Tag: nevin manimala

PLOS Glob Public Health. 2022 Jun 13;2(6):e0000277. doi: 10.1371/journal.pgph.0000277. eCollection 2022.

ABSTRACT

Disproportionately high injury rates in Sub-Saharan Africa combined with limited access to care in both the acute injury phase and for injury patients requiring continued care after hospital discharge remains a challenge. We aimed to characterize barriers to transportation and access to care in a cohort of post-hospitalized injury patients in Moshi, Tanzania. This was a mixed-methods study of a prospective cohort of trauma registry patients presenting to Kilimanjaro Christian Medical Center between August 2018 and January 2020. We conducted standardized patient/family surveys and in-depth interviews at a 2-week follow up visit after hospital discharge, and focus groups with healthcare providers. Quantitative results were analyzed using descriptive statistics and multivariable logistic regression using R statistical software. Qualitative results were analyzed using thematic analysis through an iterative process using NVivo software. A total of 1,365 patients were enrolled in the trauma registry, with 169 patients followed up at 2 weeks. Over half of patients at follow-up, 101 (59.8%), reported challenges in traveling. The majority of patients were male (80.3%). Difficulty in traveling since injury was associated with female gender (aOR 5.85 [95% CI 1.20-33.59]) and a need for non-family members escorts for travel (aOR 7.10 [95% CI 1.43-41.66]). Those who reported assault or fall as the mechanism of injury as compared to road traffic injury and had health insurance were less likely to report challenges in traveling (aOR 0.19 [95% CI 0.03-0.90]), 0.11 [95% CI 0.01-0.61], 0.14 [95% 0.02-0.80]). Transportation barriers that emerged from qualitative data included inability to use regular means of transportation, financial challenges, physical barriers, rigid compliance to physician orders, access to healthcare, and social support barriers. Our findings demonstrate several areas to address transportation barriers for post-injury patients in Tanzania. Educational interventions such as clarification of doctors’ orders of strict bedrest, provision of vouchers to support financial challenges and alternate means of transportation given physical barriers and reliance on social support may address some of these barriers.

PMID:36962378 | DOI:10.1371/journal.pgph.0000277

PLOS Glob Public Health. 2022 May 26;2(5):e0000471. doi: 10.1371/journal.pgph.0000471. eCollection 2022.

ABSTRACT

BACKGROUND: Hyperglycemia leads to serious damage to the body, especially the blood vessels and nerves. This study aimed to determine the prevalence and factors associated with hyperglycemia in a rural population of Tanvè and Dékanmey in Benin in 2019.

MATERIALS AND METHODS: This was a cross-sectional, descriptive and analytical study, nested in the Tanvè Health Study (TAHES) cohort. It covered all residents of the villages of Tanvè and Dékanmey, aged 25 years and above, and having given their written consent. Data were collected in the households during the fourth annual monitoring visit in 2019 using the WHO STEPS Wise approach. Hyperglycemia was defined as a fasting capillary blood glucose value ≥ 110 mg/dL. Data were analyzed with R Studio software version 3.5.1.

RESULTS: A total of 1331 subjects were included in the study with a 60% female predominance and a sex ratio (male/female) of 0.7. The median age was 40 years (Q1 = 32 years; Q3 = 53 years) with a range of 25 and 98 years. The prevalence of hyperglycemia was 4.6%. In multivariate analysis, advanced age (AOR = 1.03; 95%CI = 1.02-1.73; p = 0.004), male sex (AOR = 2.93; 95%CI = 1.49-5.84; p = 0.023), monthly income> 105,000 FCFA (AOR = 2.63; 95%CI = 1.24-5.63; p = 0.030), abdominal obesity (AOR = 2.80; 95%CI = 1.29-6.16; p = 0.007, and obesity (AOR = 1.68; 95%CI = 0.75-3.59; p = 0.004) were statistically associated with hyperglycemia.

CONCLUSION: The prevalence of hyperglycemia is not negligible in rural areas in Benin. Our study found that older age, male gender, high income, abdominal obesity, and obesity are determining factors in its occurrence.

PMID:36962374 | DOI:10.1371/journal.pgph.0000471

PLOS Glob Public Health. 2022 Mar 9;2(3):e0000256. doi: 10.1371/journal.pgph.0000256. eCollection 2022.

ABSTRACT

Peer support services are increasingly being integrated in programmes for the prevention of mother-to-child HIV transmission (PMTCT). We aimed to evaluate the effect of a peer-mother interactive programme on PMTCT outcomes among pregnant women on anti-retroviral treatment (ART) in routine healthcare in Dar es Salaam, Tanzania. Twenty-three health facilities were cluster-randomized to a peer-mother intervention and 24 to a control arm. We trained 92 ART experienced women with HIV to offer peer education, adherence and psychosocial support to women enrolling in PMTCT care at the intervention facilities. All pregnant women who enrolled in PMTCT care at the 47 facilities from 1st January 2018 to 31st December 2019 were identified and followed up to 31st July 2021. The primary outcome was time to ART attrition (no show >90 days since the scheduled appointment, excluding transfers) and any difference in one-year retention in PMTCT and ART care between intervention and control facilities. Secondary outcomes were maternal viral suppression (<400 viral copies/mL) and mother-to-child HIV transmission (MTCT) by ≥12 months post-partum. Analyses were done using Kaplan Meier and Cox regression (ART retention/attrition), generalized estimating equations (viral suppression) and random effects logistic regression (MTCT); reporting rates, proportions and 95% confidence intervals (CI). There were 1957 women in the peer-mother and 1384 in the control facilities who enrolled in routine PMTCT care during 2018-2019 and were followed for a median [interquartile range (IQR)] of 23 [10, 31] months. Women in both groups had similar median age of 30 [IQR 25, 35] years, but differed slightly with regard to proportions in the third pregnancy trimester (14% versus 19%); advanced HIV (22% versus 27%); and ART naïve (55% versus 47%). Peer-mother facilities had a significantly lower attrition rate per 1000 person months (95%CI) of 14 (13, 16) versus 18 (16, 19) and significantly higher one-year ART retention (95%CI) of 78% (76, 80) versus 74% (71, 76) in un-adjusted analyses, however in adjusted analyses the effect size was not statistically significant [adjusted hazard ratio of attrition (95%CI) = 0.85 (0.67, 1.08)]. Viral suppression (95%CI) was similar in both groups [92% (91, 93) versus 91% (90, 92)], but significantly higher among ART naïve women in peer-mother [91% (89, 92)] versus control [88% (86, 90)] facilities. MTCT (95%CI) was similar in both groups [2.2% (1.4, 3.4) versus 1.5% (0.7, 2.8)]. In conclusion, we learned that integration of peer-mother services in routine PMTCT care improved ART retention among all women and viral suppression among ART naïve women but had no significant influence on MTCT.

PMID:36962367 | DOI:10.1371/journal.pgph.0000256

PLOS Glob Public Health. 2022 Jul 20;2(7):e0000385. doi: 10.1371/journal.pgph.0000385. eCollection 2022.

ABSTRACT

The number of women dying during pregnancy and after childbirth remains unacceptably high, with African countries showing the slowest decline. The leading causes of maternal deaths in Africa are preventable direct obstetric causes such as haemorrhage, infection, hypertension, unsafe abortion, and obstructed labour. There is an information gap on factors contributing to maternal deaths in Africa. Our objective was to identify these contributing factors and assess the frequency of their reporting in published literature. We followed the Arksey and O’Malley methodological framework for scoping reviews. We searched six electronic bibliographic databases: MEDLINE, SCOPUS, African Index Medicus, African Journals Online (AJOL), French humanities and social sciences databases, and Web of Science. We included articles published between 1987 and 2021 without language restriction. Our conceptual framework was informed by a combination of the socio-ecological model, the three delays conceptual framework for analysing the determinants of maternal mortality and the signal functions of emergency obstetric care. We included 104 articles from 27 African countries. The most frequently reported contributory factors by level were: (1) Individual-level: Delay in deciding to seek help and in recognition of danger signs (37.5% of articles), (2) Health facility-level: Suboptimal service delivery relating to triage, monitoring, and referral (80.8% of articles) and (3) Wider health system-level: Transport to and between health facilities (84.6% of articles). Our findings indicate that health facility-level factors were the most frequently reported contributing factors to maternal deaths in Africa. There is a lack of data from some African countries, especially those countries with armed conflict currently or in the recent past. Information gaps exist in the following areas: Statistical significance of each contributing factor and whether contributing factors alone adequately explain the variations in maternal mortality ratios (MMR) seen between countries and at sub-national levels.

PMID:36962364 | DOI:10.1371/journal.pgph.0000385

PLOS Glob Public Health. 2022 Jun 15;2(6):e0000354. doi: 10.1371/journal.pgph.0000354. eCollection 2022.

ABSTRACT

The prevalence of SARS-CoV-2 exposure in children during the global COVID-19 pandemic has been underestimated due to lack of testing and the relatively mild symptoms in adolescents. Understanding the exposure rates in the pediatric population is essential as children are the last to receive vaccines and can act as a source for SARS-CoV-2 mutants that may threaten vaccine escape. This cross-sectional study aims to quantify the prevalence of anti-SARS-CoV-2 serum antibodies in children in a major city in México in the Spring of 2021 and determine if there are any demographic or socioeconomic correlating factors. We obtained socioeconomic information and blood samples from 1,005 children from 50 neighborhood clusters in Mérida, Yucatán, México. We then tested the sera of these participants for anti-SARS-CoV-2 IgG and IgM antibodies using lateral flow immunochromatography. We found that 25.5% of children in our cohort were positive for anti-SARS-CoV-2 antibodies and there was no correlation between age and antibody prevalence. Children that lived with large families were statistically more likely to have antibodies against SARS-CoV-2. Spatial analyses identified two hotspots of high SARS-CoV-2 seroprevalence in the west of the city. These results indicate that a large urban population of unvaccinated children has been exposed to SARS-CoV-2 and that a major correlating factor was the number of people within the child’s household with a minor correlation with particular geographical hotspots. There is also a larger population of children that may be susceptible to future infection upon easing of social distancing measures. These findings suggest that in future pandemic scenarios, limited public health resources can be best utilized on children living in large households in urban areas.

PMID:36962356 | DOI:10.1371/journal.pgph.0000354

PLOS Glob Public Health. 2022 Mar 9;2(3):e0000268. doi: 10.1371/journal.pgph.0000268. eCollection 2022.

ABSTRACT

Breast cancer is the number one cause of cancer death in women globally. According to the Global cancer registry, there were 2.3 million new cases of breast cancer diagnosed in 2020 worldwide, accounting for 25% of all cancer cases in women. The data on the cost burden of breast cancer on households is limited in Ghana, it is therefore imperative that it is estimated to ensure effective planning and provision of adequate resources for breast cancer treatment. This cost-of-illness study estimates the household treatment cost of breast cancer and the cost coping strategies used by patients. This cost-of-illness study was conducted at the surgical unit (Surgical unit 2) of the Korle Bu Teaching Hospital (KBTH), with 74 randomly selected patients and their accompanying caregiver(s). Data was collected using structured questionnaire on direct, indirect and intangible costs incurred and coping strategies used by patients and their households. The results are presented in descriptive and analytic cost statistics. Most of the patients were aged 40-69 years and were married with moderate education levels. Nearly 57% of patients earn an income of USD 370 or less per month. The average household expenditure was USD 990.40 (medical cost: USD 789.78; non-medical cost: USD 150.73; and indirect cost: USD 50). The publicly provided mechanism was the most utilized cost coping strategy. The direct, indirect and intangible costs associated with breast cancer treatment had significant financial and psychological implications on patients and their households. Moreover, poorer families are more likely to use the publicly provided strategies to cope with the increasing cost of breast cancer treatment.

PMID:36962351 | DOI:10.1371/journal.pgph.0000268

PLOS Glob Public Health. 2022 Feb 28;2(2):e0000136. doi: 10.1371/journal.pgph.0000136. eCollection 2022.

ABSTRACT

Antenatal care (ANC) is an important intervention that has been linked to reduce maternal and newborn adverse outcomes. However, the long years of war in Liberia may have contributed to the poor health indices including the uptake of maternal health care services. The objective of this study was to determine the marginal interaction effects between booking time and socioeconomic factors in eight or more ANC contacts. A total sample of 4,185 women who had given birth were included in this study. The 2020 Liberia Demographic and Health Survey (LDHS) dataset was analyzed. The outcome variable was eight or more ANC contacts. Percentage and Chi-square test were used in univariate and bivariate analyses respectively. The marginal interaction effects between booking time and socioeconomic factors of eight or more ANC contacts were estimated. The statistical significance was determined at 5%. The weighted prevalence of eight or more ANC contacts was 26.6% (95% CI: 23.8%, 29.6%). The uptake of eight or more ANC contacts increased steadily by increasing women’s level of education and household wealth index. Women with higher educational attainment had a prevalence of 49.0% (95%CI: 36.5%, 61.6%) and those in the richest households had an estimated prevalence of 31.4% (95%CI: 24.9%, 38.8%) respectively. Furthermore, the urban dwellers had a weighted eight or more ANC contacts prevalence of 29.0% (95%CI: 24.6%, 34.0%). The key finding is increased marginal interaction effects for higher education and early booking (48.4%), richest households and early booking (35.4%), and urban residential status and early booking (36.2%) respectively. Overall, the prevalence of eight or more ANC contacts was low. However, we found higher coverage of eight or more ANC contacts among women who initiated ANC within the first trimester and among those with higher socioeconomic status. We recommend the Liberian government to design and/or support programmes targeted at promoting early ANC initiation and supporting the disadvantaged women such as the uneducated, poor and those living in rural or remote settings.

PMID:36962339 | DOI:10.1371/journal.pgph.0000136

PLOS Glob Public Health. 2022 Jun 7;2(6):e0000335. doi: 10.1371/journal.pgph.0000335. eCollection 2022.

ABSTRACT

BACKGROUND: Family planning is critical for the health of women and their families and it can accelerate a country’s progress toward reducing poverty and achieving Sustainable Development Goals. Effective use of family planning methods helps couples achieve the desired number of children, contribute to improving maternal and child health which may help women avoid unwanted pregnancy, and reduce the risk factors for maternal and child deaths. Moreover, contraceptive prevalence and unmet need for family planning are key indicators for determining the level of improvements in access to reproductive health. So, this study aimed to identify the prevalence and associated factors of unmet need of modern family planning among reproductive-age women in the south Gondar zone.

METHODS: A community-based cross-sectional study design was conducted in the southern Gondar zone among 528 reproductive-age women. Data were collected with pre-tested, structured, interviewer-administered questionnaires. Data were coded and entered into Epi info version 7 and exported to SPSS version 20. Bivariable and multivariable logistic regression models were applied. A P-value0.05 was considered to declare a result as significant at 95% CI.

RESULT: The overall unmet need in this study area was 22.6%, from whom 15.1% of respondents were wanted children later and 7.5% were wanted no more children. For women who had been visited by health care providers within 12 months before the study, women currently on menstrual status, the desired number of children, and induced abortion were found statistically significant.

CONCLUSION: The unmet need for FP was found high in the study area as compared to the national and regional prevalence. Women visited by health care providers, currently menstruating, the desired number of children, and history of induced abortion were significantly associated with the unmet need of modern FP. Health care providers and health extension workers need to visit regularly and promote appropriate and active IEC programs that address the provision of accurate information about the availability of the services and various contraceptive options including techniques to reduce and change perceived barriers to service utilization (such as rumors and misconceptions of FP).

PMID:36962335 | DOI:10.1371/journal.pgph.0000335

PLOS Glob Public Health. 2022 Apr 26;2(4):e0000372. doi: 10.1371/journal.pgph.0000372. eCollection 2022.

ABSTRACT

Maternal and Child Health and Nutrition Improvement Project (MCHNP) is an intervention that, adopts financial strategies to provide incentives as a means of motivating community health workers and ensuring accountability. This study highlights on the service delivery component of the intervention; thus, utilization of essential community nutrition and health action. This paper aims to determine the differential impact of MCHNP on maternal health service utilization in Ghana. A retrospective longitudinal pre-test post-test study design was employed. Six administrative regions were used for analyzing the impact of the intervention in uptake of maternal health services. Administrative data were extracted from the DHIMS2 database for the periods of January 2014 to December 2018. Analysis was conducted using interrupted time series analysis (ITSA) due to the absence of a control group. The difference in the pre-intervention and post-intervention means were statistically significant in the Central, Western, Eastern and Upper West region for the proportion of ANC 4 visits. With the exception of Northern region that recorded negative impact (-0.005; p-value >0.05), all the remaining regions recorded positive impacts on the percentage of women that had 4 ANC visits. All six regions had positive impacts in the proportion of women that received supervised delivery. However, none of these impacts were statistically significant; thus, the MCHNP intervention had no significant impact on maternal health outcomes which are, ANC four visits and skilled deliveries.

PMID:36962325 | DOI:10.1371/journal.pgph.0000372

PLOS Glob Public Health. 2022 Jul 14;2(7):e0000325. doi: 10.1371/journal.pgph.0000325. eCollection 2022.

ABSTRACT

Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was ‘delayed vaccination’ [99.5% (223/224)], followed by ‘early vaccination’ [21.9% (49/224)], and ‘untimely interval vaccination’ [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers’ recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.

PMID:36962319 | DOI:10.1371/journal.pgph.0000325