69832 research outputs found
Sort by
The effect of a 5-day course of azithromycin on Streptococcus pneumoniae carriage and antimicrobial resistance among Kenyan children discharged from hospital.
No full textBACKGROUND: Mass azithromycin distribution reduces child mortality in some settings, potentially through reductions in nasopharyngeal carriage of Streptococcus pneumoniae, but has been associated with increased antimicrobial resistance. Individual-level data are lacking on the impact of azithromycin on antimicrobial resistance over time. METHODS: We analyzed data from a double-blind, randomized placebo-controlled trial (ClinicalTrials.gov; NCT02414399) which followed 1,398 hospitalized Kenyan children to evaluate the impact of a 5-day course of oral azithromycin at discharge from hospital on pneumococcal carriage and the proportion of isolates (among a random sample) resistant to azithromycin. Randomization to azithromycin or placebo (1:1) was stratified by enrollment county (Kisii or Homa Bay). Using generalized estimating equations, we calculated prevalence ratios (PRs) and 95% confidence intervals for the intervention, adjusting for enrollment site. RESULTS: Overall, 1,253/1398 (89.6%) enrolled children received antibiotics during their hospitalization. Pneumococcal carriage at discharge was similar among children randomized to the azithromycin group (158/702 [22.5%]) compared to the placebo group (171/696 [24.6%]; p = 0.4) and did not differ at month 3 (65.6% vs 67.0%; PR:0.98[0.90, 1.06]) or month 6 (66.7% vs 66.5%; PR:1.00[0.92, 1.08]). At discharge, 15.7% of isolates were resistant to azithromycin and there was no difference between azithromycin-treated and placebo groups at month 3 (35/266 [13.2%] vs 32/256 [12.5%]; PR:1.06[0.86, 1.66]) or month 6 (41/245 [16.7%] vs 43/243 [17.6%]; PR:1.01[0.69,1.49]). CONCLUSIONS: Azithromycin treatment did not effect pneumococcal carriage or antimicrobial resistance 3- or 6-months post-randomization. High inpatient antibiotic use in this recently discharged population may have reduced any further impact of azithromycin
Exploring understandings and approaches to decolonisation in the field of violence against women and girls: Towards conceptual clarity and actionable strategies for funding, programming and research.
Get PDFDespite recognition that decolonisation is important, there remains a lack of conceptual clarity on what exactly decolonising might involve. Our qualitative study explores how colonialism and decolonisation are conceptualised within the field of violence against women and girls (VAWG), and identifies practical strategies to decolonise funding, programming and research. Our findings draw from 17 semi-structured interviews, eight focus group discussions (FGDs) and five feedback workshops (n = 83) with practitioners, researchers and donors supporting VAWG prevention and response. We identified participants through existing professional networks and used snowball sampling to recruit participants from all world regions. Interviews and FGDs were conducted in English, French, Portuguese and Spanish. We used a reflexive thematic approach for analysis. There was confusion and disagreement about what the term 'decolonisation' means. To address this, VAWG actors must identify the legacy and impact of colonialism for the field, and clarify the roles of Northern and Southern actors in decolonising. Our findings highlight that the area where most work is still needed is around VAWG programming, where coloniality may be embedded into programme design and implementation, requiring more concerted actions to decolonise. Funding was also identified as a key area where structural reform is needed. Research, however, was an area where there appeared to be much higher awareness and action related to decolonising, linked to momentum around dismantling research-based power hierarchies outside of the VAWG field. This research contributes to articulating the main barriers to decolonising and identifies practical actions for funding, programming and research within the VAWG field and beyond
Assessment of a Modified High-Dimensional Propensity Score Approach for UK Electronic Health Record Data: Evaluating Upper Gastrointestinal Safety of NSAIDs and COX-2 Inhibitors.
Get PDFPURPOSE: This study extends a version of the high-dimensional propensity score (HDPS) recently modified for the UK electronic health record setting, by enriching primary care data with hospital data. The performance of this modified approach is assessed via the estimation of a well-established association, the reduced risk of upper gastrointestinal bleeding (UGIB) in cyclo-oxygenase-2 inhibitor (COX-2i) users versus non-steroidal anti-inflammatory drug (NSAID) users. METHODS: We conducted an active-comparator, new-user cohort study using UK primary care data from the Clinical Practice Research Datalink GOLD database, with linkages to hospitalisation and mortality records. We included individuals with osteoarthritis initiating NSAIDs or COX-2is between 2000-2004. We used Cox proportional hazards models to estimate the hazard ratio (HR) for UGIB, adjusting for confounders using investigator-specified and HDPS-derived propensity scores. Sensitivity analyses were conducted varying the number of HDPS covariates included and the covariate assessment period. RESULTS: We identified 74 443 and 25 742 new users of NSAID and COX-2i users, respectively. The unadjusted HR for UGIB comparing COX-2i and NSAID users was 1.28 (95% CI: 0.95-1.72). Of the included HDPS covariates, 26% originated from the hospitalisation dimension, a source not considered in previous applications indicating the considerable information contained in these data on proxies of potential confounders. The modified-HDPS obtained similar results to the other studies, shifting the HR closer to the expected association (HR 0.86; 95% CI: 0.58-1.26). CONCLUSION: We demonstrate the ability of the modified-HDPS to obtain similar results to comparable pharmacoepidemiological studies and randomised trials, highlighting the potential benefit of these approaches in UK EHRs more widely and the value of adding hospital data to enrich the pool of covariates available for the HDPS algorithm
Heterogeneity of malaria transmission in urban settings in Ethiopia: A seroprevalence and risk factor analysis.
No full textMalaria remains a significant public health concern in Ethiopia, affecting both rural and urban populations. In urban settings, rapid unplanned expansion, poor drainage, and population movement are increasingly creating aquatic habitats that support vectors such as Anopheles stephensi, thereby leading to complex and underestimated transmission patterns. Serology-based risk factor analyses offer a sensitive indicator of recent and past exposure, helping to reveal underlying transmission patterns and more tailored interventions. This study assessed malaria seroprevalence and associated risk factors among residents of three towns in Ethiopia: Adama, Metehara, and Awash Sebat Kilo to better characterize transmission dynamics and identify context-specific vulnerabilities. A community-based cross-sectional survey was conducted from January 30 to March 14, 2020, involving 912 individuals from randomly selected 196 households. Malaria infection was diagnosed using rapid diagnostic tests (RDTs) and quantitative polymerase-chain reaction (qPCR). Serological analyses were performed to determine exposure to Plasmodium falciparum and Plasmodium vivax. The study found a low malaria prevalence of 0.78% by RDT and 4% by qPCR, with 1.7% of cases due to P. falciparum and 2.3% due to P. vivax. The overall seroprevalence was 19.4% (149/767) for P. falciparum and 18% (139/767) for P. vivax using combined short-lived response markers. Seroprevalence rates varied among towns, with Awash Sebat Kilo showing the highest exposure for recent markers (36.5% for P. falciparum; 28% for P. vivax) compared to lower rates in Adama (2.8% and 2.8%, respectively). Proximity to breeding sites (OR = 2.8, 95% CI: 1.1-7.4; p = 0.037) and being older than 15 years (OR = 4.0 95% CI: 2.1-7.6; p < 0.001) were significant risk factors for P. falciparum and P. vivax malaria exposure, respectively. This study demonstrates marked heterogeneity in malaria exposure across urban settings, with the lowest seroprevalence observed in Adama and higher levels in Awash Sebat Kilo. The findings emphasize the importance of incorporating serological surveillance into routine monitoring and highlight the need for targeted, locally tailored control strategies. Such tailored approaches will be increasingly critical, particularly in the context of emerging urban transmission risks driven by the expansion of An. stephensi in the region
Greening mitigates heat-related mortality in Paris.
Get PDFCities are vulnerable to heat-related health impacts due to the compounding effects of urban heat island (UHI) and rising temperatures because of climate change. Here we characterise the contextual factors exacerbating and attenuating the risk of mortality associated with high temperature in the city of Paris. Findings suggest that reducing urban heat and mitigating UHI through urban greening should be at the forefront of adaptation strategies to prevent heat-related health impacts in cities
Street space reallocation under austerity: The case of low traffic neighbourhoods in the UK
Get PDFStreet space reallocation measures, such as Low Traffic Neighbourhoods (LTNs), have attracted substantial controversy in the UK and elsewhere, for instance around reported poor engagement with residents and local actors. However, limited attention has been given to the political-economic context shaping scheme implementation, such as the impacts of reduced resources or of the use of short-term, contingent funding. Based on 37 interviews with officers and councillors who implemented or sought to implement LTNs in 12 English local authorities, and part of a larger project investigating the impacts of LTNs in London, this paper addresses this gap. It shows how challenges to design, engagement and delivery of LTNs are often linked to funding scarcity and processes of projectification, advancing the literature on transport governance and controversy
Preparing Communities for Participatory Research: A Brief Report
Get PDFWhile participatory research is increasingly used in global health, more has been written for researchers compared to communities. This article synthesizes insights from a community panel convened during a participatory research workshop. The discussion identified key factors for communities to understand and assumptions to set aside when beginning participatory research. These considerations may help communities navigate power imbalances, inclusively design, and participate as more equal partners in research. Implications for participatory methodology and partnership training are also discussed
Recurrence of HIV-associated cryptococcal meningitis in pregnancy and the post-partum period.
Get PDFWe report a case of recurrent cryptococcal meningitis in a pregnant woman living with vertically acquired HIV. Despite effective treatment of primary infection prior to pregnancy, she later experienced a microbiological relapse of cryptococcal meningitis during pregnancy, and an immune-reconstitution inflammatory syndrome in the post-partum period. This case emphasises the impact of pregnancy related immunological changes on the natural history of complex infections. This case illustrates the challenges of managing opportunistic infections throughout pregnancy and the influence of perinatal immunological changes on disease course
Maternal screening coverage and determinants during facility-based antenatal care in Nigeria: analysis of the 2018 Demographic and Health Survey.
Get PDFBACKGROUND: Antenatal care (ANC) provides an opportunity for early identification and treatment of pregnancy-related conditions to prevent adverse maternal and foetal outcomes. The influence of socioeconomic and health system factors on maternal screening during ANC remains unclear. We evaluated the coverage and determinants of facility-based ANC use and components related to maternal screening for common pregnancy-related conditions in Nigeria.
METHODS: Using data from the 2018 Nigeria Demographic and Health Survey, we estimated the percentage of women aged 15–49 years who reported facility-based ANC for their most recent live birth in the 5 years preceding the survey. Among them, we estimated the percentage who received care components related to maternal screening (blood pressure measured, and urine and blood samples taken) at least once. We used logistic regression to examine the association between household wealth and 1) facility-based ANC utilisation and 2) screening components of care received. Facility type (private or public sector) was considered as an effect modifier.
RESULTS: Among the sample of 21,792 women, 72.8% reported facility-based ANC. Most ANC users reported having had their blood pressure measured (95.2%), and their blood (89.3%) and urine samples taken (88.0%). All three screening components were received by 83.4% of facility-based ANC users. Compared to women from the poorest quintile, the richest had significantly higher adjusted odds of having facility-based ANC (aOR 4.25, 95% CI: 3.23 – 5.59) and, among ANC users, of receiving all three screening components (aOR = 3.43, 95% CI: 2.52 – 4.68). The adjusted odds of receiving all three components were 49% lower among women who used private ANC compared to those who used only public providers (aOR = 0.51, 95% CI: 0.43 – 0.61). There was no evidence of interaction by facility type.
CONCLUSION: Wealth inequality is associated with disparities in the utilisation of facility-based ANC and maternal screening. Socio-economically disadvantaged women, who are most in need of maternal health services, face a ‘double penalty’ of deprived ANC use and maternal screening during ANC. Interventions focused on mitigating these disparities can help improve maternal outcomes. Concerted efforts are required to regulate the private facilities and strengthen the public facilities to provide high-quality maternal healthcare services. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12978-026-02269-1
Comparative assessment of the impact of iron deficiency on HbA1c accuracy in non-anaemic individuals with type 2 diabetes: A secondary data analysis.
Get PDFPURPOSE: Results from a few studies have been conflicting regarding whether iron deficiency affects HbA1c reliability, and the mechanisms by which iron might influence HbA1c are not fully understood. We aimed to compare the relationship between HbA1c and average glucose levels measured by continuous glucose monitoring, retrospectively, in iron-replete and iron-deplete states among non-anemic type 2 diabetes mellitus (T2DM) patients. METHODS: We compared the differences in HbA1c between iron-replete and iron-deplete groups using the Chi-square test for categorical data and the Mann-Whitney U test for continuous data. We also evaluated the correlation between HbA1c and mean plasma glucose for both iron-replete and iron-deplete individuals using Pearson's correlation and linear regression. RESULTS: A total of 146 of the 213 participants screened had complete data and were included in the final analysis. 43 out of 146 (29.5%) had iron deficiency, and 103 were iron-replete. No significant difference was observed in HbA1c levels between iron-replete and iron-deplete individuals: 69 (51.0, 85.0) vs 62 (46.0, 83.0) mmol/mol, P = 0.291). There was a strong positive correlation between HbA1c and mean plasma glucose concentration for both iron-replete and iron-deplete individuals (Pearson Correlation coefficient: 0.88 (0.83-0.92) and 0.93 (0.88-0.98), respectively). CONCLUSIONS: HbA1c correlates well with mean blood glucose even in the iron-deplete state amongst non-anaemic T2DM individuals. However, larger studies are needed to confirm these findings, particularly at screening and diagnostic thresholds