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Characteristics of children readmitted with severe pneumonia in Kenyan hospitals.
Get PDFBACKGROUND: Pneumonia is a leading cause of childhood morbidity and mortality. Hospital re-admission may signify missed opportunities for care or undiagnosed comorbidities. METHODS: We conducted a retrospective cohort study including children aged ≥ 2 months-14 years hospitalised with severe pneumonia between 2013 and 2021 in a network of 20 primary referral hospitals in Kenya. Severe pneumonia was defined using the 2013 World Health Organization criteria, and re-admission was based on clinical documentation from individual patient case notes. We estimated the prevalence of re-admission, described clinical management practices, and modelled risk factors for re-admission and inpatient mortality. RESULTS: Among 20,603 children diagnosed with severe pneumonia, 2,274 (11.0%, 95% CI 10.6-11.5) were readmitted. Re-admission was independently associated with age (12-59 months vs. 2-11 months: adjusted odds ratio (aOR) 1.70, 1.54-1.87; >5 years vs. 2-11 months: aOR 1.85, 1.55-2.22), malnutrition (weight-for-age-z-score (WAZ) -2SD: aOR 2.05, 1.84-2.29); WAZ - 2 to -3 SD vs. WAZ> -2SD: aOR 1.37, 1.20-1.57), wheeze (aOR 1.17, 1.03-1.33) and presence of a concurrent neurological disorder (aOR 4.42, 1.70-11.48). Chest radiography was ordered more frequently among those readmitted (540/2,274 [23.7%] vs. 3,102/18,329 [16.9%], p -2SD: aHR 1.87, 1.71-2.05); WAZ - 2 to -3 SD vs. WAZ >-2SD: aHR 1.46, 1.31-1.63), complete vaccination (aHR 0.74, 0.60-0.91), wheeze (aHR 0.87, 0.78-0.98) and anaemia (aHR 2.14, 1.89-2.43) were independently associated with mortality. CONCLUSIONS: Children readmitted with severe pneumonia account for a substantial proportion of pneumonia hospitalisations and deaths. Further research is required to develop evidence-based approaches to screening, case management, and follow-up of children with severe pneumonia, prioritising those with underlying risk factors for readmission and mortality
Correction: The importance of investing in data, models, experiments, team science, and public trust to help policymakers prepare for the next pandemic.
Get PDF[This corrects the article DOI: 10.1371/journal.pgph.0002601.]
A qualitative assessment of community perceptions and practices towards schistosomiasis prior to introduction of a potential novel treatment option for preschool-age children in Kenya
Get PDFBackground
Over 50 million preschool-age children (PSAC) in Africa need treatment for schistosomiasis but are excluded due to lack of a suitable child-friendly medication. The Paediatric Praziquantel Consortium has developed a novel paediatric formulation for PSAC. In advance of its roll-out, we conducted a social science study to draw lessons to inform implementation.
Methods
We conducted a cross-sectional study in eight villages in two purposively selected highly endemic Kenyan counties (Homa Bay and Kwale). We conducted 17 in-depth interviews with community opinion leaders and 21 with parents/guardians of PSAC. Twelve focus group discussions with parents/guardians of PSAC were also held. The aim was to assess their knowledge, perceptions, practices and willingness to participate in the medication’s roll-out for schistosomiasis. Thematic data analysis was performed.
Results
Most participants had heard of schistosomiasis and perceived it to be a serious disease whose treatment should be prioritised. Others felt it was a common disease that should not cause concern. Some people believed schistosomiasis was caused by witchcraft while others regarded it as a sexually transmitted infection. In addition, some practices like poor human waste disposal and water contact were thought to contribute to continued transmission of the disease.
Conclusion
Community members know and perceive schistosomiasis to be serious, but misinformation about its cause is prevalent. The study suggests the need for increased awareness creation to change the perceptions of communities in relation to schistosomiasis prevention and control. Community sensitisation should be prioritised in advance of medication roll-out
Does disability modify the association between poor mental health and violence victimisation over adolescence? Evidence from the CoVAC cohort study in Uganda.
Get PDFWe aimed to estimate the impact of poor mental health in early adolescence on subsequent poor mental health, depression, and violence victimisation in late adolescence and to determine whether young people living with disabilities experienced a stronger relationship between mental health and these outcomes. Data from two waves of a longitudinal cohort study of 2773 Ugandan adolescents were used to assess the impact of mental health difficulties in early adolescence (aged 11-14) on presence of subsequent mental health difficulties, depression and past year violence victimisation in later adolescence (aged 15-18). We used g-computation to examine how these outcomes changed dependent on levels of poor mental health in early adolescence and explored functional difficulties as an effect modifier. This study demonstrates high prevalence of mental health difficulties in adolescence. There is a positive association between mental health difficulties in early adolescence and experience of mental health difficulties, depression, and past year violence in later adolescence. The risk of poor outcomes is greater for individuals experiencing poorer mental health in early adolescence. The relationships between early mental health difficulties and both mental health difficulties in later adolescence and past year violence are stronger in young people with functional difficulties. Poor mental health in early adolescence is associated with depression and violence victimisation in later adolescence, and the association is stronger among adolescents living with disabilities. School-aged adolescents would benefit from violence prevention and mental health promotion interventions which are inclusive and engage and respond to the needs and rights of adolescents with disabilities
John Rennie Short Demography and the Making of the Modern World: Public Policies and Social Forces, Newcastle upon Tyne: Agenda Publishing, 2024. 171 pp.
No full textIn Demography and the Making of the Modern World, John Rennie Short aims to fill a gap between “on the one hand, demographers who like numbers but are uncomfortable with broader social and cultural theorising and, on the other, social and cultural theorists who tend to be uncomfortable with numbers and public policy analysts who tend to focus too little attention on demographic issues” (p.2). The book is framed as drawing on demographic research but without focusing on statistical modeling. Instead, the emphasis is on the social, economic and political implications of demographic trends, and the potential mediating role of public policy. The author aims to act as a conduit between professional demography and a wider audience to “reveal the demographic forces that shape our modern world
Adolescent health and well-being check-up programme in three African cities (Y-Check): protocol for a multimethod, prospective, hybrid implementation-effectiveness study.
Get PDFBACKGROUND: During adolescence, behaviours are initiated that will have substantial impacts on the individual's short-term and long-term health and well-being. However, adolescents rarely have regular contact with health services, and available services are not always appropriate for their needs. We co-developed with adolescents a health and well-being check-up programme (Y-Check). This paper describes the methods to evaluate the feasibility, acceptability, short-term effects and cost-effectiveness of Y-Check in three African cities. METHOD: This is a multi-country prospective intervention study, with a mixed-method process evaluation. The intervention involves screening, on-the-spot care and referral of adolescents through health and well-being check-up visits. In each city, 2000 adolescents will be recruited in schools or community venues. Adolescents will be followed-up at 4 months. The study will assess the effects of Y-Check on knowledge and behaviours, as well as clinical outcomes and costs. Process and economic evaluations will investigate acceptability, feasibility, uptake, fidelity and cost effectiveness. ETHICS AND DISSEMINATION: Approval has been received from the WHO (WHO/ERC Protocol ID Number ERC.0003778); Ghana Health Service (Protocol ID Number GHS-ERC: 027/07/22), the United Republic of Tanzania National Institute for Medical Research (Clearance No. NIMR/HQ/R.8a/Vol.IX/4199), the Medical Research Council of Zimbabwe (Approval Number MRCZ/A/2766) and the LSHTM (Approval Numbers 26 395 and 28312). Consent and disclosure are addressed in the paper. Results will be published in three country-specific peer-reviewed journal publications, and one multicountry publication; and disseminated through videos, briefs and webinars. Data will be placed into an open access repository. Data will be deidentified and anonymised. TRIAL REGISTRATION NUMBER: NCT06090006
General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants.
Get PDFBACKGROUND: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. METHODS: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20-64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). FINDINGS: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31-3·28) lower for women and 1·28 kg/m2 (1·02-1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. INTERPRETATION: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. FUNDING: UK Medical Research Council and UK Research and Innovation (Innovate UK)
Data for whom? Experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania.
Get PDFINTRODUCTION: Digital data systems have the potential to improve data quality and provide individual-level information to understand gaps in the quality of care. This study explored experiences and perceptions of a perinatal eRegistry in two hospitals in Mtwara region, Tanzania. Drawing from realist evaluation and systems thinking, we go beyond a descriptive account of stakeholders' experiences and provide insight into key structural drivers and underlying social paradigms. METHODS: We carried out 6 weeks of focused ethnographic observations at the labour wards of the two hospitals and 29 semi-structured qualitative interviews with labour ward staff, as well as with administrative and managerial stakeholders at hospital, district and regional levels. Multi-stage reflexive thematic data analysis was carried out. RESULTS: We provide an in-depth account of the day-to-day functioning of the eRegistry in the two hospitals, including both aspects of positive change and key challenges with its integration into routine documentation duties. Experiences with and perceptions of the eRegistry were inextricably linked to broader systemic constraints relating to staffing, workload and infrastructure. A key underlying theme shaping the way people engaged with the eRegistry was the notion of data ownership: the presence or absence of a feeling of being responsible, involved and in control of data. CONCLUSION: Some of the key systemic challenges in recording accurate, timely information about women and their babies are not solved by digital tools. Our findings also underline that when healthcare workers feel that data are not primarily for them, they document only for reporting purposes. The eRegistry increased a sense of data ownership among the nurse-midwives directly involved with data entry, but the potential for promoting and supporting data use feedback loops for improvement in care provision remained largely untapped. Our findings highlight the importance of local relevance and ownership in digitisation of routine health information systems
Switch to long-acting cabotegravir and rilpivirine in virologically suppressed adults with HIV in Africa (CARES): week 48 results from a randomised, multicentre, open-label, non-inferiority trial.
Get PDFBACKGROUND: Long-acting injectable cabotegravir and rilpivirine is licensed for individualised treatment of HIV-1 infection in resource-rich settings. Additional evidence is required to support use in African treatment programmes where demographic factors, viral subtypes, previous treatment, and delivery and monitoring approaches differ. The aim of this study was to determine whether switching to long-acting therapy with injections every 8 weeks is non-inferior to daily oral therapy in Africa. METHODS: CARES is a randomised, open-label, non-inferiority trial being conducted at eight sites in Uganda, Kenya, and South Africa. Participants with HIV viral load below 50 copies per mL on oral antiretroviral therapy and no history of virological failure were randomly assigned (1:1; web-based, permuted blocks) to receive cabotegravir (600 mg) and rilpivirine (900 mg) by intramuscular injection every 8 weeks, or to continue oral therapy. Viral load was monitored every 24 weeks. The primary outcome was week 48 viral load below 50 copies per mL, assessed with the Food and Drug Administration snapshot algorithm (non-inferiority margin 10 percentage points) in the intention-to-treat exposed population. This trial is registered with the Pan African Clinical Trials Registry (202104874490818) and is ongoing up to 96 weeks. FINDINGS: Between Sept 1, 2021, and Aug 31, 2022, we enrolled 512 participants (295 [58%] female; 380 [74%] previous non-nucleoside reverse transcriptase inhibitor exposure). Week 48 viral load was below 50 copies per mL in 246 (96%) of 255 participants in the long-acting therapy group and 250 (97%) of 257 in the oral therapy group (difference -0·8 percentage points; 95% CI -3·7 to 2·3), demonstrating non-inferiority (confirmed in per-protocol analysis). Two participants had virological failure in the long-acting therapy group, both with drug resistance; none had virological failure in the oral therapy group. Adverse events of grade 3 or greater severity occurred in 24 (9%) participants on long-acting therapy and ten (4%) on oral therapy; one participant discontinued long-acting therapy (for injection-site reaction). INTERPRETATION: Long-acting therapy had non-inferior efficacy compared with oral therapy, with a good safety profile, and can be considered for African treatment programmes. FUNDING: Janssen
