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Mahmood A, Eusaph AZ, Javed A, Muzaffar A. Exploring areas of improvement in postnatal care services in a tertiary care hospital in Lahore. Pak J Med Sci 2023; 39:732-736. [PMID: 37250562 PMCID: PMC10214816 DOI: 10.12669/pjms.39.3.6780] [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: 06/22/2022] [Revised: 01/23/2023] [Accepted: 01/28/2023] [Indexed: 11/02/2023] Open
Abstract
Background and Objective Poor postnatal care can increase morbidity and mortality. This study assessed the current deficiencies in quality of postnatal care provided to mothers in Lady Aitchison hospital, Lahore when compared to WHO standards and identifies the areas for quality improvement. Methods It is a descriptive cross-sectional study which employs quantitative method to collect and analyze the data. It was conducted to include ninety-six maternities attending the wards of Lady Aitchison Hospital, Lahore during January 2022 to February 2022. Consenting post-partum mothers were selected by random sampling and interviewed by using a structured proforma. Results Among 96 mothers, 56% were below 25 years of age, 39% had secondary education, with more than one child (71%) and 57% visited for the first time. Majority of mothers, were given medicine timely (82%) and found the attitude (85%) and information (83%) provided by the healthcare workers helpful. Their subjective satisfaction rate with staff was 90%. The main areas of concern were lack of proper examination guidelines and facilities, limited information to mothers regarding neonatal care and substandard interior of hospitals. The statistics on the detailed maternal and neonatal examination showed that it was left out in 30% to 50% patients. Information regarding the danger signs of mothers and neonates was not given in 69% and information on family planning was provided to only 28%. Contentment with the infrastructure of the hospital was subpar and it was suggested that the sanitary conditions of washrooms and the paraphernalia of the wards i.e., ACs and beds needed improvement. Conclusions This study suggests that in developing countries like Pakistan, majority of the patients were satisfied by the services of healthcare workers. The prime improvement area is the infra-structure of the hospital which can be upgraded to provide better quality facilities in terms of air-conditioning, washrooms and well-designed areas for extensive examination of breast, pelvis, abdomen and neonates. There is also need for introduction of standard guidelines for postnatal care.
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Affiliation(s)
- Atiya Mahmood
- Dr. Atiya Mahmood, MBBS. Medical Officer, Government Samanabad Hospital, Lahore, Pakistan
| | - Amna Zia Eusaph
- Prof. Dr. Amna Zia Eusaph, MBBS, FCPS. Lady Aitchison Unit 5, Lahore, Pakistan
| | - Ayesha Javed
- Dr. Ayesha Javed, MBBS. Post Graduate Trainee, Mayo Hospital, Lahore, Pakistan
| | - Arooj Muzaffar
- Dr. Arooj Muzaffar, MBBS. Post Graduate Trainee, Mayo Hospital, Lahore, Pakistan
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [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: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had <ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had < 70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania were likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with > 20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- grid.25867.3e0000 0001 1481 7466Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aduragbemi Banke-Thomas
- grid.36316.310000 0001 0806 5472School of Human Sciences, University of Greenwich, London, UK
| | - Lenka Benova
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- grid.5379.80000000121662407Department of Mathematics, The University of Manchester, Manchester, UK
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Mohammed T, Udoh RH, Kuupiel D. Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers' and managers' perceptions. BMC Pregnancy Childbirth 2021; 21:220. [PMID: 33740908 PMCID: PMC7977170 DOI: 10.1186/s12884-021-03701-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers' and providers' perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers' and providers' perspectives of free maternal healthcare and the quality of care in SSA. METHODS We used Askey and O'Malley's framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. RESULTS In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers' and providers' perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. CONCLUSION This study established evidence of existing literature on the quality of care based on healthcare providers' and managers' perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- The University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick Inkum Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Tahiru Mohammed
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Roseline H. Udoh
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
| | - Desmond Kuupiel
- Department of Global Health, Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, 7530 South Africa
- Research for Sustainable Development Consult, Sunyani, Ghana
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Ansu-Mensah M, Danquah FI, Bawontuo V, Ansu-Mensah P, Kuupiel D. Maternal perceptions of the quality of Care in the Free Maternal Care Policy in sub-Sahara Africa: a systematic scoping review. BMC Health Serv Res 2020; 20:911. [PMID: 33004029 PMCID: PMC7528345 DOI: 10.1186/s12913-020-05755-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The world aims to achieve universal health coverage by removing all forms of financial barriers to improve access to healthcare as well as reduce maternal and child deaths by 2030. Although free maternal healthcare has been embraced as a major intervention towards this course in some countries in sub-Saharan Africa (SSA), the perception of the quality of healthcare may influence utilization and maternal health outcomes. We systematically mapped literature and described the evidence on maternal perceptions of the quality of care under the free care financing policies in SSA. METHODS We employed the Arskey and O'Malley's framework to guide this scoping review. We searched without date limitations to 19th May 2019 for relevant published articles in PubMed, Google Scholar, Web of Science, Science Direct, and CINAHL using a combination of keywords, Boolean terms, and medical subject headings. We included primary studies that involved pregnant/post-natal mothers, free maternal care policy, quality of care, and was conduct in an SSA country. Two reviewers independently screened the articles at the abstract and full-text screening guided by inclusion and exclusion criteria. All relevant data were extracted and organized into themes and a summary of the results reported narratively. The recent version of the mixed methods appraisal tool was used to assess the methodological quality of the included studies. RESULTS Out of 390 studies, 13 were identified to have evidence of free maternal healthcare and client perceived quality of care. All the 13 studies were conducted in 7 different countries. We found three studies each from Ghana and Kenya, two each in Burkina Faso and Nigeria, and a study each from Niger, Sierra Leone, and Tanzania. Of the 13 included studies, eight reported that pregnant women perceived the quality of care under the free maternal healthcare policy to be poor. The following reasons accounted for the poor perception of service quality: long waiting time, ill-attitudes of providers, inadequate supply of essential drugs and lack of potable water, unequal distribution of skilled birth attendants, out-of-pocket payment and weak patient complaint system. CONCLUSION This study suggests few papers exist that looked at maternal perceptions of the quality of care in the free care policy in SSA. Considering the influence mothers perceptions of the quality of care can have on future health service utilisation, further studies at the household, community, and health facility levels are needed to help unearth and address all hidden quality of care challenges and improve maternal health services towards attaining the sustainable development goals on maternal and child health.
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Affiliation(s)
- Monica Ansu-Mensah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- University Clinic, Sunyani Technical University, Sunyani, Ghana
| | - Frederick I. Danquah
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- St. John of God College of Health, Duayaw Nkwanta, Ghana
| | - Vitalis Bawontuo
- Department of Public Health, Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Sunyani, Ghana
- Research for Sustainable Development Consult, Sunyani, Ghana
| | - Peter Ansu-Mensah
- Department of Secretaryship and Management Studies, Faculty of Business and Management Studies, Sunyani Technical University, Sunyani, Ghana
| | - Desmond Kuupiel
- Research for Sustainable Development Consult, Sunyani, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, 2nd Floor George Campbell Building, Durban, 4001 South Africa
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Philibert A, Ravit M, Ridde V, Dossa I, Bonnet E, Bedecarrats F, Dumont A. Maternal and neonatal health impact of obstetrical risk insurance scheme in Mauritania: a quasi experimental before-and-after study. Health Policy Plan 2017; 32:405-417. [PMID: 27935801 PMCID: PMC5886239 DOI: 10.1093/heapol/czw142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 01/04/2023] Open
Abstract
A variety of health financing schemes shaped on pre-payment scheme have been implemented across Sub-Saharan Africa (SSA) to address the Millennium Development Goals (MDGs). In Mauritania, the Obstetric Risk Insurance package (ORI) focusing on maternal and perinatal health has been progressively implemented at the health district level since 2002. Here, our main objective was to assess the effectiveness of the ORI in increasing facility-based delivery rates, as well as increases in family planning, antenatal and postnatal care, caesarean delivery and neonatal health, from demographic and health survey data between 2002 and 2011. We also examined whether the effects of the ORI varied between strata of the population. The study was based on a quasi-experimental before-and-after design to assess the causal link between availability of ORI and increase in use of maternal health services and neonatal mortality. In combination with geographical information system, difference-in-differences and odd ratio approaches were used to address our objectives. Indicators of access to care for pregnant women and neonatal health and improved in both non-intervention and intervention groups during the study period. There was no global effect of the availability of ORI on facility-based delivery rates, nor on the use of antenatal and postnatal care services, except for qualified antenatal services. However, delivery rates in local health centres with ORI increased more rapidly than in those with no ORI, the contrary was shown for hospitals. Caesarean delivery and family planning decreased with ORI. Although late neonatal mortality rates remained low in the country, a significant decrease was seen in districts without ORI. Except for some strata of the population, ORI has not really met its objective of attracting more pregnant women towards facility-based health care.
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Affiliation(s)
- Aline Philibert
- Interdisciplinary Research Centre on Well-being, Health, Society and Environment (Cinbiose), University of Quebec in Montreal, Montreal, Québec, Canada.,Research Institute for Development, Université Paris Descartes, COMUE Sorbonnes Paris Cité, UMR MERIT, Paris, France
| | - Marion Ravit
- IRD, CEPED, UMR 196, Université Paris Descartes-Institut de Recherche pour le Développement (IRD), Paris, France
| | - Valéry Ridde
- School of Public Health (ESPUM), University of Montreal, Montreal, Quebec, Canada.,University of Montreal Public Health Research Institute (IRSPUM), Montreal, Quebec, Canada
| | - Inès Dossa
- Research Institute for Development, Université Paris Descartes, COMUE Sorbonnes Paris Cité, UMR MERIT, Paris, France
| | - Emmanuel Bonnet
- UMR IDEES CNRS 6266, Université de Normandie/IRD RESILIENCE 236, Caen, France
| | - Florent Bedecarrats
- Agence Française de Développement (AFD), Evaluation Unit, Research and Knowledge Developpement, Paris, France
| | - Alexandre Dumont
- IRD, CEPED, UMR 196, Université Paris Descartes-Institut de Recherche pour le Développement (IRD), Paris, France
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Nuwasiima A, Nuwamanya E, Navvuga P, Babigumira JU, Asiimwe FT, Lubinga SJ, Babigumira JB. Study protocol: incentives for increased access to comprehensive family planning for urban youth using a benefits card in Uganda. A quasi-experimental study. Reprod Health 2017; 14:140. [PMID: 29078815 PMCID: PMC5659021 DOI: 10.1186/s12978-017-0400-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of contraception is one of the most cost-effective public health interventions and has the potential to prevent about 30% of maternal and 10% of child deaths in developing countries. Voucher-based initiatives for family planning are an effective and viable means of increasing contraceptive use. In this paper, we present a protocol for a pilot study of a novel incentive, a family planning benefits card (FPBC) program to increase uptake of family planning services among urban poor youth in Uganda while leveraging private sector funding. METHODS The study employs both impact and health economic evaluation methods to assess the effect of the FPBC program. We propose a quasi-experimental study design with two separate pre- and post-samples to measure program effectiveness. The main outcome of the impact evaluation is the percentage change in the prevalence of modern contraceptive use and unmet need for contraception. We will also conduct model-based incremental cost-effectiveness and budget impact analyses. The main outcomes of the economic evaluation are the cost per enrolled youth and cost per pregnancy averted, and cost per disability-adjusted life-year (DALY) averted. We will also pilot a corporate social responsibility model of sponsorship for the FPBC program in partnership with local corporations. Budget impact analysis will examine the potential affordability of scaling up the FPBC program and the fiscal implications of this scale up to the corporate social responsibility (CSR) budgets of partner corporations, the government, and the individual taxpayer. DISCUSSION In this study, we propose an impact and economic evaluation to establish the proof concept of using a FPBC program to increase uptake of family planning services among urban poor youth in Uganda. The results of this study will present stakeholders in Uganda and internationally with a potentially viable option for corporate-sponsored access to family planning in urban poor communities. TRIAL REGISTRATION MUREC1/7 No. 10/05-17. Registered 19th July 2017.
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Affiliation(s)
- Afra Nuwasiima
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda.
| | - Elly Nuwamanya
- Global Health Economics Ltd, P.O Box 27011, Kampala, Uganda
| | | | | | | | - Solomon J Lubinga
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, P.O. Box 357630, Seattle, WA, 98195, USA.,Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, 98195, USA
| | - Joseph B Babigumira
- Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, P.O. Box 357630, Seattle, WA, 98195, USA.,Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, 98195, USA
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Kuwawenaruwa A, Baraka J, Ramsey K, Manzi F, Bellows B, Borghi J. Poverty identification for a pro-poor health insurance scheme in Tanzania: reliability and multi-level stakeholder perceptions. Int J Equity Health 2015; 14:143. [PMID: 26626873 PMCID: PMC4666058 DOI: 10.1186/s12939-015-0273-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 11/17/2015] [Indexed: 11/10/2022] Open
Abstract
Background Many low income countries have policies to exempt the poor from user charges in public facilities. Reliably identifying the poor is a challenge when implementing such policies. In Tanzania, a scorecard system was established in 2011, within a programme providing free national health insurance fund (NHIF) cards, to identify poor pregnant women and their families, based on eight components. Using a series of reliability tests on a 2012 dataset of 2,621 households in two districts, this study compares household poverty levels using the scorecard, a wealth index, and monthly consumption expenditures. Methods We compared the distributions of the three wealth measures, and the consistency of household poverty classification using cross-tabulations and the Kappa statistic. We measured errors of inclusion and exclusion of the scorecard relative to the other methods. We also gathered perceptions of the scorecard criteria through qualitative interviews with stakeholders at multiple levels of the health system. Findings The distribution of the scorecard was less skewed than other wealth measures and not truncated, but demonstrated clumping. There was a higher level of agreement between the scorecard and the wealth index than consumption expenditure. The scorecard identified a similar number of poor households as the “basic needs” poverty line based on monthly consumption expenditure, with only 45 % errors of inclusion. However, it failed to pick up half of those living below the “basic needs” poverty line as being poor. Stakeholders supported the inclusion of water sources, income, food security and disability measures but had reservations about other items on the scorecard. Conclusion In choosing poverty identification strategies for programmes seeking to enhance health equity it’s necessary to balance between community acceptability, local relevance and the need for such a strategy. It is important to ensure the strategy is efficient and less costly than alternatives in order to effectively reduce health disparities.
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Affiliation(s)
- August Kuwawenaruwa
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | - Jitihada Baraka
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | - Kate Ramsey
- Columbia University, Mailman School of Public Health, New York, NY, USA.
| | - Fatuma Manzi
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania.
| | | | - Josephine Borghi
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, P.O. Box 78 373, Dar es Salaam, Tanzania. .,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK.
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