69832 research outputs found
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The waning of maternal measles antibodies: A multi-country maternal-infant seroprevalence study.
Get PDFOBJECTIVES: To assess geographical variation in maternal measles antibody levels from birth to nine months of age, to inform recommendations for the timing of the first measles vaccine dose. METHODS: Stored infant serum samples from 11 countries taken at delivery and/or follow-up time points prior to measles vaccination (N=2845) were tested for measles plaque reduction neutralisation (PRNT) and measles, mumps, and rubella immunoglobulin G at a central laboratory. Antibody decay in infants was modelled using linear mixed effects models with participant-level random intercepts and random slopes. Proportions of infants with antibody concentrations above the clinical protection threshold (0.12 IU/mL) were estimated at each age. RESULTS: At birth, most (94%, 519/552) infants had PRNT ≥0.12 IU/mL, but geometric mean concentrations ranged from 0.32 IU/mL (Guatemala) to 1.60 IU/mL (Pakistan). There was no geographical variation in the decay rate of PRNT nor immunoglobulin G. Geometric mean PRNT fell below 0.12 IU/mL between ages 2.5 months (Guatemala) and 6.2 months (Pakistan). At age 6 months, <50% of infants had PRNT ≥0.12 IU/mL in all countries except Pakistan. CONCLUSIONS: Reliance on maternal antibodies for protection until age 9 months or later leaves most infants with insufficient direct protection against measles infection between ages 6-9 months
The mediating effect of maternal blood lipids on the association between maternal exposure to PM2.5 and birth weight: a retrospective birth cohort study in Zhejiang, China.
Get PDFBACKGROUND: Maternal PM2.5 exposure and lipid levels during pregnancy were independently detected associated with birth weight. Potential mediating factors still remain unclear. METHODS: This study aimed to examine the association of maternal PM2.5 exposure and birth weight, and explore the potential mediation effect of maternal blood lipids in the relationship between PM2.5 exposure and birth weight. 5,162 pregnant women from Zhejiang, China were included in the study during 2013-2014. We measured blood lipids for each participant in the second and third trimesters. Air pollution exposure in residential districts was estimated based on satellite data for each individual throughout three trimesters in pregnancy. Linear mixed-effects models were employed to examine associations between PM2.5 and birth weight. Using a mediation analysis approach, we decomposed the total effect of PM2.5 on birth weight into natural direct and indirect effects via blood lipid concentration. RESULTS: After adjusting for covariates, a 10 µg/m3 increment in PM2.5 during the second trimester was directly associated with an 11.65 g increase in birth weight (95% CI: 2.99, 20.31 g). The indirect effects of PM2.5 exposure (each 10 µg/m3 increase) on birth weight, mediated through elevated maternal lipid levels, were - 2.35 g (95% CI: -4.07, -0.63 g) for total cholesterol to high-density lipoprotein cholesterol ratio (TC: HDL ratio), -0.69 g (95% CI: -1.16, -0.22 g) for Triglycerides (TG), and - 1.80 g (95% CI: -3.19, -0.41 g) for HDL-C, during the second trimester. CONCLUSIONS: Findings suggest prenatal PM2.5 exposure may impact term birth weight via direct biological effects and lipid-mediated pathways, underscoring the importance of incorporating air pollution mitigation into perinatal care and advancing biomarker-driven fetal monitoring. Future research should clarify PM2.5 component-specific effects, decode placental-fetal lipid regulatory mechanisms, and validate pollution-metabolism-outcome relationships through multi-regional cohorts to inform precision environmental health interventions and clinical risk management
Exploring gender stereotypes and norms among peri-urban very young adolescents in Zimbabwe using participatory and qualitative approaches.
Get PDFGender stereotypes and norms shape very young adolescents' (VYAs, 10-14 years old) behaviours, including in relation to sexual and reproductive health (SRH). This formative study sought to determine and prioritise the stereotypes and norms to be targeted as part of work to co-develop a gender-transformative intervention for VYAs in Zimbabwe to promote positive masculinities and SRH. In 2023, we collected data from VYAs, using participatory workshops encompassing various activities. We also held focus group discussions with older adolescents and parents/guardians, and individual interviews with community influencers. We used interpretive thematic analysis to generate themes across data. We later presented research findings to diverse stakeholders to explore how the findings might influence the design of our gender-transformative intervention. Gender stereotypes emerged in relation to sexual behaviour and SRH norms. Both boys and girls seemed to condone boys' multiple, concurrent relationships. Boys were deemed to be unable to control their sexual urges. Menstrual stigma, myths and misconceptions were pervasive. Stereotypes were also evident in beliefs and norms around resource and task allocation. For example, both boys and girls concurred that given limited resources, educating a boy child should be prioritised even when a girl sibling is performing better academically. Stereotypes relating to labour distribution were also evident. Daily activity charts suggested longer working hours for girls. Differential attitudes towards drug and substance use among boys and girls were driven by underlying masculine norms. Of note, adolescents disapproved of some of these norms, pointing to an opportunity to shift them. Stakeholders highlighted the need for our planned intervention to focus on the wider community, in addition to VYAs themselves. The formative research enabled us to identify key gender stereotypes and norms, information which is critical for informing the planned gender-transformative intervention. Although deeply seated, these stereotypes are not insurmountable, particularly among VYAs
Assessing the impact of Covid-19 on nurturing care in nairobi slums: Findings from 5 rounds of cross-sectional telephone surveys.
Get PDFThe Covid-19 pandemic and mitigation measures had widespread societal impacts. Young children are particularly vulnerable yet the ways the pandemic affected children in informal settlements (slums) are not well described. This study aimed to investigate the impacts of the pandemic on early childhood in three Nairobi informal settlements. Five rounds of cross-sectional computer assisted telephone surveys (with 578-774 respondents in each) in three settlements (Kibera; Mukuru-Viwandani; Kawangware) over 13 months, correlating with different phases Covid-19 restrictions. Impact was assessed through comparing changes in summary statistics on responses to survey questions on each domain of Nurturing Care over time. Survey results found significant disruptions in healthcare services, particularly in early rounds with missed vaccinations (reported by 1 in 5 parents of infants) and therapeutic healthcare seeking (missed by up to 21% of families). Persistent food and nutrition insecurity, with a large majority of families struggling to feed their children (72% in Round 1) due to financial constraints. Economic shocks were near-universal; 99.7% of respondents reporting earning less since the start of the pandemic. Use of paid childcare initially plummeted but showed a resurgence over time (up to 21% by Round 5) as pandemic control measures evolved. Young children were commonly left alone in all rounds, but especially earlier ones; underscoring the enduring challenges in providing nurturing care in these settings. Very few (<2%) of study participants reported direct experience of illness from Covid-19 in their family in any round. In conclusion, despite adaptations over time and the decrease in reported disruptions, prolonged economic shock was associated with multiple adverse effects on Nurturing Care. The study's longitudinal scope provides insights into the dynamic nature of ensuring young children in slums thrive during crises, highlighting the need for interventions and policies that address the compounded vulnerabilities of young children in these communities
Sexual dysfunction care needs of gay, bisexual, and other men who have sex with men living with HIV in Montreal, Canada.
Get PDFOBJECTIVES: Sexual dysfunction (SD) is common among gay, bisexual and other men who have sex with men (GBM) with HIV, yet little is known about their views on SD care. We explored these views to inform patient-centred SD care to improve care delivery and sexual health outcomes. METHODS: Semi-structured interviews were conducted in 2024 with 31 Montreal-based GBM with HIV who experienced SD in the last 5 years (reduced libido, erectile dysfunction, premature/delayed ejaculation and/or pain during sex), covering SD care experiences and preferences. Thematic analysis was applied to interview transcripts. RESULTS: Participants mostly reported reduced libido (83.9%) and erectile dysfunction (ED(80.6%), with over half (58.0%) experiencing multiple SDs concurrently. Themes regarding SD care experiences were (1) costs and benefits of ED medication, (2) limited benefits of testosterone replacement therapy, (3) mixed views on talk therapy (and a preference for group therapy), and (4) not seeking care due to questions of SD definition and normalcy. SD care preferences concerned both provider characteristics (identity, approach to patients and expertise) and care delivery (information provision, involvement and respect and access to diverse resources). CONCLUSIONS: Irrespective of the approach to SD care sought (medication or talk therapy), participants experienced limited success. For some, doubts about the severity of their SD impeded help-seeking. SD care preferences for the provider (e.g., expertise) and care provided (e.g., information, patient involvement) offer paths to more patient-centred care
Climate change, disability, and water, sanitation and hygiene: A scoping review of evidence and interventions in low and middle-income countries.
Get PDFClimate hazards, including extreme weather events, undermine essential water, sanitation and hygiene (WASH) services, exacerbating health disparities in people with disabilities. Despite this, WASH policies and adaptation strategies often overlook the need for disability inclusive measures. The scoping review objectives are to 1) map the evidence on how climate risks affect WASH services and coping strategies in low-and middle-income countries, with a particular focus on people with disabilities; and 2) assess evidence for the effectiveness of climate-resilient WASH interventions, emphasising their impact on people with disabilities. Our review identified substantial data on women and girls, so the results reflect binary gender considerations. A systematic search of nine databases, including CINAHL Complete, Global Health, GreenFILE, and MEDLINE via PubMed, was conducted to identify peer-reviewed and grey literature using relevant keywords related to extreme weather and climate hazards, WASH (including menstrual health), disability, and evaluations. We included studies in English, published between January 1, 2000 and December 31, 2023. Data were extracted and analysed thematically. Twenty-two studies met the inclusion criteria. Only two papers evaluated climate-resilient WASH interventions (rainwater harvesting), and neither considered disability. Most papers examined people's self-reported health impacts and experiences affected by drought-related water insecurity or WASH infrastructure damage due to extreme weather events. Data on the experiences of persons with disabilities were only included in two papers. They highlighted that persons with disabilities are disproportionately disadvantaged by climate-related damage to WASH infrastructure and emphasised the importance of social capital and social networks in supporting them when access to water is limited. Extreme weather events disrupt WASH services, yet evidence of the experiences and coping strategies of persons with disabilities remains extremely limited. This is a barrier to developing disability inclusive adaptation strategies. Evaluating climate-resilient WASH interventions is essential to enhance resilience and health equity for persons with disabilities
The Definition Dilemma: How Definitions of Disability Shape Statistics on Social Participation
Get PDFTo monitor progress in including persons with disabilities, including in interventions which can improve their health and quality of life, it is crucial to collect data on their participation. However, there are many different ways of defining disability and thus categorising individuals as disabled/not disabled, which may impact measures of participation. This study aims to assess the relationship between three different measures of disability and the level of participation of persons with disabilities. We analysed data from a population-based survey of disability amongst Syrian refugees in Istanbul, which collected data on disability using the Washington Group enhanced set of disability questions as well a two-question set asking about perceived activity limitations due to disability. The prevalence of disability ranged from 13.5 to 22.4% depending on the measure used. The group of people that are categorised as disabled also differs, indicating who is being seen as disabled changes when a different measure is used. Levels of participation, with regards to paid work, education and being partnered, also varied by measure, for example, being in paid work ranged from 26% to 38%. These findings underscore the importance of carefully selecting and clearly defining disability measures in studies, (health) interventions and policy contexts
Levels of Homonegative Abuse Among Men Who Have Sex with Men in Peru and Their Association with STI and/or HIV Testing: An Analysis from the Latin American Men Internet Survey
Get PDFObjectives: To examine the prevalence and geographic distribution of homonegative abuse (HA) among men who have sex with men (MSM) in Peru and its association with HIV/STI testing.
Method: We analyzed data from 1,934 MSM from Peru who participated in the 2018 Latin American Men Internet Survey (LAMIS). We assessed the prevalence and geographic distribution of HA (intimidation, verbal abuse, and physical violence due to sexual orientation) across four macro-regions: Lima/Callao, Coast, Highlands, and Amazonia. Associations with sociodemographic characteristics and HIV/STI testing behavior were explored through comparative analyses, using prevalence ratios adjusted for key sociodemographic variables.
Results: Approximately 61% of participants reported HA in the previous year. Intimidation (56%) was the most common, followed by verbal abuse (34%) and physical violence (4%). HA was more prevalent in the Coast (67%) and Highlands (66%) than in Lima/Callao (59%). Factors positively associated with recent HA included younger age, financial hardship, lower education, gay identity, and high levels of outness. No significant association was found between HA and HIV/STI testing.
Conclusions: HA is prevalent among Peruvian MSM, especially outside the capital macro-region (Lima/Callao). These findings highlight the need for further research to investigate whether specific sources of HA may be linked to reduced use of sexual healthcare services among MSM in Peru and support targeted interventions addressing the sociocultural contexts that perpetuate abuse against MSM in Peru
School Meals Case Study: Ecuador [Estudio de caso sobre alimentación escolar: Ecuador].
Get PDFEste estudio de caso sobre los programas de alimentación escolar forma parte de una colección liderada por la Comunidad de Práctica "Buenos Ejemplos" del Consorcio de Investigación para la Salud y la Nutrición Escolar. El estudio de caso sobre la alimentación escolar en Ecuador tiene como propósito documentar la organización, financiamiento y monitoreo del programa nacional de alimentación escolar en todo el país. Los objetivos de este estudio de caso incluyen presentar una introducción al perfil del país, describir el diseño e implementación de los programas de alimentación escolar, detallar sus procesos de monitoreo y evaluación, y resaltar lecciones aprendidas, buenas prácticas y desafíos. Este estudio de caso se presenta como un documento de trabajo y puede actualizarse para reflejar cambios y circunstancias en evolución. La Comunidad de Práctica "Buenos Ejemplos" apoya la generación de evidencia dentro del Consorcio de Investigación para la Salud y la Nutrición Escolar, que es el brazo de generación de evidencia de la Coalición para la Alimentación Escolar. El objetivo del Consorcio de Investigación es llevar a cabo estudios independientes en diversos sectores y generar evidencia sólida, convincente y aplicable sobre los beneficios de los programas de alimentación escolar, con el fin de respaldar la toma de decisiones basada en evidencia en políticas y prácticas de salud y nutrición escolar.
This school meals case study forms part of a collection led by the Research Consortium for School Health and Nutrition’s "Good Examples" Community of Practice. The School Meals Case Study of Ecuador serves to document how the national school meals programme is organized, funded, and monitored throughout the country. The objectives of this case study include presenting an introduction to the country profile, outlining the design and implementation of school feeding programmes, describing their monitoring and evaluation processes, and highlighting lessons learned, best practices, and challenges. This case study is written as a working paper, and can be updated to reflect evolving circumstances. The ‘Good Examples’ Community of Practice supports the evidence generation of the Research Consortium for School Health and Nutrition, the evidence-generating arm of the School Meals Coalition. The Research Consortium’s objective is to carry out independent research across diverse sectors and generate solid, compelling, and actionable evidence regarding the benefits of school food programs to inform evidence-based decision-making on school health and nutrition policies and practices
Case-only analysis of routine surveillance data: detection of increased vaccine breakthrough infections with SARS-CoV-2 variants in Europe
Get PDFAbstract
With the ongoing emergence of SARS-CoV-2 variants, there is a need for standard approaches to characterize the risk of vaccine breakthrough. We aimed to estimate the association between variant and vaccination status in case-only surveillance data. Included cases were symptomatic adult laboratory-confirmed COVID-19 cases, with onset between January 2021 and April 2022, reported by five European countries (Estonia, Ireland, Luxembourg, Poland, and Slovakia) to The European Surveillance System. Associations between variant and vaccination status were estimated using conditional logistic regression, within strata of country and calendar date, and adjusting for age and sex. We included 80,143 cases including 20,244 Alpha (B.1.1.7), 152 Beta (B.1.351), 39,900 Delta (B.1.617.2), 361 Gamma (P.1), 10,014 Omicron BA.1, and 9,472 Omicron BA.2. Partially vaccinated cases were more likely than unvaccinated cases to be Beta than Alpha (adjusted odds ratio [aOR] 2.48, 95% CI 1.29–4.74), and Delta than Alpha (aOR 1.75, 1.31–2.34). Fully vaccinated cases were relative to unvaccinated cases more frequently Beta than Alpha (aOR 4.61, 1.89–11.21), Delta than Alpha (aOR 2.30, 1.55–3.39), and Omicron BA.1 than Delta (aOR 1.91, 1.60–2.28). We found signals of increased breakthrough infections for Delta and Beta relative to Alpha, and Omicron BA.1 relative to Delta