69832 research outputs found
Sort by
Navigating HIV care in a mobile society: case studies of clinic transfers in South Africa's public health sector.
No full textIn South Africa, people living with HIV (PWH) often relocate for work and family obligations, which creates unique challenges for continuous HIV care. We explored the experiences of mobile individuals living with HIV navigating clinic transfers without formal letters. A qualitative study was conducted with PWH on antiretroviral therapy (ART) from two clinics in KwaZulu-Natal. Participants, who had not disclosed their HIV treatment history at registration, were interviewed in-depth between March and October 2023. Content and thematic analyses, informed by Andersen's behavioral model and self-management domains, were used. This study presents two case studies of individuals who faced challenges with accessing ART after relocating to new areas: a 37-year-old female worker and a 47-year-old male construction worker. Both faced difficulties accessing ART after relocation. When they presented at new clinics, they were told they could not access care without transfer letters. Unable to return to previous clinics, they sought treatment at a third clinic as treatment-naive, changing their names to avoid detection. To cover ART gaps, they also purchased or borrowed ART from others. These individuals developed strategies to overcome barriers. Educating clinic staff on the challenges faced by migrants could help improve transfers
Leptospirosis.
Get PDFLeptospirosis is a zoonotic bacterial infection that is prevalent across all continents and is caused by pathogenic spirochaetes of the genus Leptospira. Although infection can be asymptomatic, symptomatic disease can vary in severity from mild to severe illness, the latter characterized by icterus and/or multi-organ dysfunction and potentially death. An estimated one million cases of leptospirosis occur globally each year, resulting in ~60,000 deaths. The pathogenesis of severe leptospirosis is poorly understood but is believed to involve an interplay between genetic predisposition, pathogen virulence and dysregulated immune responses that trigger a cytokine storm with associated immunoparesis. Leptospira are susceptible to several low-cost antibiotics, including benzyl penicillin, doxycycline, cephalosporins and macrolides, when used in the early phase of infection. Late disease with organ dysfunction is treated with supportive care, and the benefit of antibiotics during late disease is doubtful. Very few countries have licensed a vaccine for human leptospirosis, and available vaccines only protect against rodent-associated serogroups. Exposure control by behavioural modifications and personal protective measures are the major preventative measures in leptospirosis, and the efficacy of prophylactic antibiotics has not been confirmed in clinical trials. Future research is needed to accurately estimate leptospirosis disease burden across the globe, to understand the pathophysiology of severe leptospirosis to inform the design of targeted immunotherapies and vaccines, and to develop cost-effective and accurate point-of-care diagnostics
Access to healthcare for people with disabilities in Zambia: a qualitative study.
Get PDFPeople with disabilities globally experience poorer health outcomes than people without disabilities. The United Nations Convention on the Rights of Persons with Disabilities emphasises that people with disabilities must have equal access to healthcare, yet evidence demonstrates barriers to access across contexts. Research on this topic is limited in Zambia, and this study therefore aimed to generate evidence on access to healthcare for people with disabilities in Zambia. In this qualitative study, we conducted in-depth interviews with 48 participants, including 16 adults with disabilities, 16 caregivers of a child with disabilities, 12 primary healthcare professionals, and four key informants from government and civil society. Participants were recruited from three districts in Lusaka Province (Lusaka, Chongwe and Kafue), the most populated province in Zambia. Participants were purposively sampled to maximise variation by sex, age, impairment type, district and locality (rural, urban, peri-urban). Data collection was completed in August 2022. Key themes were mapped against the Levesque Framework of healthcare access. Participants reported limited information on available services, stigma from community members and healthcare professionals, limited knowledge on disability and a lack of training for healthcare professionals, and challenges with inaccessible health facilities and transport. Some people with disabilities benefited from government schemes, such as the National Health Insurance Scheme, but implementation faced challenges and not all people with disabilities accessed these services. Government action is needed to improve disability-inclusive healthcare in Zambia, alleviating barriers to reduce health disparities. Recommended actions include training for healthcare professionals and improved facility accessibility
Social perception and environmental risk factors for dengue in an endemic municipality in eastern Colombia: a mixed method study.
Get PDFWith the climate changing and worsening rainfall patterns, dengue, and its vector, the Aedes spp. mosquito, are becoming an urgent matter both in Colombia and globally. The limited availability of vaccines for this arbovirus, combined with the risk of severe disease with each reinfection, means that dengue control primarily relies on targeted vector control tailored to specific areas. This study aims to analyze the social perceptions and environmental risk factors that affect mosquito presence and dengue acquisition in Restrepo, Meta, Colombia. A knowledge, attitudes and practices questionnaire, and focus groups were conducted in communities of Restrepo, and entomological indexes were calculated for the municipality. Quantitative and qualitative analysis were performed. Participants had good knowledge of arbovirus infections, but lacked specific knowledge about transmission and how best to protect themselves. Those knowledgeable of cleaning water tanks were 0.28 times as likely to have mosquitos trapped in their house than those who did not. By contrast, those that reported using bed nets were more likely to have mosquitoes in their house than those who did not, potentially due to an overestimated sense of protection or need to use a net because of their presence. There was little reported community organization to control Aedes mosquitos, and social stratum was determined to be a risk factor for mosquito presence. Participants were in favor of interventions by the Health Secretariat, especially insecticide spraying. Our findings identify areas of need for education and engagement initiatives: encouraging community responsibility and day-time bite prevention measures may empower residents to protect themselves better. This can help the Health Secretariat to guide promotion and prevention strategies by knowing the sociodemographic characteristics and popular knowledge of the inhabitants of the city of Restrepo
Experiences of introducing planetary health topics to medical school curricula: A meta-ethnography.
Get PDFINTRODUCTION: Future doctors will need to adapt to the impact on health caused by the changing climate, whilst developing more sustainable practices to decrease the burden of healthcare on the environment. Planetary Health (PH) is emerging as a crucial subject area in medical education. This systematic review synthesises evidence on integrating PH into medical school curricula globally, focusing on experiences of medical students and educators. METHODS: MEDLINE, ERIC, and EMBASE were systematically searched to identify qualitative research studies focusing on experiences of medical students and staff in PH integration into medical school curricula. We included articles published in English and in peer-reviewed journals, from 2010 onwards. Articles were assessed for quality using the CASP checklist for qualitative research. Fourteen studies were identified and synthesised using meta-ethnography. RESULTS: This review identified a strong consensus on the necessity to incorporate PH into medical school curricula. Three inter-related third-order constructs shaped our synthesis. The first was challenging existing norms, as PH represented atypical scenarios with flattened medical hierarchies and reliance on student and faculty enthusiasm and advocacy. The second was a recognition of a moral dimension, with an ethical obligation to teach PH and a responsibility to manage 'climate anxiety' that can emerge in students. The third was an enthusiasm to innovate and influence, reflecting the importance of embedding PH longitudinally in teaching and assessment. DISCUSSION: Whilst some factors that shape PH implementation into medical curricula are consistent with other new subject areas, PH integration also raises unique considerations and dynamics. These include a power and knowledge shift away from staff, and a central notion of ethical justice linked to PH education. Medical education leaders should be mindful of these when embedding and growing PH as a core topic in the medical curriculum
Safety, immunogenicity, efficacy, and effectiveness of Lassa fever vaccines in pregnant persons, children, and adolescents: a protocol for a living systematic review and meta-analysis.
Get PDFBACKGROUND: Lassa fever (LF), caused by the Lassa virus (LASV), is a zoonotic viral hemorrhagic disease endemic to West Africa, primarily transmitted through rodent excreta and infected bodily fluids. It poses significant public health challenges due to its high morbidity and mortality rates, particularly among at-risk populations like pregnant persons and children. Despite decades of research, vaccine development has been hindered by the virus's genetic diversity and complex epidemiology. While several vaccine candidates have been developed, none have received regulatory approval. Given the rapidly evolving vaccine landscape, a living systematic review (LSR) was selected to enable real-time evidence synthesis. This protocol outlines a living systematic review (LSR) to evaluate the safety, efficacy, effectiveness, and immunogenicity of LASV vaccines, providing evidence to guide public health interventions and vaccine recommendations. METHODS: We will conduct a biweekly updated LSR and meta-analysis, systematically searching databases (e.g., MEDLINE, EMBASE, CENTRAL) and clinical trial registries from January 2014 onward to identify studies of LASV vaccines in pregnant persons, children, and adolescents. All study designs, including randomized trials, cohort studies, case-control studies, and case reports, will be eligible. Pairs of reviewers will independently assess eligibility, extract data, and evaluate the risk of bias. Primary outcomes include vaccine safety, efficacy, and effectiveness in pregnant persons (including neonatal outcomes), children, and adolescents, while secondary outcomes assess immunogenicity and reactogenicity. Data on adult populations will also be included, and results on this group will be reported as available. We will conduct paired meta-analyses, including prespecified subgroup and sensitivity analyses. We will use the grading of recommendations assessment, development, and evaluation approach to evaluate the certainty of evidence. DISCUSSION: This LSR offers a dynamic framework to generate timely evidence on LASV vaccines for vulnerable populations. By integrating findings into an interactive Microsoft Power BI dashboard, stakeholders can access and utilize real-time updates to inform public health strategies. Despite challenges like study heterogeneity and vaccine platform variability, subgroup and sensitivity analyses will mitigate these issues. This review aims to support clinical trial designs, guide policy, and improve health outcomes in Lassa fever-endemic regions. STUDY REGISTRATION: Two protocols were registered in the International Prospective Register of Systematic Reviews (PROSPERO) database: CRD42024514513 and CRD42024516754
Nutritional rickets and its associated factors among under-five children in Assela referral and teaching hospital, Ethiopia: a hospital based cross-sectional study design.
Get PDFBACKGROUND: Nutritional rickets is a preventable skeletal disorder caused by deficiencies in vitamin D, calcium, or phosphate, leading to softening and weakening of bones. While it was once nearly eliminated in high-income countries, the resurgence of rickets in various parts of the world-particularly in low- and middle-income countries (LMICs)-reflects the ongoing challenges of malnutrition, inadequate healthcare, and socioeconomic factors. This study aimed to determine the prevalence and associated factors of nutritional rickets in the study area. METHODS: A hospital-based cross-sectional study was conducted from June 15 to July 30, 2022, involving 442 children under the age of five who visited the pediatric ward, pediatric OPD, EPI, and pediatric emergency departments of referral and teaching hospitals in Assala, Ethiopia. Data were collected using a pre-tested, structured questionnaire administered through face-to-face interviews. A checklist was used for chart reviews. Data were entered into Epidata version 3.1 and analyzed using STATA version 18. Predictors of nutritional rickets were assessed using multivariate logistic regression analysis, with results presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value of < 0.05 was considered statistically significant. RESULTS: The study found that the prevalence of nutritional rickets in the study area was 3.8% (95% CI: 1.90-5.70). Factors significantly associated with nutritional rickets included being male (AOR = 1.59, 95% CI: 1.10-16.57), lack of information about rickets (AOR = 7.16, 95% CI: 4.22-12.68), and exposure to sunlight while fully dressed (AOR = 3.27, 95% CI: 1.05-5.28). CONCLUSIONS: This study indicates that nearly one in every twenty-five children in the study area is affected by nutritional rickets. Factors such as male sex, lack of information about rickets, and inadequate sun exposure due to full clothing were identified as significant risk factors. To prevent this condition, coordinated efforts from all relevant bodies are required. Additionally, raising awareness among mothers and caregivers, particularly through maternal education, is essential. Educated mothers are more likely to adopt improved childcare practices, which can reduce the incidence of nutritional rickets
Kangaroo mother care among hospitalised neonates: evaluation of the validity of duration measurement methods compared to observation linked to the OMWaNA trial in Uganda.
Get PDFBACKGROUND: Studies evaluating the impact of kangaroo mother care (KMC) on neonatal mortality and morbidity often rely on healthcare worker records or caregiver reports to measure intervention duration. However, the accuracy of these methods remains uncertain. We examined the validity of different methods of KMC duration measurement amongst neonates ≤ 2000 g in Uganda. METHODS: This observational study was embedded within the OMWaNA trial, which examined the impact of KMC on neonatal mortality before clinical stability. An independent observer (considered the gold standard) monitored neonates every 2 h to confirm KMC position, using an Android tablet-based application adapted from the EN-BIRTH study. The gold standard was compared to routine healthcare workers' charting and caregiver diary reports of KMC. RESULTS: Among 222 caregiver-newborn pairs, 219 initiated KMC. The mean daily KMC duration recorded by the gold standard was 8·4 h (SD 3·5). Healthcare workers reported an average of 8·5 h (SD 4·0), while caregivers reported 10·4 h (SD 3·8). The mean difference was 0·2 h less for healthcare workers (95% CI -0·3 to 0·6) and 1·7 h more for caregivers (-2·1 to -1·3) compared to the gold standard. Agreement rates for individual KMC episodes were 55·2% (95% CI 54·4-55·9) for healthcare workers and 58·2% (57·2-59·0) for caregivers. Participants with a helper (substitute KMC provider) had longer daily duration compared to those without (mean difference 1·89 h [0·89 - 2·84]; p < 0·001). CONCLUSION: Healthcare worker records provide a reasonably accurate estimate of KMC duration at the population level, supporting the integration of KMC indicators into national health information systems to facilitate monitoring and evaluation. The presence of a helper increases KMC duration, underscoring the need for research to identify strategies to increase family involvement
Asymptomatic school children and adults are important for the human infectious reservoir for Plasmodium falciparum malaria in an area of low endemicity in The Gambia.
Get PDFOBJECTIVES: In The Gambia, the scale-up of malaria control interventions in the past decades resulted in a substantial decrease of the malaria burden. However, low levels of malaria transmission persist. METHODS: We conducted an observational cohort study in eastern Gambia to better understand the relative contribution of symptomatic and asymptomatic malaria infections to the infectious reservoir. Parasite and gametocyte carriage were determined by molecular methods. Infectiousness to mosquitoes was assessed by mosquito membrane feeding assays on a subset of symptomatic and asymptomatic individuals identified by passive case detection and community surveys. RESULTS: Incidence of clinical malaria was 1.46 episodes/100 person-months. Prevalence of malaria infection as determined by PCR in community surveys was 10.5%. Among asymptomatic malaria-infected individuals, total parasite density was positively associated with gametocyte density (β = 0.40; P < .0001). Mosquito infection rates in membrane feeding experiments were positively associated with gametocyte density (β = 2.81; P < 0.0001). More than 84% of mosquito infections occurred in asymptomatic individuals with patent infections, with the highest contribution from older children (40.3%), and adolescents and adults (45.5%). Clinical malaria cases identified by passive case detection were responsible for only 1% of mosquito infections; if the definition of clinical malaria included infected individuals identified by community surveys with a history of fever in the preceding week, the contribution of clinical cases to mosquito infections increased to 16%. CONCLUSIONS: In eastern Gambia, malaria transmission is maintained by asymptomatic malaria-infected individuals, mostly adults, adolescents and school-age children, while clinical cases are comparatively less important for transmission
SARS-CoV-2-specific humoral immunity in a Norwegian cohort between 2020 and 2023.
Get PDFBACKGROUND: We have previously reported on natural humoral immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a Norwegian cohort between 2020 and 2021. In this study, we evaluated long-term humoral (including vaccination-induced) immunity in the same cohort and assessed predictors of high antibody levels against spike protein, as well as the persistence of antibodies against the virus spike and nucleocapsid proteins. METHODS: Vaccination data and antibody levels against the spike and nucleocapsid proteins were collected at 12 (only in infected participants) and 24 months (in both infected and uninfected participants) after the participants' first polymerase chain reaction (PCR) tests for the virus. Antibody levels against spike protein at 24 months were categorized as high or low based on the 50th percentile. Possible predictors of high antibody levels against spike protein were examined using univariate and multivariate logistic regression models. RESULTS: Of 1119 original participants (400 PCR + and 719 PCR -), 574 responded to our questionnaires and were invited to antibody measurements (median age: 51 years; women: 59%). Vaccination data showed that 11% were fully immunized, and 85% were booster-immunized at 24 months. Antibody levels were evaluated in 72% (287/400) of the PCR + participants at 12 months and 58% (233/400) at 24 months. At 12 and 24 months, we observed that 97% (278/287) and 100% (233/233), respectively, still had antibodies against the spike protein, and 86% (248/287) and 95% (221/233), respectively, against the nucleocapsid protein. Antibody levels were also evaluated in 34% (247/719) of those in the PCR - group, which revealed that 99.5% and 69% had detectable antibodies against spike and nucleocapsid proteins, respectively, at 24 months. Irrespective of pre-vaccination SARS-CoV-2 infection status, the booster-immunized participants were 3.7 × more likely to have high antibody levels against spike protein vs the non-booster-immunized ones. Those aged > 60 years had the highest median antibody levels against the spike protein and were more likely to be booster-immunized. CONCLUSIONS: Our findings highlight the benefits of booster vaccinations for humoral immune responses. Long-term antibody levels against the SARS-CoV-2 spike protein were higher in booster-immunized participants vs the non-booster-immunized, irrespective of pre-vaccination infection status. TRIAL REGISTRATION: 146,469: The COVID-19 study in Telemark and Agder-COVITA. CLINICALTRIALS: gov ID: NCT04514003