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Receipt of humanitarian cash transfers, household food insecurity and the subjective wellbeing of Syrian refugee youth in Jordan.
Get PDFOBJECTIVE: Humanitarian aid, including food aid, has increasingly shifted towards the provision of cash assistance over in-kind benefits. This paper examines whether food security mediates the relationship between receipt of humanitarian cash transfers and subjective wellbeing among Syrian refugee youth in Jordan.
DESIGN: Secondary analysis of the 2020-21 Survey of Young People in Jordan, which is nationally representative of Syrian youth aged 16-30. We employ stepwise model building and structural equation models.
SETTING: Jordan.
PARTICIPANTS: Syrian refugee youth aged 16-30 (n 1572).
RESULTS: While 92 % of Syrian households with youth received cash transfers from a UN agency, 78 % of households were food insecure using the Food Insecurity Experience Scale. Fifty-one percent of youth suffered from poor wellbeing using the WHO-5 subjective wellbeing scale. Household food insecurity was associated with poorer youth wellbeing. Receiving larger cash transfer amounts was associated with better wellbeing among Syrian youth in unadjusted models. The relationship between receipt of cash transfers and youth wellbeing was not mediated by food security.
CONCLUSION: We do not find support for the hypothesis that food security is a mediator of the association between cash transfers and subjective wellbeing for this population
Rates and risk factors for relapse among children recovered from severe acute malnutrition in Mali, South Sudan, and Somalia: a prospective cohort study.
Get PDFBACKGROUND: Community-based management of acute malnutrition is an effective treatment model for severe acute malnutrition. However, sparse evidence exists on post-discharge outcomes and the sustainability of recovery. This study aimed to evaluate the risk and determinants of relapse following severe acute malnutrition recovery in high-burden settings.
METHODS: This multi-country prospective cohort study followed children who had recovered from severe acute malnutrition and their non-malnourished peers in parallel for 6 months in Mali (nine sites), South Sudan (six sites), and Somalia (one site). Nutritional status was assessed by research staff at nutrition clinics monthly to obtain the proportion of children exposed to severe acute malnutrition who relapsed to acute malnutrition and the relative risk of developing acute malnutrition for exposed versus non-exposed (ie, previously non-malnourished) children. Exposed children were eligible if they had been discharged from community-based management of acute malnutrition programmes while aged 6-47 months. Non-exposed children were eligible if they had not had an episode of acute malnutrition in the previous year; non-exposed children were matched to exposed children by age, sex, and community. Acute malnutrition was defined as having a mid-upper arm circumference of less than 125 mm, a weight-for-height Z score of less than -2, or nutritional oedema. The primary outcome was the cumulative incidence of acute malnutrition at 6 months in the exposed and non-exposed cohorts. Relapse was defined as an episode of acute malnutrition among exposed children during the 6-month follow-up period.
FINDINGS: Between April 9, 2021, and June 2, 2022, 2749 children were enrolled (1689 exposed and 1060 non-exposed). After 6 months, 30% (95% CI 25-34) of children previously exposed to severe acute malnutrition relapsed in Mali, 63% (95% CI 59-67) in South Sudan, and 22% (95% CI 19-25) in Somalia. Depending on the context, exposed children were 1·2-6·2 times more likely to have acute malnutrition compared with non-exposed children. Higher anthropometric measurements at discharge were protective against relapse; however, few other child-level or household-level factors at the time of discharge were associated with subsequent relapse. After discharge, children experiencing food insecurity or morbidity at time of follow-up were more likely to relapse than those who were not experiencing these factors.
INTERPRETATION: Following severe acute malnutrition recovery, children have a significant risk of relapsing within 6 months, highlighting the particular vulnerability of this population. Although the community-based management of acute malnutrition model proves highly effective in saving lives, high relapse indicates the need for additional services during and following treatment to better sustain recovery.
FUNDING: The United States Agency for International Development
Prevalence and factors associated with childhood malaria and anaemia in Osun state, Nigeria: a baseline household malariometric study.
Get PDFBACKGROUND: Under-5 children have been known to bear a significant burden of malaria in endemic countries. Though significant progress has been made towards malaria prevention and control in Nigeria, it is expected that the addition of new malaria prevention strategy, such as perennial malaria chemoprevention (PMC) can contribute to a more rapid decline in malaria cases. This study aimed to determine the prevalence and factors associated with malaria and anaemia among children aged 2-18 months in Osun State.
METHODS: A cross-sectional household malariometric study was conducted in 80 communities across eight Local Government areas (LGAs) in Osun State. Ethical approval was obtained from Osun State Health Research Ethical Committee (OSHREC/PRS/569T312/ on the 22nd of May 2023. Malaria test positivity was determined by rapid diagnostic test (RDT) and microscopy. In addition, haemoglobin levels were measured using Haemocue® Hb 201. Caregivers were interviewed on malaria management practices using tools adapted from Nigeria Malaria Indicator Survey.
RESULTS: A total of four hundred children aged 2-18 months were assessed in this study, which was conducted in July 2023. The caregivers were mostly the biological mothers of the children (n = 387, 96.8%). Female children were 51.8% and their male counterparts 48.2% respectively. Malaria positivity rate by RDT was 36.8% and this was higher in children aged 13-18 months (48.0%) and followed by those aged 7-12 months (44.0%). By microscopy, the positivity rate was 12.5% overall, with 15.0% positivity rate among children aged 7-12 months, about 13.5% among those 13-18 months and those aged 2-6 months had the least positivity rate whether by microscopy (8.5%) or RDT (18.5%). Overall, the prevalence of severe anaemia was 4.0%, moderate was 37.3%, mild was 18.3% and the normal was 40.4% respectively. However, higher proportion of moderate anaemia (7.0-9.9 haemoglobin (g/dL)) was reported in older children. Children from medium wealth households (aOR = 0.549; 95% CI 0.306-0.986) and those from rich households (aOR = 0.543; 95% CI 0.283-1.042) had 45.0% reduction in the odds of having malaria, when compared with their counterparts from poor households. In addition, children aged 7-12 months (aOR = 2.856; 95% CI 1.524-5.354) and those aged 13-18 months (aOR = 4.269; 95% CI 2.422-7.526) had higher odds of malaria infection, respectively, when compared with children aged 2-6 months.
CONCLUSION: Malaria infection and anaemia were found to be higher in older children. Household wealth and child's age were significantly associated with malaria infection. These findings would inform the positioning of PMC intervention touch-points to reduce malaria burden in young children
Kids' Environment and Health Cohort: Database Protocol: supplementary appendix.
Get PDFINTRODUCTION: Environmental exposures are known to affect the health and well-being of populations throughout the life course. Children are particularly susceptible to environmental impacts on educational and health outcomes as they spend more time in their local environments compared to adults. In England, no national, longitudinal dataset linking information about the physical and social environment in and around homes and schools to children's health and education outcomes currently exists. This limits our understanding of how environments might impact the health and well-being of children as they grow up.
OBJECTIVE: To establish the Kids' Environment and Health Cohort, a research-ready, de-identified and annually updated national birth cohort of all children born in England from 2006 onwards.
METHODS: The Kids' Environment and Health Cohort will link birth and mortality records, health and educational attainment datasets, to maternal health (up to 12 months prior to their child's birth), and environmental data for all children born in England from 2006 - approximately 11 million children at first build. A subset of children born between 2010 and 2012, and between 2020 and 2022 will be linked to their mothers' 2011 or 2021 Census records, respectively. The cohort database will be held in, and accessed via, a trusted research environment (TRE) at the Office for National Statistics (ONS). All geographical identifiers in the cohort, allowing for linkage to further environmental data, will be securely held by the ONS, separately to the main cohort, and will be encrypted before being shared with researchers.
CONCLUSION: The Kids' Environment and Health Cohort will, for the first time, link administrative health and education data to longitudinal environmental exposures for children at national level in England. It will serve as a data resource to support research about the health and well-being of children via improved home and school environments
Leveraging AI to optimize vaccines supply chain and logistics in Africa: opportunities and challenges.
Get PDFExamining the current situation of the vaccine supply chain in Africa, the article highlights the importance of AI technologies while outlining the prospects and problems in vaccine supply chain management in Africa. Despite the significance of vaccinations, many African children are unable to receive them due to logistical challenges and a lack of infrastructure. AI has the potential to increase productivity by streamlining logistics and inventory management, but it is hampered by issues with data privacy and technology infrastructure. This perspectiveoffers ways for utilizing AI to enhance vaccine supply chains in Africa, citing successful experiences in Nigeria, Malawi, Rwanda, and Ghana as examples of AI's advantages. In order to improve healthcare outcomes and immunization coverage in Africa, cooperation among stakeholders is stressed
Effectiveness of the GRACE risk score according to troponin elevation in patients admitted with non-ST elevation acute coronary syndrome: a post hoc analysis of the UKGRIS parallel group cluster randomised controlled trial.
Get PDFBACKGROUND: The effectiveness of risk stratification using the Global Registry of Acute Coronary Events (GRACE) Risk Score (GRS) for patients presenting to hospital with suspected non-ST elevation acute coronary syndrome (NSTEACS) according to troponin elevation is unknown. METHODS: Post hoc analysis of a phase 3 parallel group cluster randomised controlled trial (UK GRACE Risk Score, UKGRIS) of adult patients presenting with suspected NSTEACS to 42 hospitals in England between 9 March 2017 and 30 December 2019, with hospitals randomised (1:1) to standard care or according to the GRS and associated guidelines. Coprimary outcome measures were use of guideline-recommended management and time to the composite of cardiovascular death, non-fatal myocardial infarction, new-onset heart failure hospitalisation or readmission for cardiovascular event at a minimum of 24 months follow-up. RESULTS: A total of 3050 patients were randomised in UKGRIS, of whom 2602 had troponin elevation. The relative effect of GRS compared with standard care on the uptake of guideline-recommended care was greater for participants with troponin elevation compared with those without (relative OR 1.52, 95% CI 1.16 to 2.00, p<0.01). The time to the first composite event was not improved by the GRS among participants with (HR 0.89, 95% CI 0.70 to 1.14) or without troponin elevation (HR 1.14, 95% CI 0.79 to 1.64), with no interaction (relative HR 0.79, 95% CI 0.57 to 1.08, p=0.14 for interaction). CONCLUSIONS: For suspected NSTEACS, the effect of the GRS compared with standard care on uptake of recommended processes in those with elevated troponin was higher than in those without. However, this did not translate into a reduction in the composite primary or secondary outcomes at 24 months. TRIAL REGISTRATION NUMBER: ISRCTN29731761
Prevalence of Sleep Apnea and Sleepiness in Adults With and Without HIV in Mwanza, Tanzania: Baseline Results From an Ongoing Cohort Study.
Get PDFWe conducted a cross-sectional analysis of the baseline survey of participants aged > 30 years enrolled in the Mwanza HIV&CVD Cohort in Tanzania. Our primary objective was to examine the association between HIV status and sleep apnea (SA). Secondary objectives were (1) to examine the association between HIV status and excessive daytime sleepiness (EDS) and (2) to identify risk factors associated with SA and with EDS. The cohort enrolled 500 people living with HIV (PLWH) and 500 people without HIV (PWoH) in 2021-2023. Participants completed overnight oximetry; SA was defined as an oxygen desaturation index (ODI) of ≥ 5 events/h. EDS was defined as an Epworth Sleepiness Scale score (ESS) of ≥ 11. The median age was 46 and 43 in PLWH and PWoH, respectively. The prevalence of sleep apnea was similar between PLWH and PWoH (17% and 19%, respectively; adjusted odds ratio (aOR) = 0.84, 95% confidence interval (CI) = 0.60-1.17). In contrast, the prevalence of EDS (ESS score ≥ 11) was higher in PWoH (21%) than in PLWH (13%) (aOR = 0.58, 95% CI = 0.41-0.83). In a multivariable model, factors associated with SA were older age, alcohol use, higher BMI category, hypertension and depression. Both objectively measured SA and subjectively reported EDS are common in Tanzanian adults. SA was strongly associated with overweight or obesity, suggesting that the prevalence of SA will grow with projected increases in age and obesity rates in Tanzania
Acceptability and feasibility of CHANGE, a non-specialist worker delivered intervention to address alcohol use disorders and psychological distress among conflict-affected populations in Uganda: a qualitative study.
Get PDFINTRODUCTION: CHANGE is a psychological intervention designed using a systematic intervention development process for addressing the needs of men with co-existing psychological distress and alcohol use disorders (AUD) in conflict-affected settings. The aim of this study in Uganda was to understand experiences of those who delivered and received the intervention to inform contextually relevant adaptations before testing its cost-effectiveness in a randomised controlled trial. METHODS: The study was implemented in the Rhino Camp refugee settlement in Northern Uganda. We conducted three sequential sets of 10 individual semi-structured in-depth interviews each with (a) adult (≥18 years) men with hazardous/harmful drinking and psychological distress who received the CHANGE intervention, and (b) non-specialist workers (NSWs) who delivered the CHANGE intervention. Thematic analysis was used to analyse the data. RESULTS: The experiences of the men with hazardous/harmful drinking and NSWs were broadly consistent with each other. The participants found the knowledge and skill acquisition related to alcohol use, and the intervention materials such as handouts useful. Feasibility of the intervention was enhanced by its structured nature with in-built flexibility, and intervention content was perceived as easily comprehensible. On the other hand, the loss of potential earnings due to time spent in the sessions was a barrier to attendance. The intervention was perceived to result in reduced drinking and improvement in related activities such as sleep, appetite, and social relationships. Some of the perceived mechanisms for change included distraction and strengthening of supportive social networks. The day-to-day challenges of life in a refugee camp were a common barrier to changing drinking behaviour despite receiving the intervention. CONCLUSION: If proven to be effective, the acceptability and feasibility of CHANGE makes it a potentially scalable intervention in low resource settings with shortage of specialist healthcare professionals. The intervention may have the potential to be integrated with other programmes of care that can address additional adversities that the population may face in the setting
Prevalence, aetiology, and hospital outcomes of paediatric acute critical illness in resource-constrained settings (Global PARITY): a multicentre, international, point prevalence and prospective cohort study
Get PDFBACKGROUND: Children in resource-constrained settings (RCS) have disproportionately high illness and mortality; however, the prevalence in RCS of paediatric acute critical illness (P-ACI; life-threatening conditions that require time-sensitive interventions) is unknown. Most P-ACI can be managed with basic critical care (stabilisation, fluid resuscitation, oxygen, and vital-organ support), but RCS hospitals often lack such essential services. This study estimated the prevalence and examined the aetiology of P-ACI among children at RCS hospitals to support critical care capacity building and inform resource allocation.
METHODS: We conducted a hybrid prospective cohort and multinational point prevalence study of acutely ill or injured children aged 28 days to 14 years who presented to RCS hospitals on four designated days between July 20, 2021, and July 12, 2022. We measured the proportion of participants with P-ACI, applying the definition for acute paediatric critical illness (DEFCRIT) framework for research in resource-variable settings, and followed up admitted patients for hospital outcomes. In participants with P-ACI, we report diagnoses associated with critical illness. We used descriptive statistics to summarise site and cohort data by country sociodemographic category (Socio-demographic Index; SDI) and multivariable logistic regression to assess whether country sociodemographic category was independently associated with P-ACI.
FINDINGS: The study included 46 sites, 19 countries, and 7538 children, among whom 2651 (35·2%) were admitted to hospital and 68 died (all-cause mortality 0·9% [95% CI 0·7-1·1]). 985 (13·1% [95% CI 12·3-13·9]) participants had P-ACI. Among all sociodemographic categories, P-ACI prevalence was highest (28·0% [26·0-30·1]; 512 of 1828 participants) in low-SDI countries (p<0·0001). Mortality among those with P-ACI was 6·3% (4·9-8·0; 62 deaths). The most common P-ACI diagnoses were pneumonia (152 [15·4%] of 985 participants), sepsis or septic shock (102 [10·4%]), and malaria (95 [9·6%]). In an adjusted model, country sociodemographic category was not significantly associated with P-ACI frequency. Among all 68 deaths in the study, 40 (59% [46-71]) occurred within 48 h of presentation.
INTERPRETATION: P-ACI in RCS hospitals is common, associated with high mortality, disproportionately elevated in low-SDI countries, and associated with conditions that can be managed with basic critical care. This study underlines the need for investment in basic critical care services in RCS to address a major contributor to preventable mortality in hospitalised children. FUNDING: National Institutes of Health (USA); Medical Research Council (Singapore); Grand Challenges Canada; and University of Maryland, Baltimore (USA)
Clinical and cost-effectiveness of diverse posthospitalisation pathways for COVID-19: a UK evaluation using the PHOSP-COVID cohort.
Get PDFBACKGROUND: Long covid has emerged as a complex health condition for millions of people worldwide following the COVID-19 pandemic. Previously, we have categorised healthcare pathways for patients after discharge from hospital with COVID-19 across 45 UK sites. The aim of this work was to estimate the clinical and cost-effectiveness of these pathways. METHODS: We examined prospectively collected data from 1013 patients at 12 months postdischarge on whether they felt fully recovered (self-report), number of newly diagnosed conditions (NDC), quality of life (EuroQoL-five dimension-five level (EQ-5D-5L) utility score compared with pre-COVID estimate) and healthcare resource costs (healthcare records). An analysis of the cost-effectiveness was performed by combining the healthcare resource cost and 1-year EQ-5D (giving a quality-adjusted life-year (QALY)) using statistical models that accounted for observed confounding. RESULTS: At 1 year, 29% of participants felt fully recovered, and 41% of patients had an NDC. The most comprehensive services, where all patients could potentially access assessment, rehabilitation and mental health services, were more clinically effective when compared with either no service or light touch services (mean (SE) QALY 0.789 (0.012) vs 0.725 (0.026)), with an estimated cost per QALY of £1700 (95% uncertainty interval: dominated to £24 800). CONCLUSION: Our analysis supports the need for proactive, stratified, comprehensive follow-up, particularly assessment and rehabilitation for adults after hospitalisation with COVID-19, showing these services are likely to be both clinically and cost-effective according to commonly accepted thresholds