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Association between congenital Zika syndrome and hospitalizations during early childhood: a nationwide cohort study.
Get PDFOBJECTIVES: Congenital Zika Syndrome (CZS) has been linked to a wide spectrum of abnormalities. However, differences in hospitalization patterns between children with and without CZS have not yet been investigated. METHODS: We compared rates of hospital admissions for all and specific diseases, proportions of admission causes, and total length of hospital stay (LOS) between children with CZS and those without the syndrome. Adjusted incidence rate ratios (aIRR) and aLOS were estimated using negative binomial regression. RESULTS: Compared to those without CZS, the aIRR for all-cause hospitalizations in the CZS group ranged from 3.77 (95%CI: 3.47-4.06) in the neonatal period to 7.76 (95%CI: 6.91-8.61) at ages 2-4 years. Similar trends were observed for specific causes of admissions. Most admissions in the CZS group related to congenital malformations, neurological, respiratory and infectious diseases. aLOS ranged from 16.0 days [95%CI: 13.2-19.5] to 19.9 days among CZS patients and 6.0 days [95%CI: 5.9-6.2] to 9.3 days [95%CI: 9.3-9.4] for patients without the syndrome. CONCLUSION: Children born with CZS face significantly higher rates of hospitalization and longer stays compared to those without the syndrome during early childhood
Abortion and well-being: A narrative literature review
Get PDF“Well-being” is utilised in multiple ways – an everyday word, a component of health, a policy objective, reflecting a diverse set of shifting meanings, conceptualisations, definitions, measurements, and theorising. Influenced by structural and social conditions, well-being can be enhanced or diminished and is experienced at a range of scales (individual, community, society). Globally, abortion is a common practice with implications for well-being. However, the intersections and linkages between abortion and well-being have not yet been explicitly synthesised. To extend understandings, theorising, and measurements, we conducted a systematically searched narrative literature review of evidence pertaining to abortion and well-being. We used a grounded theory-driven approach to theoretically sample items until concept (abortion and well-being) saturation was reached, meaning our study was guided by the literature, rather than imposing an external set of theories. Our database searches (January 01, 2005–June 19, 2023) identified 7665 unique records yielding 753 records for the review, from which n = 167 items were selected for extraction. Our analysis of extracted items yielded four main themes. First, only a minority (13/167) of studies explicitly engaged with well-being. Second, the majority of studies incorporated well-being-allied concepts, without explicitly framing their research as about well-being. We developed insights from these studies using four sub-themes: social connectedness, individual agency, mental health, and physical health. Third, there is limited use of theory and/or frameworks in the empirical evidence. Last, we interrogated the empirical research on abortion and well-being over the life course. Well-being and allied concepts can be useful and productive analytic framings with relevance for research on abortion. We invite readers to consider how these concepts might be used to develop and iterate innovation – methodologically, empirically, and theoretically – to clarify, extend and deepen links between abortion and well-being
How has the concept of health system software been used in health policy and systems research? A scoping review.
Get PDFUnderstanding health systems as comprising interacting elements of hardware and software acknowledges health systems as complex adaptive systems (CASs). Hardware represents the concrete components of systems, whereas software represents the elements that influence actions and underpin relationships, such as processes, values, and norms. As a specific call for research on health system software was made in 2011, we conducted a qualitative scoping review considering how and for what purpose the concept has been used since then. Our overall purpose was to synthesize current knowledge and generate lessons about how to deepen research on, and understanding of, health system software. The review consisted of two phases: first, for the period 2011-23, all papers that explicitly used the concept of health system software were identified and mapped; second, drawing on a subset of papers from Phase 1, we explored how the concept was purposively used within research. The databases PubMed, Scopus, EBSCOhost, Web of Science, and Google Scholar were systematically searched using a strategy developed by a skilled librarian. In Phase 1, data were extracted from 98 papers. Our analysis revealed that a third of the papers used the software concept rather superficially; a third used it to conceptualize the importance of selected software elements; and a third used it in examining a specific health system experience, such as preparedness or resilience. In Phase 2, our analysis confirmed that researchers have found value in proactively using the software concept within studies, demonstrating two patterns of use. However, a limited understanding of how to investigate interactions among hardware and software elements was also revealed. Future health policy and systems research should purposively investigate hardware-software interactions in order to gain a greater understanding of the complex, adaptive nature of health systems, understand their operations, and institutionalize thinking that considers health systems as CASs
Short-term effect of temperature and precipitation on the incidence of West Nile Neuroinvasive Disease in Europe: a multi-country case-crossover analysis.
Get PDFBACKGROUND: In recent years, Europe has experienced several outbreaks of West Nile Virus (WNV), a mosquito-borne pathogen. This study aims to quantify the impact of weekly mean temperature and cumulative precipitation on human cases of West Nile Neuroinvasive Disease (WNND), to assess the feasibility of climate-informed early warning systems for severe forms of WNV infection. METHODS: Using a space-time-stratified case-crossover design, the short-term effects of meteorological factors on WNND cases reported in Europe from 2014 to 2022 were examined. Distributed lag nonlinear models were implemented in conditional logistic regressions to assess the delayed and nonlinear effects of temperature and precipitation on WNND risk as well as to estimate the Attributable Fraction (AF) of cases to extreme values of the two meteorological factors. FINDINGS: Between 2014 and 2022, Europe reported 3437 WNND cases. Both meteorological factors recorded in the 8 weeks before symptom onset showed positive and delayed effects on WNND risk. The strongest effect was found for weekly mean temperatures at 2 weeks lag (Odds Ratio (OR): 1.15; 95% Confidence Interval (CI) 1.12-1.19) and for weekly cumulative precipitation at 3 weeks lag (OR: 1.12; 95% CI 1.09-1.16). Of all WNND cases analyzed, 36.4% (95% CI, 31.3%-40.3%) could be attributed to weekly mean temperatures exceeding the 25 °C, while 13.1% (95% CI, 9.5%-16.4%) to weekly cumulative precipitations exceeding 40 mm. INTERPRETATION: These findings emphasize the significance of short-term variations in temperature and precipitation in driving WNND incidence in Europe. Meteorological factors can be used to operationalize early warning systems to reduce the disease burden from WNV infections, which are continually increasing across the continent. FUNDING: European Union's Horizon Europe research and innovation programme
Disability Inclusive Youth (DIY) Research: an innovative and co-creative study to improve inclusion of children and youth with disabilities in health research in East Africa: a mixed-method study protocol. [version 2; peer review: 2 approved, 1 approved with reservations]
Get PDFYoung people with disabilities are rarely included in research, yet 75% of the East African population is under 30 years old and an estimated 15% have a disability. Without including young persons with disabilities in designing and implementing health research, we will not achieve global development goals. The aim of Disability Inclusive Youth (DIY) study is to explore barriers and facilitators to inclusion of children and youth with disabilities in health research, co-create solutions to make health research in East Africa disability inclusive, and create a disability knowledge and research centre to inform and support inclusive health research in the region. The DIY study will develop a novel participatory approach to enhance the inclusion of children and youth with disabilities in health research in East Africa. We will build capacity of 12 youth with disabilities from Uganda, Kenya, and Rwanda through a research training programme. The youth researchers will conduct interviews with 75 leading health researchers, 30 key health stakeholders, and 60 children and youth with disabilities and their caregivers. Together with the youth we will design recommendations to make health research more inclusive of children and youth with disabilities through participatory workshops. At the end of the study we will have established a regional knowledge and research centre where children and youth with disabilities contribute to and health researchers consult about disability inclusive health research. Data collection methods include survey questionnaires, in-depth interviews, case studies, video and photovoice. Data will be analysed qualitatively using a thematic approach in NVIVO and quantitatively using STATA. This is a 5 year study funded by Wellcome, through the London School of Hygiene and Tropical Medicine, in partnership with the MRC/UVRI & LSHTM Uganda Research Unit, the University of Nairobi and the University of Rwanda / Lifetime Research Group
Developing an intervention to improve early infant HIV diagnosis service uptake among postpartum women in Malawi's primary healthcare using a co-designing approach with stakeholders.
Get PDFLow health service use by women and infants after birth limits early infant HIV diagnosis (EID). From August 2021 to December 2022, we collaborated with 44 healthcare workers (HCW), service users, and non-governmental organisation stakeholders from seven public facilities and five non-governmental organisations in Blantyre, building on a previous study. We analysed context-specific problems in EID services and co-designed a context-appropriate enhanced health system intervention to improve the uptake of six weeks' EID services in primary health facilities in Blantyre, Malawi, using qualitative methods and co-designing workshops. The Behaviour Change Wheel, Theoretical Domain Framework and Consolidated Framework for sustainability constructs in healthcare guided the workshops. Reflexive thematic analysis of the data showed that stakeholders found that EID services were sub-optimal and identified challenges to service provision in 5 key areas: (1) client identification, (2) context-appropriate client-centred service integration, (3) HCW coordination and accountability, (4) HCW capacity building for optimal service delivery, and (5) intervention sustainability. Specifically, client and HCW stigma perceptions, referral gaps, resource challenges, HCW lack of time and poor documentation affected client identification; HCW clustered work shifts to extend off-duty periods, failure to synchronise client appointments, and lack of resources were barriers to client-centred integrated services; dysfunctional teams, minimal supervision and misconduct among HCW impacted coordination and accountability; and lack of information sharing and limited training reduced HCW capacity for service delivery. Context-appropriate stakeholder informed co-design initiatives to address identified challenges included: clients' unique identifiers, booking systems, strengthening leadership, data validation, care pathways, and facility-based training. We recommend evaluating these initiatives in low resource settings as they have potential to address the identified EID service implementation gaps and significantly improve the EID of HIV in contexts of greatest need
Temporal trends of SARS-CoV-2 exposure in adolescents: a longitudinal pilot study nested in a Uganda birth cohort.
Get PDFBackground COVID-19 remains a significant global public health concern, contributing to hospitalization and Intensive Care Unit (ICU) admissions. However, SARS-CoV-2 exposure in adolescents remains poorly understood. The study aimed to analyse temporal trends in SARS-CoV-2 seropositivity in Ugandan adolescents using pre-pandemic (2014–2016) and pandemic-era samples (2020–2022). Methods We analysed stored blood samples from a subset of participants enrolled in the Entebbe Mother and Baby Study (EMaBS), a long-standing Ugandan birth cohort established in 2003 as a randomized trial (ISRCTN32849447). Samples were drawn from three studies: pre-pandemic samples (2014–2016) collected during a blood pressure study; pandemic-era samples collected during the POPVAC C trial (2020–2021), which evaluated the impact of BCG revaccination on vaccine responses; and samples from the CoHost study (2021–2022), a 12-month longitudinal follow-up assessing SARS-CoV-2 infection and exposure. Blood samples were collected at multiple study timepoints. SARS-CoV-2 IgG spike antibodies were measured using an in-house enzyme-linked immunosorbent assay (ELISA). Results None of the 47 participants were seropositive for SARS-CoV-2 in pre-pandemic samples (2014–2016). In pandemic-era samples (2020–2022), seropositivity increased over time. At POPVAC C screening, 2 (4%) participants were seropositive, increasing to 3 (6%) at week 4, 5 (11%) at week 8, and 36 (77%) at week 52, which also served as the CoHost baseline. At the CoHost 6-month timepoint, 40 (85%) of participants were seropositive, increasing to 45 (96%) at 12 months timepoint. SARS-CoV-2 seropositivity progressively increased, with a marked rise during the Delta wave (May‒July 2021) and peaking in the Omicron wave (November 2021 - February 2022). Conclusions Our findings indicate increased SARS-CoV-2 exposure among adolescents during later pandemic waves, likely driven by the emergence of highly transmissible variants and changes in public health measures. These preliminary findings highlight the need for age-specific mitigation strategies.</ns3:p
Rift Valley fever virus and Coxiella burnetii infections among febrile patients, Eastern Ethiopia.
Get PDFBACKGROUND: Rift Valley fever (RVF) virus and Coxiella burnetii infections are significant public health concerns in East Africa, causing recurring outbreaks. However, the prevalence of these pathogens among febrile patients in Ethiopia remains unknown. This study aimed to determine the prevalence and associated factors of these infections among febrile patients.
METHODS: A multisite cross-sectional study was conducted among 415 randomly selected adult febrile patients from health facilities in Shinile and Dire Dawa, Ethiopia, between March 01, 2023, and February 28, 2024. Serum samples were tested for the presence of antibodies against RVF virus and C. burnetii infections using various Enzyme Linked Immunosorbent Assays. Polymerase Chain Reaction (PCR) was used to detect RVF virus RNA and C. burnetii DNA in blood samples. A multivariable logistic regression model was used to identify predictive factors. A p value <0.05 was considered statistically significant.
RESULTS: Of the 402 serum samples analyzed, 21 (5.2%) tested positive for immunoglobulin G (IgG) antibodies against RVF virus, and 86 (21.4%) tested positive for C. burnetii Phase I and Phase II antibodies. No RVF virus IgM was detected. Among the C. burnetii antibodies positive sera, 6 (7.0%) were positive for Phase II IgG antibodies. No blood samples tested positive for RVF virus RNA or C. burnetii DNA. Febrile patients aged ≥35 years had significantly higher odds of RVF virus exposure (AOR: 3.1, 95% CI: 1.3-7.8). Females (AOR: 1.7, 95% CI: 1.1-2.9), rural residents (AOR: 2.4, 95% CI: 1.3-4.5), and febrile patients who disposed of dead animals (AOR: 2.6, 95% CI: 1.2-5.6) exhibited significantly higher odds of C. burnetii infection.
CONCLUSIONS: This study reveals significant but underrecognized exposure to RVF virus (5.2%) and C. burnetii (21.4%) infections among febrile patients. Risk factors for RVF included older age, whereas C. burnetii infection was associated with females, rural residents, and exposure to dead animals. Health authorities are advised to consider these infections in the differential diagnosis of fever, implement active surveillance, and target public health interventions
The contaminated blood scandal in England: exploring the social harms experienced by infected and affected individuals.
Get PDFDuring the 1970s and 1980s, over 30,000 people in the UK were infected with HIV and/or hepatitis C because of treatment with blood and blood products for conditions such as haemophilia or through blood transfusion. We used the social harms perspective to understand the experiences of those affected. We conducted in-depth interviews with 41 infected people and 11 family members and analysed the data according to five dimensions of social harm: physical harms, psychological harms, cultural harms, economic harms, and harms of misrecognition. We found that people were harmed by the medical system, the social context that perpetuated stigma and shame against them, and successive governments being largely unwilling to address the many health, social, and economic impacts of infection on families. What stood out were the many reports of harms of misrecognition, which were often experienced as more irreconcilable than the circumstances of infection itself. They were also harms that have been largely ignored.While patient safety encompasses a broad field of work, much of the research focuses on physical harm and medical error. The social harms lens can provide important insights into patient safety incidents as it can help explain the complexity of the different dimensions of harm that individuals and their families experience
Acceptability and effectiveness of a study information video in improving the research consent process for youth: a non-inferiority trial.
Get PDFINTRODUCTION: Obtaining informed consent for research includes the use of information sheets, which are often long and may be difficult for participants to understand. We conducted a trial to investigate whether consent procedures using a study information video coupled with electronic consent were non-inferior to standard consent procedures using participant information sheets (PIS) among youth aged 18-24 years in Zimbabwe. METHODS: The trial was nested within an endline population-based survey for a cluster-randomised trial from October 2021 to June 2022. Randomisation of participants to video or paper-based consent was at household level. We assessed non-inferiority in comprehension of the study using a questionnaire. The video method was accepted as non-inferior to standard consent procedures if the 95% CIs of the mean difference did not fall below the prespecified margin of 1.98. Thematic analysis was conducted on brief qualitative discussions with randomly selected youth to explore the acceptability of video and PIS within consent methods. RESULTS: Overall, 921 participants were enrolled (54% female). The median age was 20 (IQR 18-24) years. The mean comprehension score was 25.4/30 in both arms. The mean difference in comprehension between arms was -0.02 (95% CI -0.51 to 0.47) showing non-inferiority of the intervention in comprehension of study information. Youth (N=90) described both consent methods as interactive and inclusive. Those in the video consent arm felt it was exciting and youth focused. The use of imagery to explain procedures strengthened the perceived trustworthiness of the research. However, the high volume of information in both arms reduced acceptability. CONCLUSION: Comprehension of study information using an information video is non-inferior to a paper-based consent method. Using information videos for consent processes shows promise as a person-centred and context-sensitive approach to enhance the informed consent process and should be encouraged by ethics committees