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Exploring mothers' and grandmothers' perceptions of animal-source complementary foods in the diets of young children in The Gambia: A qualitative study [version 1; peer review: 2 approved with reservations]
Get PDFBackground: In The Gambia, many children consume diets that are lacking in nutrients that are essential for their growth and development. This study aims to explore Gambian mothers' and grandmothers' perceptions around animal source foods (meat, eggs, milk etc.) in order to inform future interventions focused on improving child feeding practices.
Methods: In July and August 2023, nine semi – structured focus group discussions were conducted with mothers and grandmothers in two settings in The Gambia. A purposeful sample of participants were recruited with the support of each local Medical Research Council clinic. Data were analysed using the framework method and thematic analysis. Participants included 19 mothers and 12 grandmothers in a semi-rural area and 12 mothers and 12 grandmothers in a rural area, caring for children 6-24 months. Mothers and grandmothers were in separate groups.
Results: Knowledge gaps were identified in both settings regarding aspects of complementary feeding, such as the appropriate timing and methods for introducing animal source foods to children’s diets. Differences were noted in the availability and dissemination of infant and young child feeding information in the two settings, emphasising the crucial role of contextual factors in shaping future programmes. The accessibility and affordability of animal source foods, was found to be a key determinant of their inclusion into children’s diets. A reliance on commercially available complementary foods was common in both settings.
Conclusion: This study reveals disparities between current complementary feeding practices and guidelines in this setting. It also underscores context-specific barriers caregivers encounter in offering diverse complementary foods, including animal source foods. A high reliance on commercially available complementary foods was also uncovered, particularly in Keneba. Further research is recommended to aid the development of context- specific interventions
Physical health among persons with untreated psychotic disorder in diverse settings of the Global South.
Get PDFBACKGROUND: There is limited information on the prevalence and profile of comorbid physical health conditions in persons with untreated psychotic disorder in countries of the Global South. AIM: To investigate the frequency of occurence and association of physical health indicators with untreated psychotic disorder in three diverse settings in the Global South. METHODS: Data were collected as part of the International Research Programme on Psychoses in Diverse Settings (INTREPID II), a population-based incidence and case-control study conducted in selected catchment areas in India, Nigeria, and Trinidad. Cases were aged 18-64 years with an untreated psychotic disorder diagnosed according to ICD 10 criteria. Control participants were matched for age, sex, and neighbourhood. Physical health measurements were acquired using the WHO STEPwise approach to non-communicable disease risk factors surveillance instrument (WHO STEPS). We estimated adjusted odds ratios (aOR) using unconditional logistic regression. RESULTS: We included 225, 209, and 212 case-control pairs, respectively in Kancheepuram (India), Ibadan (Nigeria), and Northern Trinidad. Among cases, we found marked variations in health behaviours and physical health indicators across settings. In case-control comparisons within settings, cases were more likely to report poor diet (aORs of 1.31 [Trinidad] to 3.70 [Ibadan]), current smoking (aORs of 2.21 [Kancheepuram] to 3.35 [Trinidad]), and physical inactivity (aORs of 0.23 [Ibadan] to 0.62 [Kancheepuram]). However, we found no strong evidence that indicators of cardiometabolic comorbidity were consistently more common among cases compared with controls (i.e.,cases across sites were less likely than controls to have high blood pressure (aORs of 0.65 [Ibadan] to 0.76 [Trinidad]) and to be overweight (aORs of 0.70 [Kancheepuram] and 0.85 [Trinidad]), but were more likely than controls to have diabetes (aOR 1.94) and raised C-reactive protein levels (aOR 2.31) in Ibadan. By contrast, cases were more likely than controls to be underweight in all sites (aORs of 1.76 [Trinidad] to 3.67 [Ibadan]). In Kencheepuram (aOR 1.60) and Ibadan (aOR 2.66), cases were more likely to have a positive blood test for infection. These findings were broadly similar after accounting for health behaviours. CONCLUSION: In three settings in the Global South, persons with untreated psychotic disorder were more likely to report poorer health behaviours, to be underweight, and experience more infections, possibly reflecting severe economic and social disadvantage in the settings of this study
Evidence to practice - lessons learnt in developing an implementation strategy for an online digital health intervention (Eczema Care Online).
Get PDFBACKGROUND: Eczema Care Online ( www.EczemaCareOnline.org.uk/ ) is an online self-management toolkit which includes tailored content for young people (13-25 years) and for parents of children that have eczema (0-12 years). Testing in two randomised controlled trials has shown that it is easy to use, cost effective and offers a sustained improvement in eczema symptoms. Implementing Eczema Care Online outside of a funded research study and ensuring that it reaches those that will most benefit from is now a key challenge. This paper describes the lessons learnt from developing and delivering an implementation strategy.
METHODS: Data from systematic reviews, stakeholder consultation meetings, interviews with trial participants, intervention usage data during the trial, and existing eczema information websites informed our implementation plan. Using Normalisation Process Theory, an implementation plan combined these findings with practical, context-specific actions to encourage wider adoption of the intervention.
RESULTS: Data was successfully mapped to the four constructs of Normalisation Process Theory, and factors and processes that encourage implementation identified. These include: promoting how Eczema Care Online is different to other sources of information; aligning to and embedding in existing eczema resources (from charities and healthcare providers); simplifying aspects to aid ease of use; and, highlighting evidence that shows that Eczema Care Online works. Key lessons in developing an implementation strategy include 1) start implementation work early 2) maintain flexibility to explore multiple routes to implementation 3) use secondary data sources 4) balance theory with practicalities 5) consider longer-term maintenance beyond the life of the research project.
CONCLUSION: Implementation planning is a key stage of the research process that is often not adequately resourced. Implementation planning ensures effective interventions developed and evaluated in research studies are utilised in everyday practice
Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study.
Get PDFBACKGROUND: Mass media campaigns, particularly edutainment, are critical in disseminating sexual health information to young people. However, there is limited understanding of the authentic viewing experience or how viewing contexts influence engagement with media campaigns. Reaction videos, a popular format in web-based culture in which users film themselves reacting to television shows, can be adapted as a research method for immediate and unfiltered insights into young people's engagement with edutainment media. OBJECTIVE: We explored how physical and social context influences young people's engagement with MTV Shuga, a dramatic television series based on sexual health and relationships among individuals aged 15 to 25 years. We trialed reaction videos as a novel research method to investigate how young people in South Africa experience the show, including sexual health themes and messages, in their viewing environments. METHODS: In Eastern Cape, in 2020, purposively selected participants aged 18 to 24 years of an evaluation study were invited to take part in further research to video record themselves watching MTV Shuga episodes with their COVID-19 social bubble. To guide the analysis of the visual and audio data, we created a framework to examine the physical setting, group composition, social dynamics, coinciding activities, and viewers' spoken and unspoken reactions to the show. We identified patterns within and across groups to generate themes about the nature and role of viewing contexts. We also reflected on the utility of the method and analytical framework. RESULTS: In total, 8 participants recorded themselves watching MTV Shuga episodes in family or friendship groups. Viewings occurred around a laptop in the home (living room or bedroom) and outside (garden or vehicle). In same-age groups, viewers appeared relaxed, engaging with the content through discussion, comments, empathy, and laughter. Intergenerational groups experienced discomfort, with older relatives' presence causing embarrassment and younger siblings' distractions interrupting the engagement. Scenes featuring physical intimacy prompted some viewers to hide their eyes or leave the room. While some would prefer watching MTV Shuga alone to avoid the self-consciousness experienced in group settings, others valued the social experience and the lively discussions it spurred. This illustrates varied preferences for consuming edutainment and the factors influencing these preferences. CONCLUSIONS: The use of reaction videos for research captured real-time verbal and nonverbal reactions, physical environments, and social dynamics that other methods cannot easily measure. They revealed how group composition, dynamics, settings, and storylines can maximize engagement with MTV Shuga to enhance HIV prevention education. The presence of parents and the camera may alter young people's behavior, limiting the authenticity of their viewing experience. Still, reaction videos offer a unique opportunity to understand audience engagement with media interventions and promote participatory digital research with young people
Visualization and tracking of tubule-derived, fluorescent-labeled NS1 as a marker of bluetongue virus in living cells.
Get PDFBluetongue virus (BTV) is an arbovirus (genus, Orbivirus; family, Sedoreoviridae) transmitted among ruminant hosts by Culicoides biting midges (genus, Culicoides). Orbivirus sp. produce large numbers of virus-specific tubules during infection. Non-structural protein 1 (NS1) derived from BTV is a highly conserved tubule-forming protein that exists in infected cells as tubular and non-tubular forms. However, the lack of tagged viruses has limited dynamic tracking of NS1 tubule protein levels in living cells. Here, four recombinant viruses (BTV1-NS1-156TC, BTV1-NS1-156eGFP, BTV1-NS1-534eGFP, and BTV1-NS1-552eGFP) were successfully rescued using a BTV reverse genetics strategy by introduction of biarsenical-tetracysteine or enhanced green fluorescent protein (eGFP) tags to the BTV NS1 protein. Inserting these tags at these three sites resulted in different equilibrium states of NS1 between the tubular and non-tubular forms. NS1 was tracked in live cells to observe the dynamic movement and aggregation processes of NS1 tubules. The formation of NS1 tubules is a prerequisite for NS1 aggregation, and NS1 tubules are dependent on cellular microtubules to aggregate at the microtubule organizing center and encapsulate by vimentin to form aggresomes. This study confirms the possibility of controlling the conversion ratio between NS1 monomers and tubule forms, for the first time elucidates the movement and aggregation processes of NS1 tubules by live-cell imaging, and confirms that NS1 tubules form aggresomes.IMPORTANCEWhile extensive research has established BTV as a model system to study large non-enveloped viruses, critical gaps remain in our understanding of its biology. During infection, BTV NS1 assembles into abundant tubulars, a hallmark feature of the Orbivirus genus. In this study, fluorescently tagged BTV NS1 proteins were engineered, and four recombinant viruses were successfully rescued. Insertion of these tags altered the equilibrium between tubular and monomeric NS1 conformations, demonstrating the feasibility of modulating the transition ratio between structural states. Additionally, NS1 tubules depend on microtubule-mediated intracellular transport for aggregation and subsequent aggresome formation. These findings provide a basis for the application of NS1 in vaccine delivery, therapy, nanotechnology, and future explorations of BTV pathogenesis
Enhanced patient counselling and SMS reminder messages to improve access to community-based eye care services in Meru, Kenya: statistical analysis plan for a Bayesian adaptive trial [version 1; peer review: 2 approved]
Get PDFBACKGROUND: Health service programmes frequently encounter challenges with patient adherence to care. A promising, low-risk approach to address this issue is providing patients with targeted information about the importance of adherence. In the Vision Impact Project (VIP), an eye health screening programme in Kenya, the adherence rate to attending triage clinics after referral is around 50%. To improve this rate, this trial will test the effectiveness of delivering relevant information to patients at the point of referral along with reminder messages.
METHODS: A pragmatic, Bayesian adaptive trial will be conducted within the VIP programme to assess the effectiveness of providing enhanced information compared to standard care. Weekly interim analyses will monitor adherence rates to referral appointments following positive vision impairment screenings. Participants will be randomized equally into intervention and control groups. The trial will stop if interim findings indicate either efficacy of one arm over the other, or futility that the two arms are performing equally.
DISCUSSION: This paper presents the statistical analysis plan for a pragmatic adaptive trial aimed at improving adherence in an eye screening programme in Kenya. This statistical analysis plan expands on the design and analysis plan detailed in the study protocol and documents decision rules to avoid post hoc decision-making.
TRIAL REGISTRATION: ISRCTN 11329596, Registered on 02 February 2024, https://doi.org/10.1186/ISRCTN11329596
Efficacy and Safety of Long-acting Injectable Cabotegravir and Rilpivirine in Improving HIV-1 Control in sub-Saharan Africa: Protocol for a Phase 3b Open-Label Randomized Controlled Trial (IMPALA).
Get PDFLong-acting (LA) injectable therapy as treatment for HIV-1 infection offers reduced dosing frequency, increased discretion and provides an alternative to two or three-drug daily oral combinations. A parenteral LA formulation of cabotegravir (CAB) and rilpivirine (RPV) given by intramuscular (IM) injection every 2 months (CAB LA + RPV LA Q2M) has shown safety and efficacy in phase 3/3b trials and could increase treatment satisfaction and improve adherence in sub-Saharan Africa. IMPALA (IMProving HIV-1 Control in Africa using Long-Acting Antiretrovirals) is a randomized, controlled, open-label, multicentre, interventional study in Uganda, Kenya, and South Africa of 540 virologically suppressed adults living with HIV-1 infection with a history of sub-optimal adherence to daily oral ART . IMPALA seeks to demonstrate the non-inferior antiviral effectiveness of switching to CAB LA + RPV LA Q2M, compared to the continuation of first-line daily oral ART containing 2 nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) plus dolutegravir (DTG). After providing informed consent, participants are screened for eligibility. Those who are viraemic (HIV RNA ≥200 copies/mL) at screening will be suppressed (<200 copies/mL for ≥3 months) on oral ART prior to randomization. On Day 1, individuals will be randomized 1:1 to either continue daily oral ART, or switch to CAB LA + RPV LA Q2M, (intervention arm) with or without a 1-month oral lead consisting of once daily oral CAB + RPV. The total follow-up period is 24 months. The primary endpoint is HIV-1 RNA <50 copies/ml at 12 months by FDA snapshot. Initial: TMC278LAHTX3005 Version Amendment 1, 30 September 2022 Superseded by: TMC278LAHTX3005 Version Amendment 2, 3 June 2024 This clinical trial was registered on Clinical Trials.gov on 19 September 2022 (NCT05546242), available from https://clinicaltrials.gov/ct2/show/NCT05546242. The study was also registered on Pan African Clinical Trials Registry on 23 January 2023 (PACT202301600757432TMC278LAHTX3005), available from https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24291
Dismantling colonial legacies: Decolonising research and teaching at the Health in Humanitarian Crises Centre, London school of hygiene and tropical medicine.
Get PDFDespite a burgeoning discourse within the humanitarian health community regarding decolonisation, there remains lack of practical guidance for researchers seeking to decolonise their work. We conducted a qualitative study which aimed to explore the perceptions of research and teaching staff at the Health in Humanitarian Crisis Centre (HHCC) and their external partners -including humanitarian health researchers, practitioners, and donors- regarding how to decolonise research, teaching and partnerships at a leading global health Higher Education institution in the UK. We conducted 20 semi-structured interviews and 3 focus group discussions with HHCC members and external partners, including donors, academic institutions in conflict-affected and humanitarian settings, and practitioners from local and international humanitarian organisations. The first theme explored the concept of decolonisation itself, examining the disparate definitions and understandings held by HHCC members and partners, along with examining the institutional appetite and the role of leadership in driving decolonisation efforts. The second theme focused on sectoral and structural barriers to decolonising HHCC's work, including the dominance of Western-defined knowledge models, inequitable funding policies and practices, and epistemic injustice. Finally, the third theme explored HHCC's experiences in decolonising teaching and curriculum. The study identifies good practices within the HHCC community including knowledge co-production, equitable authorship arrangements, co-dissemination of findings, assigning co-principal investigators from conflict-affected countries, and centring and building on the experiences of researchers with relevant lived experience. However, these individual efforts contrast with a lack of appetite at the institutional level to address the underlying structural barriers. Our study provides the foundations for humanitarian health researchers and educators based in the Global North to begin to practically decolonise their work in the sphere of global/humanitarian health
Community-led strategies for communicable disease prevention and management in low- and middle- income countries: A mixed-methods systematic review of health, social, and economic impact.
Get PDFControl of infectious diseases is a global health priority and a target of the 2015-2030 Sustainable Development Goals (SDGs). Community participation is fundamental to advancing primary health care and meeting SDGs. We conducted a mixed-methods systematic literature review of quantitative and qualitative evidence to understand the health, social, and economic impact of community-led strategies for communicable disease prevention and management in low- and middle- income countries. We searched seven electronic databases through 31 December, 2023 for cluster-randomised trials and economic evaluations of community-led communicable disease control. Reference searches identified additional studies associated with eligible database records. Data extraction and narrative synthesis summarised evidence on impact, costs, and cost-effectiveness, described the nature and extent of community participation, and examined implementation, mechanisms of impact, and contexts. Risk of bias of was assessed using the Cochrane Risk-of-Bias Tool and the Drummond checklist. Our database search yielded 14,269 records. Following database and reference screening, we included 49 records across 16 unique cluster-randomised trials, mostly from sub-Saharan Africa. Communicable disease strategies included provision of biomedical products, environmental modifications, and education and outreach. Based on evidence with moderate risk of bias, we found that community-led strategies can improve health behaviours for diarrhoeal diseases, HIV, malaria, and neglected tropical diseases. Evidence for impact on mortality and morbidity, health care access and utilisation, and community and social outcomes was less conclusive. Impact depended on the intensity of implementation by community actors. Factors facilitating implementation included motivation, trust, and health systems engagement. Contextual influences included attitudes and norms around communicable diseases. Economic studies were few and many omitted societal costs and consequences. This review supports community-led communicable disease control as a potentially effective strategy to improve health behaviours and contribute to SDGs. Operational guidance for implementation and evaluation is critical to support rapid evidence generation in this important area
Can we estimate crisis death tolls by subtracting total population estimates? A critical review and appraisal
Get PDFBACKGROUND In the absence of high-quality data, the death tolls of epidemics, conflicts, and disasters are often estimated using ad hoc methods. One understudied class of methods, which we term the growth rate discontinuity method (GRDM), estimates death tolls by projecting pre-crisis and post-crisis total population estimates using crude growth rates and then subtracting the results. Despite, or perhaps due to, its simplicity, this method is the source of prominent death toll estimates for the Black Death, the 1918 influenza pandemic, the Great Chinese Famine, and the Rwandan genocide, among others. OBJECTIVE In this article, we review the influence and validity of GRDM and its applications. METHODS Using statistical simulation and comparison with better-validated demographic methods, we assess the accuracy, precision, and biases of this method for estimating mortality in absolute and relative terms. RESULTS We find that existing GRDM estimates often misestimate death tolls by large, unpredictable margins. Simulations suggest this is because GRDM requires precision in its inputs to an extent rarely possible in the contexts of interest. CONCLUSIONS If there is sufficient data to specify GRDM well, it is probably possible to also use a more reliable method; if there is not sufficient data, GRDM estimates are so sensitive to their assumptions that they cannot be considered informative. CONTRIBUTION These findings question the empirical suitability of existing demographic and econometric work that has used GRDM to analyse mortality crises. They also underscore the need for improved data collection in crisis settings and the utility of qualitative methods in contexts where quantification using better-validated methods is not possible