 2009 to June 2013 in 55 TB treatment facilities in Burundi, to demonstrate whether improvement of combined cotrimoxazole preventive therapy and antiretroviral therapy (ART) uptake was accompanied by improvement of treatment outcomes, and to describe associated factors. Treatment success rates increased from 71% to 80% (P < 0.001). While loss to follow-up and transfer-out rates declined significantly, death rates decreased modestly, and remained high, at 14%. ART uptake was worse in suburban areas and private for-profit institutions. World Health Organization targets could be achieved if peripheral health facilities were prioritised.
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Affiliation(s)
| | - F Ciza
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - S D Nzeyimana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | - A Shingiro
- National Antituberculosis Centre, Bujumbura, Burundi
| | - T Ndikumana
- National Tuberculosis Control Programme, Ministry of Health, Bujumbura, Burundi
| | | | - M Khogali
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Public Health, Faculty of Health Sciences, University of Witwaterstand, Johannesburg, South Africa
| | - A J Reid
- Médecins Sans Frontières, Operational Research Unit, Operational Centre Brussels, Luxembourg
| | - A M V Kumar
- The Union, South-East Asia Regional Office, New Delhi, India
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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12
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Bissell K, Viney K, Brostrom R, Gounder S, Khogali M, Kishore K, Kool B, Kumar AMV, Manzi M, Marais B, Marks G, Linh NN, Ram S, Reid S, Roseveare C, Tayler-Smith K, Van den Bergh R, Harries AD. Building operational research capacity in the Pacific. Public Health Action 2015; 4:S2-S13. [PMID: 26477282 DOI: 10.5588/pha.13.0091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/27/2014] [Indexed: 11/10/2022] Open
Abstract
Operational research (OR) in public health aims to investigate strategies, interventions, tools or knowledge that can enhance the quality, coverage, effectiveness or performance of health systems. Attention has recently been drawn to the lack of OR capacity in public health programmes throughout the Pacific Islands, despite considerable investment in implementation. This lack of ongoing and critical reflection may prevent health programme staff from understanding why programme objectives are not being fully achieved, and hinder long-term gains in public health. The International Union Against Tuberculosis and Lung Disease (The Union) has been collaborating with Pacific agencies to conduct OR courses based on the training model developed by The Union and Médecins Sans Frontières Brussels-Luxembourg in 2009. The first of these commenced in 2011 in collaboration with the Fiji National University, the Fiji Ministry of Health, the World Health Organization and other partners. The Union and the Secretariat of the Pacific Community organised a second course for participants from other Pacific Island countries and territories in 2012, and an additional course for Fijian participants commenced in 2013. Twelve participants enrolled in each of the three courses. Of the two courses completed by end 2013, 18 of 24 participants completed their OR and submitted papers by the course deadline, and 17 papers have been published to date. This article describes the context, process and outputs of the Pacific courses, as well as innovations, adaptations and challenges.
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Affiliation(s)
- K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, the University of Auckland, Auckland, New Zealand
| | - K Viney
- Secretariat of the Pacific Community, Noumea, New Caledonia
| | - R Brostrom
- Division of TB Elimination, United States Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S Gounder
- National Tuberculosis Programme, Fiji Ministry of Health, Suva, Fiji
| | - M Khogali
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - K Kishore
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - B Kool
- School of Population Health, the University of Auckland, Auckland, New Zealand
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - M Manzi
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - B Marais
- Marie Bashir Institute for Emerging Infections and Biosecurity, The University of Sydney, Sydney, New South Wales, Australia
| | - G Marks
- Woolcock Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia
| | - N N Linh
- Global TB Programme, World Health Organization, Geneva, Switzerland ; Division of Pacific Technical Support, WHO Representative Office in the South Pacific, Suva, Fiji
| | - S Ram
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - S Reid
- Australian Centre for International and Tropical Health, School of Population Health, The University of Queensland, Brisbane, Queensland, Australia
| | - C Roseveare
- Regional Public Health, Hutt Valley District Health Board, Lower Hutt, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Medical Department, Operational Research Unit, Médecins Sans Frontières, MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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13
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Ramsay A, Harries AD, Zachariah R, Bissell K, Hinderaker SG, Edginton M, Enarson DA, Satyanarayana S, Kumar AMV, Hoa NB, Tweya H, Reid AJ, Van den Bergh R, Tayler-Smith K, Manzi M, Khogali M, Kizito W, Ali E, Delaunois P, Reeder JC. The Structured Operational Research and Training Initiative for public health programmes. Public Health Action 2015; 4:79-84. [PMID: 26399203 DOI: 10.5588/pha.14.0011] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières Brussels-Luxembourg (MSF) began developing an outcome-oriented model for operational research training. In January 2013, The Union and MSF joined with the Special Programme for Research and Training in Tropical Diseases (TDR) at the World Health Organization (WHO) to form an initiative called the Structured Operational Research and Training Initiative (SORT IT). This integrates the training of public health programme staff with the conduct of operational research prioritised by their programme. SORT IT programmes consist of three one-week workshops over 9 months, with clearly-defined milestones and expected output. This paper describes the vision, objectives and structure of SORT IT programmes, including selection criteria for applicants, the research projects that can be undertaken within the time frame, the programme structure and milestones, mentorship, the monitoring and evaluation of the programmes and what happens beyond the programme in terms of further research, publications and the setting up of additional training programmes. There is a growing national and international need for operational research and related capacity building in public health. SORT IT aims to meet this need by advocating for the output-based model of operational research training for public health programme staff described here. It also aims to secure sustainable funding to expand training at a global and national level. Finally, it could act as an observatory to monitor and evaluate operational research in public health. Criteria for prospective partners wishing to join SORT IT have been drawn up.
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Affiliation(s)
- A Ramsay
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; Bute Medical School, University of St Andrews, Fife, Scotland, UK
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; School of Population Health, The University of Auckland, New Zealand
| | - S G Hinderaker
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; Center for International Health, University of Bergen, Bergen, Norway
| | - M Edginton
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France ; The Union South-East Asia Regional Office, New Delhi, India
| | - N B Hoa
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - H Tweya
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - A J Reid
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - R Van den Bergh
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - K Tayler-Smith
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Manzi
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - M Khogali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - W Kizito
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - E Ali
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - P Delaunois
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), MSF-Luxembourg Luxembourg
| | - J C Reeder
- Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
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Zachariah R, Kumar AMV, Reid AJ, Van den Bergh R, Isaakidis P, Draguez B, Delaunois P, Nagaraja SB, Ramsay A, Reeder JC, Denisiuk O, Ali E, Khogali M, Hinderaker SG, Kosgei RJ, van Griensven J, Quaglio GL, Maher D, Billo NE, Terry RF, Harries AD. Open access for operational research publications from low- and middle-income countries: who pays? Public Health Action 2015; 4:142-4. [PMID: 26400799 DOI: 10.5588/pha.14.0028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 03/11/2014] [Accepted: 05/13/2014] [Indexed: 11/10/2022] Open
Abstract
Open-access journal publications aim to ensure that new knowledge is widely disseminated and made freely accessible in a timely manner so that it can be used to improve people's health, particularly those in low- and middle-income countries. In this paper, we briefly explain the differences between closed- and open-access journals, including the evolving idea of the 'open-access spectrum'. We highlight the potential benefits of supporting open access for operational research, and discuss the conundrum and ways forward as regards who pays for open access.
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Affiliation(s)
- R Zachariah
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operations Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - A J Reid
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operations Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operations Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | | | - B Draguez
- MSF, Medical Department, Brussels Operational Center, Belgium
| | - P Delaunois
- MSF, General Direction, Luxembourg, Luxembourg
| | - S B Nagaraja
- Department of Community Medicine, Employees State Insurance Corporation Medical College and Post Graduate Institute of Medical Sciences and Research, Bangalore, India
| | - A Ramsay
- United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland ; University of St Andrews Medical School, Scotland, UK
| | - J C Reeder
- United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - O Denisiuk
- International HIV/AIDS Alliance, Kyiv, Ukraine
| | - E Ali
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operations Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - M Khogali
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operations Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - S G Hinderaker
- Centre for International Health, University of Bergen, Bergen, Norway
| | - R J Kosgei
- University of Nairobi, Obstetrics and Gynecology, Nairobi, Kenya
| | | | - G L Quaglio
- Science and Technology Option Assessment (STOA), Directorate-General for Parliamentary Research Services (EPRS), European Parliament, Brussels, Belgium
| | | | - N E Billo
- The Union, Centre for Operational Research, Paris, France
| | - R F Terry
- United Nations Children's Fund/United Nations Development Programme/World Bank/World Health Organization Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - A D Harries
- The Union, Centre for Operational Research, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Denisiuk O, Smyrnov P, Kumar AMV, Achanta S, Boyko K, Khogali M, Naik B, Zachariah R. Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine. Public Health Action 2015; 4:96-101. [PMID: 26399206 DOI: 10.5588/pha.13.0110] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/26/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010-2011. OBJECTIVE Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion. DESIGN Retrospective cohort study involving record reviews. RESULTS Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert. CONCLUSIONS In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.
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Affiliation(s)
- O Denisiuk
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - P Smyrnov
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - S Achanta
- World Health Organization India Country Office, New Delhi, India
| | - K Boyko
- International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine
| | - M Khogali
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
| | - B Naik
- World Health Organization India Country Office, New Delhi, India
| | - R Zachariah
- Médecins Sans Frontières (MSF), Operational Centre Brussels, Medical Department, Operational Research Unit (LUXOR), MSF-Luxembourg, Luxembourg
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16
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Kilale AM, Ngowi BJ, Mfinanga GS, Egwaga S, Doulla B, Kumar AMV, Khogali M, van Griensven J, Harries AD, Zachariah R, Hinderaker SG. Are sputum samples of retreatment tuberculosis reaching the reference laboratories? A 9-year audit in Tanzania. Public Health Action 2015; 3:156-9. [PMID: 26393020 DOI: 10.5588/pha.12.0103] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/20/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING One reference and three zonal laboratories and 500 health facilities managing retreatment tuberculosis (TB) patients in Tanzania. OBJECTIVES The National Tuberculosis and Leprosy Programme (NTLP) requires that all notified cases of retreatment TB in Tanzania have sputum samples sent for culture and drug susceptibility testing (DST). This study determined 1) if the number of annually notified retreatment patients corresponded to the number of sputum samples received by the reference laboratories, and 2) the number of culture-positive samples and the number of cases undergoing DST. DESIGN Nine-year audit of country-wide programme data from 2002 to 2010. RESULTS Of the 40 940 retreatment TB patients notified by the NTLP, 3871 (10%) had their sputum samples received at the reference and zonal laboratories for culture and DST. A total of 3761 (97%) sputum samples were processed for culture, of which 1589 (42%) were found to be culture-positive and 1415 (89%) had DST performed. CONCLUSIONS There is a >90% shortfall between notified retreatment cases and numbers of sputum samples received, cultured and assessed for DST at reference and zonal laboratories. Steps needed to address this problem are discussed.
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Affiliation(s)
- A M Kilale
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania ; Centre for International Health, University of Bergen, Norway
| | - B J Ngowi
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - G S Mfinanga
- National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania
| | - S Egwaga
- National Tuberculosis and Leprosy Program, Dar es Salaam, Tanzania
| | - B Doulla
- National Tuberculosis and Leprosy Program, Dar es Salaam, Tanzania ; National Tuberculosis and Leprosy Program, Central TB Reference Laboratory, Dar es Salaam, Tanzania
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), New Delhi, India
| | - M Khogali
- Médecins Sans Frontières, Addis Ababa, Ethiopia
| | | | - A D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - R Zachariah
- Médecins Sans Frontières (MSF), Brussels Operational Center, Luxembourg
| | - S G Hinderaker
- Centre for International Health, University of Bergen, Norway
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Khaliaukin A, Kumar AMV, Skrahina A, Hurevich H, Rusovich V, Gadoev J, Falzon D, Khogali M, de Colombani P. Poor treatment outcomes among multidrug-resistant tuberculosis patients in Gomel Region, Republic of Belarus. Public Health Action 2015; 4:S24-8. [PMID: 26393093 DOI: 10.5588/pha.14.0042] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/23/2014] [Indexed: 11/10/2022] Open
Abstract
SETTINGS Tuberculosis (TB) health facilities in the Gomel Region, Republic of Belarus-settings with a high burden of multidrug-resistant TB (MDR-TB) and human immunodeficiency virus (HIV) infection. OBJECTIVE To determine treatment outcomes among MDR-TB patients diagnosed in 2009-2010 and factors associated with unsuccessful outcomes (death, failure and loss to follow-up). DESIGN Retrospective cohort study involving a review of an electronic patient database maintained under the National Tuberculosis Control Programme. RESULTS Of 517 patients diagnosed, 78 (15%) did not start treatment. Among 439 patients who started treatment (84% males, median age 45 years, 15% HIV-infected), 291 (66%) had unsuccessful outcomes (35% deaths, 18% treatment failure and 13% lost to follow-up). Multivariate regression analysis showed that patients aged ⩾45 years (aRR 1.2, 95%CI 1.1-1.3), HIV-infected patients and those not receiving antiretroviral therapy (ART) (aRR 1.5, 95%CI 1.4-1.6) and those with a previous history of anti-tuberculosis treatment (aRR 1.2, 95%CI 1.1-1.4) had significantly higher risk of unsuccessful outcomes. CONCLUSION Treatment outcomes among MDR-TB patients were poor, with high rates of death, failure and loss to follow-up (including pre-treatment loss to follow-up). Urgent measures to increase ART uptake among HIV-infected MDR-TB patients, improved access to second-line anti-tuberculosis drug susceptibility testing and comprehensive patient support measures are required to address this grim situation.
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Affiliation(s)
- A Khaliaukin
- Gomel Regional Tuberculosis Hospital, Gomel, Belarus
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - A Skrahina
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis, Minsk, Belarus
| | - H Hurevich
- Republican Scientific and Practical Centre of Pulmonology and Tuberculosis, Minsk, Belarus
| | - V Rusovich
- World Health Organization (WHO) Country Office in Belarus, Minsk, Belarus
| | - J Gadoev
- WHO Country Office in Uzbekistan, Tashkent, Uzbekistan
| | - D Falzon
- WHO, Global TB Programme, Geneva, Switzerland
| | - M Khogali
- Operational Research Unit/Operations, Medical Department Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
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18
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De Bruycker M, Van den Bergh R, Dahmane A, Khogali M, Schiavetti B, Nzomukunda Y, Alders P, Allaouna M, Cloquet C, Enarson DA, Satyarayanan S, Magbity E, Zachariah R. Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone. Public Health Action 2015; 3:118-24. [PMID: 26393013 DOI: 10.5588/pha.12.0060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 04/09/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING A rural paediatric hospital in Bo, Sierra Leone. OBJECTIVES To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem. DESIGN Secondary analysis of routine programme data. RESULTS Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases. CONCLUSIONS Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.
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Affiliation(s)
- M De Bruycker
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - R Van den Bergh
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - A Dahmane
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - M Khogali
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - B Schiavetti
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Y Nzomukunda
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - P Alders
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - M Allaouna
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - C Cloquet
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | - S Satyarayanan
- The Union, South East Asia Regional Office, New Delhi, India
| | | | - R Zachariah
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
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Tuinakelo LR, Tayler-Smith K, Khogali M, Marks GB. Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji. Public Health Action 2015; 3:72-5. [PMID: 26393000 DOI: 10.5588/pha.12.0069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 01/08/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING An antenatal clinic serving a population of 47 604 in Nausori, Fiji. OBJECTIVE 1) To estimate the prevalence of anaemia, syphilis and hepatitis B in pregnant women attending their first antenatal visit; and 2) to estimate the uptake of treatment for syphilis and for the prevention of hepatitis B transmission in affected individuals. DESIGN Retrospective review of the clinic register and patient records for the year 2011. RESULTS The prevalence of anaemia, hepatitis B and syphilis were respectively 22%, 2% and 5%. Among women with syphilis, 78% of those for whom data were available received a complete course of three doses of penicillin during their pregnancy, and 83% of babies born to women with hepatitis B received hepatitis B immunoglobulin. CONCLUSION The prevalence of anaemia in pregnant women has declined but remains high, and further research is required to identify the major causes of this condition in Fiji. The prevalence of syphilis has remained static, while hepatitis B has decreased over the past decade. There are some gaps in the implementation of effective interventions to manage these conditions in pregnant women.
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Affiliation(s)
| | - K Tayler-Smith
- Medical Department (Operational Research), Operational Centre, Médecins Sans Frontières, Brussels, Belgium
| | - M Khogali
- Medical Department (Operational Research), Operational Centre, Médecins Sans Frontières, Brussels, Belgium
| | - G B Marks
- Woolcock Institute of Medicine, Sydney, New South Wales, Australia ; Department of Respiratory Medicine, Liverpool Hospital, Sydney, New South Wales, Australia
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20
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Davtyan K, Zachariah R, Davtyan H, Ramsay A, Denisiuk O, Manzi M, Khogali M, Van den Bergh R, Hayrapetyan A, Dara M. Performance of decentralised facilities in tuberculosis case notification and treatment success in Armenia. Public Health Action 2015; 4:S13-6. [PMID: 26393091 DOI: 10.5588/pha.14.0038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/18/2014] [Indexed: 11/10/2022] Open
Abstract
We assessed the performance of decentralised tuberculosis (TB) out-patient centres in tuberculosis (TB) case notification and treatment success in Armenia. An average threshold case notification of ⩾37/100 000 was seen in centres that had higher numbers of presumptive TB patients, where more TB was diagnosed by in-patient facilities and where TB contacts were examined. The number of doctors and/or TB specialists at centres did not influence case notification. Onsite smear microscopy was significantly associated with a treatment success rate of ⩾85% for new TB patients. Addressing specific characteristics of TB centres associated with lower case notification and treatment success and optimising their location may improve performance.
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Affiliation(s)
- K Davtyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - R Zachariah
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - H Davtyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - A Ramsay
- University of St Andrews Medical School, Fife, Scotland, United Kingdom
| | - O Denisiuk
- International HIV/AIDS Alliance in Ukraine, Kiev, Ukraine
| | - M Manzi
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M Khogali
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R Van den Bergh
- Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A Hayrapetyan
- National Tuberculosis Control Programme, Ministry of Health of Armenia, Yerevan, Armenia
| | - M Dara
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Lucenko I, Riekstina V, Perevoscikovs J, Mozgis D, Khogali M, Gadoev J, de Colombani P, Kumar AMV. Treatment outcomes among drug-susceptible tuberculosis patients in Latvia, 2006-2010. Public Health Action 2015; 4:S54-8. [PMID: 26393099 DOI: 10.5588/pha.14.0040] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 07/26/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Latvia, an Eastern European country with a high burden of tuberculosis (TB). OBJECTIVE To describe treatment outcomes among new drug-susceptible TB patients and assess the association of treatment outcomes with selected social determinants and risk factors. DESIGN A retrospective cohort study of patients aged ⩾15 years registered during 2006-2010, with a review of records in the National Tuberculosis Registry. RESULTS Of 2476 patients, 1704 (69%) were male; the median age was 42 years. About two thirds of patients were unemployed or retired, 7% were human immunodeficiency virus (HIV) positive and 35% had a history of alcohol use. Treatment success was achieved in 2167 (88%) patients. Older age, unemployment, HIV infection and alcohol use were found to be independently associated with unsuccessful treatment (death, loss to follow-up, failure, transfer out and other). For many variables, including HIV infection, diabetes mellitus and tobacco use, it was not possible to distinguish between 'not recorded' and 'not present' in the registry. CONCLUSION The treatment success rate among new drug-susceptible TB patients exceeded the 85% global target for TB control. Additional attention and support is required for most vulnerable patients, such as those who are unemployed or retired, HIV infected and alcohol users. The National TB Registry should be revised to improve definitions and staff should be trained for proper data collection and recording.
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Affiliation(s)
- I Lucenko
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - V Riekstina
- Riga East Clinical University Hospital, Centre of Tuberculosis and Lung Diseases, Riga, Latvia
| | - J Perevoscikovs
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia
| | - D Mozgis
- Centre for Disease Prevention and Control of Latvia, Riga, Latvia ; Riga Stradins University, Riga, Latvia
| | - M Khogali
- Medical Department, Operational Research Unit, Médecins Sans Frontières (MSF), Operational Centre Brussels, MSF-Luxembourg, Luxembourg
| | - J Gadoev
- World Health Organization (WHO) Country Office, Tashkent, Uzbekistan
| | | | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
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Willcox ML, Peersman W, Daou P, Diakité C, Bajunirwe F, Mubangizi V, Mahmoud EH, Moosa S, Phaladze N, Nkomazana O, Khogali M, Diallo D, De Maeseneer J, Mant D. Human resources for primary health care in sub-Saharan Africa: progress or stagnation? Hum Resour Health 2015; 13:76. [PMID: 26358250 PMCID: PMC4566492 DOI: 10.1186/s12960-015-0073-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [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: 10/17/2014] [Accepted: 08/26/2015] [Indexed: 05/06/2023]
Abstract
BACKGROUND The World Health Organization defines a "critical shortage" of health workers as being fewer than 2.28 health workers per 1000 population and failing to attain 80% coverage for deliveries by skilled birth attendants. We aimed to quantify the number of health workers in five African countries and the proportion of these currently working in primary health care facilities, to compare this to estimates of numbers needed and to assess how the situation has changed in recent years. METHODS This study is a review of published and unpublished "grey" literature on human resources for health in five disparate countries: Mali, Sudan, Uganda, Botswana and South Africa. RESULTS Health worker density has increased steadily since 2000 in South Africa and Botswana which already meet WHO targets but has not significantly increased since 2004 in Sudan, Mali and Uganda which have a critical shortage of health workers. In all five countries, a minority of doctors, nurses and midwives are working in primary health care, and shortages of qualified staff are greatest in rural areas. In Uganda, shortages are greater in primary health care settings than at higher levels. In Mali, few community health centres have a midwife or a doctor. Even South Africa has a shortage of doctors in primary health care in poorer districts. Although most countries recognize village health workers, traditional healers and traditional birth attendants, there are insufficient data on their numbers. CONCLUSION There is an "inverse primary health care law" in the countries studied: staffing is inversely related to poverty and level of need, and health worker density is not increasing in the lowest income countries. Unless there is money to recruit and retain staff in these areas, training programmes will not improve health worker density because the trained staff will simply leave to work elsewhere. Information systems need to be improved in a way that informs policy on the health workforce. It may be possible to use existing resources more cost-effectively by involving skilled staff to supervise and support lower level health care workers who currently provide the front line of primary health care in most of Africa.
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Affiliation(s)
- Merlin L Willcox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Wim Peersman
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
| | - Pierre Daou
- Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali.
| | - Chiaka Diakité
- Department of Traditional Medicine, National Institute for Public Health Research, Bamako, Mali.
| | - Francis Bajunirwe
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Vincent Mubangizi
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda.
| | | | - Shabir Moosa
- Department of Family Medicine, University of Witwatersrand, Johannesburg, South Africa.
| | | | | | | | - Drissa Diallo
- Faculty of Medicine, Pharmacy and Dentistry, University of Bamako, Bamako, Mali.
- Department of Traditional Medicine, National Institute for Public Health Research, Bamako, Mali.
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium.
| | - David Mant
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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Eide AH, Mannan H, Khogali M, van Rooy G, Swartz L, Munthali A, Hem KG, MacLachlan M, Dyrstad K. Perceived Barriers for Accessing Health Services among Individuals with Disability in Four African Countries. PLoS One 2015; 10:e0125915. [PMID: 25993307 PMCID: PMC4489521 DOI: 10.1371/journal.pone.0125915] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/21/2015] [Indexed: 11/19/2022] Open
Abstract
There is an increasing awareness among researchers and others that marginalized and vulnerable groups face problems in accessing health care. Access problems in particular in low-income countries may jeopardize the targets set by the United Nations through the Millennium Development Goals. Thus, identifying barriers for individuals with disability in accessing health services is a research priority. The current study aimed at identifying the magnitude of specific barriers, and to estimate the impact of disability on barriers for accessing health care in general. A population based household survey was carried out in Sudan, Namibia, Malawi, and South Africa, including a total of 9307 individuals. The sampling strategy was a two-stage cluster sampling within selected geographical areas in each country. A listing procedure to identify households with disabled members using the Washington Group six screening question was followed by administering household questionnaires in households with and without disabled members, and questionnaires for individuals with and without disability. The study shows that lack of transport, availability of services, inadequate drugs or equipment, and costs, are the four major barriers for access. The study also showed substantial variation in perceived barriers, reflecting largely socio-economic differences between the participating countries. Urbanity, socio-economic status, and severity of activity limitations are important predictors for barriers, while there is no gender difference. It is suggested that education reduces barriers to health services only to the extent that it reduces poverty. Persons with disability face additional and particular barriers to health services. Addressing these barriers requires an approach to health that stresses equity over equality.
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Affiliation(s)
- Arne H. Eide
- SINTEF Technology and Society, Oslo, Norway
- Stellenbosch University, Stellenbosch, South Africa
- * E-mail:
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Kuchukhidze G, Kumar AMV, de Colombani P, Khogali M, Nanava U, Blumberg HM, Kempker RR. Risk factors associated with loss to follow-up among multidrug-resistant tuberculosis patients in Georgia. Public Health Action 2014; 4:S41-6. [PMID: 26393097 PMCID: PMC4547510 DOI: 10.5588/pha.14.0048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/22/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Georgia, a country with a high-burden of multi-drug-resistant tuberculosis (MDR-TB). OBJECTIVE To determine the proportion of loss to follow-up (LFU) among MDR-TB patients treated nationwide from 2009 to 2011, and associated risk factors. DESIGN Retrospective cohort study involving a review of the National Tuberculosis Programme electronic surveillance database. A Cox proportional hazards model was used to assess risk factors for time to LFU. RESULTS Among 1593 patients, 458 (29%) were lost to follow-up. A total of 1240 MDR-TB patients were included in the final analysis (845 treatment success, 395 LFU). Over 40% of LFU occurred during the first 8 months of MDR-TB treatment; 40% of patients had not achieved culture conversion at the time of LFU. In multivariate analysis, the factors associated with LFU included male sex, illicit drug use, tobacco use, history of previous anti-tuberculosis treatment, site of TB disease, and place and year of initiating treatment. CONCLUSION LFU was high among MDR-TB patients in Georgia and posed a significant public health risk, as many were culture-positive at the time of LFU. A multi-pronged approach is needed to address the various patient- and treatment-related characteristics associated with LFU.
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Affiliation(s)
- G. Kuchukhidze
- National Centre for Disease Control and Public Health, Tbilisi, Georgia
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - P. de Colombani
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - M. Khogali
- Department of Epidemiology, Operational Center of Brussels, Médecins Sans Frontières (MSF), MSF-Belgium, Addis Ababa, Ethiopia
| | - U. Nanava
- Department of Epidemiology, National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia
| | - H. M. Blumberg
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - R. R. Kempker
- Emory University School of Medicine, Atlanta, Georgia, USA
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Kodouda SF, Zachariah R, Khogali M, van Griensven J, Saeed M, Ibrahim EH, Schneider S, Adulazeem S, El Sadig HA, Atta R, Mahgoub NG, El Sony AI. How well are asthma treatment cards filled out in public health centres in Gazeera State, Sudan? Public Health Action 2014; 4:116-21. [PMID: 26399211 PMCID: PMC4539030 DOI: 10.5588/pha.14.0004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 01/19/2014] [Accepted: 04/29/2014] [Indexed: 11/10/2022] Open
Abstract
SETTING Four public district hospitals offering asthma treatment in Gazeera State, Sudan. Incomplete recording of patient data directly affects the quality of asthma care and the evaluation of asthma management programmes. OBJECTIVE To assess the completeness of filling out of treatment cards and accuracy of calculating peak expiratory flow (PEF) for confirming diagnosis and grading severity of asthma. DESIGN Cross-sectional audit of asthma treatment cards from asthma centres, 2006-2012. RESULTS Of 959 patient cards assessed, completeness ranged from 47% to 98%. Six of 13 variables had an unsatisfactory grade of completeness (<80% complete). Calculated PEF was indicated in 885 (92%) cards, but was correct in only 609 (69%). PEF variability was recorded in 835 (87%) cards, but was correctly calculated in 442 (53%). A scheduled follow-up visit was attended by only 359 (37%) patients, indicating 63% loss to follow-up. Contact telephone numbers were missing from 453 (47%) cards. CONCLUSION This is the first study in Africa to assess the data completeness and integrity of asthma patient cards, identifying important shortcomings. This affects quality of management of asthma patients and programme evaluation. Steps to rectify this situation are urgently needed.
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Affiliation(s)
| | - R. Zachariah
- Medical Department Operational Research Unit/Operations, Operational Centre Brussels, Médecins Sans Frontières –MSF-Luxembourg, Luxembourg
| | - M. Khogali
- Medical Department Operational Research Unit/Operations, Operational Centre Brussels, Médecins Sans Frontières –MSF-Luxembourg, Luxembourg
| | | | - M. Saeed
- The Epidemiological Laboratory, Khartoum, Sudan
| | | | - S. Schneider
- Centre for Toxicology and Public Research, University of Luxembourg, Luxembourg
| | | | | | - R. Atta
- The Epidemiological Laboratory, Khartoum, Sudan
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26
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Zachariah R, De Smet M, Etienne W, Khogali M, van Den Bergh R, Veerman R, Harries AD. Non-monetary incentives for pregnant women and antenatal attendance among Ethiopian pastoralists. Public Health Action 2014; 4:133. [PMID: 26393077 DOI: 10.5588/pha.14.0062] [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: 11/10/2022] Open
Affiliation(s)
- R Zachariah
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M De Smet
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - W Etienne
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - M Khogali
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R van Den Bergh
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R Veerman
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
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Zachariah R, Reid T, Van den Bergh R, Kumar AMV, Tayler-Smith K, Khogali M, Hinderaker SG, Upshur R, Harries AD. RE: Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers by Zachariah et al. (2013) TMIH 18, pp. 1025–1028. Trop Med Int Health 2014; 19:129-30. [PMID: 24851261 DOI: 10.1111/tmi.12242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khogali M, Zachariah R, Reid AJ, Alipon SC, Zimble S, Gbane M, Etienne W, Veerman R, Hassan A, Harries AD. Do non-monetary incentives for pregnant women increase antenatal attendance among Ethiopian pastoralists? Public Health Action 2014; 4:12-4. [PMID: 26423755 PMCID: PMC4479100 DOI: 10.5588/pha.13.0092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022] Open
Abstract
In a pastoralist setting in Ethiopia, we assessed changes in attendance between the first and subsequent antenatal care (ANC) visits following the implementation of non-monetary incentives in a primary health care centre over a 3-year period from October 2009 to September 2012. Incentives included the provision of a bar of soap, a bucket, a mosquito net, sugar, cooking oil, a jerrycan and a delivery kit. The first ANC visits increased by 48% in the first year to 60% in the second. Subsequent visits did not show a similar pattern due to ruptures in incentive stocks. Incentives appear to increase ANC attendance; however, ruptures in stock should be avoided to sustain the effect.
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Affiliation(s)
- M. Khogali
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - R. Zachariah
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - A. J. Reid
- Medical Department, Operational Research Unit and Operations Department, Operational Centre Brussels, Médecins Sans Frontières (MSF), MSF-Luxembourg, Luxembourg
| | - S. C. Alipon
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - S. Zimble
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - M. Gbane
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - W. Etienne
- Operational Centre Brussels, MSF Brussels, Belgium
| | - R. Veerman
- Operational Centre Brussels, MSF Brussels, Belgium
| | - A. Hassan
- MSF Ethiopia Country Office, Addis Ababa, Ethiopia
| | - A. D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France
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Mbuthia GW, Harries AD, Obala AA, Nyamogoba HDN, Simiyu C, Edginton ME, Khogali M, Hedt-Gauthier BL, Otsyla BK. Childhood immunisation in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake. Public Health Action 2014; 4:9-11. [PMID: 26423754 DOI: 10.5588/pha.13.0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/06/2014] [Indexed: 11/10/2022] Open
Abstract
Uptake of immunisations in children aged 1-2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%, and measles vaccine declined uptake from 89% to 60% (P < 0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines (P < 0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.
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Affiliation(s)
- G W Mbuthia
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - A D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - A A Obala
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | - C Simiyu
- College of Health Sciences, Moi University, Eldoret, Kenya
| | - M E Edginton
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - M Khogali
- Medical Department, Brussels Operation Center, Medecins Sans Frontières, Brussels, Belgium
| | - B L Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - B K Otsyla
- College of Health Sciences, Moi University, Eldoret, Kenya
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Maalim AM, Zachariah R, Khogali M, Van Griensven J, Van den Bergh R, Tayler-Smith K, Kizito W, Baruani B, Osoble A, Abdirahman F, Ayada L, Mohamed AH. Supporting 'medicine at a distance' for delivery of hospital services in war-torn Somalia: how well are we doing? Int Health 2014; 6:70-3. [DOI: 10.1093/inthealth/iht035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bishinga A, Zachariah R, Hinderaker S, Tayler-Smith K, Khogali M, van Griensven J, van den Boogaard W, Tamura M, Christiaens B, Sinabajije G. High loss to follow-up following obstetric fistula repair surgery in rural Burundi: is there a way forward? Public Health Action 2013; 3:113-7. [PMID: 26393012 DOI: 10.5588/pha.13.0001] [Citation(s) in RCA: 5] [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: 01/05/2013] [Accepted: 04/14/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Gitega Fistula Centre (GFC), a dedicated obstetric fistula repair centre providing comprehensive care at the Gitega District Hospital, rural Burundi. OBJECTIVES To describe 1) the proportion who returned for scheduled 3- and 6-month follow-up visits and 2) outcomes (fistula closure rates and continence status) at discharge from hospital and after 3 and 6 months among patients who underwent fistula repair surgery. DESIGN Retrospective cohort analysis using programme data from April 2010 to December 2011. RESULTS A total of 475 women with obstetric fistula underwent surgical repair. At discharge from hospital, 415 (87%) had a closed fistula, of whom 318 (77%) were continent of urine and/or faeces, while 97 (23%) remained incontinent despite closure. Of the 415 patients with closed fistula, only 244 (59%) were followed up at 3 months and 73 (18%) at 6 months (χ(2) for linear trend 576, P < 0.0001). This indicates progressive loss to follow-up, reaching 82% by 6 months. CONCLUSION Women undergoing obstetric fistula repair surgery at GFC achieve good hospital exit outcomes. Thereafter, substantial and progressive loss to follow-up hinder the ability to judge programme success over time. Steps to address this operational problem are discussed.
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Affiliation(s)
- A Bishinga
- Médecins Sans Frontières (MSF), Operational Center Brussels, Burundi-Gitega, Burundi
| | - R Zachariah
- Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg
| | | | - K Tayler-Smith
- Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg
| | - M Khogali
- Medical Department (Operational Research), Operational Center Brussels, MSF-Luxembourg
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Ngoy BB, Zachariah R, Hinderaker SG, Khogali M, Manzi M, van Griensven J, Ayada L, Jemmy JP, Maalim A, Amin H. Paediatric in-patient care in a conflict-torn region of Somalia: are hospital outcomes of acceptable quality? [Short communication]. Public Health Action 2013; 3:125-7. [DOI: 10.5588/pha.12.0104] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022] Open
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Zachariah R, Reid T, Van den Bergh R, Dahmane A, Kosgei RJ, Hinderaker SG, Tayler-Smith K, Manzi M, Kizito W, Khogali M, Kumar AMV, Baruani B, Bishinga A, Kilale AM, Nqobili M, Patten G, Sobry A, Cheti E, Nakanwagi A, Enarson DA, Edginton ME, Upshur R, Harries AD. Applying the ICMJE authorship criteria to operational research in low-income countries: the need to engage programme managers and policy makers. Trop Med Int Health 2013; 18:1025-8. [DOI: 10.1111/tmi.12133] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- R. Zachariah
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - T. Reid
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - R. Van den Bergh
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
- Department of Molecular and Cellular Interactions; Flemish Institute of Biotechnology; Brussels Belgium
- Department of Microbiology; Institute of Tropical Medicine; Antwerp Belgium
| | - A. Dahmane
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - R. J. Kosgei
- Department of Obstetrics and Gynecology; University of Nairobi; Nairobi Kenya
| | - S. G. Hinderaker
- Centre for International Health; University of Bergen; Bergen Norway
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - K. Tayler-Smith
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - M. Manzi
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - W. Kizito
- International Union Against TB and Lung Disease; Kampala Uganda
| | - M. Khogali
- Medecins Sans Frontieres; Addis Ababa Ethiopia
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease; South East Asia office; New Delhi India
| | - B. Baruani
- Medecins Sans Frontieres; Somali Mission; Somalia
| | | | - A. M. Kilale
- National Institute for Medical Research; Dar Es Salaam Tanzania
| | - M. Nqobili
- National Tuberculosis Control Programme; Harare Zimbabwe
| | - G. Patten
- Medecins Sans Frontieres; Capetown South Africa
| | - A. Sobry
- Medecins Sans Frontieres; Nairobi Kenya
| | - E. Cheti
- Medecins Sans Frontieres; Nairobi Kenya
| | - A. Nakanwagi
- Medical Department (Operational Research Unit); Medecins sans Frontieres; Operational Centre Brussels; MSF-Luxembourg; Luxembourg Luxembourg
| | - D. A. Enarson
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - M. E. Edginton
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
| | - R. Upshur
- Joint Center for Bioethics; University of Toronto; Toronto Canada
| | - A. D. Harries
- Center for Operational Research; International Union Against Tuberculosis and Lung Disease; Paris France
- London School of Hygiene and Tropical Medicine; London UK
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Aiyub S, Linh NN, Tayler-Smith K, Khogali M, Bissell K. Nurses graduating in Fiji between 2001 and 2010: sufficient supply for Fiji's health service demands? Public Health Action 2013; 3:63-7. [PMID: 26392998 DOI: 10.5588/pha.12.0067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 09/30/2012] [Accepted: 01/10/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Fiji's schools of nursing and government health services, 2001-2010. OBJECTIVES To report on 1) the number and characteristics of nurses who graduated in Fiji, 2) the proportion of vacant nursing positions in the government health services and 3) attrition among nurses. DESIGN Descriptive study involving a retrospective record review of Ministry of Health annual reports and nursing registers. RESULTS Over the period 2001-2010, a total of 1500 nurses graduated, with the overall trend being a gradual increase in newly qualified nurses year on year. Available data from 2007 onwards showed relatively low vacancy rates (range 0.4-2%), with a sharp rise to 15% in 2009. Complete data on nurse attrition were available only from 2007 onwards, with rates of attrition ranging from 4% to 10%; the most common reason for attrition was resignation. CONCLUSION While it was unable to directly assess whether Fiji's supply of nursing graduates has been meeting the country's health service demands, this study provides a series of baseline data on Fiji's nurse graduate and nursing workforce. In addition, it identifies some of the challenges and gaps that need to be considered to better assess and address nursing staff shortages.
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Affiliation(s)
- S Aiyub
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - N N Linh
- Division of Pacific Technical Support, World Health Organization, Suva, Fiji
| | - K Tayler-Smith
- Operational Research Unit, Brussels Operational Center, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - M Khogali
- Operational Research Unit, Brussels Operational Center, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - K Bissell
- International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand
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Khogali M, Tayler-Smith K, Zachariah R, Gbane M, Zimble S, Weyeyso T, Harries AD. Diagnosis of pulmonary tuberculosis in a pastoralist population in Ethiopia: are three sputum specimens needed? Trop Med Int Health 2013; 18:632-5. [PMID: 23437768 DOI: 10.1111/tmi.12082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the number of sputum specimens necessary for a reliable diagnosis of pulmonary tuberculosis (PTB) in a pastoralist population in Ethiopia. METHOD Using routine data from Ethiopia, where three sputum specimens are currently recommended for the diagnosis of PTB, we documented, (i) the proportion of persons with suspected, PTB who submitted a first, second and third sputum specimen for smear examination and (ii) the incremental smear-positive yield from the first, to the second and third specimens. RESULTS Of 505 persons with suspected PTB, 107 (22%) failed to submit three samples. Of 60 patients who submitted three sputum samples with at least one smear-positive sample, the first sputum sample was smear positive in 56 (93%) cases; the second sputum sample was the first to be positive in 3 (5%) cases and in only one case was the third sample the first to be smear positive (additional yield 2%). CONCLUSION In a pastoralist setting, a reliable diagnosis of PTB can be achieved with two sputum specimens and PTB diagnosis may be adequate with just one sputum specimen. However, if this more radical approach was adopted, ways of increasing diagnostic sensitivity should be explored.
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Affiliation(s)
- M Khogali
- Medecins sans Frontieres - Medical Department (Operational research Unit/Operations), Operational centre Brussels, MSF, Luxembourg, Luxembourg.
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Varman S, Bullen C, Tayler-Smith K, Van Den Bergh R, Khogali M. Primary school compliance with school canteen guidelines in Fiji and its association with student obesity. Public Health Action 2013; 3:81-4. [PMID: 26393002 DOI: 10.5588/pha.12.0063] [Citation(s) in RCA: 6] [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: 09/27/2012] [Accepted: 11/30/2012] [Indexed: 11/10/2022] Open
Abstract
SETTING Childhood obesity is of growing public health concern in Fiji. The study setting was primary schools in Fiji's Western Division. OBJECTIVE 1) To assess primary schools' compliance with national school canteen guidelines, 2) to understand reasons for non-compliance, and 3) to assess the relationship between compliance with the guidelines and students' body mass index (BMI). DESIGN Cross-sectional analysis of data collected in 2010 by public health dieticians of the Ministry of Health on annual visits to primary schools. RESULTS Among 230 schools, 33 (14%) had no canteen data. Of the 197 schools with data, only 31 (16%) were fully compliant with national school canteen guidelines, while the remaining 166 (84%) did not fully comply with the guidelines. This was irrespective of school location or whether the canteen was school or commercially operated. In a random sample (n = 44 schools), overweight and obesity were more common among children in non-compliant schools than in fully compliant schools (40% vs. 32%, P < 0.001). CONCLUSION Most primary schools in Fiji's Western Division did not comply with school canteen guidelines, which is worrying given the increasing rates of overweight children. Given the association between non-compliance and student overweight/obesity, further action is needed to ensure that these guidelines are implemented.
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Affiliation(s)
- S Varman
- College of Engineering Science and Technology, Fiji National University, Lautoka, Fiji
| | - C Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - K Tayler-Smith
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - R Van Den Bergh
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - M Khogali
- Operational Centre Brussels, Operational Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
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Tayler-Smith K, Khogali M, Keiluhu K, Jemmy JP, Ayada L, Weyeyso T, Issa A, De Maio G, Harries A, Zachariah R. The experience of implementing a 'TB village' for a pastoralist population in Cherrati, Ethiopia. Int J Tuberc Lung Dis 2011; 15:1367-72. [DOI: 10.5588/ijtld.10.0751] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- K. Tayler-Smith
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels MSF-Luxembourg, Luxembourg
| | - M. Khogali
- Médecins Sans Frontières, Addis Ababa, Ethiopia
| | - K. Keiluhu
- Médecins Sans Frontières, Addis Ababa, Ethiopia
| | - J-P. Jemmy
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - L. Ayada
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels, Brussels, Belgium
| | - T. Weyeyso
- Somali Regional Health Bureau, Jijiga, Ethiopia
| | - A.M. Issa
- Somali Regional Health Bureau, Jijiga, Ethiopia
| | | | - A.D. Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - R. Zachariah
- Medical Department, Médecins Sans Frontières, Operational Centre Brussels MSF-Luxembourg, Luxembourg
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Khogali M, Zachariah R, Keiluhu A, Van den Brande K, Tayler-Smith K, Ayada L, Jima D, Hinderaker S, Harries A. Detection of malaria in relation to fever and grade of malnutrition among malnourished children in Ethiopia. Public Health Action 2011; 1:16-8. [DOI: 10.5588/pha.11.0008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 08/22/2011] [Indexed: 11/10/2022] Open
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Yunis KA, Khawaja M, Beydoun H, Nassif Y, Khogali M, Tamim H. Intrauterine growth standards in a developing country: a study of singleton livebirths at 28-42 weeks' gestation. Paediatr Perinat Epidemiol 2007; 21:387-96. [PMID: 17697069 DOI: 10.1111/j.1365-3016.2007.00827.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aimed to develop fetal growth charts for the population of Greater Beirut, Lebanon, and compare them with previously established references. A survey of consecutive singleton livebirths admitted to normal nurseries and neonatal intensive care units of major hospitals, through the database project of the National Collaborative Perinatal Neonatal Network was used as a design. The study was conducted in nine major healthcare institutions serving the population of Beirut and its suburbs. A total of 24 767 singleton livebirths delivered between 28 and 42 weeks' gestation, with known data on gender, gestational age and anthropometric characteristics were recorded between 1 April 1999 and 31 March 2002. Growth charts were developed by plotting birthweight, length and head circumference percentiles against gestational age for male and female infants separately. Overall, 1348 (5.4%) pregnancies were delivered before 37 weeks' gestation and 1227 (4.9%) were low birthweight. Male infants were delivered slightly earlier than their female counterparts and the mean birthweight, length and head circumference were consistently higher in males. A total of 2247 (9.1%) infants were small-for-gestational-age, with a male-to-female sex ratio of 1.03. Using previously established growth references that overestimated small-for-gestational-age prevalence resulted in a greater proportion of false positives. The opposite was true for growth references that underestimated small-for-gestational-age prevalence. The current growth charts present useful tools for assessing the general health status of newborn infants delivered at sea level in the urban areas of Lebanon and other East Mediterranean countries.
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Affiliation(s)
- Khalid A Yunis
- Department of Pediatrics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
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Mumtaz G, Tamim H, Kanaan M, Khawaja M, Khogali M, Wakim G, Yunis KA. Effect of consanguinity on birth weight for gestational age in a developing country. Am J Epidemiol 2007; 165:742-52. [PMID: 17311799 DOI: 10.1093/aje/kwk108] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Consanguinity, the marriage between relatives, has been associated with adverse child health outcomes because it increases homozygosity of recessive alleles. The objective of this study was to assess the effect of consanguinity on the birth weight of newborns in Greater Beirut, Lebanon. Cross-sectional data were collected on 10,289 consecutive liveborn singleton newborns admitted to eight hospitals belonging to the National Collaborative Perinatal Neonatal Network during the years 2000 and 2001. Birth weight was modeled by use of the fetal growth ratio, defined as the ratio of the observed birth weight to the median birth weight for gestational age. A mixed-effect multiple linear regression model was used to predict the net effect of first- and second-cousin marriage on the birth weight for gestational age, accounting for within-hospital clustering of data. After controlling for medical and sociodemographic covariates, the authors found a statistically significant negative association between consanguinity and birth weight at each gestational age. No significant difference was observed in the decrease in birth weight between the first- and second-cousin marriages. Overall, consanguinity was associated with a decrease in birth weight for gestational age by 1.8% (beta = -0.018, 95% confidence interval: -0.027, -0.008). The largest effects on fetal growth were seen with lower parity and smoking during pregnancy.
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Affiliation(s)
- Ghina Mumtaz
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
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Saab BR, Nassar NT, Musharrafieh U, Araj GF, Khogali M. Prevalence of hepatitis B in a presumably healthy Lebanese population. J Med Liban 2007; 55:11-4. [PMID: 17489302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Policy makers need data on the prevalence of infection with HBV in order to determine the cost effectiveness of universal immunization against hepatitis B. This study aims at determining the prevalence rate of infection with HBV in a basically healthy group of Lebanese adults. METHODS Sera from 2634 presumably healthy Lebanese individuals, mean age 32.1 years, obtained between 1995-1997, were tested for hepatitis B surface antigen (HBsAg). The sample was composed of subjects residing in different areas in Lebanon. Detection of HBsAg was performed utilizing the ELISA technique. The analysis took place in the Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon. Chi-square test was used to examine statistical associations. RESULTS The prevalence of HBsAg among the samples was 1.6%. Blue-collar employees, smokers and those living in the South of Lebanon were significantly more likely to be infected with hepatitis B virus. CONCLUSIONS The data presented indicates that Lebanon has a low prevalence of HBV infection. Costeffective studies are needed to justify universal iminunization against hepatitis B especially in countries where budgets are tight.
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Affiliation(s)
- Bassem R Saab
- Department of Family Medicine, American University of Beirut, Lebanon.
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Obeid OA, Al-Ghali RM, Khogali M, Hwalla N. Vitamins A and E Status in an Urban Lebanese Population: A Case Study at Dar Al-Fatwa Area, Beirut. INT J VITAM NUTR RES 2006; 76:3-8. [PMID: 16711650 DOI: 10.1024/0300-9831.76.1.3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Vitamin A and E status are widely studied in various populations because of their association with several diseases. Fasting plasma vitamin A and E status of 857 Lebanese adults residing in Dar Al-Fatwa, Beirut were assessed using high performance liquid chromatography (HPLC). Mean retinol and alpha-tocopherol concentrations were 59.8 ± 29 µg/dL and 1.0 ± 0.5 mg/dL, respectively in which only 0.2% were retinol-deficient, while 0.7% were alpha-tocopherol-deficient. Vitamin A and E correlated positively with plasma concentrations of total cholesterol, low-density lipoprotein (LDL)-cholesterol, and triglycerides. Vitamin E, but not vitamin A, correlated positively with blood pressure and glucose. A good status of vitamins A and E was found among the studied Lebanese sample and the elevation in vitamin A and E levels was associated with unfavorable lipid profile.
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Affiliation(s)
- Omar A Obeid
- Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon.
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Abstract
AIMS To compare birthweight (BW), body mass index (BMI) and ponderal index (PI) as predictors of selected short-term (ST) outcomes, namely Neonatal Intensive Care Unit (NICU) admission and prolonged hospitalization (PH), among newborn (NB) infants. METHODS Data was collected prospectively on 9,226 infants born during one year at nine tertiary care hospitals in Greater Beirut, Lebanon. The predictive abilities of BW, BMI and PI were compared using the area under the receiver operator characteristic (ROC) curves and sensitivity analysis was performed at the optimal cut-off points for the best anthropometric measurement. RESULTS The area under the ROC curve suggested superior discriminative power for BW as compared to BMI or PI, as a predictor of NICU admission (ROC area = 0.73) and PH (ROC area = 0.74). The optimal BW cut-off point was 2750 g (sensitivity: 0.49; specificity: 0.89) and 2950 g (sensitivity: 0.62; specificity: 0.78) for NICU admission and PH, respectively. CONCLUSION In our population of NB infants, BW--a crude measure of fetal growth--is a better predictor than either BMI--a measure of adiposity in adults and children--or PI--a measure of thinness at birth--for selected ST outcomes in NB infants.
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Affiliation(s)
- Hala Tamim
- Department of Epidemiology and Biostatistics, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Khogali M. Health and disease in a changing Arab world 2000/2025/2050: global, environmental, and climate change and emerging diseases. Ethn Dis 2005; 15:S1-74-5. [PMID: 15787050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Affiliation(s)
- Mustafa Khogali
- Internal Medicine Department, American University of Beirut, Lebanon
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Melki IS, Beydoun HA, Khogali M, Tamim H, Yunis KA. Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health 2004; 58:476-80. [PMID: 15143115 PMCID: PMC1732777 DOI: 10.1136/jech.2003.012690] [Citation(s) in RCA: 212] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This paper examines the effect of household crowding on inter-pregnancy spacing and its association with socioeconomic indicators, among parous mothers delivered in an urban environment. DESIGN Cross sectional survey. METHODS Sociodemographic data were obtained on 2466 parous women delivering at eight hospitals in Greater Beirut over a one year period. Statistical methodology comprised Pearson chi(2) test and logistic regression analysis. MAIN RESULTS A significant inverse relation was observed between household crowding and socioeconomic status, defined as education and occupation of women and their spouses. Inter-pregnancy spacing increased with higher levels of crowding. Further analysis suggested that this positive association was confounded by maternal demographic characteristics. CONCLUSIONS These data have shown that household crowding, a correlate of low parental socioeconomic status, is associated with longer birth intervals. This association, however, seems to be largely explained by maternal age and parity.
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Affiliation(s)
- I S Melki
- Department of Paediatrics, Hotel Dieu de France Hospital, Beirut, Lebanon
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Abstract
The objective of this study was to examine risk factors for term or near-term fetal growth restriction (FGR) in the absence of pregnancy complications. We completed a survey of uncomplicated single live births delivered in Greater Beirut, Lebanon. FGR cases were defined as below the 10th percentile of expected weight at gestational age. Multivariate logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CIs). Main predictors of FGR were female gender (OR, 1.94; 95% CI, 1.46 to 2.59), nulliparity (Or, 1.66; 95% CI, 1.25 ton 2.20), low prepregnancy weight (OR, 2.52; 95% CI, 1.58 to 4.01), short stature (OR, 2.59; 95% CI, 1.57 to 4.28), and low pregnancy weight gain (OR, 1.75; 95% CI, 1.21 to 2.55). Anthropometric characteristics of mothers are important modifiable determinants of fetal size in our developing urban population of uncomplicated births.
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Affiliation(s)
- Khalid A Yunis
- Department of Pediatrics, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Yunis K, Beydoun H, Khogali M, Alameh M, Tamim H. Low socioeconomic status and neonatal outcomes in an urban population in a developing country. J Matern Fetal Neonatal Med 2004; 14:338-43. [PMID: 14986809 DOI: 10.1080/jmf.14.5.338.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the effect of low socioeconomic status indicators, specifically parental educational and occupational characteristics on neonatal health outcomes. METHODS Analysis of 3372 newborn infants admitted to five National Collaborative Perinatal Neonatal Network centers (1 February 2000 to 31 January 2002). Outcomes included birth weight, gestational age, admission to the neonatal intensive care unit (NICU) and length of hospital stay. The independent effects of mother's education and occupation as well as father's occupation on health outcomes were assessed by means of stepwise logistic regression analysis. RESULTS A total of 271 (8.0%) infants were of low birth weight, 306 (9.1%) were preterm, 410 (12.2%) had NICU admissions and 240 (7.1%) were hospitalized for more than a week. After adjusting for maternal gravidity, age, smoking during pregnancy and pregnancy-related complications, parental socioeconomic characteristics had no significant impact on low birth weight or preterm birth. NICU admission and prolonged hospitalization were significantly correlated with skilled, semi-skilled and unskilled paternal occupations. Illiterate mothers had nearly 3-5 times the risk of NICU admission and prolonged hospitalization. CONCLUSION Both father's occupation and mother's education play an important role as determinants of neonatal morbidity characteristics.
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Affiliation(s)
- K Yunis
- Department of Pediatrics, American University of Beirut, Beirut, Lebanon
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Beydoun H, Itani M, Tamim H, Aaraj A, Khogali M, Yunis K. Impact of maternal age on preterm delivery and low birthweight: a hospital-based collaborative study of nulliparous Lebanese women in Greater Beirut. J Perinatol 2004; 24:228-35. [PMID: 15029216 DOI: 10.1038/sj.jp.7211064] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To analyze the impact of maternal age at first childbirth on the incidence of preterm delivery and low birthweight among single live births delivered to nulliparous Lebanese women in Greater Beirut. STUDY DESIGN Eligible subjects were selected from a consecutive sample of neonatal admissions to nine National Collaborative Perinatal Network participating hospitals over a three-year period (April 1, 1999 to March 31, 2002). Chi-square tests and logistic regression analyses were applied. RESULTS Out of 5556 nulliparous mothers, 5.4% had a preterm delivery and 5.2% a low-birthweight infant. In the multivariate analysis, preterm delivery was not significantly affected by old maternal age. Mothers aged 25 years or more remained a high-risk group for low birthweight even after controlling for potentially confounding characteristics. CONCLUSIONS Maternal age at first childbirth above 25 years is an independent risk factor for low birthweight, but not for preterm delivery, an outcome influenced mainly by obstetric complications.
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Affiliation(s)
- Hind Beydoun
- Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
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Nakkash R, Afifi Soweid RA, Nehlawi MT, Shediac-Rizkallah MC, Hajjar TA, Khogali M. The development of a feasible community-specific cardiovascular disease prevention program: triangulation of methods and sources. Health Educ Behav 2004; 30:723-39. [PMID: 14655866 DOI: 10.1177/1090198103255521] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Triangulation of methods, sources, and investigators can lead to a multidimensional understanding of a particular issue. In this study, the combination of qualitative and quantitative data collection methods, and information from community and coalition members resulted in the development of a tailored community-specific intervention. Three components were triangulated after analyzing each separately. A household survey of community members between the ages of 25 and 64 years was conducted to identify knowledge, attitudes, and behaviors related to cardiovascular disease and to assess risk factor levels. Focus group discussions were conducted with community members to describe facilitators and barriers to healthy lifestyles, as well as possible interventions. Natural group discussions with coalition members analyzed the relevance, feasibility, affordability, acceptability, and sustainability of specific intervention activities. Results from the different components were compared and contrasted. Areas of added information, validation, and contradiction were analyzed and guided the development of intervention activities.
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Affiliation(s)
- Rima Nakkash
- Department of Family Medicine, American University of Beirut-Medical Center, Beirut, Lebanon
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Saab BR, Musharrafieh U, Nassar NT, Khogali M, Araj GF. Intestinal parasites among presumably healthy individuals in Lebanon. Saudi Med J 2004; 25:34-7. [PMID: 14758375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
OBJECTIVE To determine the prevalence period of intestinal parasites among presumably healthy subjects in Lebanon. METHODS One stool specimen from 2634 presumably healthy Lebanese subjects, mean age 32.1 years with a range of 14-71 years, resident of different areas in Lebanon was examined for the presence of parasites. The analysis took place in the Clinical Microbiology Laboratory, Department of Pathology and Laboratory Medicine, American University of Beirut Medical Center, Beirut, Lebanon, over 25-months between 1995-1997. RESULTS The prevalence of intestinal parasites was 12.4%. The most common parasites identified were Entamoeba coli (38%), Giardia lamblia (3.1%) and Entamoeba histolytica (2.3%) [corrected]. CONCLUSION The data presented shows the need to improve hygienic conditions to contain the problem of intestinal infections with parasites in Lebanon.
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Affiliation(s)
- Bassem R Saab
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
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