76 research outputs found

    Adjusting and censoring electronic monitoring device data. Implications for study outcomes

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    Electronic monitoring device (EMD) data are widely used to measure adherence in HIV medication adherence research. EMD data represent an objective measure of adherence and arguably provide more valid data than other methods such as self-reported measures, pill counts, and drug level concentration. Moreover, EMD data are longitudinal, include many measurements, and yield a rich data set. This article illustrates potential pitfalls associated with this measurement technique, including lack of clarity associated with EMD data, and the extent to which adherence outcomes are affected by data management decisions. Recommendations are given regarding what information should be included in publications that report results based on EMD data so as to facilitate comparisons between studies

    Partial Breast Irradiation: A Longitudinal Study of Symptoms and Quality of Life

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    Background: In many women with early-stage breast cancer, breast-conserving surgery (BCS) with partial breast irradiation (PBI) has similar overall survival and local recurrence rates compared to BCS with whole-breast irradiation (WBI). A better understanding of the quality of life (QOL) outcomes during and following BCS with PBI versus BCS with WBI is needed. Objectives: This study was conducted to examine symptoms, symptom distress, cosmesis, QOL, and perceived body image in women during and after BCS with PBI. Methods: A convenience sample of 31 women completed self-reports pre- and post-PBI over six months. Descriptive statistics and repeated- measures analysis were performed at baseline and three times post-PBI. Findings: Most women reported satisfaction with body image and good QOL, despite a small decline in social well-being. Fatigue and mild to moderate symptom distress persisted over time

    Multilevel influences of women’s empowerment and economic resources on risky sexual behaviour among young women in Zomba district, Malawi

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    © The Author(s) 2020. Published by Cambridge University Press. Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15–49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study’s objective was to explore associations between multilevel measures of economic resources and women’s empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl’s level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels

    Improving socioeconomic status may reduce the burden of malaria in sub Saharan Africa: A systematic review and meta-analysis

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    BackgroundA clear understanding of the effects of housing structure, education, occupation, income, and wealth on malaria can help to better design socioeconomic interventions to control the disease. This literature review summarizes the relationship of housing structure, educational level, occupation, income, and wealth with the epidemiology of malaria in sub-Saharan Africa (SSA).MethodsA systematic review and meta-analysis was conducted following the preferred reporting items for systematic reviews and meta-analyses guidelines. The protocol for this study is registered in PROSPERO (ID=CRD42017056070), an international database of prospectively registered systematic reviews. On January 16, 2016, available literature was searched in PubMed, Embase, CINAHL, and Cochrane Library. All but case studies, which reported prevalence or incidence of Plasmodium infection stratified by socioeconomic status among individuals living in SSA, were included without any limits. Odds Ratio (OR) and Relative Risk (RR), together with 95% CI and p-values were used as effect measures. Heterogeneity was assessed using chi-square, Moran’s I2, and tau2 tests. Fixed (I22≥30%) or log-linear dose-response model was used to estimate the summary OR or RR.ResultsAfter removing duplicates and screening of titles, abstracts, and full text, 84 articles were found eligible for systematic review, and 75 of them were included in the meta-analyses. Fifty-seven studies were cross-sectional, 12 were prospective cohort, 10 were case-control, and five were randomized control trials. The odds of Plasmodium infection increased among individuals who were living in poor quality houses (OR 2.13, 95% CI 1.56–3.23, I2 = 27.7), were uneducated (OR 1.36, 95% CI 1.19–1.54, I2 = 72.4.0%), and were farmers by occupation (OR 1.48, 95% CI 1.11–1.85, I2 = 0.0%) [pPlasmodium infection also increased with a decrease in the income (OR 1.02, 95% CI 1.01–1.03, tau22 = 0.028) [pPlasmodium infection among individuals who were living in poor quality houses (RR 1.86, 95% CI 1.47–2.25, I2 = 0.0%), were uneducated (OR 1.27, 1.03–1.50, I2 = 0.0%), and were farmers (OR 1.36, 1.18–1.58) [pConclusionsLack of education, low income, low wealth, living in poorly constructed houses, and having an occupation in farming may increase risk of Plasmodium infection among people in SSA. Public policy measures that can reduce inequity in health coverage, as well as improve economic and educational opportunities for the poor, will help in reducing the burden of malaria in SSA.</div

    ASSOCIATION BETWEEN HIV AWARENESS FACTORS, HEALTH FACILITY CHARACTERISTICS AND RISKY SEXUAL BEHAVIOUR AMONG YOUNG WOMEN IN ZOMBA DISTRICT, MALAWI

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    SummaryThe objective of this study was to examine the association between multilevel factors related to HIV awareness and risky sexual behaviour among young women in Zomba district, Malawi. Secondary analyses of the Schooling, Income, and Health Risk (SIHR) study were undertaken. Four outcomes related to risky sexual behaviour were examined among young women: if participants had ever had sex, consistent condom use and two scores measuring risk related to partner history and age during sexual activity. Independent variables included individual-level factors such as education and rural/urban residence, as well as higher-level factors such as household’s highest level of education and health facility characteristics. Regression models with cluster-robust standard errors and multilevel regression models were used to estimate associations; analyses were stratified into two strata by school enrolment status, i.e. whether the women were in school (N=1407) or had dropped out of school (N=407) at baseline of the SIHR study. For both strata, increasing age and residing within 16 km of an urban centre (‘near rural’ residence) increased the odds of ever having sex; lower educational achievement was associated with lower age during sexual activity. A history of pregnancy was associated with lower odds of condom use and riskier partner history. For women in school at baseline, lower household education was associated with higher odds of ever having sex (OR=1.48; 95% CI: 1.06, 2.07); near-rural and far-rural (≤16 km and &gt;16km from urban centre, respectively) residence were associated with decreased odds of condom use (OR=0.47; 95% CI: 0.28, 0.78; and OR=0.27; 95% CI: 0.11, 0.65, respectively). For those not in school at baseline, lower household education was associated with lower age during sexual activity (β=0.31, 95% CI: 0.05, 0.58). Also for women not in school, the use of private or non-governmental health facilities was associated with decreased odds of condom use (OR=0.51, 95% CI: 0.39, 0.67) and higher age during sexual activity (β=−0.30, 95% CI: −0.52, −0.09). While individual factors were associated with risky sexual behaviour in both strata, contextual factors differed.</jats:p
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