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Factors Associated With Contraceptive Initiation and Use Among Women Who Have Given Birth in the Last Year: Findings From the 2023 Women's Reproductive Health Survey.
Get PDFOBJECTIVE: This study investigates contraceptive use among individuals who have recently given birth. It aims to identify factors associated with contraceptive use at two months and one-year of giving birth. Additionally, it assesses whether receiving and being satisfied with contraceptive counselling influences contraceptive use. DESIGN: Cross-sectional analysis of data from the 2023 Women's Reproductive Health Survey. SETTING: England. POPULATION: Participants who had given birth in the last year (n = 2044). METHODS: Bivariate and multivariable logistic regressions examined factors associated with contraceptive use. MAIN OUTCOME MEASURES: Contraceptive initiation within two months of giving birth. Contraceptive use within one year of giving birth. RESULTS: Overall, 73% (n = 1489/2044) of participants were using contraception, however 58% (n = 1154/1998) had not initiated use within two months of giving birth. Bivariate analyses indicated that younger participants, those who received counselling, and those satisfied with it had higher odds of initiating contraception within two months. Similarly, younger individuals, those not desiring more children, and those who received counselling had higher odds of using contraception within one year. Multivariable analysis showed that receiving counselling and being satisfied with it were significantly associated with early initiation. CONCLUSIONS: This study highlights the need for high-quality contraceptive counselling as part of maternity care. Counselling during or immediately after pregnancy was shown to impact contraceptive initiation and use. Policy improvements and further research on achieving universal high-quality counselling are important to ensure equitable access to contraception
Effectiveness of a bedaquiline, linezolid, clofazimine 'core' for multidrug-resistant TB.
Get PDFBACKGROUND: Treatment outcomes may be compromised among individuals with multidrug/rifampicin-resistant TB (MDR/RR-TB) with fluoroquinolone (FQ) resistance. Among people in whom an FQ was unlikely to be effective, we compared the effectiveness of longer individualised regimens comprised of bedaquiline (Bdq) for 5-8 months, linezolid, and clofazimine to those reinforced with at least 1 Group C drug and/or longer Bdq duration. METHODS: We emulated a target trial to compare the effectiveness of initiating and remaining on the core regimen to a regimen reinforced with 1) Bdq for ≥9 months, 2) Bdq for ≥9 months, and delamanid (Dlm), 3) imipenem (Imp), 4) a second-line injectable, or 5) Bdq for ≥9 months, Dlm and Imp. We used cloning, censoring, and inverse-probability weighting to estimate the probabilities of successful treatment. RESULTS: Adjusted probabilities of successful treatment ranged from 0.75 (95% CI 0.61-0.89) to 0.84 (95% CI 0.76-0.91). Ratios of treatment success ranged from 1.01 for regimens reinforced with Bdq ≥9 months (95% CI 0.79-1.28) and Bdq ≥9 months plus Dlm (95% CI 0.81-1.31) to 1.11 for regimens reinforced with an injectable (95% CI 0.92-1.39) and Bdq ≥9 months, Dlm and Imp (95% CI 0.90-1.41). CONCLUSIONS: Some reinforced regimens had modestly higher treatment success rates, but estimates were imprecise. Additional studies of strategies for maximising treatment success among individuals with FQ resistance are needed
Long-Term Safety and Efficacy of Renal Denervation: 24-Month Results From the SPYRAL HTN-ON MED Trial.
Get PDFBACKGROUND: Six-month results from the SPYRAL HTN-ON MED trial (SPYRAL HTN-ON MED Study of Renal Denervation With the Symplicity Spyral Multi-Electrode Renal Denervation System) demonstrated that renal denervation (RDN) reduced office blood pressure (BP), and not 24-hour ambulatory systolic BP, compared with sham control in hypertensive patients. In this prespecified analysis of the ON MED trial, long-term changes in BP, antihypertensive drug use, and safety outcomes through 24 months are compared between RDN and sham control groups. METHODS: SPYRAL HTN-ON MED is a prospective, randomized, sham-controlled, blinded trial enrolling 337 patients globally from 56 clinical centers. Eligible patients had an office systolic BP of 150 to 180 mm Hg, a diastolic BP ≥90 mm Hg, and a 24-hour ambulatory systolic BP of 140 to 170 mm Hg. Patients were randomized to RDN or a sham control procedure and were prescribed a stable regimen of 1 to 3 antihypertensive medications through 6 months. After 6 months, patients and physicians were unblinded with permitted changes to antihypertensive therapy, and control patients were permitted to cross over. Crossover patients had their last observations carried forward as part of the control group. Statistical analyses were conducted on the population as randomized. RESULTS: At 24 months, the RDN group experienced significantly greater mean reductions in ambulatory systolic BP (-12.1±15.3 mm Hg [n=176] versus -7.0±13.1 mm Hg [n=33]; difference: -5.7 mm Hg; P=0.039) and office systolic BP (-17.4±16.1 mm Hg [n=187] versus -9.0±19.4 mm Hg [n=35]; difference: -8.7 mm Hg; P=0.0034) compared with sham controls. At 24 months, antihypertensive medications increased significantly more in the sham group (1.7 versus 2.7) compared with the RDN group (1.8 versus 2.4; P=0.046). Sensitivity analyses accounting for missing sham patient BP values due to crossover yielded consistent results in favor of RDN for 24-hour ambulatory (P=0.023) and office systolic BP (P<0.0001). Clinically adverse events were rare, with no instances of renal artery stenosis through 24 months. CONCLUSIONS: RDN produced significantly greater ambulatory and office systolic BP reductions at 24 months compared with sham control, despite higher antihypertensive medication use in the control group. REGISTRATION: URL: https://clinicaltrials.gov; Unique identifier: NCT02439775
The Importance of Lived Experience: A Scoping Review on the Value of Patient and Public Involvement in Health Research.
No full textBACKGROUND: Recently, patient and public involvement (PPI) in research has gained significant attention, particularly within the United Kingdom. Although there has been a growing focus on the impact of PPI on research outcomes, there remains an important gap in understanding its effects on the individuals involved and the value they gain from their participation. OBJECTIVE: This scoping review aims to critically examine how PPI benefits both people with lived experience and researchers, shedding light on the value of their involvement in shaping research. METHODS: We searched MEDLINE, PsycINFO, EMBASE, Cochrane and Web of Science for full-text articles published in English after 1996. Grey literature searches reviewed policies from international research funders and patient organisations. Two reviewers independently carried out the abstract, title and full-text article screening stages. Data abstraction was performed by one reviewer and verified by a second reviewer. Thematic analysis synthesised the findings. RESULTS: After searching 3024 citations, 107 published articles and nine unpublished resources were included in the review. Most of the studies were conducted in the United Kingdom in the last 10 years. Thematic analysis of the value of PPI revealed four main themes: (1) value from contributing to research, (2) importance of relationships, (3) attitudes and support for PPI and (4) emotional labour of involvement. DISCUSSION: This scoping review reveals the significant contributions alongside systemic challenges of PPI in health research. Being valued was framed as an impact of PPI to both PPI advisors and researchers. It emphasises the importance of social capital in developing relationships between researchers and people with lived experience yet highlights barriers that can hinder effective collaboration. This can lead to experiential knowledge being undervalued as a crucial perspective to inform research. Despite people being chosen to take part on account of their knowledge, skills and lived experience, these resources were not always used to their full potential due to researchers' expectations and restrictive research and institutional processes. The review calls for coordinated efforts to improve how PPI is valued and practised beyond a process or method to ensure PPI is done thoughtfully and effectively
Agro-morphological diversity and breeding potential of Bambara groundnut (Vigna subterranea L. Verdc): Insights from recombinant inbred lines evaluation
Get PDFBambara groundnut (BGN) is a nutritious, multi-stress-tolerant legume with potential to enhance food and nutrition security across Africa, particularly in regions vulnerable to climate change and resource scarcity. Its ability to thrive in harsh environments while providing a rich source of protein and essential nutrients makes it an invaluable crop for sustainable agriculture. Despite its proven resilience and benefits, BGN remains overlooked in mainstream agricultural development and research, leaving its full potential untapped. This study evaluated recombinant inbred lines (RILs) derived from hybridization of four genetically diverse parental lines to identify superior genotypes. This research aims to pinpoint elite lines with potential for enhancing future BGN breeding programs, focusing on key agro-morphological traits. The experiment followed a 90 × 5 augmented design, incorporating 21 check lines. Trait measurements adhered to the descriptors provided by the International Plant Genetic Resources Institute. Data analysis included analysis of variance (ANOVA), Pearson correlation coefficient, Principal Component Analysis (PCA) and diversity indices. Quantitative morphological traits (days to 50 % emergence (DE), days to 50 % flowering (DFF), internode length (IL), plant height (pH), and petiole length (PL)) exhibited significant variability among genotypes (p < 0.001). Multivariate analysis indicated that the first three principal components (PCs), each with eigenvalues ≥ 1, accounted for 80 % of the total variance. Key correlations include strong positive relationships between DE and DFF (r = 0.85; p = 0.017), pH (r = 0.75; p = 0.021) and PL (r = 0.75; p = 0.027). Petiole length was positively correlated with DFF (r = 0.89; p = 0.01) and pH (r = 0.86; p = 0.011). Grain yield per plot (GY) and grain yield per plant (GYP) varied significantly, which aided classification into four groups, namely: A (high-yielding g), B (moderately high yielding), C (moderate yielding) and D (low yielding). A total of 19 genotypes including; IITA686/LunT-419–324, S19/Ankpa4–339–266, IITA686/LunT-348–271, S19/Ankpa4–50–43, S19/Ankpa4–234–197, PONG-BR, S19/Ankpa4–1–1 and S19/Ankpa4–151–129 were grouped as high-yielding. The significant genotypic differences observed across most quantitative traits confirm the presence of sufficient genetic diversity, highlighting BGN's potential for selection and genetic enhancement
Short-term association between hot nights and mortality: a multicountry analysis in 178 locations considering hourly ambient temperature.
Get PDFBACKGROUND: The rise in hot nights over recent decades and projections of further increases due to climate change underscores the critical need to understand their impact. This knowledge is essential for shaping public health strategies and guiding adaptation efforts. Despite their significance, research on the implications of hot nights remains limited. OBJECTIVE: This study estimated the association between hot-night excess (the sum of excess heat during the nighttime above a threshold) and duration (the percent of nighttime with a positive excess) based on hourly ambient temperatures and daily mortality in the warm season over multiple locations worldwide. METHODS: We fitted time series regression models to mortality in 178 locations across 44 countries using a distributed lag non-linear model over lags of 0-3 days, controlling for daily maximum temperature and daily mean absolute humidity. Next, we used a multivariate meta-regression model to pool results and estimated attributable burdens. RESULTS: We found a positive, increasing mortality risk with hot-night excess and duration. Assuming 0 as a reference, the pooled relative risks of death associated with extreme excess and duration, defined as the 90th percentile in each index, were both similar at 1.026 (95 % CI, 1.017; 1.036) and 1.026 (95 % CI, 1.013; 1.040). The overall estimated attributable fractions were also observed to be closely similar at 0.60 % (95 % CI, 0.09; 1.10 %) and 0.62 % (95 % CI, 0.00; 1.23 %), respectively. DISCUSSION: This study provides new evidence that hot nights have a specific contribution to heat-related mortality risk. Modeling thermal characteristics' sub-hourly impact on mortality during the night could improve decision-making for long-term adaptions and preventive public health strategies
Identifying the active ingredients in payment for performance programmes using system dynamics modelling.
Get PDFPayment for performance (P4P) is not a uniform intervention, with programme effect dependent on several interconnected factors. In this study, a system dynamics model was developed to explore the pathways to improved outcomes and how changes in the design, implementation and context of a P4P programme affected maternal and child health (MCH) service delivery outcomes in Tanzania. A previously developed causal loop diagram of the programme effects was used to inform model development, with further data sources (including an impact evaluation of programme, health surveys, stakeholder feedback and relevant literature) used to build the model. A number of pathways were identified to improved services under P4P, with increased availability of drugs underpinning the content of care outcome (intermittent preventative treatment during ANC), which together with increased supervision, enhanced health worker motivation. This in turn increased perceived quality of care at the facility which improved the coverage of services outcome (facility-based deliveries), and with increased outreach, increased awareness of services also boosted demand. Minor delays in payment reduced provider purchasing power for medicines, with severe delays driving erosion of provider trust and motivation for programme participation. Allocating a larger share of funds for facility operations can enhance performance effects, particularly for those services that rely on efficient drug administration. Contextual factors including limited baseline provision of essential medications, lower community awareness of facility services and dispersed/distant populations reduced programme effect. This paper demonstrates the feasibility and the potential of such models to inform the design of effective health system interventions
A comprehensive review of mental health services across selected countries in sub-Saharan Africa: assessing progress, challenges, and future direction.
Get PDFMental health is a crucial but frequently neglected aspect of general health and well-being that faces numerous challenges, including underfunding, shortage of trained professionals, pervasive stigma, inadequate infrastructure, and insufficient policies in sub-Saharan Africa. This review reports the significant progress and initiatives that have been made in this region. South Africa, Nigeria, Uganda, Kenya, Tanzania, Ethiopia, Rwanda, and Ghana have developed national policies and integrated mental health services into primary healthcare, marking a shift towards community-based care and reducing stigma through awareness campaigns. Countries such as South Africa and Rwanda have robust infrastructure, while Ethiopia and Kenya emphasize training primary healthcare providers and community-based models. Ghana's Mental Health Act and Uganda's collaboration with NGOs has enhanced awareness and resource mobilization. Mental healthcare-targeted programs, such as Kenya's Friendship Bench and Ethiopia's Health Extension Program, have demonstrated the efficacy of community-based interventions. South Africa has leveraged innovative approaches, such as telepsychiatry, to expand access to holistic mental health services, particularly in rural areas. Partnerships with traditional healers in Uganda and Rwanda have enhanced early identification and referral. Despite these advancements, challenges persist. Common issues include a severe shortage of mental health professionals, inadequate budget allocation, limited access to services in rural areas, and the need for comprehensive policy frameworks that continue to stall the desired goals. Urban-centric services in Nigeria, financial constraints in Tanzania, and resource limitations in Ethiopia and Rwanda have hindered equitable access. While public-private partnerships and technological innovations are emerging, the dominance of institutionalized care in several regions limits community outreach. To chart the path forward, improving mental health services in Sub-Saharan Africa requires increased funding, expanded training programs for mental health professionals, and incorporation of mental health into basic healthcare systems. Utilizing technology such as telemedicine and mobile health applications holds promise for overcoming geographical barriers and supporting ongoing education. Community-based models and advocacy efforts are essential for reducing stigma, promoting sustainable mental healthcare, and enhancing the overall well-being of citizens insub-Saharan Africa
A novel micronemal protein MP38 is involved in the invasion of merozoites into erythrocytes.
Get PDFThe absence of an in vitro cultivation system for Plasmodium vivax hinders the exploration of molecular targets for vaccine development. To address this, functional studies often rely on alternative models, such as P. knowlesi, due to its genetic similarity to P. vivax. This study investigated the role of a novel micronemal protein, PvMP38 (PVX_110945), in both P. vivax and P. knowlesi merozoite invasion of erythrocytes. The full-length ectodomain of PvMP38 was expressed, and polyclonal antibodies were generated to assess its function. PvMP38 was confirmed to localize on micronemal organelle in both P. vivax and P. knowlesi merozoites. In vitro protein-protein interaction assays revealed that PvMP38 binds to Pv12 with high-affinity interaction. A conserved novel complex of Pv12-Pv41-PvMP38 was identified by immunoprecipitation of P. vivax antibodies on P. knowlesi schizont lysates. Linear epitopes of PvMP38 with high and moderate antigenicity were identified in clinical isolates of both species. Invasion inhibition assays demonstrated that a triple antibody combination targeting the PvMP38, Pv12, and Pv41 significantly reduced P. knowlesi merozoite invasion of erythrocytes compared to a single antibody. In addition, CRISPR/Cas9-mediated knockout of P. knowlesi mp38 markedly impaired parasite growth, underscoring its essential role during the asexual stage. These findings identify PvMP38 and its associated complex as promising targets for malaria interventions and highlight the utility of P. knowlesi as a model for investigating P. vivax erythrocyte invasion mechanisms.IMPORTANCEThis manuscript reported an effort in malaria eradication by identifying and functionally characterizing a novel Plasmodium vivax micronemal protein, PvMP38, involved in erythrocyte invasion. A narrow repertoire of an efficacious vaccine targeting P. vivax candidates is being developed due to the lack of continuous in vitro culture. This study addresses a gap in P. vivax research using P. knowlesi as a model for both genome editing and antibody functionality validation. By enhancing the protein-protein interaction screening framework, this study demonstrated that PvMP38 forms a complex with Pv12 and Pv41, opening the approaches to multi-antigen vaccines. The successful application of CRISPR/Cas9 gene editing techniques to disrupt its homolog, the pkmp38 gene, further assesses the protein's significance in the growth and invasion of the parasite. These findings provided valuable insights into the biology of P. vivax and proposed PvMP38 as a promising candidate for malaria intervention strategies
“It felt like a weight was being taken off of my shoulders”: findings from an intervention to support migrant adolescents and young people in KwaZulu-Natal, South Africa
Get PDFIn South Africa, many young people relocate from rural to urban areas for education, attending day schools while residing in rented accommodation. Migration exposes them to risk, including alcohol and drug abuse, sexual exploitation and violence. We developed and assessed a support system for young migrants, aged 14-24 in KwaZulu-Natal, South Africa. Five trained peer navigators conducted needs assessments for 283 young internal migrants between June 2021 and October 2022. The intervention included mobile phone support and streamlined referrals through a call centre, connecting young migrants to a study social worker, local healthcare facilities, and peer assistance. To assess the intervention, we conducted repeat in-depth interviews with 20 participants and 5 interviews with peer navigators, in-person and by telephone. Most young migrants rented rooms in unsafe areas to be near their schools, which presented physical, psychological, and mental challenges during the transition from living with parents/carers. The young migrants valued the intervention, including access to sexually transmitted infection treatment, psychosocial support from the social worker, and assistance from peer navigators in tackling general challenges. They appreciated that the peers provided a confidential space to engage and share openly with little fear of being judged. Our findings show that protection for young migrants can be provided through supportive structures such as peer-led interventions