6 research outputs found
Effectiveness and common side effects of Dolutegravir Compared to Efavirenz-Based Regimens of Combined Antiretroviral Therapy in Kitwe, Zambia.xlsx
No full textAn unpaired t-test was performed to compare viral load suppression and CD4 count between clients on EFV based regimen and DTG based regimen at 24 weeks, 48 weeks and 96 weeks. This test was also performed when comparing viral load and CD4 count of clients switched from EFV based regimen to DTG based regimen. In addition, to compare viral and CD4 count within treatment groups on the two regimens at different periods, the Friedman’s test was used; followed by a Pairwise comparison using the Dunn Post Hoc Test with the Bonferroni correction. To assess if clients with viral suppression remain virally suppressed after switching from EFV-based regimens to DTG based regimens VL and CD4+ were analysed 24 weeks after the switch to DTG based regimens and then at 48 weeks. Records of clients’ results before the switch to DTG based regimens were compared to records after switching to DTG based regimens and reported as percentages and proportions. To assess adherence and compliance to treatment, dates of the review were noted. Common side effects of naïve clients on both regimens’ data were collected from records of clients on both regimens and were described in proportions and assessed with the chi-square test; Side effects of experienced clients before and after the switch to DTG-based regimens, data was described using proportions and assessed with the chi-square test.Data were analysed using Microsoft Excel spreadsheets and Graph Pad Prism 7 statistical package. For statistical significance, a p-value less than 0.05 was accepted.</p
Barriers to the implementation of sexual and reproductive health education programmes in low-income and middle-income countries: a scoping review protocol
No full textIntroduction Health education programmes (HEPs) have been associated with a number of benefits. These include providing individuals with information on matters related to their mental, social, physical as well as emotional health. HEPs also play a major role in preventing diseases and reducing the level of engagement of individuals in risky behaviours. While this is the case, there are barriers to the effective implementation of HEPs, especially in low-income and middle-income countries (LMICs) where resources are scarce. Available evidence has revealed socioeconomic challenges ranging from literacy issues, discomfort about issues of sexuality, and cultural barriers to financial constraints as key barriers to the implementation of sexual and reproductive health HEPs in LMICs. We will focus on HEPs related to sexual and reproductive health; all age groups will be considered with no restrictions on geographical setting nor model of HEP delivery. This review will map literature on the barriers to the effective implementation of HEPs in LMICs to guide future implementation research.Methods Arksey and O’Malley’s 2005 scoping methodological framework will act as the guide for this review. We will search the following electronic databases: EBSCOhost (Academic search complete, PsycINFO, Health Sources, CINAHL and MEDLINE with full text), Google Scholar, PubMed, SCOPUS, Science Direct and Web of Science. Grey literature from Mount Kenya University theses and dissertations, governments’ as well as international organisations’ reports, such as WHO, and reference lists of included studies will be searched for eligible studies. We will limit our search to publications from 1 January 2000 to 30 September 2019. Using thematic content analysis, we will employ NVivo V.12 to extract the relevant outcomes from the included articles. We will conduct a quality appraisal of the included articles using the mixed methods appraisal tool (MMAT) version 2018.Ethics and dissemination No ethical approval is needed for the study as it will not include animal nor human participants. The results of the proposed scoping review will be disseminated electronically, in print and through conference presentation as well as at key stakeholder meetings
Two and three-dimensional shoreline behaviour at a MESO-MACROTIDAL barred beach
No full textThe present work investigates cross-shore shoreline migration as well as its alongshore variability (with deformation) on timescales of days to years using 6 years of time-averaged video images. The variability of the shoreline is estimated through empirical statistical methods with comprehensive reference to three scales of variability. At the meso-to macro-tidal barred Biscarrosse beach, shoreline responds in decreasing order at seasonal (winter/summer cycles, 52%), event (storms, 28%) and inter-annual scales. Whereas seasonal evolution is dominated by wave climate modulation, short-term evolution is influenced by tidal range and surf-zone sandbar characteristics. The influence of tide range and sandbars increases when timescale decreases. This is even more the case for the alongshore deformation of the shoreline which is dominated by short-term evolution. An EOF analysis reveals that the first mode of shoreline change time series is associated with cross-shore migration and explains 58% of the shoreline variability. The rest of the modes are associated to deformation which explain 42% of shoreline variabilityThe first author is co-funded by SCAC (French
embassy in Ghana) and ARTS-IRD programs. Authors acknowledge the
Region Aquitaine for financially supporting the installation of the video
system at Biscarrosse. This research has received support from French
grant through ANR COASTVAR: ANR-14-ASTR-0019. RR is supported by the AXA Research fund and the Deltares Harbour, Coastal and
Offshore Engineering Research Programme ‘Bouwen aan de Kust’. BB
is supported by French BAgence Nationale de la Recherche^ through
project CHIPO (ANR-14-ASTR-0004-01
Subjective social status and inequalities in depressive symptoms: A gender-specific decomposition analysis for South Africa
No full textBackground
Inequalities in mental health are a notable and well documented policy concern in many countries, including South Africa. Individuals’ perception of their position in the social hierarchy is strongly and negatively related to their mental health, whilst the global burden of poor mental health is greater amongst women. This paper offers a first glimpse of the factors that shape gender-based health inequalities across subjective social status.
Methods
This study employs the cross-sectional 2014 South African Social Attitudes Survey (SASAS). The prevalence of depressive symptoms is measured with the aid of the CES-D 8-item scale, with analyses disaggregated by gender. Concentration indices (CI) are used to measure inequalities in depressive symptoms related to subjective social status. The study applies the Wagstaff decomposition to determine the factors that contribute to these gender-based inequalities.
Results
More than 26% of the study sample had depressive symptoms (95% CI 24.92–28.07). The prevalence of depressive symptoms is significantly more pronounced in females (28.46% versus 24.38%; p = 0.011). The concentration index for depressive symptoms is − 0.276 (95% CI -0.341 – − 0.211), showing large inequalities across subjective social status. The observed SSS-related inequality in depressive symptoms however is higher for males (CI = -0.304) when compared to females (CI = -0.240) (p = 0.056). The most important contributor to SSS-related inequalities in depressive symptoms, at 61%, is subjective social status itself (contributing 82% in females versus 44% in males). Other variables that make large contributions to the inequalities in depressive symptoms at 11% each are race (contributing 2% in females versus 25% in males) and childhood conflict (contributing 17% in females versus 4% in males).
Conclusion
Policy makers should target a reduction in the positive contribution of SSS to depression via the implementation of programmes that improve social welfare. Given the much greater contribution to inequalities among females, these policies should target women. Policies that protect children and especially the girl child from conflict can also be useful in reducing inequalities in depression related to subjective social status during adulthood. Overall, there is need for a multi-sectoral approach to address these inequalities.publishedVersionOpen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made
Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial
No full textSummaryBackgroundChlorhexidine umbilical cord washes reduce neonatal mortality in south Asian populations with high neonatal mortality rates and predominantly home-based deliveries. No data exist for sub-Saharan African populations with lower neonatal mortality rates or mostly facility-based deliveries. We compared the effect of chlorhexidine with dry cord care on neonatal mortality rates in Zambia.MethodsWe undertook a cluster-randomised controlled trial in Southern Province, Zambia, with 90 health facility-based clusters. We enrolled women who were in their second or third trimester of pregnancy, aged at least 15 years, and who would remain in the catchment area for follow-up of 28 days post-partum. Newborn babies received clean dry cord care (control) or topical application of 10 mL of a 4% chlorhexidine solution once per day until 3 days after cord drop (intervention), according to cluster assignment. We used stratified, restricted randomisation to divide clusters into urban or two rural groups (located <40 km or ≥40 km to referral facility), and randomly assigned clusters (1:1) to use intervention (n=45) or control treatment (n=45). Sites, participants, and field monitors were aware of their study assignment. The primary outcomes were all-cause neonatal mortality within 28 days post-partum and all-cause neonatal mortality within 28 days post-partum among babies who survived the first 24 h of life. Analysis was by intention to treat. Neonatal mortality rate was compared with generalised estimating equations. This study is registered at ClinicalTrials.gov (NCT01241318).FindingsFrom Feb 15, 2011, to Jan 30, 2013, we screened 42 356 pregnant women and enrolled 39 679 women (mean 436·2 per cluster [SD 65·3]), who had 37 856 livebirths and 723 stillbirths; 63·8% of deliveries were facility-based. Of livebirths, 18 450 (99·7%) newborn babies in the chlorhexidine group and 19 308 (99·8%) newborn babies in the dry cord care group were followed up to day 28 or death. 16 660 (90·0%) infants in the chlorhexidine group had chlorhexidine applied within 24 h of birth. We found no significant difference in neonatal mortality rate between the chlorhexidine group (15·2 deaths per 1000 livebirths) and the dry cord care group (13·6 deaths per 1000 livebirths; risk ratio [RR] 1·12, 95% CI 0·88–1·44). Eliminating day 0 deaths yielded similar findings (RR 1·12, 95% CI 0·86–1·47).InterpretationDespite substantial reductions previously reported in south Asia, chlorhexidine cord applications did not significantly reduce neonatal mortality rates in Zambia. Chlorhexidine cord applications do not seem to provide clear benefits for newborn babies in settings with predominantly facility-based deliveries and lower (<30 deaths per 1000 livebirths) neonatal mortality rates.FundingBill & Melinda Gates Foundation
Estimated SARS-CoV-2 infection rate and fatality risk in Gauteng Province, South Africa : a population-based seroepidemiological survey
No full textDATA AVAILABILITY : De-identified individual-level data and data sets generated during the
current study are available for researchers who provide a methodologically sound proposal. If approved, the requestor must sign a data-use
agreement. Additionally, the study protocol is available on request.
All requests must be addressed to the corresponding author. Data will
be available 3 months after publication of this manuscript.BACKGROUND : Limitations in laboratory testing capacity undermine the ability to quantify the overall burden of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection.
METHODS : We undertook a population-based serosurvey for SARS-CoV-2 infection in 26 subdistricts, Gauteng Province (population 15.9 million), South Africa, to estimate SARS-CoV-2 infection, infection fatality rate (IFR) triangulating seroprevalence, recorded COVID-19 deaths and excess-mortality data. We employed three-stage random household sampling with a selection probability proportional to the subdistrict size, stratifying the subdistrict census-sampling frame by housing type and then selecting households from selected clusters. The survey started on 4 November 2020, 8 weeks after the end of the first wave (SARS-CoV-2 nucleic acid amplification test positivity had declined to <10% for the first wave) and coincided with the peak of the second wave. The last sampling was performed on 22 January 2021, which was 9 weeks after the SARS-CoV-2 resurgence. Serum SARS-CoV-2 receptor-binding domain (RBD) immunoglobulin-G (IgG) was measured using a quantitative assay on the Luminex platform.
RESULTS : From 6332 individuals in 3453 households, the overall RBD IgG seroprevalence was 19.1% [95% confidence interval (CI): 18.1–20.1%] and similar in children and adults. The seroprevalence varied from 5.5% to 43.2% across subdistricts. Conservatively, there were 2 897 120 (95% CI: 2 743 907–3 056 866) SARS-CoV-2 infections, yielding an infection rate of 19 090 per 100 000 until 9 January 2021, when 330 336 COVID-19 cases were recorded. The estimated IFR using recorded COVID-19 deaths (n = 8198) was 0.28% (95% CI: 0.27–0.30) and 0.67% (95% CI: 0.64–0.71) assuming 90% of modelled natural excess deaths were due to COVID-19 (n = 21 582). Notably, 53.8% (65/122) of individuals with previous self-reported confirmed SARS-CoV-2 infection were RBD IgG seronegative.
CONCLUSIONS : The calculated number of SARS-CoV-2 infections was 7.8-fold greater than the recorded COVID-19 cases. The calculated SARS-CoV-2 IFR varied 2.39-fold when calculated using reported COVID-19 deaths (0.28%) compared with excess-mortality-derived COVID-19-attributable deaths (0.67%). Waning RBD IgG may have inadvertently underestimated the number of SARS-CoV-2 infections and conversely overestimated the mortality risk. Epidemic preparedness and response planning for future COVID-19 waves will need to consider the true magnitude of infections, paying close attention to excess-mortality trends rather than absolute reported COVID-19 deaths.The Bill and Melinda Gates Foundation.https://academic.oup.com/ijehj2023Family Medicin
