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"I know your problems; take your bag and go home": a qualitative study using the social-ecological model to understand drivers of suboptimal school and social participation among secondary schoolgirls in Northwest Tanzania.
Get PDFBACKGROUND: School attendance and completion among girls protect them from multiple sexual and reproductive health problems. However, inadequate resources for managing menstruation remains a barrier to school participation and learning in low- and middle-income countries. With the increased global focus on closing the gender gap in education, schoolgirls' voices are important in understanding drivers of suboptimal social and school participation during menstruation. This paper explores how menstruation influences social and school participation from the perspectives of schoolgirls. METHODS: We conducted 40 in-depth interviews with purposively-selected secondary schoolgirls aged 13-20 years in two rural and two urban schools in Northern Tanzania from 2021 to 2022. To be eligible for participation, the schoolgirls must have reported missing school during their last menstruation. We used an in-depth interview guide to elicit girls' menstrual experiences and how such experience influenced their school and social participation. We used NVivo 12 software to code data and employed thematic analysis using the social-ecological model. RESULTS: The respondents described the drivers of suboptimal social and school participation at the individual level (negative menstrual experience, i.e. menstrual pain and constant worries of menstrual blood leaking, and individual economic constraints); interpersonal level (the fear of menstrual status disclosure, and peer's attitude); school level (inadequate emergency pad at school, lack of private place to change, and unhygienic school WASH); and societal level socio-cultural restrictions (girls are prohibited from touching plants/vegetables, engaging in household chores/religious worship, or physical contact with men during menstruation, and refusal to use conventional painkillers to relief menstrual pain). CONCLUSIONS: The findings suggest that drivers of suboptimal social and school participation among secondary schoolgirls exist at the individual, interpersonal relationship, school, and societal levels. Multi-level evidence-based multicomponent interventions to improve menstrual health at all socio-ecological levels are warranted for optimal social and school participation among schoolgirls
Increase in intimate partner violence during the COVID19 lockdown in uganda: a household survey.
Get PDFINTRODUCTION: During the novel COVID-19 pandemic, governments worldwide limited people's movements in what became known as lockdowns to contain the spread of infection. Uganda experienced one of Africa's strictest, longest, and most widespread lockdowns. In this paper, we examine how the novel COVID-19 pandemic and government response to address it impacted intimate partner violence (IPV) among men and women in two diverse districts in central Uganda. METHODOLOGY: A household survey was conducted in Luwero and Mukono districts among 1680 respondents from 84 villages from October 25th, 2021, to December 3rd, 2021. Data were collected using standardized structured questionnaires adapted from UN guidelines for producing statistics on violence in women. Outcome variables were lifetime and current (measured as incidents in the past 12 months) prevalence of IPV and whether there was reported increase during the COVID-19 lockdown, assessed by several items under emotional, socio-economic, physical and sexual violence and analyzed as individual items or derived composite variables. RESULTS: The lifetime prevalence of IPV was 55.4%, higher among women compared to men (57.9% vs. 47.4%, p < 0.001). The current prevalence of IPV was 31.0% (497/1603), higher among women than men but the difference did not reach statistical significance (32.2% vs. 27.3%, p = 0.071). Of these, 73.0% (363/497) reported that the COVID-19 lockdown worsened their IPV experiences, which was higher among women than men (74.7% vs. 67.0%,) p = 0.113) but not statistically significant. At multivariable analysis, the reported increase in IPV during the COVID-19 lockdown was significantly lower in participants with at least a diploma education, in subsistence farming or self-employed. While emotional violence was the most prevalent across both genders, socioeconomic violence was reported to have increased most during the lockdown. Only 41.9% of those who experienced violence sought help, and the majority sought help from non-formal mechanisms like family members. CONCLUSION: While IPV was more likely to be experienced by women than men, in almost all cases, those of both genders who had experienced IPV reported that it had gotten worse during the lockdowns. Pandemic preparedness and government responses during future pandemics must consider how lockdowns can create unintended negative consequences, including exacerbating IPV
Modelling the effects of adult emergence on the surveillance and age distribution of medically important mosquitoes.
Get PDFEntomological surveillance is an important component of mosquito-borne disease control. Mosquito abundance, infection prevalence and the entomological inoculation rate are the most widely reported entomological metrics, although these data are notoriously noisy and difficult to interpret. For many infections, only older mosquitoes are infectious, which is why, in part, vector control tools that reduce mosquito life expectancy have been so successful. The age structure of wild mosquitoes has been proposed as a metric to assess the effectiveness of interventions that kill adult mosquitoes, and age grading tools are becoming increasingly advanced. Mosquito populations show seasonal dynamics with temporal fluctuations. How seasonal changes in adult mosquito emergence and vector control could affect the mosquito age distribution or other important metrics is unclear. We develop stochastic mathematical models of mosquito population dynamics to show how variability in mosquito emergence causes substantial heterogeneity in the mosquito age distribution, with low frequency, positively autocorrelated changes in emergence being the most important driver of this variability. Fitting a population model to mosquito abundance data collected in experimental hut trials indicates these dynamics are likely to exist in wild Anopheles gambiae populations. Incorporating age structuring into an established compartmental model of mosquito dynamics and vector control, indicates that the use of mosquito age as a metric to assess the efficacy of vector-control tools will require an understanding of underlying variability in mosquito ages, with the mean age and other entomological metrics affected by short-term and seasonal fluctuations in mosquito emergence
Compound and cascading effects of climatic extremes on dengue outbreak risk in the Caribbean: an impact-based modelling framework with long-lag and short-lag interactions.
Get PDFBACKGROUND: Small islands developing states in the Caribbean are exposed to increasingly frequent and intense extreme climatic events, which can exacerbate outbreaks of climate-sensitive infectious diseases. Few forecasting tools incorporate the compound and cascading effects of multiple delayed climatic indicators on disease outbreak risk. We aimed to create an impact-based modelling framework that employs interactions between climatic predictors to forecast the probability of a climate-sensitive infectious disease outbreak 3 months ahead, and to investigate the compound and cascading effects of temperature and long-lag and short-lag standardised precipitation index (SPI) on dengue outbreak risk in Barbados. METHODS: We developed a modelling framework to predict the probability of a dengue outbreak in Barbados with a 3-month lead time. We assessed the relationships between dengue incidence and interacting long-lag and short-lag hydrometeorological predictors with confirmed cases from 1999 to 2022 and a Bayesian hierarchical framework accounting for seasonal and interannual variation. With this long-short-lag interaction model, we piloted a dengue early warning system in Barbados for the International Cricket Council Men's Twenty20 World Cup in June, 2024, as a real-world prospective example. FINDINGS: We found that a three-way interaction between the 3-month averaged mean temperature anomaly lagged by 3 months, 6-month SPI (SPI-6) lagged by 5 months, and SPI-6 lagged by 1 month best predicted dengue outbreak risk in Barbados. Our findings showed that long-lag dry (lagged by 5 months), mid-lag hot (lagged by 3 months), and short-lag wet (lagged by 1 month) conditions led to the greatest dengue risk. During cross-validation from 2012 to 2022, the model exhibited a true positive rate (TPR) of 81% and a false positive rate (FPR) of 29%, outperforming a baseline model representing standard practice with a TPR of 68% and an FPR of 48%. For the Twenty20 World Cup, the model predicted a 95% outbreak probability due to epidemiological and climatic conditions, which was shared with the Barbados Ministry of Health and Wellness ahead of the tournament. INTERPRETATION: Our impact-based modelling framework with long-lag and short-lag interactions explicitly accounted for the compound and cascading effects of drought, heat, and excessively wet conditions on dengue outbreak risk in Barbados. The model is being implemented in a national dengue early warning system with ongoing monitoring and evaluation to ensure its reliability and usefulness in operational contexts. Future work could explore the applicability of this methodology to modelling or predicting climate-sensitive infectious diseases in other endemic settings. FUNDING: Wellcome Trust, Horizon Europe, European Development Fund, and Royal Society
Immune responses to human papillomavirus infection and vaccination.
Get PDFHuman papillomavirus (HPV) is the most common sexually transmitted infection. About 90% of HPV infections are transient, resolving without any need for intervention. Most of HPV infections are low-risk non-oncogenic. However, persistent infection with high-risk oncogenic HPV types is the cause of cervical as well as various other anogenital and oropharyngeal cancers. HPV infection on either cutaneous or mucosal surfaces activates both innate and adaptive antiviral immune cells including Langerhans and keratinocyte cells, natural killer cells, B and T cells. These cellular responses alongside their corresponding cytokine profiles have been associated with clearance of HPV infection and regression of HPV associated disease although the actual immune mechanisms involved are not well understood. Current HPV vaccines are based on self -assembled virus-like particles (VLP) from the major viral capsid protein and target the high-risk HPV types as well as two low-risk types responsible for genital warts. The vaccines generate antibody protection against new infections with no effect on already established infections and HPV-associated diseases. Certainly, despite the high effectiveness of current prophylactic HPV vaccines, therapeutic HPV vaccines are needed for treatment of already established HPV infections and disease. Although there have been great efforts in development of therapeutic vaccines, none is yet to be licensed due to low efficacy and safety concerns. There is therefore a need to understand both natural and vaccine-induced immunity, for development of effective and safe therapeutic HPV vaccines. Additionally, a better understanding of the immunogenicity of HPV vaccines, which are among the best subunit vaccines developed to date, may identify immune pathways that could be targeted for development of similarly effective vaccines for other diseases. This review summarises available literature on immune responses to both HPV infection and vaccination, with an aim of improving overall understanding on this subject. This may provide insights for better targeting of both therapeutic and prophylactic vaccines, not only for HPV but also other antigen targets
Birth Travellers Seeking Childbirth and Birthright Citizenship in Canada and the United States of America: A Qualitative Study with Nigerian Women
Get PDFCanada and the United States (USA) are top destinations for women travelling abroad for childbirth. However, end-to-end experiences of non-resident women travelling to seek childbirth and birthright citizenship in these destination countries are not fully understood, more so amongst Nigerian women, amongst whom the practice is particularly common. This study sought to address this gap in the literature. Twenty-five Nigerian women who had children in Canada or the USA were recruited via social media. In-depth interviews were conducted remotely, audio-recorded, transcribed, and analysed thematically. Five key themes emerged from this study including that the experience of visa application to travel abroad for childbirth was mixed; and the travel itself has recognised risks and can be stressful. Further, being pregnant did not mean women were treated well when they arrived at the entry port in the destination country. However, childbirth abroad was highly satisfactory for most, and obtaining birth certificates and passports for the babies was generally straightforward. Our findings underscore the necessity of clarifying the legality of seeking childbirth abroad and birthright citizenship. If deemed legal, the voices of women who opt to travel abroad for childbirth need to be elevated, their vulnerability recognised, and the quality of care they receive guaranteed
Management of microbial keratitis by private pharmacies in Uganda: a study of knowledge, attitude, and practice.
Get PDFPurpose To determine the knowledge, attitude, and practice of pharmacy attendants in the management of microbial keratitis. Methods This mixed-methods study was conducted in selected pharmacies and drug shops located in Mbarara City between March and May 2022. We administered questionnaires assessing the knowledge, attitudes, and practices (KAP) related to microbial keratitis (MK) to 140 pharmacy attendants (PAs) in the drug shops and pharmacies. We also conducted 40 in-depth interviews (IDI) and three focus group discussions (FGD) with pharmacy attendants to discuss practices, challenges, and opportunities to improve the management of MK. Results Of the 140 pharmacy attendants, almost half (49.29%) reported that they were not confident when making diagnoses in patients with eye problems, and 19.29% were uncertain of which drug to prescribe. In the IDIs and FGDs, the pharmacy attendants reported that they receive and manage patients with MK. Some immediately refer any patients they receive with eye complaints without prescribing any medication while others only refer those who are not responding to medication. The challenges faced in managing patients with MK included inadequate knowledge of managing eye diseases including MK, patients presenting with severe diseases because of delays in seeking healthcare, and the use of traditional eye medicine. The pharmacy attendants suggested ways of improving the management of MK and other eye diseases in the community including community sensitisation on eye diseases and conducting continued professional development lecture sessions on MK in pharmacies, drug shops, and clinics. Conclusion The study showed that probable MK was a common presentation among patients seeking to buy drugs from pharmacies and drug shops. Pharmacies are key stakeholders in the health seeking journey of patients and hence need to be supported through capacity building and strengthening the referral network to improve the outcomes of patients with eye diseases and MK.</ns3:p
Innovation and diversity in public health team engagement in local alcohol premises licensing: qualitative interview findings from the ExILEnS study.
Get PDFBACKGROUND: Evidence suggests that controls on the physical and temporal availability of alcohol can reduce alcohol-related harms. Public health teams in England and Scotland have in recent years been given a statutory role in licensing systems through which premises are granted permits to sell alcohol. The Exploring the Impact of alcohol premises Licensing in England and Scotland study examined public health team efforts to engage in alcohol licensing from 2012 to 2019.
OBJECTIVE: We aimed to describe the range of public health team practice in engaging with alcohol licensing across England and Scotland, with a particular focus on unusual or innovative practices.
METHODS: Two sets of interviews were conducted with 20 public health teams in England and Scotland who were actively engaged in alcohol premises licensing. Firstly, representatives of each public health team with experience of licensing activity took part in structured face-to-face or telephone interviews (n = 41) and provided documentation to identify how and when their team engaged with alcohol premises licensing. Secondly, members of public health teams took part in in-depth one-to-one interviews (n = 28) which focused on individual roles and responsibilities. Relevant public health team activity was analysed quantitatively within 19 activities in 6 categories using the 'Public Health engagement In Alcohol Licensing' measure, as well as qualitatively using NVivo (QSR International, Melbourne, Australia). Innovative practices were identified using the highest Public Health engagement In Alcohol Licensing scores for specific activity types across single or multiple 6-month periods.
FINDINGS: Within each of the six activity categories, a range of practices were observed. More unusual practices included having a dedicated post to work full-time on alcohol licensing; developing a standardised reviewer tool allowing the team to respond to applications and provide the most relevant evidence in a consistent and systematic way; committing to additional scrutiny of occasional licences or temporary event notices; maintaining a detailed database recording applications made, whether the public health team decided to object and the outcome of the licensing board's decision; engaging with applicants prior to them submitting an application; visiting proposed/current licensed premises to gather bespoke data; leading the writing of local licensing policy; and working closely with licensing standards officers.
CONCLUSIONS: Across six categories of public health team activity relating to the local alcohol premises licensing system, public health team practices varied, and some public health teams stood out as engaging in more innovative or intensive activities. The identified examples will be of value in informing public health team practice in what remains a relatively new area of work for many, despite limitations in the system. The inclusion of examples from both England and Scotland and from many public health teams will facilitate cross-fertilisation of ideas and practice across public health teams.
FUNDING: This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 15/129/11
Evaluating Tranexamic Acid Dosing Strategies for Postpartum Hemorrhage: A Population Pharmacokinetic Approach in Pregnant Individuals.
Get PDFTranexamic acid (TXA) is used for the treatment and occasionally prevention of postpartum hemorrhage (PPH); however, questions still remain regarding dosing regimen optimization. This study evaluated TXA pharmacokinetic (PK) data from four clinical trials (NCT: 04274335, 03287336, 00872469, and 02797119) conducted in pregnant participants receiving intravenous, intramuscular, or oral TXA to prevent or treat PPH. The goal of this analysis was to comprehensively characterize TXA PK in a large, heterogeneous population of pregnant individuals to (1) assess the need for weight-based dosing and (2) compare exposure target attainment for alternative routes of administration. A population PK analysis was performed using nonlinear mixed-effects modeling in Pumas, and a stepwise approach was implemented to select the structural model and identify significant covariates. A total of 211 pregnant participants who received between 0.35 and 4 g of TXA intravenously, orally, or intramuscularly offered 1303 TXA plasma concentrations for model development. A two-compartment model with first-order elimination and first-order absorption for both intramuscular and oral administration best described the disposition of TXA. Actual body weight was the only statistically significant covariate identified, but inclusion into the model did not explain a substantial amount of the observed variability. Simulations of virtual pregnant individuals indicated minimal differences in TXA exposure between fixed and weight-based dosing regimens, supporting the use of fixed dosing. Intramuscular TXA was additionally found to be a viable alternative to intravenous administration, achieving similar target exposure metrics
Development and validation of a diagnostic prediction model for pancreatic ductal adenocarcinoma: VAPOR 1, protocol for a prospective multicentre case-control study.
Get PDFINTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) continues to have extremely poor patient outcomes, unlike other cancer types which have seen significant improvements in their treatments and survival. A major contributing factor is that PDAC is often detected at an advanced, incurable stage. In the UK, nearly half of patients have stage 4 disease at the time of diagnosis, which has a profound effect on treatment options and, ultimately, survival. To address the challenge of early detection of PDAC, this study aims to develop and validate a clinical prediction model based on a non-invasive breath test. The proposed breath test aims to assist general practitioners in the triaging of patients who present with symptoms that do not meet current criteria for urgent suspected PDAC pathway referral. METHODS AND ANALYSIS: The Volatile organic compound Assessment in Pancreatic ductal adenOcaRcinoma (VAPOR 1) study is a prospective, multicentre, case-control study that aims to recruit 771 participants from England, Wales and Scotland. These include adult participants, aged ≥18 years, in three cohorts: pancreatic ductal adenocarcinoma; benign pancreatic controls (chronic pancreatitis or new-onset diabetes); healthy controls with a normal pancreas on imaging. A one-off breath sample will be obtained from participants who have fasted for at least 6 hours, and participant demographics and clinical data will be recorded. Breath samples will be analysed using gas chromatography-mass spectrometry to identify the volatile organic compounds (VOCs) present. Relationships between VOCs of interest and the presence of PDAC will be explored, and a clinical prediction model will be developed using statistical and machine learning methods and internally validated. ETHICS AND DISSEMINATION: The VAPOR 1 study has received approval from the South East Scotland Research Ethics Committee 02, and from the Health Research Authority and Health and Care Research Wales (REC 22/SS/0061). Results of this study will be published in open-access peer-reviewed journals, and disseminated through pancreatic cancer conference presentations. In addition, lay summaries shared on our website, social media platforms and through our charitable funder, Pancreatic Cancer UK, will enable engagement with patients and the wider public. TRIAL REGISTRATION NUMBER: NCT05727020