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Eriksen CB, Minja DT, Christensen DL, Bygbjerg IC, Damm P, Schmiegelow C, Grunnet LG, Hjort L. Do WHO criteria for gestational diabetes fit a rural population in Tanzania? - A follow-up study assessing mother and child health six years after a pregnancy diagnosed with gestational diabetes. Diabetes Res Clin Pract 2024; 211:111657. [PMID: 38583780 DOI: 10.1016/j.diabres.2024.111657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/23/2024] [Accepted: 04/02/2024] [Indexed: 04/09/2024]
Abstract
AIMS AND METHODS In low- and middle- income countries (LMICs) consequences of gestational diabetes (GDM) is understudied. Using a prospective cohort of mothers (n = 197)and children (n = 251), from rural north-eastern Tanzania, we assessed prediabetes and type 2 diabetes (T2D) prevalence six years after a pregnancy with/without GDM. RESULTS The prevalence of prediabetes (49.4 % vs. 46.4 %) orT2D (20.0 % vs. 16.1 %), p ≥ 0.36, based on fasting plasma glucose (FPG) or HbA1clevels (prediabetes: 16.9 % vs. 13.8 % and T2D 1.2 % vs. 0 %, p = 0.47), andcardio-metabolic health parameters,weresimilar between women with/without previous GDM. These results were supported by similar perinatal outcomes and child health at follow-up.The overall prevalence ofprediabetes/T2D was high, but no differences in other cardio-metabolic risk markers were observed in women with prediabetes/T2D compared to women with normal glucose tolerance. CONCLUSIONS Despite high prevalence of GDM amongTanzanian women, the diagnosis was not associated with adverse pregnancy outcomes, nor with increased risk of prediabetes or T2D at follow-up. FPG and HbA1c may be poor markers for diabetes in this population, and further follow-up studies with longer time intervals are warranted to evaluate which GDM diagnostic criteria are most optimal for women in rural Tanzania and similar LMIC settings.
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Affiliation(s)
- Camilla Byskou Eriksen
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Daniel Thomas Minja
- National Institute for Medical Research, Tanga Centre, P.O. Box 5004, Tanga, Tanzania.
| | - Dirk Lund Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark.
| | - Peter Damm
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
| | - Christentze Schmiegelow
- Centre for Translational Medicine and Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Department of Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Gynecology and Obstetrics, Copenhagen University Hospital - North Zealand, Dyrehavevej 29, 3400 Hilleroed, Denmark.
| | - Louise Groth Grunnet
- Global Health Section, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1353 Copenhagen, Denmark; Clinical and Translational Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark.
| | - Line Hjort
- Center for Pregnant Women with Diabetes, Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2100 Copenhagen, Denmark.
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Meyrowitsch DW, Thi Dang NA, Phong TV, Nielsen J, Søndergaard J, Cuong ND, Le Minh H, Vu TKD, Bygbjerg IC, Gammeltoft TM, Thanh ND. The effects of diabetes clubs on peer-support, disclosure of diabetes status, and sources of information regarding diabetes management: results of a pilot-intervention in rural Vietnam. Public Health 2024; 228:171-177. [PMID: 38364677 DOI: 10.1016/j.puhe.2023.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 12/13/2023] [Accepted: 12/29/2023] [Indexed: 02/18/2024]
Abstract
OBJECTIVES To measure the effects of diabetes clubs on peer support, disclosure of diabetes status, and the source of information regarding the management of diabetes among persons living with type-2 diabetes (T2D) in rural Vietnam. STUDY DESIGN A pre- and post-pilot intervention study was carried out in Thai Binh Province, Vietnam (n = 222). RESULTS Post-intervention, 57.7 % reported using experiences shared by other persons with T2D during the diabetes club sessions. Compared to pre-intervention, there was an increase in the proportion of persons with T2D who disclosed their diabetes status to friends and/or community members (an increase of 15.3 and 13.8 percentage points, respectively). The proportion of persons who reported gathering their own information regarding diabetes management without any support from others decreased from 15.7 % to 6.3 %. Those who reported a relative inside their home or a relative outside their household as their primary source of T2D-relevant information increased from 10.8 % to 18.6 % and from 2.7 % to 9.5 %, respectively. Persons who mentioned that they did not have a need for further support for their diabetes care increased from 18.5 % to 32.0 %. Specific support regarding diabetes-related knowledge received from family members, friends, and/or community members increased from 27.5 % to 62.2 % CONCLUSIONS: These findings suggest a promising potential for the implementation of diabetes clubs to enhance diabetes-relevant knowledge and the quality of self-management among persons living with T2D diabetes in rural areas of Vietnam.
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Affiliation(s)
- D W Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark.
| | - N-A Thi Dang
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T V Phong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - J Nielsen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Denmark
| | - N D Cuong
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - H Le Minh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - T K D Vu
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - T M Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353 Copenhagen K, Denmark
| | - N D Thanh
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh City, Thai Binh Province, Viet Nam
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Schmiegelow C, Møller SL, Yde AM, Nielsen BB, Hjort L, Theander TG, Lusingu JPA, Minja DTR, Bygbjerg IC. Anaemia in the first trimester and poor physiological plasma expansion during pregnancy negatively impact foetal weight and newborn anthropometrics: An observational cohort study in Tanzania. Trop Med Int Health 2024; 29:243-255. [PMID: 38191232 DOI: 10.1111/tmi.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
OBJECTIVES Anaemia during pregnancy is a major health challenge affecting pregnancy outcome worldwide. The objectives of this study were to investigate the impact of severe-moderate anaemia in the first trimester, as well as changes in haemoglobin during pregnancy among non-anaemic women, on foetal weight, placental blood flow and newborn anthropometrics. METHODS In a prospective cohort study, 346 women residing in rural Tanzania were followed throughout pregnancy with serial ultrasound and newborn anthropometrics assessed within 24 h of delivery. Associations between placental blood flow, foetal weight and newborn anthropometrics with either first trimester severe-moderate anaemia (haemoglobin≤9.5 g/dL) or changes in haemoglobin from the first to the third trimester among non-anaemic women, were assessed by mixed model regression and multiple linear regression, adjusting for maternal and foetal co-variables. Foetal weights and birthweight were converted to z-scores using a population based sex-specific weight reference. RESULTS Severe-moderate anaemia in the first trimester was associated with significantly reduced foetal weight z-scores (adjusted mean difference (aMD) -0.44 (95% CI -0.81, -0.07)) and newborn anthropometric indices (birth weight z-score aMD -0.55 (-0.9, -0.13), abdominal circumference aMD -11 mm (95% CI -20, -3)). There were no association between first trimester severe-moderate anaemia and placental blood flow. Among women who were non-anaemic in the first trimester, women with the least reduction in haemoglobin (Δ ≥ -0.3 g/dL) delivered significantly smaller newborns (birthweight z-score aMD -0.55 (-0.91, -0.20), abdominal circumference aMD -10 mm (95% CI -17, -3), compared to women with the greatest reduction (Δ haemoglobin ≤ -1.4 g/dL)). CONCLUSIONS Severe-moderate anaemia in early pregnancy was associated with smaller newborn anthropometrics which was reflected in smaller mean foetal weights in the second and third trimester. Furthermore, among women who were non-anaemic in the first trimester, there was an association between smaller newborn anthropometrics and limited haemoglobin decrease during pregnancy, possibly reflecting insufficient plasma expansion.
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Affiliation(s)
- Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- Department of Gynaecology and Obstetrics, Copenhagen University Hospital-North Zealand, Hilleroed, Denmark
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Mathilde Yde
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | | | - Line Hjort
- Department of Gynecology and Obstetrics, Julianne Marie Centre, Copenhagen, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thor Grundtvig Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - John Peter Andrea Lusingu
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
- National Institute for Medical Research Tanga Centre, Korogwe, Tanzania
| | | | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Dang NAT, Phong Vu T, M. Gammeltoft T, Christian Bygbjerg I, W. Meyrowitsch D, Søndergaard J. Pre-/-post-analyses of a feasibility study of a peer-based club intervention among people living with type 2 diabetes in Vietnam's rural communities. PLoS One 2023; 18:e0290355. [PMID: 38015901 PMCID: PMC10684024 DOI: 10.1371/journal.pone.0290355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/05/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES Insufficient self-management is a significant barrier for people with type 2 diabetes (T2D) to achieve glycemic control and consequently reduce the risk of acute and long-term diabetes complications, negatively affecting their quality of life and increasing their risk of diabetes-related death. This pre-post study aimed to evaluate whether a peer-based club intervention might reduce glycated hemoglobin from baseline to post-intervention and enhance self-management among people living with T2D in two rural communities in Vietnam. METHODS A pre-post study was implemented with 222 adults with T2D residing in two rural communities in Vietnam. We used a structured questionnaire, clinical examination, and glycated hemoglobin to evaluate the possible effects of a diabetes club intervention by comparing Glycated Hemoglobin (HbA1c), Body Mass Index (BMI), Blood Pressure (BP), and diabetes-related self-management behaviors at baseline and post-intervention. The data were analyzed using SPSS 20, applying two related sample tests (Wilcoxon and McNemar test) and a paired-sample t-test at a significance level of less than 0.05. RESULTS The findings indicated that after implementation of the intervention, there were no significant statistical differences when comparing pre-and post-intervention levels of the primary outcome HbA1c, but some components of diabetes self-management showed statistically significant improvement. CONCLUSIONS After the peer support intervention in a Vietnamese rural community, there was no significant reduction in the primary outcome proportion of patients having an HbA1c less than 7%, but foot care knowledge and practice had improved. TRIAL REGISTRATION ClinicalTrials.gov NCT05602441.
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Affiliation(s)
- Ngoc-Anh Thi Dang
- Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tuc Phong Vu
- Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tine M. Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen K, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Dan W. Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Jens Søndergaard
- The Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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5
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Hjort L, Wewer Albrechtsen NJ, Minja D, Rasmussen C, Møller SL, Lusingu J, Theander T, Bygbjerg IC, Schmiegelow C, Grunnet LG. Cord Blood FGF-21 and GDF-15 Levels Are Affected by Maternal Exposure to Moderate to Severe Anemia and Malaria. J Endocr Soc 2023; 7:bvad120. [PMID: 37795192 PMCID: PMC10546908 DOI: 10.1210/jendso/bvad120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 10/06/2023] Open
Abstract
Context Anemia and malaria are global health problems affecting >50% of pregnant women in sub-Saharan Africa and are associated with intrauterine growth restriction. The hormones fibroblast growth factor 21 (FGF-21) and growth differentiation factor 15 (GDF-15) are involved in metabolic regulation and are expressed in the placenta. No studies exist on FGF-21 and GDF-15 responses to exposures of malaria and anemia in pregnancy. Objective and Methods Using a prospective, longitudinal pregnancy and birth cohort of women with an average age of 26 years from a rural region in northeastern Tanzania, we examined if FGF-21 and GDF-15 levels in maternal blood at week 33 ± 2 (n = 301) and in cord blood at birth (n = 353), were associated with anemia and malaria exposure at different time points in pregnancy and with neonatal anthropometry. Results Among mothers at gestation week 33 ± 2, lower FGF-21 levels were observed after exposure to malaria in the first trimester, but not anemia, whereas GDF-15 levels at week 33 ± 2 were not associated with malaria nor anemia. In cord blood, moderate to severe anemia at any time point in pregnancy was associated with higher levels of FGF-21, whereas malaria exposure in the third trimester was associated with lower FGF-21 levels in cord blood. Negative associations were observed between cord blood FGF-21 and GDF-15 levels and neonatal skinfold thicknesses and birthweight. Conclusion Our results suggest that moderate to severe anemia throughout pregnancy associates with higher FGF-21 levels, and malaria in last trimester associates with lower FGF-21 levels, in the neonates, thereby potentially affecting the future cardiometabolic health of the child.
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Affiliation(s)
- Line Hjort
- Department of Obstetrics, Copenhagen University Hospital, Copenhagen 2100, Denmark
- Novo Nordisk Foundation Center for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Nicolai J Wewer Albrechtsen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Departments of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen 2200, Denmark
- Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Daniel Minja
- National Institute for Medical Research, Tanga Center, Tanga 5004, Tanzania
| | - Christine Rasmussen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
- Departments of Clinical Biochemistry, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen 2200, Denmark
| | - Sofie Lykke Møller
- Department of Public Health, Section of Global Health, University of Copenhagen, Copenhagen 2200, Denmark
| | - John Lusingu
- National Institute for Medical Research, Tanga Center, Tanga 5004, Tanzania
| | - Thor Theander
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen 2100, Denmark
| | - Ib Christian Bygbjerg
- Department of Public Health, Section of Global Health, University of Copenhagen, Copenhagen 2200, Denmark
| | - Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen 2200, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen 2100, Denmark
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Msemo OA, Pérez-Alós L, Minja DT, Hansen CB, Gesase S, Mtove G, Mbwana J, Larsen VML, Bøgestad ECS, Grunnet LG, Christensen DL, Bygbjerg IC, Burgner D, Schmiegelow C, Garred P, Hjort L. High anti-SARS-CoV-2 seroprevalence among unvaccinated mother-child pairs from a rural setting in north-eastern Tanzania during the second wave of COVID-19. IJID Reg 2023; 6:48-57. [PMID: 36466214 PMCID: PMC9709504 DOI: 10.1016/j.ijregi.2022.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
Background The reported infection rates and burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in low- and middle-income countries, including those in sub-Saharan Africa, are relatively low compared to the rates and burden in Europe and America, partly due to limited testing capability. Unlike many countries, Tanzania has implemented neither mass screening nor restrictive measures such as lockdowns to date. The prevalence of SARS-CoV-2 infection in rural mainland Tanzania is largely unknown. Methods A cross-sectional study was conducted between April and October 2021 to assess the anti-SARS-CoV-2 seroprevalence among mother-child pairs (n = 634 children, n = 518 mothers) in a rural setting in north-eastern Tanzania. Results A very high prevalence of anti-SARS-CoV-2 antibody titres was found, with seroprevalence rates ranging from 29% among mothers and 40% among children, with a dynamic peak in seropositivity incidence at the end of July/early August being revealed. Significant differences in age, socioeconomic status, and body composition were associated with seropositivity in mothers and children. No significant associations were observed between seropositivity and comorbidities, including anaemia, diabetes, malaria, and HIV. Conclusions The transmission of SARS-CoV-2 in a rural region of Tanzania during 2021 was high, indicating a much higher infection rate in rural Tanzania compared to that reported in the UK and USA during the same period. Ongoing immune surveillance may be vital to monitoring the burden of viral infection in rural settings without access to molecular genotyping, where the load of communicable diseases may mask COVID-19. Surveillance could be implemented in tandem with the intensification of vaccination strategies.
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Affiliation(s)
- Omari Abdul Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Laura Pérez-Alós
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Daniel T.R. Minja
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Cecilie Bo Hansen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Samwel Gesase
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - George Mtove
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Joyce Mbwana
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Victoria Marie Linderod Larsen
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Emilie Caroline Skuladottir Bøgestad
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Technology, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | | | - Dirk Lund Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - David Burgner
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia,Department of Paediatrics, Melbourne University, Melbourne, Victoria, Australia
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen and Department of Infectious Diseases, Copenhagen University Hospital, Copenhagen, Denmark,Department of Obstetrics, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, Section 7631, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Line Hjort
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Corresponding author: Line Hjort, he Novo Nordisk Foundation Centre for Basic Metabolic Research, Metabolic Epigenetics Group, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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7
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Sørensen JB, Housseine N, Maaløe N, Bygbjerg IC, Pinkowski Tersbøl B, Konradsen F, Sequeira Dmello B, van Den Akker T, van Roosmalen J, Mookherji S, Siaity E, Osaki H, Khamis RS, Kujabi ML, John TW, Wolf Meyrowitsch D, Mbekenga C, Skovdal M, L Kidanto H. Scaling up Locally Adapted Clinical Practice Guidelines for Improving Childbirth Care in Tanzania: A Protocol for Programme Theory and Qualitative Methods of the PartoMa Scale-up Study. Glob Health Action 2022; 15:2034136. [PMID: 35311627 PMCID: PMC8942528 DOI: 10.1080/16549716.2022.2034136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Effective, low-cost clinical interventions to improve facility-based care during childbirth are critical to reduce maternal and perinatal mortality and morbidity in low-resource settings. While health interventions for low- and lower-middle-income countries are often developed and implemented top-down, needs and circumstances vary greatly across locations. Our pilot study in Zanzibar improved care through locally co-created intrapartum clinical practice guidelines (CPGs) and associated training (the PartoMa intervention). This intervention was context-tailored with health-care providers in Zanzibar and now scaled up within five maternity units in Dar es Salaam, Tanzania. This PartoMa Scale-up Study thereby provides an opportunity to explore the co-creation process and modification of the intervention in another context and how scale-up might be successfully achieved. The overall protocol is presented in a separate paper. The aim of the present paper is to account for the Scale-up Study’s programme theory and qualitative methodology. We introduce social practice theory and argue for its value within the programme theory and towards qualitative explorations of shifts in clinical practice. The theory recognizes that the practice we aim to strengthen – safe and respectful clinical childbirth care – is not practiced in a vacuum but embedded within a socio-material context and intertwined with other practices. Methodologically, the project draws on ethnographic and participatory methodologies to explore current childbirth care practices. In line with our programme theory, explorations will focus on meanings of childbirth care, material tools and competencies that are being drawn upon, birth attendants’ motivations and relational contexts, as well as other everyday practices of childbirth care. Insights generated from this study will not only elucidate active ingredients that make the PartoMa intervention feasible (or not) but develop the knowledge foundation for scaling-up and replicability of future interventions based on the principles of co-creation and contextualisation.
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Affiliation(s)
- Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira Dmello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania.,Comprehensive Community Based Rehabilitation in Tanzania Tanzania
| | - Thomas van Den Akker
- Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jos van Roosmalen
- Athena Institute is the department, Athena Institute, VU University, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington DC, US
| | - Eunice Siaity
- Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Columba Mbekenga
- Medical college, Aga Khan University, School of Nursing and Midwifery East Africa, Dar Es Salaam Campus Tanzania
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L Kidanto
- Medical College, Aga Khan University, Medical College East Africa, Dar Es Salaam Campus Tanzania
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Maaløe N, Housseine N, Sørensen JB, Obel J, Sequeira DMello B, Kujabi ML, Osaki H, John TW, Khamis RS, Muniro ZSS, Nkungu DJ, Pinkowski Tersbøl B, Konradsen F, Mookherji S, Mbekenga C, Meguid T, van Roosmalen J, Bygbjerg IC, van den Akker T, Jensen AK, Skovdal M, L. Kidanto H, Wolf Meyrowitsch D. Scaling up context-tailored clinical guidelines and training to improve childbirth care in urban, low-resource maternity units in Tanzania: A protocol for a stepped-wedged cluster randomized trial with embedded qualitative and economic analyses (The PartoMa Scale-Up Study). Glob Health Action 2022; 15:2034135. [PMID: 35410590 PMCID: PMC9009913 DOI: 10.1080/16549716.2022.2034135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 01/21/2022] [Indexed: 11/04/2022] Open
Abstract
While facility births are increasing in many low-resource settings, quality of care often does not follow suit; maternal and perinatal mortality and morbidity remain unacceptably high. Therefore, realistic, context-tailored clinical support is crucially needed to assist birth attendants in resource-constrained realities to provide best possible evidence-based and respectful care. Our pilot study in Zanzibar suggested that co-created clinical practice guidelines (CPGs) and low-dose, high-frequency training (PartoMa intervention) were associated with improved childbirth care and survival. We now aim to modify, implement, and evaluate this multi-faceted intervention in five high-volume, urban maternity units in Dar es Salaam, Tanzania (approximately 60,000 births annually). This PartoMa Scale-up Study will include four main steps: I. Mixed-methods situational analysis exploring factors affecting care; II. Co-created contextual modifications to the pilot CPGs and training, based on step I; III. Implementation and evaluation of the modified intervention; IV. Development of a framework for co-creation of context-specific CPGs and training, of relevance in comparable fields. The implementation and evaluation design is a theory-based, stepped-wedged cluster-randomised trial with embedded qualitative and economic assessments. Women in active labour and their offspring will be followed until discharge to assess provided and experienced care, intra-hospital perinatal deaths, Apgar scores, and caesarean sections that could potentially be avoided. Birth attendants' perceptions, intervention use and possible associated learning will be analysed. Moreover, as further detailed in the accompanying article, a qualitative in-depth investigation will explore behavioural, biomedical, and structural elements that might interact with non-linear and multiplying effects to shape health providers' clinical practices. Finally, the incremental cost-effectiveness of co-creating and implementing the PartoMa intervention is calculated. Such real-world scale-up of context-tailored CPGs and training within an existing health system may enable a comprehensive understanding of how impact is achieved or not, and how it may be translated between contexts and sustained.Trial registration number: NCT04685668.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Natasha Housseine
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Obel
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira DMello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
- Comprehensive Community Based Rehabilitation in Tanzania, Dar Es Salaam, Tanzania
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Haika Osaki
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Thomas Wiswa John
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Rashid Saleh Khamis
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Konradsen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sangeeta Mookherji
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Columba Mbekenga
- School of Nursing and Midwifery East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | | | - Jos van Roosmalen
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, Netherlands
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Andreas Kryger Jensen
- Section for Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Morten Skovdal
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Hussein L. Kidanto
- Medical College East Africa, Aga Khan University, Dar Es Salaam, Tanzania
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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9
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Hegelund MH, Fjordside L, Faurholt-Jepsen D, Christensen DL, Bygbjerg IC. Opportunistic non-communicable diseases in times of COVID-19. APMIS 2022; 131:13-18. [PMID: 36177674 DOI: 10.1111/apm.13274] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/28/2022] [Indexed: 11/27/2022]
Abstract
We previously proposed the term "opportunistic non-communicable diseases (NCDs)" to raise awareness of how NCDs thrive in societies with inadequate healthcare services. However, we did not anticipate that within the next year the new corona virus disease (COVID-19) would sweep the globe. Lockdowns became the primary strategy for mitigation in most countries. However, the extensive restrictions and allocation of resources towards the containment of the pandemic has likely served as a catalyst of NCDs, especially in populations, societies, and individuals already at high risk. We are presenting evidence to qualify two primary factors responsible for the potential impact on the development of NCDs during the COVID-19 pandemic. The first is disrupted healthcare services including avoidance and postponement of health care visits. The second is effects of changing lifestyle and living conditions including isolation, loss of job and income. The accumulated effect of these factors will likely further accelerate the development of NCDs and impair their management, especially in low- and middle-income countries. Insufficient vaccination coverage due to inequality in vaccine distribution and vaccine hesitancy left room for the incubation of immune-evasive variants that threatened to sustain or reinitiate the pandemic. We believe the concept of opportunistic NCDs and the potential catalytic effect that pandemics may have on the development of NCDs and their management, should be used as further arguments to secure equal vaccine distribution, promote global vaccine acceptance and to speed up and increase investments in primary health care in low and middle-income countries to cope with the already existing NCD crisis and to prepare for future epidemics.
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Affiliation(s)
- Maria Hein Hegelund
- Department of Pulmonary and Infectious Diseases, Copenhagen University Hospital of North Zealand, Denmark
| | - Lasse Fjordside
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Daniel Faurholt-Jepsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
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10
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Hatem G, Hjort L, Asplund O, Minja DTR, Msemo OA, Møller SL, Lavstsen T, Groth-Grunnet L, Lusingu JPA, Hansson O, Christensen DL, Vaag AA, Artner I, Theander T, Groop L, Schmiegelow C, Bygbjerg IC, Prasad RB. Mapping the Cord Blood Transcriptome of Pregnancies Affected by Early Maternal Anemia to Identify Signatures of Fetal Programming. J Clin Endocrinol Metab 2022; 107:1303-1316. [PMID: 35021220 PMCID: PMC9016468 DOI: 10.1210/clinem/dgac010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Anemia during early pregnancy (EP) is common in developing countries and is associated with adverse health consequences for both mothers and children. Offspring of women with EP anemia often have low birth weight, which increases risk for cardiometabolic diseases, including type 2 diabetes (T2D), later in life. OBJECTIVE We aimed to elucidate mechanisms underlying developmental programming of adult cardiometabolic disease, including epigenetic and transcriptional alterations potentially detectable in umbilical cord blood (UCB) at time of birth. METHODS We leveraged global transcriptome- and accompanying epigenome-wide changes in 48 UCB from newborns of EP anemic Tanzanian mothers and 50 controls to identify differentially expressed genes (DEGs) in UCB exposed to maternal EP anemia. DEGs were assessed for association with neonatal anthropometry and cord insulin levels. These genes were further studied in expression data from human fetal pancreas and adult islets to understand their role in beta-cell development and/or function. RESULTS The expression of 137 genes was altered in UCB of newborns exposed to maternal EP anemia. These putative signatures of fetal programming, which included the birth weight locus LCORL, were potentially mediated by epigenetic changes in 27 genes and associated with neonatal anthropometry. Among the DEGs were P2RX7, PIK3C2B, and NUMBL, which potentially influence beta-cell development. Insulin levels were lower in EP anemia-exposed UCB, supporting the notion of developmental programming of pancreatic beta-cell dysfunction and subsequently increased risk of T2D in offspring of mothers with EP anemia. CONCLUSIONS Our data provide proof-of-concept on distinct transcriptional and epigenetic changes detectable in UCB from newborns exposed to maternal EP anemia.
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Affiliation(s)
- Gad Hatem
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Line Hjort
- Department of Obstetrics, Center for Pregnant Women with Diabetes, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Endocrinology (Diabetes and Bone-Metabolic Research Unit), 2100 Copenhagen, Denmark
| | - Olof Asplund
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Daniel T R Minja
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
| | - Omari Abdul Msemo
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Thomas Lavstsen
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Louise Groth-Grunnet
- Department of Endocrinology (Diabetes and Bone-Metabolic Research Unit), 2100 Copenhagen, Denmark
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - John P A Lusingu
- National Institute for Medical Research, Tanga Center, 0255 Tanga, Tanzania
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ola Hansson
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Dirk Lund Christensen
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Allan A Vaag
- Steno Diabetes Center Copenhagen, 2730 Gentofte, Denmark
| | - Isabella Artner
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
| | - Thor Theander
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Leif Groop
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
- Finnish Institute of Molecular Medicine (FIMM), 00290 Helsinki, Finland
| | - Christentze Schmiegelow
- Center for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, 1353 Copenhagen, Denmark
| | - Rashmi B Prasad
- Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, 205 02, Malmö, Sweden
- Finnish Institute of Molecular Medicine (FIMM), 00290 Helsinki, Finland
- Correspondence: Rashmi B Prasad, PhD, Genomics, Diabetes and Endocrinology, Department of Clinical Sciences, Clinical Research Centre, Lund University Diabetes Centre, Jan Waldenströms gata 35, 205 02 Malmö, Sweden.
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Byashalira KC, Chamba NG, Alkabab Y, Mbelele PM, Ntinginya NE, Ramaiya KL, Alimohamed MZ, Heysell SK, Mmbaga BT, Bygbjerg IC, Christensen DL, Mpagama SG, Lillebaek T. Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania. BMC Infect Dis 2022; 22:260. [PMID: 35296241 PMCID: PMC8925287 DOI: 10.1186/s12879-022-07249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers. Methods Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol. Results Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia. Conclusion The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.
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Affiliation(s)
- Kenneth Cleophace Byashalira
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania. .,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania.
| | - Nyasatu Godfrey Chamba
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Peter Masunga Mbelele
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Nyanda Elias Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | | | - Mohamed Zahir Alimohamed
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Scott Kirkland Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Ib Christian Bygbjerg
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Lund Christensen
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah George Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Troels Lillebaek
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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12
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Nguyen TD, Bygbjerg IC, Meyrowitsch DW, Gammeltoft T, Le CD, Nguyen AT, Søndergaard J. Perceived knowledge on type-2 diabetes of informal caregivers in rural communities of Thai Binh, Vietnam: Implications for health education. Public Health in Practice 2021; 2:100210. [PMID: 36101603 PMCID: PMC9461477 DOI: 10.1016/j.puhip.2021.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives Informal caregivers' (ICGs') knowledge has substantial influence on the quality of caregiving. This study aims to identify caregivers’ perceived knowledge status and analyse associations between their characteristics and perceived knowledge on how to care for individuals with type-2 diabetes (T2D). Study design Cross-sectional study. Methods Data were collected using a face-to-face survey with ICGs and perceived knowledge was evaluated on the 5-point Likert scale (ranging from 0 to 4). Results Between April and July 2019, 1238 eligible ICGs were enrolled in the study. The mean age of participants was 48.3 years, about half (48.8%) were males and the majority (83.3%) were spouses or children of the person they cared for. ICGs mean knowledge score on overall activities was 2.48 (SD = 0.90); the highest score was seen for diet preparation (2.74 ± 0.85) and lowest for foot care (1.76 ± 1.45). Multivariate analyses showed that the following ICG characteristics were significantly more likely to result in a low level of T2D-related knowledge (mean score ≤2): age <40 years, educational level below high school, farming occupation, low economic status and caring for an individual with mild or moderate T2D. Conclusions The level of perceived knowledge on T2D among ICGs was particularly low for the care of T2D complications. Development of targeted and tailored educational interventions for ICGs is recommended.
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13
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Thi DK, Xuan BN, Le Duc C, Gammeltoft T, Søndergaard J, Meyrowitsch DW, Bygbjerg IC, Nielsen J. Unmet needs for social support and diabetes-related distress among people living with type 2 diabetes in Thai Binh, Vietnam: a cross-sectional study. BMC Public Health 2021; 21:1532. [PMID: 34380449 PMCID: PMC8356389 DOI: 10.1186/s12889-021-11562-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 07/28/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Diabetes-related distress (DRD) refers to negative emotional and affective experiences from daily demands of living with diabetes. People who received social support seem less likely to experience DRD. The prevalence of T2D in Vietnam is rapidly increasing. Yet, DRD and its association with social support have not been investigated. This study investigates DRD and how it is associated with unmet needs for social support in people with T2D in Thai Binh Province, Vietnam. METHODS A total of 806 people, age ≥ 40 years, treated for T2D at primary hospitals in Thai Binh Province, Vietnam, completed a questionnaire-based cross-sectional survey. DRD was self-reported, based on the Problem Areas In Diabetes scale 5 (PAID5). We assessed 6 types of unmet needs for social support from family/friends/community including: (i) Transport and company when visiting health facilities; (ii) Reminders to take medication; (iii) Purchase and preparation of food; (iv) Reminders to engage in physical exercise; (v) Emotional support; and (vi) Financial support. Multivariable logistic regression was used to model DRD as an outcome of each type of unmet need for social support, and as an outcome of the number of unmet needs for social support, adjusted for three sets of covariates. RESULTS In this study, 50.0% of people with T2D experienced DRD. Odds for DRD were higher among those who had any unmet need for social support. After adjustment for household economic status, only unmet needs for emotional and financial support were associated with higher odds ratios of DRD (OR = 2.59, CI95%: 1.19-5.63 and OR = 1.63, CI95%: 1.10-2.40, respectively). People who had ≥2 type of unmet need were not a higher risk of experiencing DRD as compared to those with no unmet need. CONCLUSIONS Half of the people with T2D experienced DRD. The results suggest that having enough finances may decrease most needs for social support with the exception of emotional support. Thus, social support to financial and emotional of diabetes aspects may contribute to prevent or reverse DRD.
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Affiliation(s)
- Diep Khong Thi
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh city, Thai Binh, Vietnam.
| | - Bai Nguyen Xuan
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh city, Thai Binh, Vietnam
| | - Cuong Le Duc
- Thai Binh University of Medicine and Pharmacy, 373 Ly Bon Street, Thai Binh city, Thai Binh, Vietnam
| | - Tine Gammeltoft
- Department of Anthropology, University of Copenhagen, Øster Farimagsgade 5, DK-1353, Copenhagen K, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of South Denmark, Odense, Denmark
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Jannie Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Global Health, Emory University, Atlanta, GA, USA
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14
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Maaløe N, Ørtved AMR, Sørensen JB, Sequeira Dmello B, van den Akker T, Kujabi ML, Kidanto H, Meguid T, Bygbjerg IC, van Roosmalen J, Meyrowitsch DW, Housseine N. The injustice of unfit clinical practice guidelines in low-resource realities. Lancet Glob Health 2021; 9:e875-e879. [PMID: 33765437 PMCID: PMC7984859 DOI: 10.1016/s2214-109x(21)00059-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 12/18/2022]
Abstract
To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation (eg, human resources) as well as gains and losses (eg, cost-efficiency). Such development of more realistic clinical practice guidelines at the global level will pave the way for simpler and achievable adaptation at local levels. We also urge the development and adaptation of high-quality clinical practice guidelines at national and subnational levels in low-income and middle-income countries through co-creation with end-users, and we encourage global sharing of these experiences.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Hvidovre University Hospital, Hvidovre, Denmark.
| | - Anna Marie Rønne Ørtved
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jane Brandt Sørensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Brenda Sequeira Dmello
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Comprehensive Community-Based Rehabilitation in Tanzania, Dar es salaam, Tanzania; Medical College of East Africa, Aga Khan University, Dar es Salaam, Tanzania
| | - Thomas van den Akker
- Athena Institute, Faculty of Science, VU University, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Monica Lauridsen Kujabi
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Department of Obstetrics and Gynaecology, Edna Adan Hospital, Hargeisa, Somalia
| | - Hussein Kidanto
- Medical College of East Africa, Aga Khan University, Dar es Salaam, Tanzania
| | | | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, Faculty of Science, VU University, Amsterdam, Netherlands; Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, Netherlands
| | - Dan Wolf Meyrowitsch
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Medical College of East Africa, Aga Khan University, Dar es Salaam, Tanzania
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15
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Skinhøj P, Bygbjerg IC. [Development and use of vaccines from the 18th century to the SARS-CoV 2 period]. Ugeskr Laeger 2021; 183:V11200892. [PMID: 33734072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This review is about the development and use of vaccines from the early smallpox vaccine in the 18th century to the forthcoming SARS-CoV 2 vaccines. Immunisations have been of paramount importance for childhood mortality and public health in general, but some obstacles have also been encountered such as vaccine failures and vaccine scepticism. This calls for continued emphasis on large phase three studies not only for demonstration of efficacy but also for safety and possible side effects. The rapid approval of SARS-CoV 2 vaccines requires special attention.
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16
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Bygbjerg IC. [Brug af hydroxychloroquin til COVID-19]. Ugeskr Laeger 2020; 182:V205023. [PMID: 32400382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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17
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Bygbjerg IC. [Not Available]. Ugeskr Laeger 2019; 181:V70692. [PMID: 31791455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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Abstract
Background: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland. Objective: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers. Methods: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team. Results: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a ‘tiny’ nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans. Conclusions: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.
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Affiliation(s)
- Geir Gunnlaugsson
- a Faculty of Sociology, Anthropology and Folkloristics , University of Iceland , Reykjavík , Iceland
| | - Íris Eva Hauksdóttir
- b School of Global Health, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Ib Christian Bygbjerg
- b School of Global Health, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
| | - Britt Pinkowski Tersbøl
- b School of Global Health, Department of Public Health , University of Copenhagen , Copenhagen , Denmark
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Paulsen CB, Nielsen BB, Msemo OA, Møller SL, Ekmann JR, Theander TG, Bygbjerg IC, Lusingu JPA, Minja DTR, Schmiegelow C. Anthropometric measurements can identify small for gestational age newborns: a cohort study in rural Tanzania. BMC Pediatr 2019; 19:120. [PMID: 31014291 PMCID: PMC6477730 DOI: 10.1186/s12887-019-1500-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 04/10/2019] [Indexed: 01/24/2023] Open
Abstract
Background Small-for-gestational-age (SGA) is associated with increased neonatal mortality and morbidity. In low and middle income countries an accurate gestational age is often not known, making the identification of SGA newborns difficult. Measuring foot length, chest circumference and mid upper arm circumference (MUAC) of the newborn have previously been shown to be reasonable methods for detecting low birth weight (< 2500 g) and prematurity (gestational age < 37 weeks). The aim of this study was to investigate if the three anthropometric measurements could also correctly identify SGA newborns. Methods In the current study from a rural area of northeastern Tanzania, 376 live newborns had foot length, chest circumference, and MUAC measured within 24 h of birth. Gestational age was estimated by transabdominal ultrasound in early pregnancy and SGA was diagnosed using a sex-specific weight reference chart previously developed in the study area. Receiver operating characteristic curves were generated for each of the anthropometric measurements and the area under the curve (AUC) compared. Operational cutoffs for foot length, chest circumference, and MUAC were defined while balancing as high as possible sensitivity and specificity for identifying SGA. Positive and negative predictive values (PPV and NPV) were then calculated. Results Of the 376 newborns, 68 (18.4%) were SGA. The AUC for detecting SGA was 0.78 for foot length, 0.88 for chest circumference, and 0.85 for MUAC. Operational cut-offs to detect SGA newborns were defined as ≤7.7 cm for foot length, ≤31.6 cm for chest circumference and ≤ 10.1 cm for MUAC. Foot length had 74% sensitivity, 69% specificity, PPV of 0.35 and NPV of 0.92 for identifying SGA. Chest circumference had 79% sensitivity, 81% specificity, PPV of 0.49 and NPV of 0.95 for identifying SGA. Finally, MUAC had 76% sensitivity, 77% specificity, PPV of 0.43 and NPV of 0.94 for identifying SGA. Conclusion In a setting with limited availability of an accurate gestational age, all three methods had a high NPV and could be used to rule out the newborn as being SGA. Overall, chest circumference was the best method to identify SGA newborns, whereas foot length and MUAC had lower detection ability. Trial registration Clinicaltrials.gov (NCT02191683). Registered 2 July 2014. Electronic supplementary material The online version of this article (10.1186/s12887-019-1500-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cecilie Bøge Paulsen
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, Building 07-11-56, 2200, Copenhagen, Denmark.
| | | | - Omari Abdul Msemo
- National Institute for Medical Research, Tanga Centre, Tanga, Tanzania
| | - Sofie Lykke Møller
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Josephine Roth Ekmann
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, Building 07-11-56, 2200, Copenhagen, Denmark
| | - Thor Grundtvig Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, Building 07-11-56, 2200, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Blegdamsvej 3B, Building 07-11-56, 2200, Copenhagen, Denmark
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Maaløe N, Meguid T, Housseine N, Tersbøl BP, Nielsen KK, Bygbjerg IC, van Roosmalen J. Local adaption of intrapartum clinical guidelines, United Republic of Tanzania. Bull World Health Organ 2019; 97:365-370. [PMID: 31551633 PMCID: PMC6747036 DOI: 10.2471/blt.18.220830] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/06/2018] [Accepted: 03/01/2019] [Indexed: 11/27/2022] Open
Abstract
Problem Gaps exist between internationally derived clinical guidelines on care at the time of birth and realistic best practices in busy, low-resourced maternity units. Approach In 2014-2018, we carried out the PartoMa study at Zanzibar's tertiary hospital, United Republic of Tanzania. Working with local birth attendants and external experts, we created easy-to-use and locally achievable clinical guidelines and associated in-house training to assist birth attendants in intrapartum care. Local setting Around 11 500 women gave birth annually in the hospital. Of the 35-40 birth attendants employed, each cared simultaneously for 3-6 women in labour. At baseline (1 October 2014 to 31 January 2015), there were 59 stillbirths per 1000 total births and 52 newborns with an Apgar score of 1-5 per 1000 live births. Externally derived clinical guidelines were available, but rarely used. Relevant changes Staff attendance at the repeated trainings was good, despite seminars being outside working hours and without additional remuneration. Many birth attendants appreciated the intervention and were motivated to improve care. Improvements were found in knowledge, partograph skills and quality of care. After 12 intervention months, stillbirths had decreased 34% to 39 per 1000 total births, while newborns with an Apgar score of 1-5 halved to 28 per 1000 live births. Lessons learnt After 4 years, birth attendants still express high demand for the intervention. The development of international, regional and national clinical guidelines targeted at low-resource maternity units needs to be better attuned to input from end-users and the local conditions, and thereby easier to use effectively.
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark
| | - Tarek Meguid
- Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania
| | | | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark
| | | | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen, Denmark
| | - Jos van Roosmalen
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Schmiegelow C, Msemo OA, Møller SL, Nielsen BB, Paulsen CB, Ødum L, Theander TG, Kavishe RA, Lusingu JPA, Minja DT, Bygbjerg IC. Preconceptional factors associated with haemoglobin concentration in early pregnancy: a community-based cohort study in rural northeastern Tanzania. Trop Med Int Health 2019; 24:596-607. [PMID: 30767358 DOI: 10.1111/tmi.13219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Maternal anaemia in early pregnancy is associated with poor pregnancy outcomes. Furthermore, preconceptional health can influence the health during pregnancy. The aim of this study was to investigate which preconceptional factors were associated with haemoglobin (Hb) concentration in early pregnancy. METHODS In Tanzania, 226 women were followed at preconception and during early pregnancy. Red blood cell (RBC) morphology, serum micronutrient concentration, demographic characteristics and health status were assessed in preconception and in early pregnancy. The association between preconceptional factors and Hb concentration in early pregnancy was investigated using simple and multiple linear regression analyses stratified by preconceptional anaemia status. RESULTS Mean Hb was 123 and 119 g/l before conception and during early pregnancy (median gestational age 53 days) respectively. Preconceptional mid-upper arm circumference (MUAC) (adjusted coefficient (AC) 0.35 95% CI 0.9-0.61) and preconceptional Hb concentration (AC 0.45 95% CI 0.36-0.54) were positively associated with early pregnancy Hb concentration, whereas preconceptional microcytic hypochromic RBC morphology (AC -6.00 95% CI -9.56 to -2.44) was negatively associated with early pregnancy Hb concentration. In addition, treatment of preconceptional malaria was positively associated with early pregnancy Hb concentration (AC 6.45 95% CI 0.74-12.2) among women with preconceptional anaemia. In contrast, among preconceptional non-anaemic women, only preconceptional Hb concentration and medium socio-economic status was positively associated with early pregnancy Hb concentration. CONCLUSIONS Mid-upper arm circumference (MUAC) and Hb measurements in preconception can help to detect women at increased risk of low Hb concentration in early pregnancy.
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Affiliation(s)
- Christentze Schmiegelow
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Omari Abdul Msemo
- National Institute for Medical Research Tanga Centre, Korogwe, Tanzania
| | - Sofie Lykke Møller
- Department of Public Health, Division of Global Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Cecilie Bøge Paulsen
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Ødum
- Department for Clinical Biochemistry, Roskilde Hospital, Roskilde, Denmark
| | - Thor Grundtvig Theander
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark
| | - Reginald Adolph Kavishe
- Kilimanjaro Christian Medical University College and Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - John Peter Andrea Lusingu
- Department of Immunology and Microbiology, Centre for Medical Parasitology, University of Copenhagen, Copenhagen, Denmark.,National Institute for Medical Research Tanga Centre, Korogwe, Tanzania
| | | | - Ib Christian Bygbjerg
- Department of Public Health, Division of Global Health, University of Copenhagen, Copenhagen, Denmark
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Bygbjerg IC, Skinhøj P. [Not Available]. Ugeskr Laeger 2018; 180:V70161. [PMID: 30375959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen AKG, Khamis RS, Mohamed AG, Ali MM, Said SM, van Roosmalen J, Bygbjerg IC. Authors' reply re: Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: A quasi-experimental pre-post-study (The PartoMa study). BJOG 2017; 125:394-395. [PMID: 29266853 DOI: 10.1111/1471-0528.14962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Natasha Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tarek Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,School of Health & Medical Sciences, State University of Zanzibar, Zanzibar, Tanzania
| | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Aksel Karl Georg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, Amsterdam, the Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Maaløe N, Housseine N, Meguid T, Nielsen BB, Jensen A, Khamis RS, Mohamed AG, Ali MM, Said SM, van Roosmalen J, Bygbjerg IC. Effect of locally tailored labour management guidelines on intrahospital stillbirths and birth asphyxia at the referral hospital of Zanzibar: a quasi-experimental pre-post study (The PartoMa study). BJOG 2017; 125:235-245. [PMID: 28892306 DOI: 10.1111/1471-0528.14933] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate effect of locally tailored labour management guidelines (PartoMa guidelines) on intrahospital stillbirths and birth asphyxia. DESIGN Quasi-experimental pre-post study investigating the causal pathway through changes in clinical practice. SETTING Tanzanian low-resource referral hospital, Mnazi Mmoja Hospital. POPULATION Facility deliveries during baseline (1 October 2014 until 31 January 2015) and the 9th to 12th intervention
month (1 October 2015 until 31 January 2016) [corrected]. METHODS Birth outcome was extracted from all cases of labouring women during baseline (n = 3690) and intervention months (n = 3087). Background characteristics and quality of care were assessed in quasi-randomly selected subgroups (n = 283 and n = 264, respectively). MAIN OUTCOME MEASURES Stillbirths and neonates with 5-minute Apgar score ≤5. RESULTS Stillbirth rate fell from 59 to 39 per 1000 total births (RR 0.66, 95% CI 0.53-0.82), and subanalyses suggest that this was primarily due to reduction in intrahospital stillbirths. Apgar scores between 1 and 5 fell from 52 to 28 per 1000 live births (RR 0.53, 95% CI 0.41-0.69). Median time from last fetal heart assessment till delivery (or fetal death diagnosis) fell from 120 minutes (IQR 60-240) to 74 minutes (IQR 30-130) (Mann-Whitney test for difference, P < 0.01). Oxytocin augmentation declined from 22% to 12% (RR 0.54, 95% CI 0.37-0.81) and timely use improved. CONCLUSION Although low human resources and substandard care remain major challenges, PartoMa guidelines were associated with improvements in care, leading to reductions in stillbirths and birth asphyxia. Findings furthermore emphasise the central role of improved fetal surveillance and restricted intrapartum oxytocin use in safety at birth. TWEETABLE ABSTRACT: #PartoMa guidelines aided in reducing stillbirths and birth asphyxia at a Tanzanian low-resource hospital PLAIN LANGUAGE SUMMARY: PartoMa guidelines help birth attendants in Tanzania to save lives Every year, 3 million babies die on the day of birth. The vast majority of these deaths occur in the poorest countries. If their mothers had received better care during birth, most babies would have survived. At Mnazi Mmoja Hospital, an East African referral hospital, the PartoMa study shows that use of locally developed guidelines helps birth attendants to deliver better quality of care, which has led to improved survival at birth. At the hospital studied, resources are scarce. Each birth attendant assists four to six birthing women simultaneously, and many have less than 1 year of professional experience. International guidelines are available, but they are often unachievable and seldom applied. The PartoMa guidelines were developed in close collaboration with the birth attendants and approved by seven international experts. The result is an 8-page pocket booklet providing locally achievable and simple decision support for care during birth. Use of the PartoMa guidelines began in February 2015. As the staff group frequently changes, quarterly seminars are conducted where birth attendants are welcomed after working hours to learn about the guidelines. The guidelines have been positively received, and seminar attendance remains high. Use of the PartoMa guidelines is associated with: A decrease by one-third in stillbirths (59 to 39 per 1000 total births) A nearly halving in the number of babies born in immediate poor medical condition (52 to 28 per 1000 live births) The results presented here derive from a comparison of births before using the PartoMa guidelines and during the 9th-12th month of use. Such a 'before-after' study cannot exclude the possibility of other causes of better survival at birth. However, the improved survival is consistent with improved care during birth, which is in line with the PartoMa guidelines.
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Affiliation(s)
- N Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - N Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - T Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania.,School of Health & Medical Sciences, State University of Zanzibar, Zanzibar, Tanzania
| | - B B Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Akg Jensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - R S Khamis
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | | | - M M Ali
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - S M Said
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - J van Roosmalen
- Athena Institute, VU University of Amsterdam, Amsterdam, the Netherlands
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Handlos LN, Petersen JH, Bygbjerg IC, Norredam M. Role of disease and demographic factors as determinants of return migration: A nationwide register-based cohort study. Scand J Public Health 2017; 46:221-228. [PMID: 28992795 DOI: 10.1177/1403494817731008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIMS A number of aspects of the health status of migrants who return to their country of origin have been explored in the literature; however, a more general description of the incidence of disease and demographic characteristics is lacking. The aim of this research was to contribute such a description. METHODS A nationwide cohort study was conducted of 114,331 migrants who obtained residence in Denmark between 1 January 1993 and 31 December 2010. Demographic characteristics and ten disease groups were included as explanatory variables and hazards ratios for the association between return migration and disease incidence, as well as demographic characteristics, were estimated using Cox regressions. RESULTS The tendency to return-migrate when ill was not the same among younger and elderly migrants; migrants <55 years of age had a significantly smaller propensity to return-migrate if they had suffered from a disease during the 18 years of follow-up compared with those who had not had a disease, whereas migrants ≥55 years of age were more prone to return if ill. The likelihood of returning decreased with increasing comorbidity in both age groups. Among those who were <55 years of age, the tendency to return increased with age at obtainment of residence; among those who were ≥55 years, more men than women return-migrated. CONCLUSIONS In Denmark, younger migrants are less inclined to return-migrate if they are ill compared with healthy migrants, whereas elderly migrants are more inclined to return if ill. The returnees also differ demographically from non-returnees in various ways.
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Affiliation(s)
- Line Neerup Handlos
- 1 Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jorgen Holm Petersen
- 2 Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- 3 Section of Global Health, Department of Public Health, University of Copenhagen, Denmark
| | - Marie Norredam
- 4 Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark.,5 Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Denmark
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Maaløe N, Housseine N, van Roosmalen J, Bygbjerg IC, Tersbøl BP, Khamis RS, Nielsen BB, Meguid T. Labour management guidelines for a Tanzanian referral hospital: The participatory development process and birth attendants' perceptions. BMC Pregnancy Childbirth 2017; 17:175. [PMID: 28592237 PMCID: PMC5463375 DOI: 10.1186/s12884-017-1360-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While international guidelines for intrapartum care appear to have increased rapidly since 2000, literature suggests that it has only in few instances been matched with reviews of local modifications, use, and impact at the targeted low resource facilities. At a Tanzanian referral hospital, this paper describes the development process of locally achievable, partograph-associated, and peer-reviewed labour management guidelines, and it presents an assessment of professional birth attendants' perceptions. METHODS Part 1: Modification of evidence-based international guidelines through repeated evaluation cycles by local staff and seven external specialists in midwifery/obstetrics. Part 2: Questionnaire evaluation 12 months post-implementation of perceptions and use among professional birth attendants. RESULTS Part 1: After the development process, including three rounds of evaluation by staff and two external peer-review cycles, there were no major concerns with the guidelines internally nor externally. Thereby, international recommendations were condensed to the eight-paged 'PartoMa guidelines ©'. This pocket booklet includes routine assessments, supportive care, and management of common abnormalities in foetal heart rate, labour progress, and maternal condition. It uses colour codes indicating urgency. Compared to international guidelines, reductions were made in frequency of assessments, information load, and ambiguity. Part 2: Response rate of 84% (n = 84). The majority of staff (93%) agreed that the guidelines helped to improve care. They found the guidelines achievable (89%), and the graphics worked well (90%). Doctors more often than nurse-midwives (89% versus 74%) responded to use the guidelines daily. CONCLUSIONS The PartoMa guidelines ensure readily available, locally achievable, and acceptable support for intrapartum surveillance, triage, and management. This is a crucial example of adapting evidence-based international recommendations to local reality. TRIAL REGISTRATION This paper describes the intervention of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Britt Pinkowski Tersbøl
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Rashid Saleh Khamis
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 København Ø, Denmark
| | - Tarek Meguid
- Department of Obstetrics and Gynaecology, Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
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Aftab H, Ambreen A, Jamil M, Garred P, Petersen JH, Nielsen SD, Bygbjerg IC, Christensen DL. Comparative study of HbA 1c and fasting plasma glucose vs the oral glucose tolerance test for diagnosis of diabetes in people with tuberculosis. Diabet Med 2017; 34:800-803. [PMID: 28326618 DOI: 10.1111/dme.13354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2017] [Indexed: 12/16/2022]
Abstract
AIM To compare HbA1c and fasting plasma glucose assessment, with the 2-h oral glucose tolerance test as reference, in screening for diabetes in people with turberculosis. METHODS Individuals (N=268) with newly diagnosed smear-positive tuberculosis were screened for diabetes at a tertiary hospital in Lahore, Pakistan. Diabetes diagnosis was based on WHO criteria: thresholds were ≥48 mmol/mol (≥6.5%) for HbA1c and ≥7.0mmol/l for fasting plasma glucose. RESULTS The proportion of participants diagnosed with diabetes was 4.9% (n =13) by oral glucose tolerance test, while 11.9% (n =32) and 14.6% (n =39) were diagnosed with diabetes using HbA1c and fasting plasma glucose criteria, respectively. The area under the receiver-operating characteristic curve was 0.79 (95% CI 0.64 to 0.94) for HbA1c and 0.61 (95% CI 0.50 to 0.73) for fasting plasma glucose, with a borderline significant difference between the two tests (P=0.07). CONCLUSIONS HbA1c and fasting plasma glucose performed equally in terms of diagnosing new diabetes cases in individuals with tuberculosis, but the proportion of participants falsely classified as positive was higher for fasting plasma glucose. This may be explained by acute blood glucose fluctuations when using fasting plasma glucose. HbA1c may be a more reliable test in individuals with transient hyperglycaemia.
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Affiliation(s)
- H Aftab
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Ambreen
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - M Jamil
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - P Garred
- Laboratory of Molecular Medicine, Department of Clinical Immunology, University of Copenhagen, Copenhagen, Denmark
| | - J H Petersen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - S D Nielsen
- Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
| | - I C Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D L Christensen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Bygbjerg IC. [The Danish Society for Tropical Medicine and International Health: 50 years against tropical diseases and for international health]. Ugeskr Laeger 2017; 179:V69236. [PMID: 28504625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Andersen GS, Kamper-Jørgensen Z, Carstensen B, Norredam M, Bygbjerg IC, Jørgensen ME. Diabetes among migrants in Denmark: Incidence, mortality, and prevalence based on a longitudinal register study of the entire Danish population. Diabetes Res Clin Pract 2016; 122:9-16. [PMID: 27750090 DOI: 10.1016/j.diabres.2016.09.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/23/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies of diabetes in migrant populations have shown a higher prevalence compared to their respective countries of origin and to people natively born in the host country, but there is little population-based data on diabetes incidence and mortality in migrant populations. The aim of the current study was (1) to describe the incidence rates and prevalence of diabetes among first generation migrants in Denmark compared to the Danish background population, and (2) to compare standardised mortality rates (SMRs) for individuals with and without diabetes according to country of origin. RESEARCH DESIGN AND METHODS Information was obtained from linkage of the National Diabetes Register with mortality statistics and information from the Central Personal Register on country of origin. Age- and sex-specific estimates of prevalence, incidence rates, mortality rates and SMRs relative to the part of the population without diabetes were calculated based on follow up of the entire Danish population. RESULTS Compared with native born Danes, the incidence of diabetes was about 2.5 times higher among migrants from Africa, Asia, and the Middle East, and these migrant groups also showed significantly higher prevalence. The standardised mortality rates (SMR) were higher particularly above 50years of age among most migrant groups compared with native born Danes, and with a higher annual increase. CONCLUSIONS The highest diabetes incidence rates and prevalence estimates were observed among migrants from Africa, Asia, and the Middle East, and the annual increase in SMRs was higher in these groups compared to native born Danes.
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Affiliation(s)
| | - Zaza Kamper-Jørgensen
- Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark; Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark; Section of Global Health, Department of Public Health, Faculty of Medicine and Health Sciences, University of Copenhagen, Denmark
| | - Bendix Carstensen
- Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity and Health, Section for Health Services Research, Department of Public Health, University of Copenhagen, Denmark; Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Section of Global Health, Department of Public Health, Faculty of Medicine and Health Sciences, University of Copenhagen, Denmark
| | - Marit Eika Jørgensen
- Steno Diabetes Center A/S, Department of Clinical Epidemiology, Gentofte, Denmark; Center for Health Research in Greenland, University of Southern Denmark, Denmark
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Maaløe N, Housseine N, Bygbjerg IC, Meguid T, Khamis RS, Mohamed AG, Nielsen BB, van Roosmalen J. Stillbirths and quality of care during labour at the low resource referral hospital of Zanzibar: a case-control study. BMC Pregnancy Childbirth 2016; 16:351. [PMID: 27832753 PMCID: PMC5103376 DOI: 10.1186/s12884-016-1142-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To study determinants of stillbirths as indicators of quality of care during labour in an East African low resource referral hospital. METHODS A criterion-based unmatched unblinded case-control study of singleton stillbirths with birthweight ≥2000 g (n = 139), compared to controls with birthweight ≥2000 g and Apgar score ≥7 (n = 249). RESULTS The overall facility-based stillbirth rate was 59 per 1000 total births, of which 25 % was not reported in the hospital's registers. The majority of singletons had birthweight ≥2000 g (n = 139; 79 %), and foetal heart rate was present on admission in 72 (52 %) of these (intra-hospital stillbirths). Overall, poor quality of care during labour was the prevailing determinant of 71 (99 %) intra-hospital stillbirths, and median time from last foetal heart assessment till diagnosis of foetal death or delivery was 210 min. (interquartile range: 75-315 min.). Of intra-hospital stillbirths, 26 (36 %) received oxytocin augmentation (23 % among controls; odds ratio (OR) 1.86, 95 % confidential interval (CI) 1.06-3.27); 15 (58 %) on doubtful indication where either labour progress was normal or less dangerous interventions could have been effective, e.g. rupture of membranes. Substandard management of prolonged labour frequently led to unnecessary caesarean sections. The caesarean section rate among all stillbirths was 26 % (11 % among controls; OR 2.94, 95 % CI 1.68-5.14), and vacuum extraction was hardly ever done. Of women experiencing stillbirth, 27 (19 %) had severe hypertensive disorders (4 % among controls; OR 5.76, 95 % CI 2.70-12.31), but 18 (67 %) of these did not receive antihypertensives. An additional 33 (24 %) did not have blood pressure recorded during active labour. When compared to controls, stillbirths were characterized by longer admissions during labour. However, substandard care was prevalent in both cases and controls and caused potential risks for the entire population. Notably, women with foetal death on admission were in the biggest danger of neglect. CONCLUSIONS Intrapartum management of women experiencing stillbirth was a simple yet strong indicator of quality of care. Substandard care led to perinatal as well as maternal risks, which furthermore were related to unnecessary complex, time consuming, and costly interventions. Improvement of obstetric care is warranted to end preventable birth-related deaths and disabilities. TRIAL REGISTRATION This is the baseline analysis of the PartoMa trial, which is registered on ClinicalTrials.org ( NCT02318420 , 4th November 2014).
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Affiliation(s)
- Nanna Maaløe
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Natasha Housseine
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Building 9, 1353 Copenhagen K, Denmark
| | - Tarek Meguid
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
- School of Health & Medical Sciences, State University of Zanzibar, P.O.Box:146, Zanzibar, Tanzania
| | | | | | - Birgitte Bruun Nielsen
- Department of Obstetrics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jos van Roosmalen
- Athena Institute, VU University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
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31
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Sarkodie F, Hassall O, Owusu-Dabo E, Owusu-Ofori S, Bates I, Bygbjerg IC, Owusu-Ofori A, Harritshøj LH, Ullum H. Improving the screening of blood donors with syphilis rapid diagnostic test (RDT) and rapid plasma reagin (RPR) in low- and middle-income countries (LMIC). Transfus Med 2016; 27:52-59. [PMID: 27723157 DOI: 10.1111/tme.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Syphilis testing conventionally relies on a combination of non-treponemal and treponemal tests. The primary objective of this study was to describe the positive predictive value (PPV) of a screening algorithm in a combination of a treponemal rapid diagnostic test (RDT) and rapid plasma reagin (RPR) test at Komfo Anokye Teaching Hospital (KATH), Ghana. MATERIALS AND METHODS From February 2014 to January 2015, 5 mL of venous blood samples were taken from 16 016 blood donors and tested with a treponemal RDT; 5 mL of venous blood was taken from 526 consenting initial syphilis sero-reactive blood donors. These RDT reactive samples were confirmed with an algorithm, applying the Vitros® /Abbott-Architect® algorithm as gold standard. RESULTS A total of 478 of 526 RDT reactive donors were confirmed positive for syphilis, making a PPV of 90·9%. Of the 172 (32·7%) donors who were also RPR positive, 167 were confirmed, resulting in a PPV of 97·1%. The PPV of the combined RDT and RPR (suspected active syphilis) testing algorithm was highest among donors at an enhanced risk of syphilis, family/replacement donors (99·9%), and among voluntary donors above 25 years (98·6%). DISCUSSION Screening of blood donors by combining syphilis RDT and RPR with relatively good PPV may provide a reasonable technology for LMIC that has a limited capacity for testing and can contribute to the improvement of blood safety with a minimal loss of donors.
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Affiliation(s)
- F Sarkodie
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - O Hassall
- Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - E Owusu-Dabo
- School of Public Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - S Owusu-Ofori
- Transfusion Medicine Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - I Bates
- Faculty of Health and Life Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - I C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Owusu-Ofori
- Department of Clinical Microbiology Kumasi, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - L H Harritshøj
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - H Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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32
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Kamper-Jørgensen Z, Carstensen B, Norredam M, Bygbjerg IC, Andersen PH, Jørgensen ME. Diabetes-related tuberculosis in Denmark: effect of ethnicity, diabetes duration and year of diagnosis. Int J Tuberc Lung Dis 2016; 19:1169-75. [PMID: 26459528 DOI: 10.5588/ijtld.14.0932] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The association between diabetes mellitus (DM) and tuberculosis (TB) has been established on the basis of cross-sectional studies; however, only a few longitudinal studies have been conducted, with inconsistent results. OBJECTIVE To study the effect of ethnicity and the presence and duration of DM on the risk of incident TB based on 15 years of follow-up of the entire Danish population. DESIGN AND METHODS Using Poisson regression analysis, we estimated TB incidence in individuals with DM vs. those without DM by linking nationwide DM and TB registers to the National Civil Register at case level. RESULTS The TB rate ratio was 1.9 in individuals with DM compared to non-DM individuals, regardless of country of birth, with the exception of African-born individuals (rate ratio 0.5). The risk decreased drastically within the first 2 years after the diagnosis of DM; no association was found with longer durations of DM. The risk also decreased the later the year of DM diagnosis. CONCLUSIONS The study confirmed DM as a risk factor for TB, except in the case of African-born individuals. Other non-DM risk factors for TB could act as effect-modifiers on the DM-TB association. Implementing earlier DM diagnosis and improving metabolic control may reduce the risk of DM-related TB.
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Affiliation(s)
- Z Kamper-Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark; Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - B Carstensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
| | - M Norredam
- Section for Health Services Research, Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark; Department of Infectious Diseases and Department of Immigrant Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - I C Bygbjerg
- Immunology and Microbiology Faculty of Medicine and Health Sciences, Department of International Health, University of Copenhagen, Copenhagen, Denmark
| | - P H Andersen
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - M E Jørgensen
- Clinical Epidemiology, Steno Diabetes Center, Gentofte, Denmark
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Affiliation(s)
- Karoline Kragelund Nielsen
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark.
| | - Ib Christian Bygbjerg
- Global Health Section, Department of Public Health, University of Copenhagen, DK-1014 Copenhagen, Denmark
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34
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Livingstone RS, Grunnet LG, Thomas N, Eapen A, Antonisamy B, Mohan VR, Spurgeon R, Frank ID, Bygbjerg IC, Vaag A. Are hepatic and soleus lipid content, assessed by magnetic resonance spectroscopy, associated with low birth weight or insulin resistance in a rural Indian population of healthy young men? Diabet Med 2016; 33:365-70. [PMID: 26172248 DOI: 10.1111/dme.12852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2015] [Indexed: 12/22/2022]
Abstract
AIMS To assess young healthy men from rural India, who had normal or low birth weights, using magnetic resonance spectroscopy to determine the potential differences in ectopic fat storage between birth weight groups, and to determine if ectopic fat storage was associated with insulin resistance in this population. METHODS A total of 54 lean men with normal birth weight and 49 lean men with low birth weight (age range 18-22 years) from rural India were recruited. All the men underwent anthropometry, magnetic resonance spectroscopy, a hyperinsulinaemic-euglycaemic clamp and a dual-energy X-ray absorptiometry. RESULTS The median (interquartile range) values for hepatic cellular lipids, intramyocellular lipids and extramyocellular lipids, measured using magnetic resonance spectroscopy were 0.76 (0.1-1.8)%, 1.27 (1.0-2.3)% and 1.89 (1.3-3.2)%, respectively, for the normal birth weight group and 0.4 (0.1-1.3)%, 1.38 (0.9-2.2)% and 2.07 (1.2-2.8)%, respectively, for the low birth weight group (P > 0.05). No difference in ectopic fat storage was observed between the low and normal birth weight groups, with or without adjustment for age and total fat percentage. Homeostatic model assessment of insulin resistance values were not associated with hepatic cellular, intramyocellular or extramyocellular lipid content in any of the groups. Total fat percentage was the only independent predictor of intramyocellular and extramyocellular lipid content. CONCLUSION Young and lean men from rural India with low birth weight were not observed to have ectopic fat storage in the liver or muscle, and the amount of liver and muscle fat was unrelated to insulin resistance. Older age and/or an urban affluent lifestyle may be required to show a potential role of ectopic fat storage on insulin resistance in Indian people with low or normal birth weight.
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Affiliation(s)
- R S Livingstone
- Department of Radiology, Christian Medical College and Hospital, Vellore, India
| | - L G Grunnet
- Diabetes and Metabolism, Copenhagen University Hospital (Rigshospitalet), Denmark
| | - N Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - A Eapen
- Department of Radiology, Christian Medical College and Hospital, Vellore, India
| | - B Antonisamy
- Department of Biostatistics, Christian Medical College and Hospital, Vellore, India
| | - V R Mohan
- Department of Community Health, Christian Medical College and Hospital, Vellore, India
| | - R Spurgeon
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - I D Frank
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College and Hospital, Vellore, India
| | - I C Bygbjerg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Vaag
- Diabetes and Metabolism, Copenhagen University Hospital (Rigshospitalet), Denmark
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35
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Drabe CH, Vestergaard LS, Helleberg M, Nyagonde N, Rose MV, Francis F, Theilgaard OP, Asbjørn J, Amos B, Bygbjerg IC, Ruhwald M, Ravn P. Performance of Interferon-Gamma and IP-10 Release Assays for Diagnosing Latent Tuberculosis Infections in Patients with Concurrent Malaria in Tanzania. Am J Trop Med Hyg 2016; 94:728-35. [PMID: 26834199 DOI: 10.4269/ajtmh.15-0633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 12/14/2015] [Indexed: 01/14/2023] Open
Abstract
Interferon-gamma (IFN-γ) release assays (IGRAs) are used to detect cellular immune recognition of Mycobacterium tuberculosis The chemokine IFN-γ-inducible protein 10 (IP-10) is an alternative diagnostic biomarker to IFN-γ. Several conditions interfere with IGRA test performance. We aimed to assess the possible influence of Plasmodium falciparum infection on the IGRA test QuantiFERON-TB GOLD® In-Tube (QFT) test and an in-house IP-10 release assay. In total, 241 Tanzanian adults were included; 184 patients with uncomplicated malaria (88 human immunodeficiency virus [HIV] coinfected) and 57 HIV-infected patients without malaria infection. Malaria was treated with artemether-lumefantrine (Coartem®). QFT testing was performed before initiation of malaria treatment and at days 7 and 42. In total, 172 patients completed follow-up. IFN-γ and IP-10 was measured in QFT supernatants. We found that during malaria infection IFN-γ and IP-10 levels in the unstimulated samples were elevated, mitogen responsiveness was impaired, and CD4 cell counts were decreased. These alterations reverted after malaria treatment. Concurrent malaria infection did not affect QFT test results, whereas there were more indeterminate IP-10 results during acute malaria infection. We suggest that IGRA and IP-10 release assay results of malaria patients should be interpreted with caution and that testing preferably should be postponed until after malaria treatment.
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Affiliation(s)
- Camilla H Drabe
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Lasse S Vestergaard
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Marie Helleberg
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Nyagonde Nyagonde
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Michala V Rose
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Filbert Francis
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Ola P Theilgaard
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Asbjørn
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Ben Amos
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Ib Christian Bygbjerg
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Morten Ruhwald
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Pulmonary and Infectious Diseases, Nordsjaelland Hospital, Hillerød, Denmark; Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark; InterACT Project, Muheza District Hospital, Muheza, Tanzania; Centre for Medical Parasitology, Department of Immunology and Microbiology and Department of Public Health, University of Copenhagen; Department of Infectious Diseases and Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; National Institute for Medical Research, Tanga, Tanzania; Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark; Department of Infectious Disease Immunology, Statens Serum Institut, Copenhagen, Denmark
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Hansson HH, Turner L, Møller L, Wang CW, Minja DTR, Gesase S, Mmbando B, Bygbjerg IC, Theander TG, Lusingu JPA, Alifrangis M, Lavstsen T. Haplotypes of the endothelial protein C receptor (EPCR) gene are not associated with severe malaria in Tanzania. Malar J 2015; 14:474. [PMID: 26620701 PMCID: PMC4666078 DOI: 10.1186/s12936-015-1007-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/20/2015] [Indexed: 12/20/2022] Open
Abstract
Background Endothelial protein C receptor (EPCR) was recently identified as a key receptor for Plasmodium falciparum erythrocyte membrane protein 1 mediating sequestration of P. falciparum-infected erythrocytes in patients suffering from severe malaria. Soluble EPCR (sEPCR) inhibits binding of P. falciparum to EPCR in vitro and increased levels of sEPCR have been associated with the H3 haplotype of the EPCR encoding PROCR gene. It has been hypothesized that elevated sEPCR levels, possibly linked to the PROCR H3 genetic variant, may confer protection against severe forms of malaria. This study determined the frequencies of PROCR haplotypes H1–4 and plasma levels of sEPCR in a Tanzanian study population to investigate a possible association with severe malaria.
Methods Study participants were children under 5 years of age admitted at the Korogwe District Hospital (N = 143), and diagnosed as having severe malaria (N = 52; including cerebral malaria N = 17), uncomplicated malaria (N = 24), or an infection other than malaria (N = 67). In addition, blood samples from 71 children living in nearby villages were included. The SNPs defining the haplotypes of PROCR gene were determined by post-PCR ligation detection reaction-fluorescent microsphere assay. Results Individuals carrying at least one H3 allele had significantly higher levels of sEPCR than individuals with no H3 alleles (P < 0.001). No difference in the frequency of H3 was found between the non-malaria patients, malaria patients or the village population (P > 0.1). Plasma levels of sEPCR differed between these three groups, with higher sEPCR levels in the village population compared to the hospitalized patients (P < 0.001) and higher levels in malaria patients compared to non-malaria patients (P = 0.001). However, no differences were found in the distribution of H3 (P = 0.2) or levels of sEPCR (P = 0.8) between patients diagnosed with severe and uncomplicated malaria. Conclusion Frequencies of SNPs determining PROCR haplotypes were in concordance with other African studies. The PROCR H3 allele was associated with higher levels of sEPCR, confirming earlier findings, however, in this Tanzanian population; neither PROCR haplotype nor level of sEPCR was associated with severe malaria, however, larger studies are needed to confirm these findings.
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Affiliation(s)
- Helle Holm Hansson
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Louise Turner
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Line Møller
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Christian William Wang
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Daniel T R Minja
- Tanga Research Centre, National Institute for Medical Research, Bombo Area, PO Box 5004, Tanga, United Republic of Tanzania.
| | - Samwel Gesase
- Tanga Research Centre, National Institute for Medical Research, Bombo Area, PO Box 5004, Tanga, United Republic of Tanzania.
| | - Bruno Mmbando
- Tanga Research Centre, National Institute for Medical Research, Bombo Area, PO Box 5004, Tanga, United Republic of Tanzania.
| | - Ib Christian Bygbjerg
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Thor G Theander
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - John P A Lusingu
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Tanga Research Centre, National Institute for Medical Research, Bombo Area, PO Box 5004, Tanga, United Republic of Tanzania.
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Thomas Lavstsen
- Centre for Medical Parasitology, Department of Immunology and Microbiology, Faculty of Health and Medical Science, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1356, Copenhagen K, Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
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Hansson HH, Maretty L, Balle C, Goka BQ, Luzon E, Nkrumah FN, Schousboe ML, Rodrigues OP, Bygbjerg IC, Kurtzhals JAL, Alifrangis M, Hempel C. Polymorphisms in the Haem Oxygenase-1 promoter are not associated with severity of Plasmodium falciparum malaria in Ghanaian children. Malar J 2015; 14:153. [PMID: 25888733 PMCID: PMC4396170 DOI: 10.1186/s12936-015-0668-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background Haem oxygenase-1 (HO-1) catabolizes haem and has both cytotoxic and cytoprotective effects. Polymorphisms in the promoter of the Haem oxygenase-1 (HMOX1) gene encoding HO-1 have been associated with several diseases including severe malaria. The objective of this study was to determine the allele and genotype frequencies of two single nucleotide polymorphisms; A(−413)T and G(−1135)A, and a (GT)n repeat length polymorphism in the HMOX1 promoter in paediatric malaria patients and controls to determine possible associations with malaria disease severity. Methods Study participants were Ghanaian children (n=296) admitted to the emergency room at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana during the malaria season from June to August in 1995, 1996 and 1997, classified as having uncomplicated malaria (n=101) or severe malaria (n=195; defined as severe anaemia (n=63) or cerebral malaria (n=132)). Furthermore, 287 individuals without a detectable Plasmodium infection or asymptomatic carriers of the parasite were enrolled as controls. Blood samples from participants were extracted for DNA and allele and genotype frequencies were determined with allele-specific PCR, restriction fragment length analysis and microsatellite analysis. Results The number of (GT)n repeats in the study participants varied between 21 and 46 with the majority of alleles having lengths of 26 (8.1%), 29/30 (13.2/17.9%) and 39/40 (8.0/13.8%) repeats, and was categorized into short, medium and long repeats. The (−413)T allele was very common (69.8%), while the (−1135)A allele was present in only 17.4% of the Ghanaian population. The G(−1135)A locus was excluded from further analysis after failing the Hardy-Weinberg equilibrium test. No significant differences in allele or genotype distribution of the A(−413)T and (GT)n repeat polymorphisms were found between the controls and the malaria patients, or between the disease groups, for any of the analysed polymorphisms and no associations with malaria severity were found. Conclusion These results contribute to the understanding of the role of HMOX1/HO-1. This current study did not find any evidence of association between HMOX1 promoter polymorphisms and malaria susceptibility or severe malaria and hence contradicts previous findings. Further studies are needed to fully elucidate the relationship between HMOX1 polymorphisms and malarial disease.
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Affiliation(s)
- Helle H Hansson
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Lasse Maretty
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Christina Balle
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Bamenla Q Goka
- Department of Child Health, Korle Bu Teaching Hospital, PO Box KB 77, Korle Bu, Accra, Ghana.
| | - Elisa Luzon
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Francis N Nkrumah
- Noguchi Memorial Institute for Medical Research, PO Box LG 581, Legon, Ghana.
| | - Mette L Schousboe
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Onike P Rodrigues
- Department of Child Health, Korle Bu Teaching Hospital, PO Box KB 77, Korle Bu, Accra, Ghana.
| | - Ib Christian Bygbjerg
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Jørgen A L Kurtzhals
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Michael Alifrangis
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
| | - Casper Hempel
- Centre for Medical Parasitology at Department of Immunology & Microbiology, University of Copenhagen, Østerfarimagsgade 5, Building 22-23, 1014, Copenhagen K., Denmark. .,Department of Clinical Microbiology and Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark.
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Bygbjerg IC. [Not Available]. Ugeskr Laeger 2014; 176:V66693. [PMID: 25430579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Ib Christian Bygbjerg
- Afdelingen for International Sundhed, Immunologi og Mikrobiologi, Det Sundheds-videnskabelige Fakultet, Københavns Universitet, Center for Sundhed og Samfund, øster Farimagsgade 5, 1014, København K.
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Zheng Y, Li XG, Wang QZ, Ma AG, Bygbjerg IC, Sun YY, Li Y, Zheng MC, Wang X. Enhancement of vitamin A combined vitamin D supplementation on immune response to Bacille Calmette-Guérin vaccine revaccinated in Chinese infants. ASIAN PAC J TROP MED 2014; 7:130-5. [DOI: 10.1016/s1995-7645(14)60008-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Revised: 12/15/2013] [Accepted: 01/15/2014] [Indexed: 11/24/2022] Open
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Nielsen KK, Kapur A, Damm P, de Courten M, Bygbjerg IC. From screening to postpartum follow-up - the determinants and barriers for gestational diabetes mellitus (GDM) services, a systematic review. BMC Pregnancy Childbirth 2014; 14:41. [PMID: 24450389 PMCID: PMC3901889 DOI: 10.1186/1471-2393-14-41] [Citation(s) in RCA: 168] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 01/06/2014] [Indexed: 12/25/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) – a transitory form of diabetes first recognised during pregnancy complicates between < 1% and 28% of all pregnancies. GDM has important short and long-term health consequences for both the mother and her offspring. To prevent adverse pregnancy outcomes and to prevent or delay future onset of type 2 diabetes in mother and offspring, timely detection, optimum treatment, and preventive postpartum care and follow-up is necessary. However the area remains grossly under-prioritised. Methods To investigate determinants and barriers to GDM care from initial screening and diagnosis to prenatal treatment and postpartum follow-up, a PubMed database search to identify quantitative and qualitative studies on the subject was done in September 2012. Fifty-eight relevant studies were reviewed. Results Adherence to prevailing GDM screening guidelines and compliance to screening tests seems sub-optimal at best and arbitrary at worst, with no clear or consistent correlation to health care provider, health system or client characteristics. Studies indicate that most women express commitment and motivation for behaviour change to protect the health of their unborn baby, but compliance to recommended treatment and advice is fraught with challenges, and precious little is known about health system or societal factors that hinder compliance and what can be done to improve it. A number of barriers related to health care provider/system and client characteristics have been identified by qualitative studies. Immediately following a GDM pregnancy many women, when properly informed, desire and intend to maintain healthy lifestyles to prevent future diabetes, but find the effort challenging. Adherence to recommended postpartum screening and continued lifestyle modifications seems even lower. Here too, health care provider, health system and client related determinants and barriers were identified. Studies reveal that sense of self-efficacy and social support are key determinants. Conclusions The paper identifies and discusses determinants and barriers for GDM care, fully recognising that these are highly dependent on the context.
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Affiliation(s)
- Karoline Kragelund Nielsen
- Department of International Health, Immunology and Microbiology, University of Copenhagen, Oester Farimagsgade 5, Building 9, Copenhagen DK-1014, K, Denmark.
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Hansson HH, Kurtzhals JA, Goka BQ, Rodriques OP, Nkrumah FN, Theander TG, Bygbjerg IC, Alifrangis M. Human genetic polymorphisms in the Knops blood group are not associated with a protective advantage against Plasmodium falciparum malaria in Southern Ghana. Malar J 2013; 12:400. [PMID: 24200236 PMCID: PMC4226212 DOI: 10.1186/1475-2875-12-400] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 10/23/2013] [Indexed: 11/25/2022] Open
Abstract
Background The complex interactions between the human host and the Plasmodium falciparum parasite and the factors influencing severity of disease are still not fully understood. Human single nucleotide polymorphisms SNPs associated with Knops blood group system; carried by complement receptor 1 may be associated with the pathology of P. falciparum malaria, and susceptibility to disease. Methods The objective of this study was to determine the genotype and haplotype frequencies of the SNPs defining the Knops blood group antigens; Kna/b, McCoya/b, Swain-Langley1/2 and KCAM+/- in Ghanaian patients with malaria and determine possible associations between these polymorphisms and the severity of the disease. Study participants were patients (n = 267) admitted to the emergency room at the Department of Child Health, Korle-Bu Teaching Hospital, Accra, Ghana during the malaria season from June to August in 1995, 1996 and 1997, classified as uncomplicated malaria (n = 89), severe anaemia (n = 57) and cerebral malaria (n = 121) and controls who did not have a detectable Plasmodium infection or were symptomless carriers of the parasite (n = 275). The frequencies were determined using a post-PCR ligation detection reaction-fluorescent microsphere assay, developed to detect the SNPs defining the antigens. Chi-square/Fisher’s exact test and logistic regression models were used to analyse the data. Results As expected, high frequencies of the alleles Kna, McCb, Sl2 and KCAM- were found in the Ghanaian population. Apart from small significant differences between the groups at the Sl locus, no significant allelic or genotypic differences were found between the controls and the disease groups or between the disease groups. The polymorphisms define eight different haplotypes H1(2.4%), H2(9.4%), H3(59.8%), H4(0%), H5(25.2%), H6(0.33%), H7(2.8%) and H8(0%). Investigating these haplotypes, no significant differences between any of the groups were found. Conclusion The results confirm earlier findings of high frequencies of certain CR1 alleles in Africa; and shed more light on earlier conflicting findings; the alleles McCb, Sl2, Knb and KCAM- or combined haplotypes do not seem to confer any protective advantage against malaria infection or resulting disease severity. Based on these findings, in a very well-characterized population, malaria does not seem to be the selective force on these alleles.
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Affiliation(s)
- Helle H Hansson
- Centre for Medical Parasitology, Department of International Health, Immunology and Microbiology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Khalil IF, Alifrangis M, Tarimo DS, Staalsø T, Satti GMH, Theander TG, Rønn AM, Bygbjerg IC. The roles of thepfcrt 76Tandpfmdr1 86Ymutations, immunity and the initial level of parasitaemia, in predicting the outcome of chloroquine treatment in two areas with different transmission intensities. Annals of Tropical Medicine & Parasitology 2013; 99:441-8. [PMID: 16004703 DOI: 10.1179/136485905x46441] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The resistance of Plasmodium falciparum to chloroquine (CQ) is probably mediated by point mutations in two genes: pfcrt and pfmdr1. The aim of the present study was to investigate, in patients treated with CQ, the association between host factors, such as immunity and initial level of parasitaemia, and the ability to clear P. falciparum parasites carrying the key chloroquine-resistance (CQR) mutations, pfcrt 76T and pfmdr1 86Y. Identical CQ-efficacy trials were performed in 51 young children (aged <5 years) from Kibaha, in north-western Tanzania, and 44 patients (aged 3-57 years) from Darawish, in eastern Sudan. In both areas, all the CQ-treatment failures had infections with the 76T and 86Y alleles before treatment. Although the presence of these two alleles was significantly associated with treatment failure in Sudan (P=0.001), the corresponding association in Tanzania did not reach statistical significance (P=0.1). Of the 39 patients from Darawish and 44 from Kibaha who harboured parasites with the CQR mutations, 12 and 19, respectively, managed to clear their parasitaemias. The ability to clear CQR parasites was significantly associated with the initial level of parasitaemia (with P-values of 0.05 in Tanzania and 0.01 in Sudan) and with age-- the best surrogate for protective immunity in endemic areas (with P-values of 0.02 in Tanzania and 0.001 in Sudan). These results confirm previous observations that indicated that the 76T and 86Y alleles play a role in the mechanism of CQR, although other factors, such as level of parasitaemia when treated and age, are also important. The 76T and 86Y alleles could still be used as predictive markers for CQR, in non-immune individuals and low-transmission areas.
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Affiliation(s)
- I F Khalil
- Department of International Health, Institute for Medical Microbiology and Immunology and Center for Medical Parasitology (CMP), Copenhagen, Denmark.
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Wang Q, Ma A, Bygbjerg IC, Han X, Liu Y, Zhao S, Cai J. Rationale and design of a randomized controlled trial of the effect of retinol and vitamin D supplementation on treatment in active pulmonary tuberculosis patients with diabetes. BMC Infect Dis 2013; 13:104. [PMID: 23442225 PMCID: PMC3599006 DOI: 10.1186/1471-2334-13-104] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 02/18/2013] [Indexed: 01/03/2023] Open
Abstract
Background The association between pulmonary tuberculosis (PTB) and diabetes mellitus (DM) has been previously attracted much attention. Diabetes alters immunity to tuberculosis, leading to more frequent treatment failure in TB patients with DM. Moreover, TB and DM often coincide with micronutrients deficiencies, such as retinol and vitamin D, which are especially important to immunity of the body and may influence pancreas β-cell function. However, the effects of retinol and vitamin D supplementation in active TB patients with diabetes on treatment outcomes, immune and nutrition state are still uncertain. We are conducting a randomized controlled trial of vitamin A and/or D in active PTB patients with DM in a network of 4 TB treatment clinics to determine whether the supplementation could improve the outcome in the patients. Methods/design This is a 2×2 factorial trial. We plan to enroll 400 active PTB patients with DM, and randomize them to VA (2000 IU daily retinol); VD (400 IU daily cholecalciferol); VAD (2000 IU daily retinol plus 400 IU cholecalciferol) or control (placebo) group. Our primary outcome measure is the efficacy of anti-tuberculosis treatment and ameliorating of glucose metabolism, and the secondary outcome measure being immune and nutrition status of the subjects. Of the first 37 subjects enrolled: 8 have been randomized to VA, 10 to VD, 9 to VAD and 10 to control. To date, the sample is 97.3% Han Chinese and 91.9% female. The average fasting plasma glucose level is 12.19 mmol/L. Discussion This paper describes the design and rationale of a randomized clinical trial comparing VA and/or VD supplementation to active pulmonary TB patients with DM. Our trial will allow rigorous evaluation of the efficacy of the supplementation to active TB and DM therapy for improving clinical outcomes and immunological condition. This detailed description of trial methodology can serve as a template for the development of future treatment scheme for active TB patient with DM. Trial registration ChiCTR-TRC-12002546
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Affiliation(s)
- Qiuzhen Wang
- The Institute of Human Nutrition, Medical College of Qingdao University, 38 Dengzhou Road, Qingdao 266021, China
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Nguyen NTT, Rasch V, Bygbjerg IC, Mogensen HO. Vietnamese women's struggle to access antiretroviral drugs in a context of free treatment. Health Care Women Int 2013; 34:209-26. [PMID: 23394322 DOI: 10.1080/07399332.2012.755979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This qualitative study aims to explore how HIV positive women living in a northern province of Vietnam experience seeking antiretroviral (ARV) treatment in the public health system, and how they address obstacles encountered along the way. Despite the fact that antiretroviral drugs were freely provided, they were not always accessible for women in need. A variety of factors at the population and health system level interacted in ways that often made access to ARV drugs a complicated and time-consuming process. We have suggested changes that could be made at the health system level that may help facilitate women's ability to access treatment.
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Abstract
On top of the unfinished agenda of infectious diseases in low- and middle-income countries, development, industrialization, urbanization, investment, and aging are drivers of an epidemic of noncommunicable diseases (NCDs). Malnutrition and infection in early life increase the risk of chronic NCDs in later life, and in adult life, combinations of major NCDs and infections, such as diabetes and tuberculosis, can interact adversely. Because intervention against either health problem will affect the other, intervening jointly against noncommunicable and infectious diseases, rather than competing for limited funds, is an important policy consideration requiring new thinking and approaches.
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Affiliation(s)
- I C Bygbjerg
- Copenhagen School of Global Health, Department of International Health, Immunology and Microbiology, Faculty of Health Sciences, University of Copenhagen, 5 Øster Farimagsgade, DK-1014, Copenhagen K, Denmark.
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Maaløe N, Bygbjerg IC, Onesmo R, Secher NJ, Sorensen BL. Disclosing doubtful indications for emergency cesarean sections in rural hospitals in Tanzania: a retrospective criterion-based audit. Acta Obstet Gynecol Scand 2012; 91:1069-76. [PMID: 22642620 DOI: 10.1111/j.1600-0412.2012.01474.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate in depth to what extent indications for emergency cesarean sections followed evidence-based audit criteria for realistic best practice. DESIGN A quality assurance analysis based on a retrospective criterion-based audit. SETTING Two rural hospitals in Tanzania. POPULATION From 2009, 400 cesarean section instances were investigated. Of these, 303 were emergency cesarean sections and therefore included. METHODS Documented indications for and management preceding the emergency cesarean sections were compared with the audit criteria. MAIN OUTCOME MEASURES Prevalence of suboptimal care. RESULTS Of the emergency sections, 26% appeared to be decided based on inappropriate indications, and in an additional 38%, the indications were unclear. Prolonged labor was the leading indication; in 36% of these, labor progressed timely and/or the membranes were still intact. In 26%, previous cesarean section was the indication, half of these with one previous section only. Fetal distress was an indication in 14%, but for 84% of these the fetal heart rate was either reassuring or not documented. For nine women, section was decided upon because of intrauterine fetal death; none had a trial of forceps/vacuum extraction or destructive surgery. CONCLUSION A considerable number of the audited emergency cesarean sections were performed on doubtful indications. In the light of the rising trend in global cesarean section rates, there seems to be a need to ensure quality of management preceding cesarean sections. This is particularly called for in rural sub-Saharan Africa where cesarean rates are still low and health risks of emergency surgery not negligible.
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Affiliation(s)
- Nanna Maaløe
- Department of International Health, Immunology, and Microbiology, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, Denmark.
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Wang Q, Han X, Ma A, Wang Y, Bygbjerg IC, Li G, Sun Y, Zhou X. Screening and intervention of diabetes mellitus in patients with pulmonary tuberculosis in poverty zones in China: rationale and study design. Diabetes Res Clin Pract 2012; 96:385-91. [PMID: 22153416 DOI: 10.1016/j.diabres.2011.11.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/28/2011] [Accepted: 11/14/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The merging epidemics of pulmonary tuberculosis (PTB) and diabetes mellitus (DM) have been raised concerns by many experts but no large scale screening and intervention have been launched yet, especially in low-income areas. The current study aims to understand the prevalence of DM in active PTB patients and evaluate the outcomes of diet and living habit intervention in poverty zones in China. METHODS/DESIGN A cross-sectional investigation and intervention study will be carried out. At least 7000 active PTB patients will be recruited, together with 7000 nonTB persons from the same community. The project will be divided into two stages. The first stage is to train TB workers on DM screening and regular treatment. Screening and related investigation will be carried out afterwards. The second stage is focussed on intervention. A comprehensive strategy will be utilized to conduct health promotion among the patients, the health providers and the lay public. DISCUSSION To our knowledge, this is the first and largest study which focuses on the prevalence of DM in PTB in China. We hypothesize that the current prevalence of DM in PTB in China will be understood and the results of our study will provide important evidence for preventing and controlling DM and PTB.
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Affiliation(s)
- Qiuzhen Wang
- The Institute of Human Nutrition, Medical College of Qingdao University, Qingdao, China
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Bygbjerg IC. [Challenges and solutions in global health]. Ugeskr Laeger 2012; 174:1516. [PMID: 22668644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Kamper-Jørgensen Z, Andersen AB, Kok-Jensen A, Kamper-Jørgensen M, Bygbjerg IC, Andersen PH, Thomsen VO, Lillebaek T. Migrant tuberculosis: the extent of transmission in a low burden country. BMC Infect Dis 2012; 12:60. [PMID: 22423983 PMCID: PMC3342118 DOI: 10.1186/1471-2334-12-60] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 03/18/2012] [Indexed: 11/17/2022] Open
Abstract
Background Human migration caused by political unrest, wars and poverty is a major topic in international health. Infectious diseases like tuberculosis follow their host, with potential impact on both the migrants and the population in the recipient countries. In this study, we evaluate Mycobacterium tuberculosis transmission between the national population and migrants in Denmark. Methods Register study based on IS6110-RFLP results from nationwide genotyping of tuberculosis cases during 1992 through 2004. Cases with 100% identical genotypes were defined as clustered and part of a transmission chain. Origin of clusters involving both Danes and migrants was defined as Danish/migrant/uncertain. Subsequently, the proportion of cases likely infected by the "opposite" ethnic group was estimated. Results 4,631 cases were included, representing 99% of culture confirmed cases during 1992 through 2004. Migrants contributed 61.6% of cases. Up to 7.9% (95% CI 7.0-8.9) of migrants were infected by Danes. The corresponding figure was 5.8% (95% CI 4.8-7.0) for Danes. Thus, transmission from Danes to migrants occurred up to 2.5 (95% CI 1.8-3.5) times more frequent than vice versa (OR = 1). A dominant strain, Cluster-2, was almost exclusively found in Danes, particular younger-middle-aged males. Conclusions Transmission between Danes and migrants is limited, and risk of being infected by the "opposite" ethnic group is highest for migrants. TB-control efforts should focus on continues micro-epidemics, e.g. with Cluster-2 in Danes, prevention of reactivation TB in high-risk migrants, and outbreaks in socially marginalized migrants, such as Somalis and Greenlanders. Fears that TB in migrants poses a threat for resident Danes seem exaggerated and unjustified. We believe this to be true for other low incidence countries as well.
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Affiliation(s)
- Zaza Kamper-Jørgensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.
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Maaløe N, Sorensen BL, Onesmo R, Secher NJ, Bygbjerg IC. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals. BJOG 2012; 119:605-13. [PMID: 22329559 DOI: 10.1111/j.1471-0528.2012.03284.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. DESIGN A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. SETTING Two Tanzanian rural mission hospitals. POPULATION Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. METHODS Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. MAIN OUTCOME MEASURES Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. RESULTS Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. CONCLUSION The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections.
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Affiliation(s)
- N Maaløe
- Department of International Health, Immunology, and Microbiology, University of Copenhagen, Copenhagen, Denmark.
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