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Ngusie HS, Ahmed MH, Mengiste SA, Kebede MM, Shemsu S, Kanfie SG, Kassie SY, Kalayou MH, Gullslett MK. The effect of capacity building evidence-based medicine training on its implementation among healthcare professionals in Southwest Ethiopia: a controlled quasi-experimental outcome evaluation. BMC Med Inform Decis Mak 2023; 23:172. [PMID: 37653419 PMCID: PMC10472735 DOI: 10.1186/s12911-023-02272-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Evidence-based medicine (EBM) bridges research and clinical practice to enhance medical knowledge and improve patient care. However, clinical decisions in many African countries don't base on the best available scientific evidence. Hence, this study aimed to determine the effect of training interventions on background knowledge and awareness of EBM sources, attitude, competence, and practice of EBM among healthcare professionals. METHOD We designed a controlled group quasi-experimental pre-post test study to evaluate the effect of capacity-building EBM training. A total of 192 healthcare professionals were recruited in the study (96 from the intervention and 96 from the control group). We used a difference-in-differences (DID) analysis to determine the effect of the training. Along the way, we used a fixed effect panel-data regression model to assess variables that could affect healthcare professionals' practice of EBM. The cut point to determine the significant effect of EBM training on healthcare professionals' background knowledge and awareness of EBM sources, attitude, and competence was at a P-value < 0.05. RESULT The DID estimator showed a significant net change of 8.0%, 17.1%, and 11.4% at P < 0.01 on attitude, competence, and practice of EBM, respectively, whereas no significant increment in the background knowledge and awareness of EBM sources. The fixed effect regression model showed that the attitude [OR = 2.288, 95% CI: (1.049, 4.989)], competence [OR = 4.174, 95% CI: 1.984, 8.780)], technical support [OR = 2.222, 95% CI: (1.043, 3.401)], and internet access [OR = 1.984, 95% CI: (1.073, 4.048)] were significantly affected EBM practice. CONCLUSION The capacity-building training improved attitude, competence, and EBM practice. Policymakers, government, and other concerned bodies recommended focusing on a well-designed training strategy to enhance the attitude, competence, and practice towards EBM among healthcare professionals. It was also recommended to enhance internet access and set mechanisms to provide technical support at health facilities.
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Affiliation(s)
- Habtamu Setegn Ngusie
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.
| | - Mohammadjud Hasen Ahmed
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | | | | | - Shuayib Shemsu
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Shuma Gosha Kanfie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Sisay Yitayih Kassie
- Department of Health Informatics, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | - Mulugeta Hayelom Kalayou
- Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Al-Obaidi I, Krome AK, Wagner KG, Pfarr K, Kuesel AC, Batchelor HK. Drugs for neglected tropical diseases: availability of age-appropriate oral formulations for young children. Parasit Vectors 2022; 15:462. [PMID: 36510275 PMCID: PMC9746163 DOI: 10.1186/s13071-022-05546-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/12/2022] [Indexed: 12/14/2022] Open
Abstract
It is recognised that paediatric indications and age-appropriate formulations are required to ensure that paediatric populations receive appropriate pharmacotherapeutic treatment. The lack of information on dosing, efficacy and safety data (labelling) is a well-recognised problem for all diseases affecting children. For neglected tropical diseases, the fact that they affect to a large extent poor and marginalised populations in low- and middle-income countries means that there is a low economic return on investment into paediatric development activities compared to other diseases [e.g. human immunodeficiency virus (HIV)]. This review provides an introduction to issues affecting the availability and development of paediatric population-relevant data and appropriate formulations of drugs for NTDs. We are summarising why age-appropriate formulations are important to ensure treatment efficacy, safety and effectiveness, outline initiatives to increase the number of paediatric indications/labelling and age-appropriate formulations, provide an overview of publicly available information on the formulations of oral drugs for NTDs relative to age appropriateness and give an introduction to options for age-appropriate formulations. The review completes with 'case studies' of recently developed paediatric formulations for NTDs, complemented by case studies for fixed-dose combinations for HIV infection in children since such formulations have not been developed for NTDs.
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Affiliation(s)
- Issraa Al-Obaidi
- grid.11984.350000000121138138Strathclyde Institute of Pharmacy and Biomedical Sciences, 161 Cathedral Street, Glasgow, G4 0RE UK
| | - Anna K. Krome
- grid.10388.320000 0001 2240 3300Department of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, 53121 Bonn, Germany
| | - Karl G. Wagner
- grid.10388.320000 0001 2240 3300Department of Pharmaceutical Technology and Biopharmaceutics, University of Bonn, 53121 Bonn, Germany
| | - Kenneth Pfarr
- grid.15090.3d0000 0000 8786 803XInstitute for Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany ,grid.452463.2German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Germany
| | - Annette C. Kuesel
- grid.3575.40000000121633745UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Hannah K. Batchelor
- grid.11984.350000000121138138Strathclyde Institute of Pharmacy and Biomedical Sciences, 161 Cathedral Street, Glasgow, G4 0RE UK
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N’Goran EK, Yalkinoglu Ö, Kourany-Lefoll E, Tappert A, Hayward B, Yin X, Bezuidenhout D, Huber E, Aka NAD, Ouattara M, Bagchus W. Efficacy and Safety of New Orodispersible Tablet Formulations of Praziquantel (Racemate and L-Praziquantel) in Schistosoma mansoni-Infected Preschool-Age Children and Infants: A Randomized Dose-Finding Phase 2 Study. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.679373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IntroductionTwo novel formulations of praziquantel (PZQ) and Levo-(L-)PZQ (arpraziquantel) have been developed for the treatment of schistosomiasis in preschool-age children and infants.MethodsThis open-label, dose-finding Phase 2 study assessed the efficacy and safety of PZQ formulations in children and infants infected with Schisostoma mansoni in Côte d’Ivoire. In Part 1, 420 children aged 2.1–6.9 years (weight 10.0–29.9 kg) were enrolled and randomized to one of 7 treatment arms (n=60 per arm): commercially available racemate (rac)-PZQ at 3x20 mg/kg or 40 mg/kg (treatment arms 1 and 2); rac-PZQ orodispersible tablet (ODT) at 40 mg/kg or 60 mg/kg (treatment arms 3 and 4); or L-PZQ ODT at 30 mg/kg, 45 mg/kg, or 60 mg/kg (treatment arms 5, 6, and 7). The optimal formulation and dose identified (L-PZQ ODT 50 mg/kg) was used in Part 2, which enrolled 24 infants aged 6–24 months (weight 7.5–14.8 kg). Infants were treated in an age-staggered approach: age 13–24 months (treatment arm 8, n=20) and age 6–12 months (treatment arm 9, n=4). The primary endpoint was clinical cure rate (CR) demonstrated by the Kato–Katz method 14–21 days post-treatment. Secondary endpoints included CR by point-of-care circulating cathodic antigen, egg reduction rate (ERR), and adverse events (AEs).ResultsIn Part 1, CRs ≥70% were achieved in all treatment arms and were highest with L-PZQ ODT 60 mg/kg (89.7%), rac-PZQ 3x20 mg/kg (89.5%), and L-PZQ ODT 45 mg/kg (86.0%). In Part 2, CRs were >90%. All treatment arms had ERRs >95%. Treatment-related AEs were reported by 71 participants (16.0%) and were similar across treatment arms; most were mild and transient. The most common treatment-emergent AEs were laboratory abnormalities. No deaths or discontinuation due to treatment-emergent AEs were reported and no new safety concerns were identified.ConclusionNew rac-PZQ and L-PZQ ODT formulations used as single-dose therapy against S. mansoni demonstrated acceptable overall efficacy and safety in preschool-age children and infants, warranting further studies in this population.Clinical Trial RegistrationClinicalTrials.gov, identifier NCT02806232; Pan African Clinical Trials Registry, identifier PACTR201604001493593.
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Toor J, Rollinson D, Turner HC, Gouvras A, King CH, Medley GF, Hollingsworth TD, Anderson RM. Achieving Elimination as a Public Health Problem for Schistosoma mansoni and S. haematobium: When Is Community-Wide Treatment Required? J Infect Dis 2021; 221:S525-S530. [PMID: 31829414 PMCID: PMC7289541 DOI: 10.1093/infdis/jiz609] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The World Health Organization (WHO) has set elimination as a public health problem (EPHP) as a goal for schistosomiasis. As the WHO treatment guidelines for schistosomiasis are currently under revision, we investigate whether school-based or community-wide treatment strategies are required for achieving the EPHP goal. In low- to moderate-transmission settings with good school enrolment, we find that school-based treatment is sufficient for achieving EPHP. However, community-wide treatment is projected to be necessary in certain high-transmission settings as well as settings with low school enrolment. Hence, the optimal treatment strategy depends on setting-specific factors such as the species present, prevalence prior to treatment, and the age profile of infection.
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Affiliation(s)
- Jaspreet Toor
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - David Rollinson
- Department of Life Sciences, Natural History Museum, London, UK.,Global Schistosomiasis Alliance, Department of Life Sciences, Natural History Museum, London, UK
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Anouk Gouvras
- Global Schistosomiasis Alliance, Department of Life Sciences, Natural History Museum, London, UK
| | - Charles H King
- Center for Global Health and Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Graham F Medley
- Centre for Mathematical Modelling of Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
| | - T Déirdre Hollingsworth
- Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - Roy M Anderson
- London Centre for Neglected Tropical Disease Research, Department of Infectious Disease Epidemiology, Imperial College London, London, UK.,Medical Research Council Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, UK.,The DeWorm3 Project, Natural History Museum, London, UK
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Torres-Vitolas CA, Dhanani N, Fleming FM. Factors affecting the uptake of preventive chemotherapy treatment for schistosomiasis in Sub-Saharan Africa: A systematic review. PLoS Negl Trop Dis 2021; 15:e0009017. [PMID: 33465076 PMCID: PMC7846123 DOI: 10.1371/journal.pntd.0009017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/29/2021] [Accepted: 11/30/2020] [Indexed: 11/29/2022] Open
Abstract
Background Schistosomiasis affects nearly 220 million people worldwide, mainly in Sub-Saharan Africa (SSA). Preventive chemotherapy (PC) treatment, through regular mass-drug administration (MDA) of Praziquantel tablets remains the control measure of choice by Ministries of Health. Current guidelines recommend that 75% of school-aged children receive treatment. Many programmes, however, struggle to achieve this target. Given the risk of high reinfection rates, attaining sustained high levels of treatment coverage is essential. This study provides a comprehensive review of the barriers and facilitators operating at different levels of analysis, from the individual to the policy level, conditioning the uptake of PC for schistosomiasis in SSA. Methodology/Principal findings A systematic literature search was conducted in several databases for publications released between January 2002 and 2019 that examined factors conditioning the uptake of Praziquantel in the context of MDA campaigns in SSA. A total of 2,258 unique abstracts were identified, of which 65 were selected for full text review and 30 met all eligibility criteria. Joanna Briggs Institute’s Critical Appraisal and the Mixed-Methods Assessment tools were used to assess the strength of the evidence. This review was registered with PROSPERO (CRD42017058525). A meta-synthesis approach was used. Results indicated publication bias, with the literature focusing on East African rural settings and evidence at the individual and programmatic levels. The main influencing factors identified included material wellbeing, drug properties, knowledge and attitudes towards schistosomiasis and MDAs, fears of side effects, gender values, community and health systems support, alongside programme design features, like training, sensitisation, and provision of incentives for drug-distributors. The effect of these factors on determining Praziquantel uptake were explored in detail. Conclusions/Significance Multiple determinants of treatment uptake were found in each level of analysis examined. Some of them interact with each other, thus affecting outcomes directly and indirectly. The promotion of context-based transdisciplinary research on the complex dynamics of treatment uptake is not only desirable, but essential, to design effective strategies to attain high levels of treatment coverage. Schistosomiasis is a parasitic infection that affects nearly 220 million people worldwide. Long-term effects include anaemia, growth stunting, bladder cancer and infertility. Currently, the main approach to schistosomiasis control involves mass preventive chemotherapy treatment. Current guidelines recommend treating 75% of school-aged children but many programmes struggle to achieve this target. This study conducted a comprehensive review of factors conditioning the uptake of treatment in Sub-Saharan Africa across different levels of analysis: individual, interpersonal, organisational, community and policy. This examination showed, first, that the literature suffers of publication bias, with most studies based in rural East African sites and focusing in discussing individual- and policy-level factors. It indicated as well that people’s livelihoods, food security, and school-enrolment, alongside knowledge and attitudinal factors influenced treatment uptake at the individual level. Various contextual factors concerning interpersonal relations, organisations’ resources, and prevalent socio-cultural features (e.g., gender) further shaped people’s responses to MDA campaigns. Finally, it was observed that the effectiveness of programme-level decisions on sensitisation, training, and drug-delivery strategies were constantly re-shaped by mediating factors operating at lower levels of analysis. We conclude that the promotion of context-based transdisciplinary research is essential to design effective strategies to promote sustainable high levels of treatment coverage.
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Affiliation(s)
- Carlos A. Torres-Vitolas
- SCI Foundation, London, United Kingdom
- School of Public Health, Imperial College, London, United Kingdom
- * E-mail:
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Insights gained from conducting a randomised controlled trial on Ivermectin-Albendazole against Trichuris trichiura in Côte d'Ivoire, Lao PDR and Pemba Island. ADVANCES IN PARASITOLOGY 2020; 111:253-276. [PMID: 33482976 DOI: 10.1016/bs.apar.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is only limited scientific literature on trial methodology, trial procedures and mitigation strategies to overcome challenges faced during clinical research taking place in resource constrained healthcare environments. Organisational, cultural, infrastructural and ethical challenges may vary between settings although conduct of clinical trials for the same disease (in our case soil-transmitted helminth (STH) infections) share similar risks for implementation. We use the example of a phase III randomised controlled trial, conducted between 2018 and 2020 in Côte d'Ivoire, Lao PDR and Pemba Island (Tanzania), to share challenges faced and mitigation strategies to guide future planning of studies in similar settings. We describe the planning, screening, enrolment and implementation phases in each of the three settings. Our findings indicate that involvement of local staff and close collaboration are essential factors for successful trial preparation and implementation. A strategic plan adapted to each setting with a distinct focus on community engagement and workforce is crucial to proceed efficiently. Mutual trust between the trial population and the trial team is of utmost importance and allows for early reaction and adaption to emerging issues.
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The Neglected Cestode Infection: Epidemiology of Hymenolepis Nana Infection Among Children in Rural Yemen. Helminthologia 2020; 57:293-305. [PMID: 33364898 PMCID: PMC7734673 DOI: 10.2478/helm-2020-0038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/26/2020] [Indexed: 12/20/2022] Open
Abstract
Hymenolepis nana is the most common cestode reported in humans worldwide. It is prevalent among children in the tropics and subtropics, particularly in rural poor communities where sanitation is inadequate or lacking. This cross-sectional study aims to determine the prevalence and significant risk factors of H. nana infection among children in rural Yemen. Faecal samples were collected from 498 children and screened for intestinal parasites by using wet mount, formalin-ether concentration and Kato–Katz techniques. A pretested questionnaire was used to collect demographic, socioeconomic, housing condition, and personal hygiene information. Overall, 77.5 % (386/498) of the children were found to be infected by at least one intestinal parasite species. The overall prevalence of H. nana was 17.5 % (87/498). Multivariate analysis confirmed that an age of < 6 years (adjusted odds ratio [AOR] = 4.28; 95 % (confidence interval [CI] = 2.04, 8.98), presence of other family members infected with H. nana (AOR = 2.48; 95 % CI = 1.45, 4.24), living in the highlands (AOR = 2.87; 95 % CI = 1.56, 5.26), living in a house without improved toilet facilities (AOR = 2.19; 95 % CI = 1.23, 3.88), not washing vegetables before consumption (AOR = 2.11; 95 % CI = 1.06, 4.19), and not washing hands after defecation (AOR = 1.88; 95 % CI = 1.08, 3.27) were the key factors significantly associated with H. nana infection among the studied children. In conclusion, H. nana is prevalent among children in rural Yemen, particularly among preschool-aged children. Thus, an integrated and effective programme to control intestinal parasitic infections should include preschool-aged children. Such a programme should focus on providing health education on hygienic practices, providing adequate sanitation and improved sources of drinking water, and screening and treating other infected family members.
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De Pretto-Lazarova A, Brancati-Badarau DO, Burri C. Informed consent approaches for clinical trial participation of infants with minor parents in sub-Saharan Africa: A systematic review. PLoS One 2020; 15:e0237088. [PMID: 32750084 PMCID: PMC7402474 DOI: 10.1371/journal.pone.0237088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Regulations are vague regarding the appropriate decision-maker and authority to consent for children of minor parents participating in clinical trials. In countries with high rates of underage mothers, such as in sub-Saharan Africa, this lack of guidance may affect the rights of potential paediatric participants already bearing increased vulnerability. It can also influence the recruitment and generalizability of the research. We provide evidence and discuss informed consent management in such cases to inform best practice. MATERIALS AND METHODS We searched PubMed/MEDLINE, Embase, CINAHL, and Google Scholar for articles published up to March 2019. In total, 4382 articles were screened, of which 16 met our inclusion criteria. Studies addressing informed consent in clinical trials involving children with minor parents in sub-Saharan Africa were included. We performed descriptive and qualitative framework analyses. The review was registered in PROSPERO: CRD42018074220. RESULTS Various informed consent approaches were reported. Articles supporting individual consent by minor parents based on emancipation or "mature minor" status lacked evidence in the context of research. National laws on medical care guided consent instead. When no laws or guidance existed an interpretation of the local decision-making culture, including community engagement and collaboration with local ethics committees, defined the informed consent approach. CONCLUSIONS The review emphasises that the implementation of informed consent for children with minor parents may be variable and hampered by absent or ambiguous clinical trial regulations, as well as divergent local realities. It may further be influenced by the research area and study-specific risks. Clear guidance is required to help address these challenges proactively in clinical trial planning. We provided a set of questions to be considered in the development of an ethically acceptable informed consent approach and proposed information that should be integrated into international clinical trial guidelines.
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Affiliation(s)
- Angela De Pretto-Lazarova
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| | - Domnita Oana Brancati-Badarau
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Life and Health Sciences and Aston Brain Centre, Aston University, Birmingham, United Kingdom
| | - Christian Burri
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Preface. ADVANCES IN PARASITOLOGY 2019. [DOI: 10.1016/s0065-308x(19)30014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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