69832 research outputs found
Sort by
How does the medicines retail sector ensure continued access to medicines during public health emergencies? Lessons from the COVID-19 pandemic in Uganda.
Get PDFBACKGROUND: The medicines retail sector (MRS) enables access to life-saving health commodities. Despite efforts to harness this market for public health goals, in low- and middle-income countries it is rarely incorporated into pandemic preparedness. This paper analyses the role of the MRS in the response to COVID-19 in Uganda, the extent to which it was incorporated into national planning and in the continuity of essential services.
METHODS: We conducted a cross-sectional study using sequential mixed methods in two purposively sampled rural districts in central Uganda. Qualitative research comprised 27 focus group discussions with drug shop vendors (DSVs), pharmacists, clinic staff and community members across two districts (n = 250); key informant interviews at national (n = 6) and district (n = 11) levels. Qualitative findings were used to modify a facility-based survey conducted in MRS outlets (n = 625). A household survey focusing on household dynamics and treatment seeking during COVID-19 was conducted in both districts (n = 1680).
RESULTS: At the national level, attempts were made to involve the MRS in policy and technical advice but this was not sustained. At the district level, almost no effort was made to include the MRS in the response to COVID-19. In the community, residents described their reliance on the MRS to provide medicines, especially during lockdowns. Medicine sellers subject to stringent rules on their movement during lockdown, reported some disruptions in tracer medicine stocks and an increase in prices at their suppliers. They adapted, finding new ways to purchase medicines but overall sales of medicines fell.
CONCLUSIONS: The MRS is critical to the distribution of medicines in many countries. This remains the case or can be heightened during health crises. Pandemic preparedness must incorporate strategies to support medicine sellers to ensure ongoing access to commodities during public health emergencies
Household structure in Ghana: Exploring dynamics over three decades
Get PDFBACKGROUND The nuclear convergence hypothesis proposes that development and urbanisation lead to increasing proportions of nuclear families. We explore this hypothesis in Ghana by charting household living arrangements as captured in censuses and surveys. OBJECTIVE To classify household structure in Ghana and track trends to test whether households converge towards nucleation during processes of development and urbanisation. METHODS We employ two methods of classification – manual and data-driven (latent class analysis) – to create household structures using Ghana’s censuses (1984–2021) and Demographic and Health Surveys (1993–2022). We explore trends over time and compare urban and rural areas to track nuclear convergence while documenting the differences and similarities between data sources and methods of classification. RESULTS We find that though the manual and data-driven approaches produce similar results, the latter is vulnerable to possible misclassification. From the manual approach, we identify seven different typologies of household structure in Ghana and find that, on average, a substantial proportion are core nuclear (couple with children only), other extended (non-multigenerational), and single-member households. Overall, we find weak evidence for nuclear convergence. There has not been a significant shift in the average distribution of household types in Ghana, and in urban areas there is a growing proportion of multigenerational extended households, with region-based peculiarities. We also observe that the surveys provide more reliable evidence on trends than the censuses do. CONTRIBUTION There is no strong evidence to support nuclear convergence in Ghana. We make a methodological contribution, highlighting that the use of data-driven methods for household classification needs to be approached with caution
Digital strategies to promote crowdsourcing open calls for co-creating HIV interventions: a youth community-based participatory approach.
Get PDFINTRODUCTION: The HIV epidemic disproportionately affects adolescents and young adults (AYA), yet their engagement in HIV programming remains limited. Digital strategies, such as social media campaigns, engage a diverse range of AYA to co-create HIV interventions, but their effectiveness is less known. This study examines the digital strategies employed to engage AYA (ages 14-24) in the participatory design of HIV research and interventions in Nigeria. METHODS: We employed youth participatory action research (PAR), specifically using a crowdsourcing open call strategy to generate innovative ideas from AYA on how community-based organizations can sustain youth-friendly HIV services for at-risk youth. Crowdsourcing involves a group of people solving a problem and then sharing selected solutions with the public. The open call was held between February and March 2024 as part of the Sustaining Innovative Tools to Expand Youth-Friendly HIV Self-Testing (S-ITEST) study. The open call was promoted on social media platforms and through peer youth ambassadors. Submissions were received via various channels, including Google Forms, WhatsApp, and in-person submissions. Social media engagement metrics and open call submission data were collected and analyzed descriptively using R version 4.4.2. RESULTS AND DISCUSSION: Using social media metrics, the first Instagram post reached 310 people (75% of followers) and generated 43 engagements. The second post reached 272 people (79% of followers) with 29 interactions. The first and second Facebook posts reached 153 and 58 people, respectively, with each post receiving five interactions. We received 123 submissions, with 104 submitted online. Youth in all six geopolitical zones submitted ideas (40 males and 64 females). The mean age of participants was 21.9 (SD =5.35), and most (81%) learned about the open call through digital channels, with WhatsApp (n = 20) being the most common channel. Older youth were more likely to hear about the open call digitally (Mean = 22.5; SD = 5.12) compared to younger participants (Mean = 19.8; SD = 5.87). Building digital communities and opportunities could sustain youth involvement in HIV research. Our findings suggest that digital strategies can complement and optimize in-person engagement to effectively leverage AYA's creativity in co-creating HIV interventions in low-resource settings
Clinical outcomes of participants of a TB prevalence survey with an abnormal chest X-ray but no evidence of TB disease after a median follow-up of 9 months in Zambia and South Africa.
Get PDFWHO recommends computer-aided detection (CAD) in chest X-ray (CXR) for systematic screening of TB. Increased detection of individuals with high CAD score but without bacteriologically confirmed TB can be expected, requiring guidance on their clinical management. We followed participants of a TB prevalence survey (TBPS) in Zambia and South Africa with a high CAD score but no bacteriologically confirmed TB over a median time of 9 months and assessed their clinical outcomes. At the TBPS participants with TB-suggestive symptoms or a CAD score ≥40 submitted two sputum samples for Xpert-Ultra testing, and, an additional sample was collected the next day for liquid culture and Xpert-ultra testing. Participants with a CAD score ≥70 and no bacteriologically confirmed TB were eligible for follow-up. At follow-up visit participants were asked about TB symptoms and treatment, underwent a repeat CXR with CAD, and those with either TB-suggestive symptoms or a CAD score ≥70 at follow-up submitted a sputum sample for Xpert-Ultra testing. A composite "clinical" outcome was defined based on changes in CAD-score and TB-suggestive symptoms between the TBPS and the follow-up. Of the 254 eligible TBPS participants 162 (65%) completed follow-up. Most of the participants self-reported previous TB (65% 105/162), were from Zambia (79%, 128/162,) and male (70%, 97/162). Overall, 43% (70/162) participants progressed clinically/remained radiologically abnormal and 6% (10/162) developed TB between the TBPS and the follow-up, with an overall TB incidence rate of 7% per year (95% CI: 3.8-13.3). Patients with high CAD score but no bacteriological confirmation may have had a past TB or other pulmonary lesions identified in the CXR, which may need to be investigated. Also, these participants may be at risk of progressing to TB over time and could benefit from a follow-up visit and from repeated assessment of symptoms and CXR
Genomic decoding of drug-resistant tuberculosis transmission in Thailand over three decades.
Get PDFThailand has a high burden of tuberculosis, with control efforts hindered by drug-resistant Mycobacterium tuberculosis (Mtb). The increasing use of whole-genome sequencing (WGS) of Mtb offers valuable insights for clinical management and public health surveillance. WGS can be used to profile drug resistance, identify circulating sub-lineages, and trace transmission pathways or outbreaks. We analysed WGS data from 2,005 Mtb isolates collected across Thailand from 1994-2020, including 816 retrieved and 1,189 newly sequenced samples, with most isolates being multidrug-resistant (MDR-TB). Most isolates are lineage two strains (78·3%), primarily the Beijing sub-lineage (L2.2.1). Drug resistance profiling revealed substantial isoniazid and rifampicin resistance, and 67·3% classified as MDR-TB. Phenotypic and genotypic drug susceptibility testing showed high concordance (91·1%). Clustering analysis identified 206 transmission clades (maximum size 288), predominantly with MDR-TB, especially in Central and Northeastern regions. One cluster (n = 22) contains the ddn Gly81Ser mutation, linked to delamanid resistance, with some members pre-dating drug roll-out. In the largest cluster (n = 288), containing isolates spanning two decades, we applied transmission reconstruction methods to estimate a mutation rate of 1·1 × 10-7 substitutions per site per year. Overall, this study demonstrates the value of WGS in uncovering TB transmission and drug resistance, offering key data to inform better control strategies in Thailand and elsewhere
Do neonatal intensive care unit (NICU) health workers know about retinopathy of prematurity (ROP)? A qualitative study at a Regional Referral Hospital in Uganda.
Get PDFINTRODUCTION: Retinopathy of prematurity (ROP) is a significant cause of blindness and visual impairment in preterm infants globally, particularly in low-income and middle-income countries. ROP is associated with prematurity, and with the increase in the survival of preterm infants, its global burden continues to rise. However, there is limited information available on health workers' perspectives regarding ROP in Uganda. METHODS: This qualitative study explored health workers' experiences regarding ROP in the neonatal intensive care unit (NICU) at Hoima Regional Referral Hospital. This study involved in-depth interviews with eight health workers working in the NICU. We examined individual, facility and national factors that could impact the health workers' perspectives on ROP at the hospital. The data obtained were transcribed and coded, and themes were generated for further analysis. RESULTS: We identified key barriers and facilitators to effective ROP care. Four major themes emerged from the analysis: (1) Knowledge and awareness of ROP, (2) Challenges and limitations in implementing the ROP screening programme, (3) Training and guidelines for ROP screening and treatment and (4) Recommendations for ROP prevention screening and management. ROP awareness, knowledge of ROP and witchcraft and ROP were identified as specific subthemes under the knowledge and awareness of ROP theme. DISCUSSION AND CONCLUSION: This study reveals significant gaps in health workers' knowledge and awareness of ROP. Limited access to essential equipment and specialised personnel may further limit ROP screening capacity. We suggest implementing a multidisciplinary team approach, continuous professional development and establishing national ROP guidelines. We recommend developing a formal training structure and syllabus for ROP screening. The training can enhance task shifting among health workers in areas without specialised health workers. Addressing the identified barriers is crucial for improving the care and outcomes for preterm infants in Uganda and similar settings
Genomic epidemiology of enteropathogenic Escherichia coli in southwestern Nigeria.
Get PDFBACKGROUND: Enteropathogenic Escherichia coli (EPEC) are etiological agents of diarrhea. We studied the genetic diversity and virulence factors of EPEC in southwestern Nigeria, where this pathotype is rarely characterized. METHODOLOGY/PRINCIPAL FINDINGS: EPEC isolates (n = 96) recovered from recent southwestern Nigeria diarrhea case-control studies were whole genome-sequenced using Illumina technology. Genomes were assembled using SPAdes and quality was evaluated using QUAST. Virulencefinder, Ectyper, and ResFinder were used to identify virulence genes, serotypes, and resistance genes. Multilocus sequence typing was done by STtyping. Single nucleotide polymorphisms (SNPs) were called out of whole genome alignment using SNP-sites and a phylogenetic tree was constructed using IQtree. Thirty-nine of the 96(40.6%) EPEC isolates were from diarrhea cases diarrhea. Nine isolates from diarrhea patients and four from healthy controls were typical EPEC, harboring bundle-forming pilus (bfp) genes whilst the rest were atypical EPEC. There were 15 EPEC-EAEC hybrids. Atypical serotypes O71:H19 (16, 16.6%), O108:H21 (6, 6.3%), O157:H39 (5, 5.2%), and O165:H9 (4, 4.2%) were the most prevalent; only 8 (8.3%) isolates belonged to classical EPEC serovars. The largest, ST517 clade harbored multiple siderophore and serine protease autotransporter genes and included an O71:H19 subclade <10 SNPs apart, representing a likely outbreak involving 15 children, four with diarrhea. Likely outbreaks, of typical O119:H6(ST28) and atypical O127:H29(ST7798) were additionally identified. CONCLUSION/SIGNIFICANCE: EPEC circulating in southwestern Nigeria are diverse and differ substantially from well-characterized lineages seen previously elsewhere. EPEC carriage and outbreaks could be commonplace but are largely undetected, hence, unreported, and require genomic surveillance for identification
Clinical and psychosocial context of HIV perinatally infected young mothers in Harare, Zimbabwe: A longitudinal mixed-methods study.
Get PDFBACKGROUND: The lives of adolescents and young people living with HIV (LHIV) are dominated by complex psychological and social stressors. These may be more pronounced among those perinatally infected. This longitudinal mixed-methods study describes the clinical and psychosocial challenges faced by HIV perinatally infected young mothers in Harare, Zimbabwe to inform tailored support.
METHODS: HIV perinatally infected young mothers were recruited in 2013 and followed up in 2019. In 2013, they completed a structured interview, clinical examination, psychological screening and had viral load and drug resistance testing. A subset completed in-depth interviews (n = 10). In 2019, they were re-interviewed and had viral load testing. Data were analyzed using STATA 15.0. and thematic analysis.
RESULTS: Nineteen mothers aged 17-24 years were recruited in 2013. Eleven (57.9%) were successfully recontacted in 2019; 3 had died, 2 had relocated and 3 were untraceable. In 2013, all 19 mothers were taking antiretroviral therapy (median duration 8 years, range 2-11 years) and median CD4 count was 524 (IQR 272). In 2013, eight mothers (42.1%) had virological failure (≥1000 copies/ml) (3 of whom subsequently died) and 7 (36.8%) had evidence of drug resistance. In 2019, the proportion with virological failure was 2/11 (18.1%). Six of 11 (54.5%) had switched to second line therapy. In 2013, 64.3% were at risk of common mental disorder and this risk was higher at follow-up (72.7%). Qualitative data highlighted three pertinent themes: HIV status disclosure, adherence experiences and, social and emotional support.
CONCLUSIONS: Findings from this study underscore the significant clinical, social and psychological challenges faced by perinatally infected young mothers. The high rates of virological failure, drug resistant mutations, mental health issues and mortality observed in this population indicate the need for tailored and comprehensive health and support services to assist these young mothers
Community-based mortality surveillance among internally displaced vulnerable populations in Banadir region, Somalia, 2022-2023.
Get PDFSomalia faces a severe humanitarian crisis driven by conflict, drought, and rising food prices, straining its fragile health system. Internally displaced persons (IDPs) suffer high mortality rates, yet data on causes of death remain limited. This study integrates verbal autopsy (VA) with community-based surveillance (CBS) to identify mortality causes in IDP populations. A hybrid retrospective-prospective mortality surveillance study was conducted in 57 IDP camps across Daynile and Kahda districts, Banadir region, from October 2022 to November 2023. Retrospective baseline data from 20,323 individuals were collected in January-February 2023, followed by prospective surveillance rounds in March, April, and May-November 2023. Causes of death were determined using WHO-standardized VA methods. During the retrospective period, Daynile had a CDR of 3.15 per 10,000 person-time, while Kahda's was 1.26. Mortality rates fluctuated, showing significant reductions at certain times. Over the prospective data collection period, the overall CDR was 0.64 per 10,000 person-time. Verbal autopsies revealed that severe malnutrition, respiratory infections, and diarrheal diseases were the leading causes of death. Among children under five, malnutrition, measles, and neonatal pneumonia were the primary causes. Our study highlights the severe impact of malnutrition and infectious diseases on mortality rates among IDPs in Banadir. Continuous surveillance and targeted health interventions are crucial to address the ongoing humanitarian crisis in Somalia. Enhancing training for data collectors and fostering community engagement can improve data accuracy and support timely humanitarian responses
Antimicrobial resistance in community-acquired enteric pathogens among children aged ≤ 10-years in low-and middle-income countries: a systematic review and meta-analysis.
Get PDFINTRODUCTION: Antimicrobial resistance (AMR) is a global health priority. This systematic review summarizes the prevalence of AMR in enteric pathogens originating from the community, specifically among ≤10-year-old children in low-and middle-income countries (LMICs). In addition, it presents the proportions of pooled resistance in Campylobacter spp., Escherichia coli, Shigella spp., and Salmonella spp. (CESS) to clinically relevant antibiotics.
METHODS: Six online repositories, namely PubMed, Medline, Web of Science, Cochrane Library, CABI, and EMBASE were searched for articles published between January 2005 and September 2024. Random-effects meta-analysis models were constructed to estimate the pooled AMR proportions for CESS pathogens, and a subgroup analysis by region was also carried out.
RESULTS: A total of 64 publications from 23 LMICs met our inclusion criteria. The pooled estimates of E. coli AMR for clinically important antibiotics were as follows: sulfamethoxazole/trimethoprim (SXT) 71% [95%CI: 57-82%]; ampicillin (AMP) 56% [95%CI: 44-67%]; ciprofloxacin (CIP) 10% [95%CI: 5-20%]; and ceftriaxone (CRO) 8% [95%CI: 2-31%]. The proportions of AMR detected in Shigella spp. were AMP 76% [95%CI: 60-87%]; nalidixic acid (NA) 9% [95%CI: 2-31%]; CIP 3% [95%CI: 0-15%]; and CRO 2% [95%CI: 0-19%]. The proportions of Salmonella spp. AMR were AMP 55% [95%CI: 35-73%] and SXT 25% [95%CI: 15-38%]. The proportions of Campylobacter spp. AMR were erythromycin (ERY) 33% [95%CI: 12-64%] and CIP 27% [95%CI: 8-61%]. There was high variability in the regional subgroup analysis, with high interstudy and regional heterogeneity I2 ≥ 75%.
CONCLUSION: Our results shed light on drug-resistant enteric bacterial pathogens in young children, providing evidence that CESS pathogens are becoming increasingly resistant to clinically important antimicrobials. Regional differences in resistance patterns between these community isolates highlight the need for strong national and regional surveillance to detect regional variations and inform treatment and appropriate antibiotic stewardship programs. The limitations of our findings include high regional variability, significant interstudy heterogeneity, and underrepresentation of certain LMICs.
SYSTEMATIC REVIEW REGISTRATION: https://inplasy.com/inplasy-2024-2-0051/, registration number: INPLASY202420051