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Labour companionship and respectful treatment of women during childbirth: a cross-sectional study across 16 hospitals in Benin, Malawi, Tanzania and Uganda.
Get PDFINTRODUCTION: Evidence suggests that women value and benefit from having a labour companion during childbirth. However, the applicability of the evidence to low-income and lower-middle-income countries is limited and varies. Thus, we assessed the association between the presence of labour companions and mistreatment in 16 hospitals of Benin, Malawi, Tanzania and Uganda.
METHODS: We conducted a cross-sectional survey using a validated questionnaire administered to women at discharge after birth between December 2021 and March 2024. The main outcomes were factor-weighted respectful treatment score and its subscores on maintained respect and dignity, privacy and maintained confidentiality and no physical and verbal abuse. The independent variable was labour companionship. We assessed the association between labour companionship and mistreatment using a linear regression model with fixed effects and cluster robust standard errors.
RESULTS: Of the 4006 included women, 39% (n=1573) had a companion during labour and/or birth. Women across the four countries and regardless of companions' presence reported high degrees of maintained privacy and confidentiality (subscores ranging between 9.5/10 in Benin to 9.9/10 in Malawi). The presence of a labour companion was significantly associated with the absence of physical and verbal abuse experiences (β=0.07; p=0.004; 95% CI: 0.02; 0.12).
CONCLUSIONS: Our study adds evidence on the positive relation between labour companionship and physical and verbal abuse. The coverage of labour companionship was low across the four countries. We call for the implementation of labour companionship to allow for greater benefits of this practice
Cost-Effectiveness of Regular Surveillance Versus Endoscopy at Need for Patients With Barrett's Esophagus: Economic Evaluation Alongside the Barrett's Oesophagus Surveillance Study (BOSS) Randomized Controlled Trial.
Get PDFBACKGROUND & AIMS: The Barrett's Oesophagus Surveillance Study (BOSS) was the first randomized study of surveillance. This study reports the costs and quality of life outcomes from the BOSS trial and models the outcomes and cost-effectiveness of surveillance beyond the follow-up period of the BOSS study. This trial showed similar stages and rates of esophageal cancer in both arms, but the regular surveillance arm did identify more high-grade dysplasia after a median of 12.8 years follow-up.
METHODS: We used a decision tree model based on results from BOSS to conduct a cost-effectiveness analysis of costs and quality-adjusted life years (QALYs). A Markov model was used to extrapolate costs and outcomes over a further 10 years after the trial had ended, representing a 22.8-year time horizon. The proportion with high-grade dysplasia and QALYs was derived from the randomized trial.
RESULTS: The total costs associated with 2-yearly surveillance was 3182 in the at-need arm. Total QALYs in the 2-yearly endoscopy arm were 8.647 compared with 8.629 in the at-need arm. Compared with at-need endoscopy, 2-yearly surveillance costs 94,513/QALY for the best-case and $146,272/QALY for the worst-case scenario.
CONCLUSION: Barrett's esophagus surveillance every 2 to 3 years is unlikely to be a cost-effective strategy. Guidelines should take this into account when deciding surveillance intervals
Evaluating the impact of two next-generation long-lasting insecticidal nets on malaria incidence in Uganda: an interrupted time-series analysis using routine health facility data.
Get PDFINTRODUCTION: Malaria remains a significant public health challenge globally, particularly in sub-Saharan Africa, where progress has stalled in recent years. Long-lasting insecticidal nets (LLINs) are a critical preventive tool against malaria. This study investigated the effectiveness of newer-generation LLINs following a universal coverage campaign in Uganda.
METHODS: Health facility data collected 36 months prior to LLIN distribution and 24 months after LLIN distribution were used from 64 sites that took part in a cluster-randomised trial comparing two newer-generation LLINs (pyrethroid-piperonyl butoxide and pyrethroid-pyriproxyfen). Using an interrupted time-series approach, we compared observed malaria incidence with counterfactual scenarios if no LLINs were distributed, adjusting for precipitation, vegetation, seasonality and care-seeking behaviour. Analyses were also stratified by LLIN type and study-site level estimates of transmission intensity.
RESULTS: Overall, malaria incidence decreased from 827 cases per 1000 person-years in the predistribution period to 538 per 1000 person-years in the postdistribution period. Interrupted time-series analyses estimated a 23% reduction in malaria incidence (incidence rate ratio [IRR]=0.77, 95% CI 0.65 to 0.91) in the first 12 months following distribution relative to what would be expected had no distribution occurred, which was not sustained in the 13-24 month post-distribution period (IRR=0.97, 95% CI 0.75 to 1.28). Findings were similar when stratified by LLIN type. In the first 12 months following distribution, LLIN effectiveness was greater in the high-transmission sites (IRR=0.67, 95% CI 0.54 to 0.86) compared with the medium- (IRR=0.74, 95% CI 0.59 to 0.92) and low-transmission sites (IRR=0.87, 95% CI 0.56 to 1.32).
CONCLUSION: This study demonstrated a modest reduction in malaria incidence following the distribution of newer-generation LLINs that was sustained for only 12 months, highlighting the need for improved strategies to maintain net effectiveness. Adjusting the frequency of universal coverage campaigns based on local malaria transmission intensity may enhance control efforts
Urogenital Schistosoma haematobium Cases at the Hospital for Tropical Diseases, London (1998-2018), and Suggested Pragmatic Follow-up Pathway for Non-endemic Settings.
Get PDFBACKGROUND: Characteristics of confirmed urogenital Schistosoma haematobium infections and outcomes in non-endemic regions are scarce in the literature and there is a minimal evidence base for appropriate management in this setting. Specific schistosomal urinary and urological complications include risk of hydronephrosis, renal impairment, and malignant transformation. Therefore, approach to follow-up should be robust and systematic.
METHODS: This is a retrospective case-note review of all patients with confirmed S haematobium infection (defined as visible ova in terminal urine and/or histopathological diagnosis on biopsy) at the Hospital for Tropical Diseases (HTD), London, between 1998 and 2018. Outcomes of follow-up were reviewed and formulated into a pragmatic guideline for follow-up of these patients in this setting.
RESULTS: A majority of the 186 patients with confirmed S haematobium infection presented before 2012. Young, male migrants were at highest risk of complications from chronic infection and were most prone to being lost to follow-up. One patient was referred with squamous cell carcinoma of the bladder found on biopsy with S haematobium infection.
CONCLUSIONS: We put forward a pragmatic pathway for S haematobium investigation and follow-up for patients presenting to nonendemic settings with the current resource capabilities of the United Kingdom
The Systematic Development of a Mobile Phone Delivered Text-Messaging Tobacco Cessation Intervention in India.
Get PDFINTRODUCTION: Tobacco consumption is a leading cause of mortality globally. Eighty percent of these deaths occur in low- and middle-income countries. Despite this, there is a large treatment gap due to both demand and supply-side barriers. Digital interventions are an innovative solution to bridge this gap. We describe the systematic development of ToQuit, a text-messaging intervention for tobacco cessation in India.
AIMS AND METHODS: ToQuit was developed in sequential steps: (1) Identifying Behaviour Change Techniques (BCTs) from evidence-based tobacco cessation interventions; (2) Identifying additional BCTs through in-depth interviews; (3) Online expert survey to rate BCTs on feasibility, acceptability, and perceived effectiveness when delivered via text messaging; and (4) A consultation workshop with practitioners.
RESULTS: Thirty BCTs were identified from steps 1 and 2. Three were excluded in step 3. The final intervention included 27 BCTs delivered over three phases: phase 1-orientation (information about antecedents and consequences of tobacco consumption, goal setting, reattribution, pros and cons of quitting); phase 2-skill building (self-monitoring, avoidance of cues for behavior, behavior substitution, distraction, stress management, handling urges, restructuring physical and social environments, instructions on how to perform a behavior, prompts and cues, problem-solving, social support, and referrals among others); and phase 3-relapse prevention (psychoeducation about lapse and relapse, review goals, action planning, and feedback on behavior). The intervention is delivered via text messages over 8 weeks with 2-3 messages a day, 2-3 days a week.
CONCLUSIONS: ToQuit is a contextually relevant and potentially scalable text-messaging intervention for tobacco cessation in resource-constrained settings. IMPLICATIONS: This manuscript is an important piece in the development of contextually relevant digital interventions for the cessation of both smoked and smokeless forms of tobacco. The detailed description of the steps followed in developing the ToQuit intervention will help others replicate these procedures while developing similar interventions responsive to their contexts; particularly in low- and middle-income countries
Investigating parental perceptions of respiratory syncytial virus (RSV) and attitudes to RSV vaccine in Jiangsu, China: Insights from a cross-section study.
Get PDFINTRODUCTION: Our study aimed to assess parents' perceptions of respiratory syncytial virus (RSV) and their attitudes towards the RSV vaccine in China.
METHOD: The cross-section study was performed between August 21 and November 15, 2023, in Jiangsu province, eastern China. We collected socio-demographics, awareness, knowledge, perceptions of susceptibility and severity of RSV, and attitudes towards RSV vaccine using online survey questionnaire from parents of child aged ≤14 years old. The chi-square test and logistic regression model to explore the associated factors.
RESULTS: A total of 2135 participants were included. About 26.0 % indicated that they had never heard of RSV (556/2135) and were unaware that infants and young children are at a high risk of contracting RSV (557/2135). The proportion of parents with a child under 1 year of age who were unaware of RSV was notably higher than that of parents with children in other age groups. 42.9 % of parents (916/2135) showed low level of perceived susceptibility of contacting RSV infection for their child. 70.6 % of parents (1508/2135) expressed their willingness to vaccinate their child against RSV. The most common reason for refusing the RSV vaccine was "Concern about vaccine's safety or side effects." 60.8 % of participants (1299/2135) considered a price of the RSV vaccine below 200 CNY (28 USD) as acceptable.
CONCLUSION: The parents, particularly those with younger children, exhibited limited awareness and knowledge regarding RSV infection. Our study also showed the potential role of vaccine price as a barrier to the future use of RSV vaccine in China
EnteroBase in 2025: exploring the genomic epidemiology of bacterial pathogens.
Get PDFThis paper presents an update on the content, accessibility and analytical tools of the EnteroBase platform for web-based pathogen genome analysis. EnteroBase provides manually curated databases of genome sequence data and associated metadata from currently >1.1 million bacterial isolates, more recently including Streptococcus spp. and Mycobacterium tuberculosis, in addition to Salmonella,Escherichia/Shigella,Clostridioides,Vibrio,Helicobacter,YersiniaandMoraxella. We have implemented the genome-based detection of antimicrobial resistance determinants and the new bubble plot graphical tool for visualizing bacterial genomic population structures, based on pre-computed hierarchical clusters. Access to data and analysis tools is provided through an enhanced graphical user interface and a new application programming interface (RESTful API). EnteroBase is now being developed and operated by an international consortium, to accelerate the development of the platform and ensure the longevity of the resources built. EnteroBase can be accessed at https://enterobase.warwick.ac.uk as well as https://enterobase.dsmz.de
Strengthening pharmacovigilance systems through post-vaccination surveillance in Nigeria: A narrative review
Get PDFImmunization remains a vital pillar of Nigeria’s public health agenda, significantly reducing the burden of vaccine-preventable diseases. However, the success of immunization programs hinges not only on vaccine access and delivery but also on robust post-vaccination surveillance systems that ensure vaccine safety and foster public confidence. In Nigeria, post-vaccination pharmacovigilance, led by the National Agency for Food and Drug Administration and Control (NAFDAC), faces critical challenges, including underreporting of adverse events following immunization (AEFIs), inadequate healthcare worker training, infrastructural limitations, and the widespread influence of misinformation. These systemic weaknesses threaten to undermine vaccine confidence, particularly in underserved and rural areas. The aim of this study was to examine the current state of Nigeria’s post-vaccination surveillance infrastructure, highlighting gaps in AEFI reporting and data management. Drawing on global best practices and successful models from other low- and middle-income countries (LMICs), this study proposes a set of strategic interventions to strengthen pharmacovigilance. These include the adoption of digital and mobile health technologies, capacity building for healthcare providers, community engagement, and integration of artificial intelligence in safety signal detection. This study underscores the urgency of regulatory reform and private sector inclusion, advocating a holistic and sustainable approach to vaccine safety monitoring. By reinforcing pharmacovigilance systems, Nigeria can build public confidence, improve vaccine uptake, and enhance the overall effectiveness of its national immunization program
Immunogenicity of COVID-19 Vaccines During Pregnancy: A Systematic Review and Comparison of Pregnant Versus Nonpregnant Persons.
No full textBACKGROUND: The COVID-19 pandemic induced the rapid deployment of novel vaccines with pregnant persons identified as an at-risk population due to their increased risk of severe outcomes. Limited data on the immunogenicity of COVID-19 vaccines in pregnant persons were available at the time of implementation. To address this data gap, we developed a living systematic review summarizing emerging evidence on vaccine immunogenicity in pregnancy. METHODS: Following Cochrane, World Health Organization, and Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we included studies on COVID-19 vaccines during pregnancy. We carried out comprehensive biweekly literature searches from March 2022 to October 2023, covering multiple databases. Study selection, data extraction and risk of bias assessment were conducted by pairs of authors independently. Immunogenicity outcomes, primarily post-vaccination neutralizing or binding antibody concentrations, were analyzed descriptively. Post-vaccination antibody ratios in pregnant versus nonpregnant individuals were calculated for the subset of studies that included nonpregnant comparators. RESULTS: By October 2023, our review encompassed 62 studies predominantly analyzing maternal sera (87%), with limited investigation regarding cord, neonatal and infant sera. Most studies investigated mRNA vaccines (97%) and focused on primary vaccination (82%), with some investigating booster doses (15%). Immunogenicity end points included spike-specific IgG (84%) and neutralizing antibodies (24%), with limited data on T-cell responses (3%). Antibodies were detectable after primary vaccination in most pregnant individuals, with similar or modestly attenuated concentrations compared to nonpregnant individuals (ratios > 0.7 for 5/6 estimates of spike-specific IgG), albeit with modest differences in antibody quality and kinetics. Long-term antibody-waning trajectories were similar between pregnant and nonpregnant individuals for up to 8 months after vaccination. CONCLUSIONS: mRNA COVID-19 vaccines induce a robust antibody response during pregnancy comparable (or modestly attenuated) relative to nonpregnant individuals. Immunogenicity data on non-mRNA vaccines are notably underrepresented in the existing literature
Power hierarchies during “field” visits: recommendations for researchers
Get PDFThis project examines how power hierarchies affect research visits conducted by staff and students at the
London School of Hygiene and Tropical Medicine (LSHTM) and outlines practical recommendations to help
researchers navigate these dynamics.
While efforts to promote equitable research partnerships and decolonise research have resulted in guidance
about shifting decision-making from "Northern" (e.g., UK) to "Southern" (Global South) institutions more broadly,
there is less practical guidance on how to identify and navigate complex power dynamics (especially those related
to gender, race, age, and expertise) during “field” visits, when data collection, training or meetings occur.
These power dynamics exist not only between Northern/Southern actors but also within research teams
themselves and can manifest in many ways, including as sexism, racism, White Saviourism, microaggressions,
cultural insensitivity, and assumptions about expertise. However, there are many promising practices being
implemented to promote equitable research and change these dynamics.
The project aims to develop practical recommendations for researchers to address these micro- and macro-level
power hierarchies during overseas visits, through: a) a rapid review of literature; b) interviews with LSHTM staff,
Research Degree students, and research partners, and c) feedback workshops with research participants, as well
as other interested staff, students and research partners, filling gaps in existing global health research guidance
and LSHTM's own resources