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Sivalogan K, Banda B, Wagner J, Biemba G, Gagne N, Grogan C, Hamomba F, Herlihy JM, Mabeta C, Shankoti P, Simamvwa G, Sooli B, Yeboah-Antwi K, Hamer DH, Semrau KEA. Impact of beliefs on perception of newborn illness, caregiver behaviors, and care-seeking practices in Zambia's Southern province. PLoS One 2023; 18:e0282881. [PMID: 37228055 DOI: 10.1371/journal.pone.0282881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 02/25/2023] [Indexed: 05/27/2023] Open
Abstract
Despite reductions in the number of under-five deaths since the release of the Sustainable Development Goals, the proportion of neonatal deaths among all under-five deaths has remained high. Neonatal health is linked to newborn care practices which are tied to distinct cultural perceptions of health and illness. We assessed how community beliefs in Zambia's Southern Province influence newborn care behaviors, perception of illness, and care-seeking practices, using qualitative data collected between February and April 2010. A total of 339 women participated in 36 focus group discussions (FGDs), with 9 FGDs conducted in each of the four study districts. In addition, 42 in-depth interviews (IDIs) were conducted with various key informants, with 11 IDIs conducted in Choma, 11 IDIs in Monze, 10 IDIs in Livingstone, and 10 IDIs in Mazabuka. The FGDs and IDIs indicate that beliefs among the Tonga people regarding postnatal illness prevention and management influence perceptions of newborn illness and care-seeking practices. Care seeking behaviors including when, why, and where parents seek newborn care are intimately tied to perception of disease among the Tonga people. These beliefs may stem from both indigenous and Western perspectives in Zambia's Southern Province. Findings are consistent with other analyses from Southern Province that highlighted the benefit of integrating local practices with Western biomedical care. Health systems models, led by policy makers and program designers, could aim to find synergies between community practices and formal health systems to support positive behavior change and satisfy multiple stakeholders.
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Affiliation(s)
- Kasthuri Sivalogan
- Emory Global Health Institute at Emory University, Atlanta, Georgia, United States of America
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Bowen Banda
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - John Wagner
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Godfrey Biemba
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
- National Health Research Authority, University Teaching Hospital Paediatric Centre of Excellence, Lusaka, Zambia
| | - Natalie Gagne
- Canadian Federal Department of Indigenous Services Canada, Gatineau, Canada
| | - Caroline Grogan
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Fern Hamomba
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - Julie M Herlihy
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Catherine Mabeta
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - Peggy Shankoti
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - Grace Simamvwa
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - Bernadine Sooli
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
| | - Kojo Yeboah-Antwi
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Zambian Center for Applied Health Research and Development, Limited, Lusaka, Zambia
- Department of Medicine, Section of Infectious Diseases, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Katherine E A Semrau
- Ariadne Labs, Harvard T.H Chan School of Public Health, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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Taffere GR, Abebe HT, Zerihun Z, Mallen C, Price HP, Mulugeta A. Systematic review of community engagement approach in research: describing partnership approaches, challenges and benefits. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01799-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Carcelen AC, Limaye RJ, Mutembo S, Hamahuwa M, Thuma PE, Moss WJ, Hayford K. Acceptability of serosurveys in southern Zambia: data collector and caregiver perspectives. DISCOVER SOCIAL SCIENCE AND HEALTH 2023; 3:3. [PMID: 36824432 PMCID: PMC9940080 DOI: 10.1007/s44155-023-00032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/13/2023] [Indexed: 02/25/2023]
Abstract
Background Factors associated with whether individuals choose to participate in serosurveys are not well understood. Understanding perceptions from multiple perspectives, including the perspectives of both data collectors and participants, through a holistic model such as the socio-ecological model contextualizes individual, interpersonal, and structural level influences on survey research participation. We used a multiple methods approach to characterize reasons for serosurvey participation in communities in Southern Province, Zambia where a serosurvey was conducted in 2016. Methods The first phase conducted focus group discussions and in-depth interviews with 24 data collectors who participated in a measles-rubella serosurvey in 2016. The second phase surveyed 34 caregivers at health facilities to identify barriers and facilitators to serosurvey participation. Emergent themes were then classified into a socio-ecological model using individual, interpersonal, and structural level constructs. Results Common themes emerged from data collectors as well as caregivers surveyed. At the individual level, providing incentives was a facilitator, and some religious beliefs were described as a barrier to serosurvey participation. At the interpersonal level, family dynamics and community peer influences could help or hinder serosurvey participation. Community health workers were consistently named as facilitators of participation. At the structural level, concerns about specimen collection, who was selected for serosurveys, and not receiving test results arose as potential barriers. The most frequently reported facilitator was provision of information about the purpose of the serosurvey (85% of respondents). The most frequently reported barrier was lack of clarity regarding use of their blood specimen (53% of respondents). For specimen collection type, caregivers consistently preferred finger prick blood collection over both venous blood draw and oral swabs. Conclusion Serosurvey participation was deemed acceptable to most study participants. The socio-ecological model revealed barriers and facilitators for participation to guide strategies to improve participation which can be applied to ongoing serosurveys for SARS-CoV-2. Serosurveys should continue to develop engagement plans to provide information about blood collection ahead of the serosurvey and communicate the objectives of such studies through trusted sources such as community health workers and traditional leaders.
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Affiliation(s)
- Andrea C. Carcelen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
| | - Rupali J. Limaye
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Simon Mutembo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Government of the Republic of Zambia, Ministry of Health, Lusaka, Zambia
| | | | | | - William J. Moss
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Kyla Hayford
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 415 N. Washington Street, Floor 5, Baltimore, MD 21231 USA
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Bain LE, Akondeng C, Njamnshi WY, Mandi HE, Amu H, Njamnshi AK. Community engagement in research in sub-Saharan Africa: current practices, barriers, facilitators, ethical considerations and the role of gender - a systematic review. Pan Afr Med J 2022; 43:152. [PMID: 36785694 PMCID: PMC9922083 DOI: 10.11604/pamj.2022.43.152.36861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/20/2022] [Indexed: 02/15/2023] Open
Abstract
Introduction meaningful community engagement is increasingly being considered the major determinant of successful research, innovation and intervention uptake. Even though there is available literature recommending community engagement in health research, there are still knowledge gaps in how communities might be best engaged in Sub-Saharan Africa. We, therefore, synthesized the existing literature on the current practices, barriers and facilitators, ethical considerations, and gender mainstreaming in the engagement of communities in research in sub-Saharan Africa. Methods this synthesis was developed following the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA). A combination of keywords and medical subject headings was used to search MEDLINE, EMBASE, Global Health Library through OVID SP, the Cochrane Library, PsychINFO, CINAHL, WHO Afro Library, WHO Global Index Medicus and the National Institute for Health Research, for all literature published between 1 January 2000 to 31 July 2021. Results thirty articles met our inclusion criteria. The key reported facilitators of effective community engagement in research included appropriate community entry and engagement of stakeholders. Barriers to effective community engagement in research included the availability of prohibitive cultural, historical and religious practices; geographical/spatial limitations, difficulties in planning and executing community engagement activities and communication barriers. Awareness creation and sensitization on the research through drama, social media, documentaries, and community durbars are some of the existing practices adopted in engaging communities in research. Gender mainstreaming was not considered appropriately in the engagement of communities in research, as only a few studies made provisions for gender considerations, and most of the time, interchanging gender for sex. Respect for autonomy, privacy and informed consent were the main ethical issues reported. Conclusion gender mainstreaming and ethical standards were reported as important, but not explored in depth. Gender as a social construct needs to be carefully integrated in the entire research cycle. Clear ethical concerns within a research project have to be co-discussed by the research team, community members and potential research participants.
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Affiliation(s)
- Luchuo Engelbert Bain
- Triangle Research Foundation (TRIFT), Limbe, Cameroon,,Department of Psychology, Faculty of Humanities, University of Johannesburg, Johannesburg, South Africa,,Global South Health Services and Research (GSHS), Amsterdam, The Netherlands,,Corresponding author: Luchuo Engelbert Bain, Triangle Research Foundation (TRIFT), Limbe, Cameroon.
| | - Claudine Akondeng
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon,,Cameroon National Association of Family Welfare (CAMNAFAW), Yaoundé, Cameroun
| | - Wepnyu Yembe Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon,,Education and Learning for All (ELFA) Cameroon, Yaoundé, Cameroon,,Division of Operational Research in Health, DROS, Ministry of Public Health, Yaoundé, Cameroon
| | - Henshaw Eyambe Mandi
- Triangle Research Foundation (TRIFT), Limbe, Cameroon,,Coalition for Epidemic Preparedness Innovations, Oslo, Norway
| | - Hubert Amu
- Department of Population and Behavioral Sciences, Fred N. Binka School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Alfred Kongnyu Njamnshi
- Brain Research Africa Initiative (BRAIN), Yaoundé, Cameroon,,Education and Learning for All (ELFA) Cameroon, Yaoundé, Cameroon,,Faculty of Medicine and Biomedical Sciences (FMBS), The University of Yaoundé I, Yaoundé, Cameroon
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Olsen SH, Roh EJ, Syakayuwa T, Chola M, Agbakwuru C, Stafford KA, Stoebenau K, Dzekedzeke K, Charurat M. Confluence of crises: COVID-19, "gassings", blood draws and the continued importance of community engagement in Zambia. Health Promot Perspect 2022; 12:67-76. [PMID: 35854852 PMCID: PMC9277288 DOI: 10.34172/hpp.2022.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/24/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Nationally representative, household-based, health-related surveys are an invaluable source of health information, but face implementation challenges. In sub-Saharan Africa, these challenges are exacerbated when surveys include the collection of biological specimens. In this study, we describe the potential implementation challenges identified during field practice leading up to the 2020 Zambia Population-based HIV Impact Assessment (ZAMPHIA) survey, and explore the role of two crises on community mistrust of, and apprehension to, participate in the survey. Methods: Using focus group methodology to better understand the influence of crises on ZAMPHIA participation, we conducted 12 focus group discussions (FGDs) in five districts across two provinces. FGDs were conducted with three purposively sampled study groups: recognized household heads, community leaders, and young adults aged 18-24 years. We used reflexive thematic analysis to develop themes from across the FGDs. Results: We identified two key themes: the ever-present threat a stranger posed to the community is enhanced by crises, and endorsement of community awareness through sensitization can mitigate outsider challenges in medical research. Conclusion: We argue that these crises emphasized underlying mistrust that can only be addressed with substantial investment in community engagement efforts to build trust and partnership in medical research endeavors. Our findings underline the importance of prioritizing community engagement through substantial investment in varied and extensive approaches to sensitization to facilitate community engagement toward community acceptance of ZAMPHIA and similar studies.
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Affiliation(s)
- Sara H Olsen
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | - Esther J Roh
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | - Tandwa Syakayuwa
- Center for International Health, Education, and Biosecurity, Zambia
| | - Mumbi Chola
- Center for International Health, Education, and Biosecurity, Zambia
| | - Chinedu Agbakwuru
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA
| | - Kristen A Stafford
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA.,Institute of Human Virology, University of Maryland School of Medicine, Maryland, USA
| | - Kirsten Stoebenau
- Department of Behavioral and Community Health, University of Maryland School of Public Health, Maryland, USA
| | | | - Manhattan Charurat
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Maryland, USA.,Institute of Human Virology, University of Maryland School of Medicine, Maryland, USA
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Solomon H, Henry EG, Herlihy J, Yeboah-Antwi K, Biemba G, Musokotwane K, Bhutta A, Hamer DH, Semrau KEA. Intended versus actual delivery location and factors associated with change in delivery location among pregnant women in Southern Province, Zambia: a prespecified secondary observational analysis of the ZamCAT. BMJ Open 2022; 12:e055288. [PMID: 35256443 PMCID: PMC8905985 DOI: 10.1136/bmjopen-2021-055288] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This prespecified, secondary analysis of the Zambia Chlorhexidine Application Trial (ZamCAT) aimed to determine the proportion of women who did not deliver where they intended, to understand the underlying reasons for the discordance between planned and actual delivery locations; and to assess sociodemographic characteristics associated with concordance of intention and practice. DESIGN Prespecified, secondary analysis from randomised controlled trial. SETTING Recruitment occurred in 90 primary health facilities (HFs) with follow-up in the community in Southern Province, Zambia. PARTICIPANTS Between 15 February 2011 and 30 January 2013, 39 679 pregnant women enrolled in ZamCAT. SECONDARY OUTCOME MEASURES The location where mothers gave birth (home vs HF) was compared with their planned delivery location. RESULTS When interviewed antepartum, 92% of respondents intended to deliver at an HF, 6.1% at home and 1.2% had no plan. However, of those who intended to deliver at an HF, 61% did; of those who intended to deliver at home, only 4% did; and of those who intended to deliver at home, 2% delivered instead at an HF. Among women who delivered at home, women who were aged 25-34 and ≥35 years were more likely to deliver where they intended than women aged 20-24 years (adjusted OR (aOR)=1.31, 95% CI=1.11 to 1.50 and aOR=1.32, 95% CI=1.12 to 1.57, respectively). Women who delivered at HFs had greater odds of delivering where they intended if they received any primary schooling (aOR=1.34, 95% CI=1.09 to 1.72) or more than a primary school education (aOR=1.54, 95% CI=1.17 to 2.02), were literate (aOR=1.33, 95% CI=1.119 to 1.58), and were not in the lowest quintile of the wealth index. CONCLUSION Discrepancies between intended and actual delivery locations highlight the need to go beyond the development of birth plans and exposure to birth planning messaging. More research is required to address barriers to achieving intentions of a facility-based childbirth. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT01241318).
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Affiliation(s)
- Hiwote Solomon
- Doctor of Public Health Program, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie Herlihy
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kojo Yeboah-Antwi
- Public Health Unit, Fr Thomas Alan Rooney Memorial Hospital, Kumasi, Asankrangwa, Ghana
| | - Godfrey Biemba
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Zambia National Health Research Authority, Lusaka, Zambia
| | | | - Afsah Bhutta
- MBBS Department, Dow University of Health Sciences, Karachi, Pakistan
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Disease, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Katherine E A Semrau
- Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Global Health Equity & Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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Scott NA, Kaiser JL, Ngoma T, McGlasson KL, Henry EG, Munro-Kramer ML, Biemba G, Bwalya M, Sakanga VR, Musonda G, Hamer DH, Boyd CJ, Bonawitz R, Vian T, Kruk ME, Fong RM, Chastain PS, Mataka K, Ahmed Mdluli E, Veliz P, Lori JR, Rockers PC. If we build it, will they come? Results of a quasi-experimental study assessing the impact of maternity waiting homes on facility-based childbirth and maternity care in Zambia. BMJ Glob Health 2021; 6:e006385. [PMID: 34876457 PMCID: PMC8655557 DOI: 10.1136/bmjgh-2021-006385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Maternity waiting homes (MWHs) aim to increase access to maternity and emergency obstetric care by allowing women to stay near a health centre before delivery. An improved MWH model was developed with community input and included infrastructure, policies and linkages to health centres. We hypothesised this MWH model would increase health facility delivery among remote-living women in Zambia. METHODS We conducted a quasi-experimental study at 40 rural health centres (RHC) that offer basic emergency obstetric care and had no recent stockouts of oxytocin or magnesium sulfate, located within 2 hours of a referral hospital. Intervention clusters (n=20) received an improved MWH model. Control clusters (n=20) implemented standard of care. Clusters were assigned to study arm using a matched-pair randomisation procedure (n=20) or non-randomly with matching criteria (n=20). We interviewed repeated cross-sectional random samples of women in villages 10+ kilometres from their RHC. The primary outcome was facility delivery; secondary outcomes included postnatal care utilisation, counselling, services received and expenditures. Intention-to-treat analysis was conducted. Generalised estimating equations were used to estimate ORs. RESULTS We interviewed 2381 women at baseline (March 2016) and 2330 at endline (October 2018). The improved MWH model was associated with increased odds of facility delivery (OR 1.60 (95% CI: 1.13 to 2.27); p<0.001) and MWH utilisation (OR 2.44 (1.62 to 3.67); p<0.001). The intervention was also associated with increased odds of postnatal attendance (OR 1.55 (1.10 to 2.19); p<0.001); counselling for family planning (OR 1.48 (1.15 to 1.91); p=0.002), breast feeding (OR 1.51 (1.20 to 1.90); p<0.001), and kangaroo care (OR 1.44 (1.15, 1.79); p=0.001); and caesarean section (OR 1.71 (1.16 to 2.54); p=0.007). No differences were observed in household expenditures for delivery. CONCLUSION MWHs near well-equipped RHCs increased access to facility delivery, encouraged use of facilities with emergency care capacity, and improved exposure to counselling. MWHs can be useful in the effort to increase delivery at advanced facilities in areas where substantial numbers of women live remotely. TRIAL REGISTRATION NUMBER NCT02620436.
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Affiliation(s)
- Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Thandiwe Ngoma
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | - Kathleen L McGlasson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Elizabeth G Henry
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle L Munro-Kramer
- Department of Health Behavior & Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Godfrey Biemba
- National Health Research Authority Zambia, Lusaka, Zambia
| | - Misheck Bwalya
- Department of Research, Right to Care Zambia, Lusaka, Zambia
| | | | | | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Section of Infectious Diseases, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taryn Vian
- University of San Francisco - School of Nursing and Health Professions, San Francisco, California, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Parker S Chastain
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | | | - Philip Veliz
- Applied Biostatistics Laboratory, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jody R Lori
- Center for Global Affairs & PAHO/WHO Collaborating Center, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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Kakuhikire B, Satinsky EN, Baguma C, Rasmussen JD, Perkins JM, Gumisiriza P, Juliet M, Ayebare P, Mushavi RC, Burns BFO, Evans CQ, Siedner MJ, Bangsberg DR, Tsai AC. Correlates of attendance at community engagement meetings held in advance of bio-behavioral research studies: A longitudinal, sociocentric social network study in rural Uganda. PLoS Med 2021; 18:e1003705. [PMID: 34270581 PMCID: PMC8323877 DOI: 10.1371/journal.pmed.1003705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/30/2021] [Accepted: 06/21/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Community engagement is central to the conduct of health-related research studies as a way to determine priorities, inform study design and implementation, increase recruitment and retention, build relationships, and ensure that research meets the goals of the community. Community sensitization meetings, a form of community engagement, are often held prior to the initiation of research studies to provide information about upcoming study activities and resolve concerns in consultation with potential participants. This study estimated demographic, health, economic, and social network correlates of attendance at community sensitization meetings held in advance of a whole-population, combined behavioral, and biomedical research study in rural Uganda. METHODS AND FINDINGS Research assistants collected survey data from 1,630 adults participating in an ongoing sociocentric social network cohort study conducted in a rural region of southwestern Uganda. These community survey data, collected between 2016 and 2018, were linked to attendance logs from community sensitization meetings held in 2018 and 2019 before the subsequent community survey and community health fair. Of all participants, 264 (16%) attended a community sensitization meeting before the community survey, 464 (28%) attended a meeting before the community health fair, 558 (34%) attended a meeting before either study activity (survey or health fair), and 170 (10%) attended a meeting before both study activities (survey and health fair). Using multivariable Poisson regression models, we estimated correlates of attendance at community sensitization meetings. Attendance was more likely among study participants who were women (adjusted relative risk [ARR]health fair = 1.71, 95% confidence interval [CI], 1.32 to 2.21, p < 0.001), older age (ARRsurvey = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001; ARRhealth fair = 1.02 per year, 95% CI, 1.01 to 1.02, p < 0.001), married (ARRsurvey = 1.74, 95% CI, 1.29 to 2.35, p < 0.001; ARRhealth fair = 1.41, 95% CI, 1.13 to 1.76, p = 0.002), and members of more community groups (ARRsurvey = 1.26 per group, 95% CI, 1.10 to 1.44, p = 0.001; ARRhealth fair = 1.26 per group, 95% CI, 1.12 to 1.43, p < 0.001). Attendance was less likely among study participants who lived farther from meeting locations (ARRsurvey = 0.54 per kilometer, 95% CI, 0.30 to 0.97, p = 0.041; ARRhealth fair = 0.57 per kilometer, 95% CI, 0.38 to 0.86, p = 0.007). Leveraging the cohort's sociocentric design, social network analyses suggested that information conveyed during community sensitization meetings could reach a broader group of potential study participants through attendees' social network and household connections. Study limitations include lack of detailed data on reasons for attendance/nonattendance at community sensitization meetings; achieving a representative sample of community members was not an explicit aim of the study; and generalizability may not extend beyond this study setting. CONCLUSIONS In this longitudinal, sociocentric social network study conducted in rural Uganda, we observed that older age, female sex, being married, membership in more community groups, and geographical proximity to meeting locations were correlated with attendance at community sensitization meetings held in advance of bio-behavioral research activities. Information conveyed during meetings could have reached a broader portion of the population through attendees' social network and household connections. To ensure broader input and potentially increase participation in health-related research studies, the dissemination of research-related information through community sensitization meetings may need to target members of underrepresented groups.
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Affiliation(s)
| | - Emily N. Satinsky
- Department of Psychology, University of Southern California, Los Angeles, California, United States of America
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- * E-mail:
| | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justin D. Rasmussen
- Department of Psychology, Duke University, Durham, North Carolina, United States of America
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | | | - Mercy Juliet
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Rumbidzai C. Mushavi
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Bridget F. O. Burns
- Department of Urban Studies and Planning, Massachusetts Institute of Technology, Boston, Massachusetts, United States of America
| | - Claire Q. Evans
- Peabody College, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Mark J. Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, United States of America
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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9
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Park JH, Hamer DH, Mbewe R, Scott NA, Herlihy JM, Yeboah-Antwi K, Semrau KEA. Components of clean delivery kits and newborn mortality in the Zambia Chlorhexidine Application Trial (ZamCAT): An observational study. PLoS Med 2021; 18:e1003610. [PMID: 33951036 PMCID: PMC8133479 DOI: 10.1371/journal.pmed.1003610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/19/2021] [Accepted: 04/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Neonatal infection, a leading cause of neonatal death in low- and middle-income countries, is often caused by pathogens acquired during childbirth. Clean delivery kits (CDKs) have shown efficacy in reducing infection-related perinatal and neonatal mortality. However, there remain gaps in our current knowledge, including the effect of individual components, the timeline of protection, and the benefit of CDKs in home and facility deliveries. METHODS AND FINDINGS A post hoc secondary analysis was performed using nonrandomized data from the Zambia Chlorhexidine Application Trial (ZamCAT), a community-based, cluster-randomized controlled trial of chlorhexidine umbilical cord care in Southern Province of Zambia from February 2011 to January 2013. CDKs, containing soap, gloves, cord clamps, plastic sheet, razor blade, matches, and candle, were provided to all pregnant women. Field monitors made a home-based visit to each participant 4 days postpartum, during which CDK use and newborn outcomes were ascertained. Logistic regression was used to study the association between different CDK components and neonatal mortality rate (NMR). Of 38,579 deliveries recorded during the study, 36,996 newborns were analyzed after excluding stillbirths and those with missing information. Gloves, cord clamps, and plastic sheets were the most frequently used CDK item combination in both home and facility deliveries. Each of the 7 CDK components was associated with lower NMR in users versus nonusers. Adjusted logistic regression showed that use of gloves (odds ratio [OR] 0.33, 95% CI 0.24-0.46), cord clamp (OR 0.51, 95% CI 0.38-0.68), plastic sheet (OR 0.46, 95% CI 0.34-0.63), and razor blade (OR 0.69, 95% CI 0.53-0.89) were associated with lower risk of newborn mortality. Use of gloves and cord clamp were associated with reduced risk of immediate newborn death (<24 hours). Reduction in risk of early newborn death (1-6 days) was associated with use of gloves, cord clamps, plastic sheets, and razor blades. In examining perinatal mortality (stillbirth plus neonatal death in the first 7 days of life), similar patterns were observed. There was no significant reduction in risk of late newborn mortality (7-28 days) with CDK use. Study limitations included potential recall bias of CDK use and inability to establish causality, as this was a secondary observational study. CONCLUSIONS CDK use was associated with reductions in early newborn mortality at both home and facility deliveries, especially when certain kit components were used. While causality could not be established in this nonrandomized secondary analysis, given these beneficial associations, scaling up the use of CDKs in rural areas of sub-Saharan Africa may improve neonatal outcomes. TRIAL REGISTRATION Name of trial: Zambia Chlorhexidine Application Trial (ZamCAT) Name of registry: Clinicaltrials.gov Trial number: NCT01241318.
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Affiliation(s)
- Jason H. Park
- Department of Internal Medicine, University of Michigan Hospitals, Ann Arbor, Michigan, United States of America
- * E-mail:
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Reuben Mbewe
- Levy Mwanawasa University Teaching Hospital, Lusaka, Zambia
| | - Nancy A. Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Julie M. Herlihy
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | | | - Katherine E. A. Semrau
- Ariadne Labs, Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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10
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Buser JM, Moyer CA, Boyd CJ, Zulu D, Ngoma-Hazemba A, Mtenje JT, Jones AD, Lori JR. Cultural beliefs and health-seeking practices: Rural Zambians' views on maternal-newborn care. Midwifery 2020; 85:102686. [PMID: 32172077 PMCID: PMC7249502 DOI: 10.1016/j.midw.2020.102686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/22/2020] [Accepted: 02/28/2020] [Indexed: 01/27/2023]
Abstract
Mothers caring for newborns have a maternal dualism between cultural and health system obligations. Traditional newborn protective rituals were identified to help nurses provide health education. Family and community expressed a strong need to protect the newborn using traditional belief systems.
Background - Far too many newborns die or face serious morbidity in Zambia, as in many other sub-Saharan African countries. New knowledge is needed to enhance our understanding of newborn care and the cultural factors influencing the ways mothers seek newborn care. This study adds to the literature about rural Zambians’ cultural beliefs and practices related to newborn care and health-seeking practices that influence maternal-newborn health. Objective - The goal of this study was to describe the factors associated with newborn care in rural Zambia. Design - Sixty focus groups were conducted. Each group contained a minimum of 8 and maximum of 12 participants. Recruitment was conducted orally by word of mouth through the nurse in charge at the health facilities and village chiefs. Setting – Data were collected between June and August 2016 in 20 communities located in Zambia's rural Lundazi (Eastern province), Mansa, and Chembe (Luapula province) Districts. Participants - The study included community members (n = 208), health workers (n = 225), and mothers with infants younger than 1-year-old (n = 213). Findings - The following themes emerged. From mothers with infants, the dominant theme concerned traditional and protective newborn rituals. From community members, the dominant theme was a strong sense of family and community to protect the newborn, and from health workers, the major theme was an avoidance of shame. A fourth theme, essential newborn care, was common among all groups. Key conclusions – Together the themes pointed toward a maternal dualism for mothers in rural Zambia. Mothers with infants in rural Zambia likely experience a dualistic sense of responsibility to satisfy both cultural and health system expectations when caring for their newborns. Mothers are pulled to engage in traditional protective newborn care rituals while at the same time being pushed to attend ANC and deliver at the health facility. These findings can be used to understand how mothers care for their newborns to develop interventions aimed at improving maternal-child health outcomes. Implications for practice - There were findings about the culture-specific prevention of cough, care of the umbilical cord, and early introduction of traditional porridge that carry implications for nursing practice. There is an obvious need to reinforce the importance of partner testing for STIs during routine ANC even though there is a desire to preserve dignity.
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Affiliation(s)
- Julie M Buser
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Ann Arbor, MI, 48109, United States.
| | - Cheryl A Moyer
- Global REACH, University of Michigan Medical School, United States; Departments of Learning Health Sciences and, Obstetrics & Gynecology, University of Michigan Medical School, United States
| | - Carol J Boyd
- Center for the Study of Drugs, Alcohol, Smoking & Health (DASH Center), University of Michigan, United States; Women's Studies, LS&A, University of Michigan; Institute for Research on Mothers & Gender, University of Michigan, United States
| | - Davy Zulu
- Republic of Zambia Ministry of Health, Lundazi, Zambia
| | - Alice Ngoma-Hazemba
- School of Public Health, Department of Community and Family Medicine, University of Zambia, Lusaka, Zambia
| | | | - Andrew D Jones
- Nutritional Sciences, Center for Human Growth and Development, School of Public Health, United States
| | - Jody R Lori
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, United States
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11
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Scott NA, Kaiser JL, Vian T, Bonawitz R, Fong RM, Ngoma T, Biemba G, Boyd CJ, Lori JR, Hamer DH, Rockers PC. Impact of maternity waiting homes on facility delivery among remote households in Zambia: protocol for a quasiexperimental, mixed-methods study. BMJ Open 2018; 8:e022224. [PMID: 30099401 PMCID: PMC6089313 DOI: 10.1136/bmjopen-2018-022224] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Maternity waiting homes (MWHs) aim to improve access to facility delivery in rural areas. However, there is limited rigorous evidence of their effectiveness. Using formative research, we developed an MWH intervention model with three components: infrastructure, management and linkage to services. This protocol describes a study to measure the impact of the MWH model on facility delivery among women living farthest (≥10 km) from their designated health facility in rural Zambia. This study will generate key new evidence to inform decision-making for MWH policy in Zambia and globally. METHODS AND ANALYSIS We are conducting a mixed-methods quasiexperimental impact evaluation of the MWH model using a controlled before-and-after design in 40 health facility clusters. Clusters were assigned to the intervention or control group using two methods: 20 clusters were randomly assigned using a matched-pair design; the other 20 were assigned without randomisation due to local political constraints. Overall, 20 study clusters receive the MWH model intervention while 20 control clusters continue to implement the 'standard of care' for waiting mothers. We recruit a repeated cross section of 2400 randomly sampled recently delivered women at baseline (2016) and endline (2018); all participants are administered a household survey and a 10% subsample also participates in an in-depth interview. We will calculate descriptive statistics and adjusted ORs; qualitative data will be analysed using content analysis. The primary outcome is the probability of delivery at a health facility; secondary outcomes include utilisation of MWHs and maternal and neonatal health outcomes. ETHICS AND DISSEMINATION Ethical approvals were obtained from the Boston University Institutional Review Board (IRB), University of Michigan IRB (deidentified data only) and the ERES Converge IRB in Zambia. Written informed consent is obtained prior to data collection. Results will be disseminated to key stakeholders in Zambia, then through open-access journals, websites and international conferences. TRIAL REGISTRATION NUMBER NCT02620436; Pre-results.
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Affiliation(s)
- Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rachel M Fong
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | | | - Godfrey Biemba
- National Health Research Authority, Pediatric Centre of Excellence, Lusaka, Zambia
| | - Carol J Boyd
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Jody R Lori
- Center for Global Affairs and PAHO/WHO Collaborating Center, School of Nursing, University of Michigan, Ann Arbor, Michigan, USA
| | - Davidson H Hamer
- Section of Infectious Diseases, Department of Medicine, Boston University, Boston, Massachusetts, USA
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
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12
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Herlihy JM, Gille S, Grogan C, Bobay L, Simpamba K, Akonkwa B, Chisenga T, Hamer DH, Semrau K. Can community health workers identify omphalitis? A validation study from Southern Province, Zambia. Trop Med Int Health 2018; 23:806-813. [PMID: 29752848 DOI: 10.1111/tmi.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Omphalitis, or umbilical cord infection, is an important cause of newborn morbidity and mortality in low-resource settings. We tested an algorithm that task-shifts omphalitis diagnosis to community-level workers in sub-Saharan Africa. METHODS Community-based field monitors and Zambian paediatricians independently evaluated newborns presenting to health facilities in Southern Zambia using a signs and symptoms checklist. Responses were compared against the paediatrician's gold standard clinical diagnosis. RESULTS Of 1009 newborns enrolled, 6.2% presented with omphalitis per the gold standard clinical diagnosis. Paediatricians' signs and symptoms with the highest sensitivity were presence of pus (79.4%), redness at the base (50.8%) and newborn flinching when cord was palpated (33.3%). The field monitor's signs and symptoms answers had low correlation with paediatrician's answers; all signs and symptoms assessed had sensitivity <16%. CONCLUSION Despite extensive training, field monitors could not consistently identify signs and symptoms associated with omphalitis in the sub-Saharan African setting.
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Affiliation(s)
- Julie M Herlihy
- Department of Pediatrics, School of Medicine, University of California Davis, Sacramento, CA, USA
| | - Sara Gille
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | | | - Kelvin Simpamba
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | | | - Tina Chisenga
- Ministry of Health, Government of the Republic of Zambia, Lusaka, Zambia
| | - Davidson H Hamer
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.,Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Katherine Semrau
- Ariadne Labs, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Global Health Equity, Brigham & Women's Hospital, Boston, MA, USA
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13
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Influence of newborn health messages on care-seeking practices and community health behaviors among participants in the Zambia Chlorhexidine Application Trial. PLoS One 2018; 13:e0198176. [PMID: 29902234 PMCID: PMC6002239 DOI: 10.1371/journal.pone.0198176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022] Open
Abstract
Background Identifying and understanding traditional perceptions that influence newborn care practices and care-seeking behavior are crucial to developing sustainable interventions to improve neonatal health. The Zambia Chlorhexidine Application Trial (ZamCAT), a large-scale cluster randomized trial, assessed the impact of 4% chlorhexidine on neonatal mortality and omphalitis in Southern Province, Zambia. The main purpose of this post-ZamCAT qualitative study was to understand the impact of newborn care health messages on care-seeking behavior for neonates and the acceptability, knowledge, and attitudes towards chlorhexidine cord care among community members and health workers in Southern Province. Methods & findings Five focus group discussions and twenty-six in-depth interviews were conducted with mothers and health workers from ten health centers (5 rural and 5 peri-urban/urban). Community perceptions and local realities were identified as fundamental to care-seeking decisions and influenced individual participation in particular health-seeking behaviors. ZamCAT field monitors (data collectors) disseminated health messages at the time of recruitment at the health center and during subsequent home visits. Mothers noted that ZamCAT field monitors were effective in providing lessons and education on newborn care practices and participating mothers were able to share these messages with others in their communities. Although the study found no effect of chlorhexidine cord washes on neonatal mortality, community members had positive views towards chlorhexidine as they perceived that it reduced umbilical cord infections and was a beneficial alternative to traditional cord applications. Conclusion The acceptability of health initiatives, such as chlorhexidine cord application, in community settings, is dependent on community education, understanding, and engagement. Community-based approaches, such as using community-based cadres of health workers to strengthen referrals, are an acceptable and potentially effective strategy to improve care-seeking behaviors and practices.
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14
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Tiwari A, Russpatrick S, Hoehne A, Matimelo SM, Mazimba S, Nkhata I, Osbert N, Soloka G, Winters A, Winters B, Larsen DA. Assessing the Impact of Leveraging Traditional Leadership on Access to Sanitation in Rural Zambia. Am J Trop Med Hyg 2017; 97:1355-1361. [PMID: 29016281 DOI: 10.4269/ajtmh.16-0612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Open defecation is practiced by more than one billion people throughout the world and leads to significant public health issues including infectious disease transmission and stunted growth in children. Zambia implemented community-led total sanitation (CLTS) as an intervention to eliminate open defecation in rural areas. To support CLTS and the attainment of open defecation free communities, chiefs were considered key agents of change and were empowered to drive CLTS and improve sanitation for their chiefdom. Chiefs were provided with data on access to sanitation in the chiefdom during chiefdom orientations prior to the initiation of CLTS within each community and encouraged to make goals of universal sanitation access within the community. Using a survival regression, we found that where chiefs were orientated and mobilized in CLTS, the probability that a village would achieve 100% coverage of adequate sanitation increased by 23% (hazard ratio = 1.263, 95% confidence interval = 1.080-1.478, P = 0.003). Using an interrupted time series, we found a 30% increase in the number of individuals with access to adequate sanitation following chiefdom orientations (95% confidence interval = 28.8-32.0%). The mobilization and support of chiefs greatly improved the uptake of CLTS, and empowering them with increased CLTS knowledge and authority of the program in their chiefdom allowed chiefs to closely monitor village sanitation progress and follow-up with their headmen/headwomen. These key agents of change are important facilitators of public health goals such as the elimination of open defecation in Zambia by 2020.
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Affiliation(s)
| | | | - Alexandra Hoehne
- United Nations Children's Emergency Fund Water and Sanitation Unit, Lusaka, Zambia
| | - Selma M Matimelo
- Ministry of Local Government and Housing, Government of the Republic of Zambia, Lusaka, Zambia
| | | | | | - Nicolas Osbert
- United Nations Children's Emergency Fund Water and Sanitation Unit, Lusaka, Zambia
| | - Geoffrey Soloka
- Ministry of Chiefs and Traditional Affairs, Government of the Republic of Zambia, Lusaka, Zambia
| | - Anna Winters
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana.,Akros, Lusaka, Zambia
| | - Benjamin Winters
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana.,Akros, Lusaka, Zambia
| | - David A Larsen
- Akros, Lusaka, Zambia.,Department of Public Health, Food Studies and Nutrition, Syracuse University, Syracuse, New York
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15
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Henry EG, Thea DM, Hamer DH, DeJong W, Musokotwane K, Chibwe K, Biemba G, Semrau K. The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia. Glob Public Health 2017; 13:1481-1494. [PMID: 28994352 PMCID: PMC6176772 DOI: 10.1080/17441692.2017.1385824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 2012, Saving Mothers, Giving Life (SMGL), a multi-level health systems initiative, launched in Kalomo District, Zambia, to address persistent challenges in reducing maternal mortality. We assessed the impact of the programme from 2012 to 2013 using a quasi-experimental study with both household- and health facility-level data collected before and after implementation in both intervention and comparison areas. A total of 21,680 women and 75 non-hospital health centres were included in the study. Using the difference-in-differences method, multivariate logistic regression, and run charts, rates of facility-based birth (FBB) and delivery with a skilled birth provider were compared between intervention and comparison sites. Facility capacity to provide emergency obstetric and newborn care was also assessed before and during implementation in both study areas. There was a 45% increase in the odds of FBB after the programme was implemented in Kalomo relative to comparison districts, but there was a limited measurable change in supply-side indicators of intrapartum maternity care. Most facility-level changes related to an increase in capacity for newborn care. As SMGL and similar programmes are scaled-up and replicated, our results underscore the need to ensure that the health services supply is in balance with improved demand to achieve maximal reductions in maternal mortality.
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Affiliation(s)
- Elizabeth G Henry
- a Department of Global Health , Boston University School of Public Health , Boston , MA , USA
| | - Donald M Thea
- a Department of Global Health , Boston University School of Public Health , Boston , MA , USA
| | - Davidson H Hamer
- a Department of Global Health , Boston University School of Public Health , Boston , MA , USA.,b Section of Infectious Diseases, Department of Medicine , Boston University School of Medicine , Boston , MA , USA.,c Zambian Center for Applied Health Research and Development (ZCAHRD) Limited , Lusaka , Zambia
| | - William DeJong
- d Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
| | | | | | - Godfrey Biemba
- a Department of Global Health , Boston University School of Public Health , Boston , MA , USA.,c Zambian Center for Applied Health Research and Development (ZCAHRD) Limited , Lusaka , Zambia
| | - Katherine Semrau
- g Ariadne Labs , Boston , MA , USA.,h Division of Global Health Equity, Brigham & Women's Hospital , Boston , MA , USA.,i Department of Medicine , Harvard Medical School , Boston , MA , USA
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16
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Henry EG, Semrau K, Hamer DH, Vian T, Nambao M, Mataka K, Scott NA. The influence of quality maternity waiting homes on utilization of facilities for delivery in rural Zambia. Reprod Health 2017; 14:68. [PMID: 28558800 PMCID: PMC5450262 DOI: 10.1186/s12978-017-0328-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/19/2017] [Indexed: 11/25/2022] Open
Abstract
Background Residential accommodation for expectant mothers adjacent to health facilities, known as maternity waiting homes (MWH), is an intervention designed to improve access to skilled deliveries in low-income countries like Zambia where the maternal mortality ratio is estimated at 398 deaths per 100,000 live births. Our study aimed to assess the relationship between MWH quality and the likelihood of facility delivery in Kalomo and Choma Districts in Southern Province, Zambia. Methods We systematically assessed and inventoried the functional capacity of all existing MWH using a quantitative facility survey and photographs of the structures. We calculated a composite score and used multivariate regression to quantify MWH quality and its association with the likelihood of facility delivery using household survey data collected on delivery location in Kalomo and Choma Districts from 2011–2013. Results MWH were generally in poor condition and composite scores varied widely, with a median score of 28.0 and ranging from 12 to 66 out of a possible 75 points. Of the 17,200 total deliveries captured from 2011–2013 in 40 study catchment area facilities, a higher proportion occurred in facilities where there was either a MWH or the health facility provided space for pregnant waiting mothers compared to those with no accommodations (60.7% versus 55.9%, p <0.001). After controlling for confounders including implementation of Saving Mothers Giving Life, a large-scale maternal health systems strengthening program, among women whose catchment area facilities had an MWH, those women with MWHs in their catchment area that were rated medium or high quality had a 95% increase in the odds of facility delivery than those whose catchment area MWHs were of poor quality (OR: 1.95, 95% CI 1.76, 2.16). Conclusions Improving both the availability and the quality of MWH represents a potentially useful strategy to increasing facility delivery in rural Zambia. Trial registration The Zambia Chlorhexidine Application Trial is registered at Clinical Trials.gov (identifier: NCT01241318)
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Affiliation(s)
- Elizabeth G Henry
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | - Katherine Semrau
- Ariadne Labs, Boston, USA.,Division of Global Health Equity, Brigham & Women's Hospital, Boston, USA.,Department of Medicine, Harvard Medical School, Boston, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Zambia Center for Applied Health Research and Development (ZCAHRD) Limited, Lusaka, Zambia
| | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, Boston, USA
| | | | - Kaluba Mataka
- Zambia Center for Applied Health Research and Development (ZCAHRD) Limited, Lusaka, Zambia
| | - Nancy A Scott
- Department of Global Health, Boston University School of Public Health, Boston, USA.
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17
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Rockers PC, Fink G, Zanolini A, Banda B, Biemba G, Sullivan C, Mutembo S, Silavwe V, Hamer DH. Impact of a community-based package of interventions on child development in Zambia: a cluster-randomised controlled trial. BMJ Glob Health 2016; 1:e000104. [PMID: 28588962 PMCID: PMC5321359 DOI: 10.1136/bmjgh-2016-000104] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 10/01/2016] [Accepted: 10/03/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Community-based programmes are a critical platform for improving child health and development. We tested the impact of a community-based early childhood intervention package in rural Zambia. METHODS We conducted a non-blinded cluster randomised controlled trial in Southern Province, Zambia. 30 clusters of villages were matched based on population density and distance from the nearest health centre, and randomly assigned to intervention (15 clusters and 268 caregiver-child dyads) or control (15 clusters and 258 caregiver-child dyads). Caregivers were eligible if they had a child aged 6-12 months at baseline. In intervention clusters, health workers screened children for infections and malnutrition, and invited caregivers to attend fortnightly group meetings covering a nutrition and child development curriculum. 220 intervention and 215 control dyads were evaluated after 1 year. The primary outcomes were stunting and INTERGROWTH-21st neurodevelopmental assessment (NDA) scores. Weight-for-age and height-for-age z-scores based on WHO growth standards were also analysed. Secondary outcomes were child illness symptoms, dietary intake and caregiver-child interactions based on self-report. Impact was estimated using intention-to-treat analysis. RESULTS The intervention package was associated with a 0.12 SD increase in weight-for-age (95% CI -0.14 to 0.38), a 0.15 SD increase in height-for-age (95% CI -0.18 to 0.48) and a reduction in stunting (OR 0.68; 95% CI 0.36 to 1.28), whereas there was no measurable impact on NDA score. Children receiving the intervention package had fewer symptoms, a more diverse diet and more caregiver interactions. CONCLUSIONS In settings like Zambia, community-based early childhood programmes appear to be feasible and appreciated by caregivers, as evidenced by high rates of uptake. The intervention package improved parenting behaviours and had a small positive, though statistically insignificant, impact on child development. Given the short time frame of the project, larger developmental impact is likely if differential parenting behaviours persist. TRIAL REGISTRATION NUMBER NCT02234726; Results.
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Affiliation(s)
- Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Günther Fink
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Arianna Zanolini
- American Institutes for Research, Washington, District of Columbia, USA
| | - Bowen Banda
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Godfrey Biemba
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
| | - Cierra Sullivan
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Denver, Colorado, USA
| | | | | | - Davidson H Hamer
- Zambia Center for Applied Health Research and Development, Lusaka, Zambia
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Semrau KEA, Herlihy J, Grogan C, Musokotwane K, Yeboah-Antwi K, Mbewe R, Banda B, Mpamba C, Hamomba F, Pilingana P, Zulu A, Chanda-Kapata P, Biemba G, Thea DM, MacLeod WB, Simon JL, Hamer DH. Effectiveness of 4% chlorhexidine umbilical cord care on neonatal mortality in Southern Province, Zambia (ZamCAT): a cluster-randomised controlled trial. LANCET GLOBAL HEALTH 2016; 4:e827-e836. [PMID: 27693439 DOI: 10.1016/s2214-109x(16)30215-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 05/11/2016] [Accepted: 08/08/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chlorhexidine 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. METHODS We 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). FINDINGS From 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). INTERPRETATION Despite 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. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Katherine E A Semrau
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Julie Herlihy
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Caroline Grogan
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Kebby Musokotwane
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Ministry of Community Development, Mother and Child Health, Lusaka, Zambia
| | - Kojo Yeboah-Antwi
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Bowen Banda
- ZamCAT Field Office, Zambia Centre for Applied Research and Development (ZCAHRD), Choma, Zambia
| | - Chipo Mpamba
- ZamCAT Field Office, Zambia Centre for Applied Research and Development (ZCAHRD), Choma, Zambia
| | - Fern Hamomba
- ZamCAT Field Office, Zambia Centre for Applied Research and Development (ZCAHRD), Choma, Zambia
| | - Portipher Pilingana
- ZamCAT Field Office, Zambia Centre for Applied Research and Development (ZCAHRD), Choma, Zambia
| | - Andisen Zulu
- ZamCAT Field Office, Zambia Centre for Applied Research and Development (ZCAHRD), Choma, Zambia
| | | | - Godfrey Biemba
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA; ZCAHRD, Lusaka, Zambia
| | - Donald M Thea
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - William B MacLeod
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jonathon L Simon
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA; ZCAHRD, Lusaka, Zambia
| | - Davidson H Hamer
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA; Department of Global Health, Boston University School of Public Health, Boston, MA, USA; ZCAHRD, Lusaka, Zambia; Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA.
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Baqui AH, Mitra DK, Begum N, Hurt L, Soremekun S, Edmond K, Kirkwood B, Bhandari N, Taneja S, Mazumder S, Nisar MI, Jehan F, Ilyas M, Ali M, Ahmed I, Ariff S, Soofi SB, Sazawal S, Dhingra U, Dutta A, Ali SM, Ame SM, Semrau K, Hamomba FM, Grogan C, Hamer DH, Bahl R, Yoshida S, Manu A. Neonatal mortality within 24 hours of birth in six low- and lower-middle-income countries. Bull World Health Organ 2016; 94:752-758B. [PMID: 27843165 PMCID: PMC5043199 DOI: 10.2471/blt.15.160945] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 05/06/2016] [Accepted: 05/09/2016] [Indexed: 12/02/2022] Open
Abstract
Objective To estimate neonatal mortality, particularly within 24 hours of birth, in six low- and lower-middle-income countries. Methods We analysed epidemiological data on a total of 149 570 live births collected between 2007 and 2013 in six prospective randomized trials and a cohort study from predominantly rural areas of Bangladesh, Ghana, India, Pakistan, the United Republic of Tanzania and Zambia. The neonatal mortality rate and mortality within 24 hours of birth were estimated for all countries and mortality within 6 hours was estimated for four countries with available data. The findings were compared with published model-based estimates of neonatal mortality. Findings Overall, the neonatal mortality rate observed at study sites in the six countries was 30.5 per 1000 live births (range: 13.6 in Zambia to 47.4 in Pakistan). Mortality within 24 hours was 14.1 per 1000 live births overall (range: 5.1 in Zambia to 20.1 in India) and 46.3% of all neonatal deaths occurred within 24 hours (range: 36.2% in Pakistan to 65.5% in the United Republic of Tanzania). Mortality in the first 6 hours was 8.3 per 1000 live births, i.e. 31.9% of neonatal mortality. Conclusion Neonatal mortality within 24 hours of birth in predominantly rural areas of six low- and lower-middle-income countries was higher than model-based estimates for these countries. A little under half of all neonatal deaths occurred within 24 hours of birth and around one third occurred within 6 hours. Implementation of high-quality, effective obstetric and early newborn care should be a priority in these settings.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA)
| | - Dipak K Mitra
- International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA)
| | - Nazma Begum
- International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA)
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales
| | - Seyi Soremekun
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, England
| | - Karen Edmond
- School of Paediatrics and Child Health, University of Western Australia, Perth, Australia
| | - Betty Kirkwood
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, England
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Sarmila Mazumder
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Muhammad Imran Nisar
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Ilyas
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Murtaza Ali
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Imran Ahmed
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Shabina Ariff
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sajid B Soofi
- Department of Paediatric and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Sunil Sazawal
- International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA)
| | - Usha Dhingra
- International Center for Maternal and Newborn Health, Johns Hopkins University, Baltimore, United States of America (USA)
| | - Arup Dutta
- Center for Public Health Kinetics, New Delhi, India
| | - Said M Ali
- Public Health Laboratory Ivo de Carneri, Pemba, United Republic of Tanzania
| | - Shaali M Ame
- Public Health Laboratory Ivo de Carneri, Pemba, United Republic of Tanzania
| | | | | | | | - Davidson H Hamer
- Center for Global Health and Development, Boston University, Boston, USA
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Sachiyo Yoshida
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Alexander Manu
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
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