2564 research outputs found
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Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care
No full textWithin the first year of implementation, 43% of women who tested HIV positive at their first antenatal care visit were no longer retained and being followed in the free prevention of mother to child transmission (PMTCT) of HIV program offered by the Kenyan Ministry of Health and Médecins Sans Frontières in the informal settlement of Kibera, Nairobi. This study aimed to explore barriers to enrolling and remaining engaged in PMTCT services throughout the pregnancy and postpartum periods. Qualitative data from 31 focus group discussions and 35 in-depth interviews across six stakeholder groups that included women, men, and PMTCT service providers were analyzed. Using an inductive exploratory approach, four researchers coded the data and identified key themes. Five themes emerged from the data that may influence attrition from PMTCT service in this setting: 1) HIV in the context of Kibera, 2) knowledge of HIV status, 3) knowledge of PMTCT, 4) disclosure of HIV status, and 5) male partner support for PMTCT services. A new HIV diagnosis during pregnancy immediately triggered an ongoing risk assessment of perceived hazards in the home, community, and clinic environments that could occur as a result of female participation in PMTCT services. Male partners were a major influence in this risk assessment, but were generally unaware of PMTCT services. To preserve relationships with male partners, meet community expectations of womanhood, and maintain confidentiality while following recommendations of healthcare providers, women had to continuously weigh the risks and benefits of PMTCT services and interventions. Community-based HIV testing and PMTCT education, male involvement in antenatal care, and counseling customized to assist each woman in her own unique risk assessment, may improve uptake of and retention in care and optimize the HIV prevention benefit of PMTCT interventions
Long-term clinical, immunological and virological outcomes of patients on antiretroviral therapy in southern Myanmar
No full textTo study the long-term clinical, immunological and virological outcomes among people living with HIV on antiretroviral therapy (ART) in Myanmar
"Kala-Azar is a Dishonest Disease": Community Perspectives on Access Barriers to Visceral Leishmaniasis (Kala-Azar) Diagnosis and Care in Southern Gadarif, Sudan
No full textEarly diagnosis and treatment is the principal strategy to control visceral leishmaniasis (VL), or kala-azar in East Africa. As VL strikes remote rural, sparsely populated areas, kala-azar care might not be accessed optimally or timely. We conducted a qualitative study to explore access barriers in a longstanding kala-azar endemic area in southern Gadarif, Sudan. Former kala-azar patients or caretakers, community leaders, and health-care providers were purposively sampled and thematic data analysis was used. Our study participants revealed the multitude of difficulties faced when seeking care. The disease is well known in the area, yet misconceptions about causes and transmission persist. The care-seeking itineraries were not always straightforward: "shopping around" for treatments are common, partly linked to difficulties in diagnosing kala-azar. Kala-azar is perceived to be "hiding," requiring multiple tests and other diseases must be treated first. Negative perceptions on quality of care in the public hospitals prevail, with the unavailability of drugs or staff as the main concern. Delay to seek care remains predominantly linked to economic constraint: albeit treatment is for free, patients have to pay out of pocket for everything else, pushing families further into poverty. Despite increased efforts to tackle the disease over the years, access to quality kala-azar care in this rural Sudanese context remains problematic. The barriers explored in this study are a compelling reminder of the need to boost efforts to address these barriers
Baseline health survey for displaced population in Daquq IDP camp, Daquq district, Kirkuk governate, Iraq.
No full textResearch Protocol2. Survey objectives\ud
2.1. Primary objective\ud
To estimate the vaccination coverage for key vaccine preventable diseases in children aged 6-59 months and the prevalence of key morbidities in the population.\ud
2.2. Secondary objective\ud
• To describe the demographic characteristics of the population \ud
• To estimate the global acute malnutrition (GAM) rate of in children aged 6-59 months and pregnant women\ud
• To estimate the prevalence of self-reported major chronic diseases \ud
• To estimate the prevalence of symptoms commonly associated with mental health distress \ud
• To estimate the prevalence of violence/trauma experienced during the recall period \ud
• To estimate the current and retrospective mortality during the recall period \ud
• To determine the most common barriers to healthcar
Review of maternal mortality cases in MSF-OCA projects 2015 (a capture-recapture study)
No full textResearch ProtocolAim\ud
To identify the best method to monitor maternal mortality in MSF-OCA facilities prospectively.\ud
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Objectives/Research questions\ud
Evaluate the current surveillance system for maternal mortality in MSF-OCA facilities\ud
Estimate maternal mortality in MSF-OCA facilities for 2015\ud
Identify contributing factors to maternal mortality in MSF-OCA facilities for 201
Secondary prophylaxis of visceral leishmaniasis relapses in HIV co-infected patients using pentamidine as a prophylactic agent: a prospective cohort study
No full textResearch Protocol2.1 OBJECTIVES \ud
2.1.1 General objective:\ud
\ud
To document the effectiveness, safety and feasibility of monthly PM secondary prophylaxis (PSP) in VL/HIV co-infected patients that have documented parasite clearance after VL treatment when used for prevention of VL relapse. \ud
2.1.2 Specific objectives of the primary study period\ud
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2.1.2.1 Primary objectives\ud
\ud
In VL/HIV co-infected patients that have documented parasite clearance after VL treatment:\ud
- to assess the effectiveness of PSP in terms of preventing relapse and death;\ud
- to assess the safety of PSP in terms of drug-related serious adverse events or permanent drug discontinuations due to adverse events;\ud
- to assess the feasibility of PSP in terms of number of patients compliant to therapy\ud
during the first year of monthly PM secondary prophylaxis. \ud
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2.1.2.2 Secondary objectives;\ud
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In VL/HIV co-infected patients that have documented parasite clearance after VL treatment:\ud
- to assess the safety of PSP in terms of:\ud
- drug-related non-serious adverse events\ud
- serious adverse events (drug-related or not)\ud
- to assess the feasibility of PSP in terms of:\ud
- number of treatment interruptions/discontinuations,\ud
- number of therapeutic interventions needed to treat adverse drug reaction
Cholera epidemic in Yemen, 2016-18: an analysis of surveillance data
No full textIn war-torn Yemen, reports of confirmed cholera started in late September, 2016. The disease continues to plague Yemen today in what has become the largest documented cholera epidemic of modern times. We aimed to describe the key epidemiological features of this epidemic, including the drivers of cholera transmission during the outbreak
Acquisition of virulence genes by a carrier strain gave rise to the ongoing epidemics of meningococcal disease in West Africa
No full textIn the African meningitis belt, a region of sub-Saharan Africa comprising 22 countries from Senegal in the west to Ethiopia in the east, large epidemics of serogroup A meningococcal meningitis have occurred periodically. After gradual introduction from 2010 of mass vaccination with a monovalent meningococcal A conjugate vaccine, serogroup A epidemics have been eliminated. Starting in 2013, the northwestern part of Nigeria has been affected by yearly outbreaks of meningitis caused by a novel strain of serogroup C Neisseria meningitidis (NmC). In 2015, the strain spread to the neighboring country Niger, where it caused a severe epidemic. Following a relative calm in 2016, the largest ever recorded epidemic of NmC broke out in Nigeria in 2017. Here, we describe the recent evolution of this new outbreak strain and show how the acquisition of capsule genes and virulence factors by a strain previously circulating asymptomatically in the African population led to the emergence of a virulent pathogen. This study illustrates the power of long-read whole-genome sequencing, combined with Illumina sequencing, for high-resolution epidemiological investigations
Vulnerability to snakebite envenoming: a global mapping of hotspots
No full textSnakebite envenoming is a frequently overlooked cause of mortality and morbidity. Data for snake ecology and existing snakebite interventions are scarce, limiting accurate burden estimation initiatives. Low global awareness stunts new interventions, adequate health resources, and available health care. Therefore, we aimed to synthesise currently available data to identify the most vulnerable populations at risk of snakebite, and where additional data to manage this global problem are needed
Catastrophic costs of tuberculosis care: a mixed methods study from Puducherry, India
No full textThe average expenditure incurred by patients in low- and middle-income countries towards diagnosis and treatment of TB ranges from 8198. This out-of-pocket expenditure leads to impoverishment of households. One of the three main targets of the End TB Strategy (2016-2035) is that no TB-affected household suffers catastrophic costs due to TB. Study setting was free care under national tuberculosis program (NTP), Puducherry district, India