1
|
Pearson J, Khan A, Bhogal T, Wong H, Law A, Mills S, Santamaria N, Bishop J, Cliff J, Errington D, Hall A, Hart C, Malik Z, Sripadam R, Innes H, Flint H, Langton G, Ahmed E, Jackson R, Palmieri C. A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone. ESMO Open 2023; 8:102033. [PMID: 37866031 PMCID: PMC10774880 DOI: 10.1016/j.esmoop.2023.102033] [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: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. No direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs in patients commencing T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. PATIENTS AND METHODS Patients with human epidermal growth factor receptor 2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinicopathological information, prior treatment, the presence or absence of central nervous system (CNS) disease, outcomes and treatment-emergent adverse events (TEAEs) were recorded. RESULTS Twenty-nine female patients, with a median age of 52 years (interquartile range 44-62 years), were identified; the prevalence of BM was 41%. Median number of lines of prior therapy was 2 (range 2-6). At a median follow-up of 13.8 months, median progression-free survival (PFS) for the overall population was 13.9 months [95% confidence interval (CI) 12.4 months-not estimable (NE)], 16.1 months (95% CI 15.1 months-NE) for active BMs and 12.4 months (95% CI 8.3 months-NE) for progressive extracranial disease alone. The 12-month overall survival (OS) rate was 74% (95% CI 59% to 95%) in the overall population, and 83% (95% CI 58% to 100%) and 66% (95% CI 45% to 96%) for active BMs and extracranial disease only, respectively. Most common TEAEs were fatigue, alopecia, and constipation. In nine patients (31%, including two deaths), pneumonitis occurred. CONCLUSION In this real-world population, we demonstrate T-DXd to be effective in patients with active BMs and those with progressive extracranial disease alone. PFS and OS were numerically longer in those with active BMs. These data demonstrate that patients with active BM treated with T-DXd have at least comparable outcomes to those with extracranial disease alone. The high rate of pneumonitis warrants further consideration.
Collapse
Affiliation(s)
- J Pearson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - A Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - H Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Law
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - S Mills
- The Walton NHS Foundation Trust, Liverpool, UK
| | - N Santamaria
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Bishop
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Cliff
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Errington
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Hall
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - C Hart
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Sripadam
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Innes
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Flint
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - G Langton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - E Ahmed
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jackson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool.
| |
Collapse
|
2
|
Abstract
Gleadow et al. introduce the food crop cassava.
Collapse
Affiliation(s)
- Roslyn Gleadow
- School of Biological Sciences, Monash University, Clayton, Melbourne, VIC 3800, Australia.
| | - Kira Maher
- School of Biological Sciences, Monash University, Clayton, Melbourne, VIC 3800, Australia
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| |
Collapse
|
3
|
Baguma M, Nzabara F, Maheshe Balemba G, Malembaka EB, Migabo C, Mudumbi G, Bito V, Cliff J, Rigo JM, Chabwine JN. Konzo risk factors, determinants and etiopathogenesis: What is new? A systematic review. Neurotoxicology 2021; 85:54-67. [PMID: 33964344 DOI: 10.1016/j.neuro.2021.05.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 12/13/2022]
Abstract
Konzo is a toxico-nutritional upper motor neuron disease causing a spastic paraparesis in schoolchildren and childbearing women in some African countries. Almost a century since the first description of konzo, its underlying etiopathogenic mechanisms and causative agent remain unknown. This paper aims at refreshing the current knowledge of konzo determinants and pathogenesis in order to enlighten potential new research and management perspectives. Literature research was performed in PubMed and Web of Science databases according to the PRISMA methodology. Available data show that cassava-derived cyanide poisoning and protein malnutrition constitute two well-documented risk factors of konzo. However, observational studies have failed to demonstrate the causal relationship between konzo and cyanide poisoning. Thiocyanate, the current marker of choice of cyanide exposure, may underestimate the actual level of cyanide poisoning in konzo patients as a larger amount of cyanide is detoxified via other unusual pathways in the context of protein malnutrition characterizing these patients. Furthermore, the appearance of konzo may be the consequence of the interplay of several factors including cyanide metabolites, nutritional deficiencies, psycho-emotional and geo-environmental factors, resulting in pathophysiologic phenomena such as excitotoxicity or oxidative stress, responsible for neuronal damage that takes place at sparse cellular and/or subcellular levels.
Collapse
Affiliation(s)
- Marius Baguma
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium.
| | - Fabrice Nzabara
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Ghislain Maheshe Balemba
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Espoir Bwenge Malembaka
- École Régionale de Santé Publique (ERSP), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Christiane Migabo
- Faculty of Agronomy, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Department of Geography and Environmental Studies, College of Social Sciences and Humanities, Jimma University, Jimma, Ethiopia
| | - Germain Mudumbi
- Department of Pediatrics, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo
| | - Virginie Bito
- Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
| | - Julie Cliff
- Faculty of Medicine, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Jean-Michel Rigo
- Biomedical Research Institute (BIOMED), UHasselt - Hasselt University, Agoralaan, 3590 Diepenbeek, Belgium
| | - Joëlle Nsimire Chabwine
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo; Department of Neuroscience and Movement Science, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
| |
Collapse
|
4
|
Baguma M, Nzabara F, Bwenge E, Mudumbi G, Maheshe G, Cliff J, Rigo J, Chabwine J. Seasonal variation but not processing methods differently affect cassava-derived cyanide exposure in two areas with different konzo prevalence in south-kivu (D.R. Congo). IBRO Rep 2019. [DOI: 10.1016/j.ibror.2019.09.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Mate I, Come CE, Gonçalves MP, Cliff J, Gudo ES. Knowledge, attitudes and practices regarding antibiotic use in Maputo City, Mozambique. PLoS One 2019; 14:e0221452. [PMID: 31437215 PMCID: PMC6705831 DOI: 10.1371/journal.pone.0221452] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 08/08/2019] [Indexed: 11/19/2022] Open
Abstract
Background Irrational use of antibiotics is a major driver of antimicrobial resistance (AMR) worldwide. Sub-Saharan Africa, where the risk of spread of AMR is highest, lacks data on the knowledge, attitudes and practices regarding antibiotic prescription and use. This is the first study in Mozambique to address this gap. Methods A cross-sectional study was conducted in 2016 in 1091 adults (age ≥18 years) living in five districts in peri-urban areas of Maputo City. Three stage cluster sampling was used to select the households. A semi-structured questionnaire was used to collect information on the knowledge, attitudes and practices regarding antibiotics and their use and socio-demographic data. Results Of the 1091 participants, 20.9% (228/1091) had used non-prescribed antibiotics. Most of the non-prescribed antibiotics were purchased in pharmacies (199/228; 87.3%). The proportion of use of non-prescribed antibiotics was higher in those who purchased from informal markets (82.6%; 14/17) and home stores (66.7%; 12/18), compared to pharmacies (24.6%; 199/810) (p = 0.000). Variables significantly associated with use of non-prescribed antibiotics were male gender (p = 0.004), living in the Central A (p<0.001), Aeroporto B (p<0.001) or 25 de Junho (p<0.001) neighborhoods, purchase of antibiotics in informal markets (p<0.002) or obtaining from home stores (p = 0.026), not completing the course (p<0.001) and having poor knowledge on the use of antibiotics (p<0.001). Main reasons for use of non-prescribed antibiotics were a perception that there was no need to attend a health facility (26.8%), followed by someone else’s advice (7.7%), symptoms similar to a previous episode (6.2%) and poor quality of care in health facilities (6.7%). Conclusions Our study shows for the first time that knowledge regarding antibiotics is poor in Maputo City. Purchase of non-prescribed antibiotics is a common practice and most are sold in pharmacies, indicating deficient inspection. Interventions to reinforce adherence by pharmacies to current legislation for dispensing antibiotics, combined with community education are urgently needed.
Collapse
Affiliation(s)
- Inocêncio Mate
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | | | - Julie Cliff
- Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Samo Gudo
- National Institute of Health, Ministry of Health, Maputo, Mozambique
- * E-mail:
| |
Collapse
|
6
|
Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Abstract P6-18-32: Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-32] [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: 11/16/2022]
Abstract
Abstract
Background: Palbociclib plus endocrine therapy (ET) significantly increases progression free survival compared to ET alone. Within PALOMA2 neutropenia was the most common AE and reason for dose reductions. No real data exists regarding dose reductions (DRs), dose interruptions (DIs), toxicities and benefits of palbociclib. Objective: To describe the early haematological dynamics, DRs/DIs with 1st line palbociclib in the context of a routine UK clinical practice. Methods: A prospective record was maintained of all patients with ER-positive, HER2-negative metastatic BC registered on the Pfizer patient programme at the Clatterbridge Cancer Centre NHS Foundation Trust. The clinical records of all patients commenced on treatment between April and December 2017 were reviewed, and clinico-pathological information, haematological data & toxicity data recorded. Data lock was 31st March 2018. Results: 48 patients received at least one cycle of treatment. The median age was 58, 29% (14/48) premenopausal & 71% (34/48) postmenopausal. 43% (21/48) had bone only disease with 42% (20/48) having visceral disease. The median number of cycles delivered 8 (range 2-11). DRs: 18/48 (38%) patients had a total of 21 DRs; 14/18 (78%) had 1 DR to 100mg; 1/18 (5%) 1 DR to 75mg; & 3/18 (17%) 2 DRs to 75mg. Reasons for DRs: 13 neutropenia, 2 leukopenia, 1 thrombocytopenia, 2 fatigue, 1 poor appetite, 1 sore mouth & 1 non-specially unwell. DIs: occurred in 24/48 patients (50%). Details of DRs/DIs by cycle will be presented. 85% (41 of 48) patients remain on treatment with 59% (24/41) on 125mg; 34% (14/41) on 100mg & 7% (3/41) on 75mg. FBC were available for 41/48 (85%) cases & dynamics considered over the first 6 cycles using FBC at the time of planned treatment delivery. Hb Baseline all patients (AP):129 (121 – 138), patients; patients with no dose reductions (NDR) 127 (123 – 139) & patient dose reduction (DR): 130 (118 – 136). Hb changes to cycles 2, 4 and 6 AP: 122 (115 – 131), 121 (116 – 127) and 125 (116 – 134); NDR:122 (110 - 135), 125 (117 - 127) and 131 (116 – 135); DR: 115 (112 - 120), 120 (115 - 124) and 122 (115 – 129). WCC Baseline AP: 6.8 (5.6 – 7.7); NDR: 7.2 (6.3 – 7.7); DR: 6.7 (5.2 – 7.7). WCC changes to cycles 2, 4 and 6 AP: 3.7 (2.9 – 4.4), 3.7 (3.1 – 4.4) and 3.3 (3 – 3.9); NDR: 3.5 (2.9 – 4.1), 3.6 (3.2 – 4.3) and 3.6 (3.1 – 4.1); DR: 2.1 (1.7 – 2.5), 4.3 (3 – 4.6) and 3.3 (2.8 – 3.5). ANC Baseline AP: 4.0 (3.2 – 5.1); NDR: 4.4 (3.4 – 5.0); DR: 3.6 (2.9 – 5.2). ANC changes to cycles 2, 4 and 6 AP: 1.5 (1.2 – 2.1), 1.7 (1.3 – 2.0) and 1.4 (1.2 – 1.9) NDR: 1.5 (1.1 – 2.1), 1.7 (1.4 – 2.0) and 1.3 (1.2 – 2.0); DR: 0.8 (0.6 – 0.8), 1.7 (1.2 – 2.3) and 1.4 (1.3 – 1.6). Plts Baseline AP: 298 (226 – 339), NDR: 252 (211 – 336); DR: 299 (253 – 339). Plt changes to cycles 2, 4 and 6 AP: 252 (198 – 310), 221 (186 – 259) and 200 (169 – 243). NDR: 249 (185 – 334), 229 (171 – 267) and 205 (177 – 263);DR: 208 (199 – 210), 216 (199 – 243) and 194 (162 -210). Conclusion: These initial real world data are consistent with the PALOMA2 data. Baseline WCC & ANC show no significant difference between NDR and DR cases. Updated data will be presented as well as outcome data for first time.
Citation Format: Bhojwani A, Flint H, Hall B, Wong H, Innes H, Cliff J, Ahmed E, Malik Z, O'Hagan J, Tolan S, Hall A, Hyatt K, Errington D, Alam F, Robson P, Thorp N, O'Reilly S, Law A, Cicconi S, Jackson R, Palmieri C. Profiling the early haematological dynamics and treatment modifications with palbociclib when used as first line treatment for ER-positive, HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-32.
Collapse
Affiliation(s)
- A Bhojwani
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Flint
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - B Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Wong
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - H Innes
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J Cliff
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - E Ahmed
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - Z Malik
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - J O'Hagan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Tolan
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Hall
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - K Hyatt
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - D Errington
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - F Alam
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - P Robson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - N Thorp
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S O'Reilly
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - A Law
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - S Cicconi
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - R Jackson
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| | - C Palmieri
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, Merseyside, Switzerland; University of Liverpool, Liverpool, Merseyside, United Kingdom
| |
Collapse
|
7
|
Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Abstract P6-17-27: Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-17-27] [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: 11/16/2022]
Abstract
Abstract
Background: Studies of neoadjuvant (NA) dual HER2 blockade with trastuzumab (T) and pertuzumab (P) in combination with chemotherapy (CT) for early breast cancer (BC) have reported pathological complete response (pCR) rates of 39 to 62%. These studies also report manageable toxicity with diarrhoea reported in up to 73% of cases. To date no real-world studies have explored the efficacy and toxicity of this treatment. The objective of this study was to describe the medical and surgical management of women treated with neoadjuvant T-P in combination with CT (NAT-P-CT). As well as to determine the efficacy toxicity of NAT-P-CT in the context of a routine UK NHS clinical practice.
Methods: Patients with HER2+ BC treated neoadjuvantly with T-P accessed via the NHS England Cancer Drug Fund (CDF) at the Clatterbridge Cancer Centre NHS Foundation Trust between October 2016 and January 2018 were retrospectively identified. Clinico-pathological information, treatment data, nurse led toxicity review and echocardiographic were reviewed. Data lock was 19th June 2018.
Results: 78 female patients were identified with a median age of 50 years (IQR: 44.4-60.2). At diagnosis: median tumour size 30mm (23.0-47.5mm), 62% (48/78) were LN positive & 56% (44/78) ER+. CT regimens: 81% (63/78) FEC-DHP of these 30% (19/63) switched to weekly paclitaxel (wP). or nab-paclitaxel; 5% (4/78); AC/EC-DHP; 9% (8/78) TCHP with 13% (1/8) switched to wP. At time of analysis, 88% (69/78) had undergone definitive surgery. Surgical details: Breast: 52% (36/69) mastectomy & 48% (33/69) WLE, Axillary management: 51% (35/69) axillary dissection (Ax Dx) & 49% (34/69) sentinel node biopsy (4 performed prior to NA treatment). 91% (32/35) of those undergoing Ax Dx were LN+ at presentation, of these 59% (19/32) had no evidence of axillary involvement at surgery. pCR rate (ypT0/is, N0) was 46% (32/69) [pCR by HR: ER+ 43% (21/49) & ER- 55% (11/20]. pCR for 20 patients switched to wP was 60% (12/20). 7% (5/69) achieved pCR in the breast alone (in these LN status ITCx1, micrometsx3 & macrometsx1). Of the 54% (37/69) with residual breast tumour median size was 13mm (1-22mm). Toxicity Data: Ejection fraction (EF) did not decline beyond 10% of baseline in any patients. Diarrhoea (any grade) occurred in 74% of cases, and CTCAE grade 3-4 toxicity occurring in >2% of patients: diarrhoea, fatigue, and infection. Updated analysis regarding pCR rate and toxicity, as well as initial outcome data will be presented.
Conclusion: These results (1) confirm the efficacy of NA T-P in a real world population; (2) support the use of NA wP; (3) indicate significant proportion of patients axilla are downstaged & (4) reveal diarrhoea rates in keeping with the literature. Currently, NHS England rules do not allow wP to be used routinely in NA setting with T-P this should be reviewed in light of these data and those of the BERENICE study. Measures to identify patients who can avoid axillary dissection as well as to mitigate diarrhoea should be considered.
Citation Format: Hall B, Bhojwani A, Innes H, Ahmed E, Cliff J, Malik Z, O'Hagan J, Tolan S, Hall A, Hayat K, Errington D, Alam F, Thorp N, Flint H, Law A, Wong H, O'Reilly S, Jackson R, Cicconi S, Palmieri C. Real world experience of the medical and surgical management of HER2 positive early breast cancer treated with neoadjuvant trastuzumab and pertuzumab via the NHS England cancer drug fund [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-17-27.
Collapse
Affiliation(s)
- B Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Bhojwani
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Innes
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - E Ahmed
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J Cliff
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Z Malik
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - J O'Hagan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Tolan
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Hall
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - K Hayat
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - D Errington
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - F Alam
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - N Thorp
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Flint
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A Law
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - H Wong
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S O'Reilly
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - R Jackson
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Cicconi
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C Palmieri
- University of Liverpool, Liverpool, Hammersmith and Fulham, United Kingdom; Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
8
|
Gudo ES, Falk K, Cliff J. Historical Perspective of Arboviruses in Mozambique and Its Implication for Current and Future Epidemics. Adv Exp Med Biol 2018; 1062:11-18. [PMID: 29845522 DOI: 10.1007/978-981-10-8727-1_2] [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] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Mozambique is a tropical country situated in the Southern part of Africa, a region where data on the burden and epidemiology of arbovirus is presently quite scarce although the frequency of outbreaks caused by arboviruses is rapidly increasing. Outbreaks of dengue fever have been reported in Mozambique, Angola and Tanzania and a recent unprecedented outbreak of Yellow fever has been recorded in Angola. These new outbreaks collectively suggest that arboviruses, and specifically flavivirus infections, are endemic in Mozambique.Although recent data on arbovirus activity is scarce, the work of Kokernot et al. [R.H. Kokernot, K.C. Smithburn, A.F. Gandara, B.M. Mc'Intosh and C.S. Heymann Anais Inst Med Trop (1960), 17:201-230] describes seroepidemiological and entomological studies carried out in several parts of Mozambique during the 1950s. Complementary seroepidemiological investigations on arboviruses that were conducted in the early 1980s also found serological evidence of several arboviruses which included Dengue, Chikungunya, Zika, Rift Valey Fever, Sinbdis virus, Wesselsbron, Bunyamwera, Pongola and Bawamba Fever and Yellow Fever.Notably the first description of Chikungunya virus in 1952-1953 in Tanzania also included reported cases in northern Mozambique. Furthermore, DENV serotype 3 was for the first time described in northern Mozambique in 1984 and 1985. Since several arboviral infections result in acute self limiting fever they have remained unsuspected for several decades. However, it is well known that during the 1980's intensive malaria control initiatives which included massive distribution of bed nets, community education and indoor and outdoor spraying campaigns were implemented. It is possible that these measures may have influenced the epidemiology of arboviruses. However, the impact of these interventions in controlling the spread of arboviruses is not known.In conclusion, the old literature on arboviruses in Mozambique is relevant for assessing the gaps and current risk of occurrence of these pathogens at the region, particularly in a time in which they are spreading worldwide.
Collapse
Affiliation(s)
| | - Kerstin Falk
- The Public Health Agency of Sweden and Karolinska Institute, Solna, Sweden
| | - Julie Cliff
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| |
Collapse
|
9
|
Muloliwa AM, Cliff J, Oku A, Oyo-Ita A, Glenton C, Ames H, Kaufman J, Hill S, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Using the COMMVAC taxonomy to map vaccination communication interventions in Mozambique. Glob Health Action 2018; 10:1321313. [PMID: 28573937 PMCID: PMC5496065 DOI: 10.1080/16549716.2017.1321313] [Citation(s) in RCA: 3] [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: 11/03/2022] Open
Abstract
BACKGROUND Improved communication about childhood vaccination is fundamental to increasing vaccine uptake in low-income countries. Mozambique, with 64% of children fully vaccinated, uses a range of communication interventions to promote uptake of childhood immunisation. OBJECTIVES Using a taxonomy developed by the 'Communicate to Vaccinate' (COMMVAC) project, the study aims to identify and classify the existing communication interventions for vaccination in Mozambique and to find the gaps. METHODS We used a qualitative research approach to identify the range of communication interventions used in Mozambique. In-depth semi-structured interviews were carried out with key purposively selected personnel at national level and relevant documents were collected and analysed. These data were complemented with observations of communication during routine vaccination and campaigns in Nampula province. We used the COMMVAC taxonomy, which organises vaccination communication intervention according to its intended purpose and the population targeted, to map both routine and campaign interventions. RESULTS We identified interventions used in campaign and routine vaccination, or in both, fitting five of the seven taxonomy purposes, with informing or educating community members predominating. We did not identify any interventions that aimed to provide support or facilitate decision-making. There were interventions for all main target groups, although fewer for health providers. Overlap occurred: for example, interventions often targeted both parents and community members. CONCLUSIONS We consider that the predominant focus on informing and educating community members is appropriate in the Mozambican context, where there is a high level of illiteracy and poor knowledge of the reasons for vaccination. We recommend increasing interventions for health providers, in particular training them in better communication for vaccination. The taxonomy was useful for identifying gaps, but needs to be more user-friendly if it is to be employed as a tool by health service managers.
Collapse
Affiliation(s)
| | - Julie Cliff
- b Faculdade de Medicina , Universidade Eduardo Mondlane , Maputo , Mozambique
| | - Afiong Oku
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Angela Oyo-Ita
- c Community Medicine Department , University of Calabar , Calabar , Nigeria
| | - Claire Glenton
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Heather Ames
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway
| | - Jessica Kaufman
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Sophie Hill
- e Centre for Health Communication and Participation, School of Psychology and Public Health , La Trobe University , Melbourne , Australia
| | - Yuri Cartier
- f International Union for Health Promotion and Education , Saint-Maurice , France
| | - Xavier Bosch-Capblanch
- g Swiss Tropical and Public Health Institute , Basel , Switzerland.,h University of Basel , Basel , Switzerland
| | - Gabriel Rada
- i Evidence-based Healthcare Program , Pontificia Universidad Católica de Chile , Santiago , Chile
| | - Simon Lewin
- d Global Health Unit , Norwegian Institute of Public Health , Oslo , Norway.,j Health Systems Research Unit , South African Medical Research Council , Tygerberg , South Africa
| |
Collapse
|
10
|
Parkkali S, Nwaru BI, Augusto O, Abacassamo F, Cliff J, Hemminki E. Causes of death among women aged 17-49 years between 2007 and 2010 in Maputo, Mozambique. J Glob Health 2018; 7:020411. [PMID: 29302317 PMCID: PMC5735779 DOI: 10.7189/jogh.07.020411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objectives To describe causes of death among young women and estimate the role of HIV/AIDS as a cause in Maputo City, based on the civil death register. Methods Death data of 17–49 year–old women were abstracted from January 2007–March 2010 from the civil death register in Maputo City, registering overall about 15 000 deaths per–year. Causes of death in the register were either based on physicians’ diagnoses on death certificates or determined by asking questions to deceased relatives. Causes of death were written in Portuguese; we translated them into English and classified them into 106 codes using ICD–9; these codes were then categorized into 10 groups. Estimated populations from the 2007 census were used to calculate annual mortality rates. An earlier study was used to compare deaths in 2001. Findings A total of 9640 deaths (6510 for residents of Maputo City) were registered and 77% had a specified cause of death reported. HIV–deaths represented 36% of all deaths and 40% among 25–39 year–olds. The death rate did not increase linearly by age, as there was a peak among women aged 30–34 years. The overall annual death rate was 6.7 deaths per 1000 population, with a notable decline by year. Death rates for HIV slightly declined by year. HIV–deaths explained most of the peak in death rate among 30–34–year–olds. The share of HIV–deaths among all deaths increased from 18% in 2001 to 35% in 2007–2010. Sixty–eight percent of all and 92% of HIV–related deaths occurred in hospital, with no increase over time. Conclusions Routine death register was useful to study death rates, distribution of deaths, and change over time in the urban setting of Maputo during late 2000s. Over time, the death rate among 17–49 years old women seemed to have declined, but the relative contribution of HIV increased.
Collapse
Affiliation(s)
- Saara Parkkali
- Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| | - Bright I Nwaru
- Krefting Research Centre, Institute of Medicine, University of Gothenburg, Gothenburg, Swede.,Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Orvalho Augusto
- Department of Community Health, Medical Faculty, Eduardo Mondlane University, Maputo, Mozambique
| | - Fatima Abacassamo
- Department of Community Health, Medical Faculty, Eduardo Mondlane University, Maputo, Mozambique
| | - Julie Cliff
- Department of Community Health, Medical Faculty, Eduardo Mondlane University, Maputo, Mozambique
| | - Elina Hemminki
- Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
11
|
Cliff J, Jorgensen AL, Lord R, Azam F, Cossar L, Carr DF, Pirmohamed M. The molecular genetics of chemotherapy-induced peripheral neuropathy: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2017; 120:127-140. [PMID: 29198326 DOI: 10.1016/j.critrevonc.2017.09.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 08/12/2017] [Accepted: 09/11/2017] [Indexed: 01/13/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) can adversely affect completion of systemic anti-cancer treatment and cause long-term morbidity. Increasingly pharmacogenetic studies have been performed to explore susceptibility to this important adverse effect. A systematic review was conducted to identify pharmacogenetic studies, assess their quality and findings and undertake meta-analysis where possible. 93 studies were included. Notable methodological issues included lack of standardisation and detail in phenotype definition and acknowledgement of potential confounding factors. Insufficient data was presented in many studies meaning only a minority could be included in meta-analysis showing mainly non-significant effects. Nonetheless, SNPs in CYP2C8, CYP3A4, ARHGEF10, EPHA and TUBB2A genes (taxanes), FARS2, ACYP2 and TAC1 (oxaliplatin), and CEP75 and CYP3A5 (vincristine) are of potential interest. These require exploration in large cohort studies with robust methodology and well-defined phenotypes. Seeking standardisation of phenotype, collaboration and subsequently, individual-patient-data meta-analysis may facilitate identifying contributory SNPs which could be combined in a polygenic risk score to predict those most at risk of CIPN.
Collapse
Affiliation(s)
- J Cliff
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | | | - R Lord
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - F Azam
- Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - L Cossar
- University of Liverpool, Liverpool, L69 3BX, UK; Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Wirral, CH63 4JY, UK.
| | - D F Carr
- University of Liverpool, Liverpool, L69 3BX, UK.
| | - M Pirmohamed
- University of Liverpool, Liverpool, L69 3BX, UK.
| |
Collapse
|
12
|
Ames H, Njang DM, Glenton C, Fretheim A, Kaufman J, Hill S, Oku A, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Muloliwa AM, Oyo-Ita A, Kum AP, Lewin S. Stakeholder perceptions of communication about vaccination in two regions of Cameroon: A qualitative case study. PLoS One 2017; 12:e0183721. [PMID: 28859101 PMCID: PMC5578665 DOI: 10.1371/journal.pone.0183721] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 08/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Understanding stakeholders' (parents', communities' and health workers') perspectives of communication about childhood vaccination, including their preferences for its format, delivery and content, is an important step towards designing better communication strategies and ensuring more informed parents. Our objectives were to explore stakeholders' views, experiences and preferences for childhood vaccination communication in Cameroon. METHODS In 2014, in the Central and North West Regions of Cameron, we gathered qualitative data for our case study using the following methods: semi structured interviews; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; document analysis of reports and mass media communications about vaccination; and a survey of parents. We conducted a thematic analysis of the qualitative data to identify themes relating to views, experiences and perceptions of vaccination information and its delivery. Survey data were analysed using simple descriptive statistics. RESULTS All of the parents interviewed felt that vaccinating their child was important, and trusted the information provided by health workers. However, many parents wanted more information. Parents did not always feel that they could ask questions during vaccination appointments. All participants felt that health workers and vaccination clinics were important sources of information. Social mobilisation activities such as door-to-door visits and announcements during religious services were important and accepted ways of communicating information, especially during vaccination campaigns. Information communicated through mass media and text messages was also seen as important. In general, stakeholders believed that more consistent messaging about routine vaccination through community channels would be helpful to remind parents of the importance of routine vaccination during ongoing rounds of vaccination campaigns against polio. CONCLUSIONS This study confirms that parents regard information about childhood vaccination as important, but that health services need to be organized in ways that prioritize and facilitate communication, particularly about routine vaccination.
Collapse
Affiliation(s)
- Heather Ames
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Diangha Mabel Njang
- Department of Anthropology, University of Yaoundé 1, Yaoundé, Central Province, Cameroon
| | - Claire Glenton
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
| | - Atle Fretheim
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
- Institute of Health and Society, University of Oslo, 0318 Oslo Norway
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Afiong Oku
- University of Calabar, Nigeria, Calabar Municipal, Cross River State, Nigeria
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Programme, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Angela Oyo-Ita
- University of Calabar, Nigeria, Calabar Municipal, Cross River State, Nigeria
| | - Awah Paschal Kum
- Department of Anthropology, University of Yaoundé 1, Yaoundé, Central Province, Cameroon
| | - Simon Lewin
- Global Health Unit, Norwegian Institute of Public Health, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
13
|
Kaufman J, Ryan R, Lewin S, Bosch-Capblanch X, Glenton C, Cliff J, Oyo-Ita A, Muloliwa AM, Oku A, Ames H, Rada G, Cartier Y, Hill S. Identification of preliminary core outcome domains for communication about childhood vaccination: An online Delphi survey. Vaccine 2017; 36:6520-6528. [PMID: 28835344 DOI: 10.1016/j.vaccine.2017.08.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 01/03/2017] [Revised: 08/04/2017] [Accepted: 08/10/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Communication interventions for childhood vaccination are promising strategies to address vaccine hesitancy, but current research is limited by the outcomes measured. Most studies measure only vaccination-related outcomes, with minimal consideration of vaccine hesitancy-relevant intermediate outcomes. This impedes understanding of which interventions or elements are effective. It is also unknown which outcomes are important to the range of stakeholders affected by vaccine hesitancy. Outcome selection shapes the evidence base, informing future interventions and trials, and should reflect stakeholder priorities. Therefore, our aim was to identify which outcome domains (i.e. broad outcome categories) are most important to different stakeholders, identifying preliminary core outcome domains to inform evaluation of three common vaccination communication types: (i) communication to inform or educate, (ii) remind or recall, and (iii) enhance community ownership. METHODS We conducted a two-stage online Delphi survey, involving four stakeholder groups: parents or community members, healthcare providers, researchers, and government or non-governmental organisation representatives. Participants rated the importance of eight outcome domains for each of the three communication types. They also rated specific outcomes within one domain ("attitudes or beliefs") and provided feedback about the survey. RESULTS Collectively, stakeholder groups prioritised outcome domains differently when considering the effects of different communication types. For communication that aims to (i) inform or educate, the most important outcome domain is "knowledge or understanding"; for (ii) reminder communication, "vaccination status and behaviours"; and for (iii) community engagement communication, "community participation". All stakeholder groups rated most outcome domains as very important or critical. The highest rated specific outcome within the "attitudes or beliefs" domain was "trust". CONCLUSION This Delphi survey expands the field of core outcomes research and identifies preliminary core outcome domains for measuring the effects of communication about childhood vaccination. The findings support the argument that vaccination communication is not a single homogenous intervention - it has a range of purposes, and vaccination communication evaluators should select outcomes accordingly.
Collapse
Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
| | - Simon Lewin
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, P.O. Box 19070, 7505 Tygerberg, Cape Town, South Africa.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Claire Glenton
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway.
| | - Julie Cliff
- Faculdade de Medicina, Eduardo Mondlane University, CP 257 Maputo, Mozambique.
| | - Angela Oyo-Ita
- University of Calabar, PMB 1115 Calabar, Cross River State, Nigeria.
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n° 1016 R/C, C.P. N° 14, Nampula, Mozambique.
| | - Afiong Oku
- University of Calabar, PMB 1115 Calabar, Cross River State, Nigeria.
| | - Heather Ames
- Norwegian Institute of Public Health, Boks 7004, St Olavs plass, 0130 Oslo, Norway.
| | - Gabriel Rada
- Pontifical Catholic University of Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile.
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Boulevard de la Libération, 93203 Saint-Denis, France.
| | - Sophie Hill
- Centre for Health Communication and Participation, Health Sciences 2, School of Psychology and Public Health, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia.
| |
Collapse
|
14
|
Salomão C, Nacima A, Cuamba L, Gujral L, Amiel O, Baltazar C, Cliff J, Gudo ES. Epidemiology, clinical features and risk factors for human rabies and animal bites during an outbreak of rabies in Maputo and Matola cities, Mozambique, 2014: Implications for public health interventions for rabies control. PLoS Negl Trop Dis 2017; 11:e0005787. [PMID: 28742094 PMCID: PMC5542695 DOI: 10.1371/journal.pntd.0005787] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/03/2017] [Accepted: 07/06/2017] [Indexed: 11/04/2022] Open
Abstract
Background In Mozambique, the majority of rabies outbreaks are unreported and data on the epidemiological features of human rabies and animal bites are scarce. An outbreak of human rabies in adjacent Maputo and Matola cities in 2014 prompted us to investigate the epidemiology, clinical features and risk factors of human rabies and animal bites in the two cities. Methodology/Principal findings We reviewed cases of human rabies and animal bites from April to July 2014, and carried out a community investigation in July and August in the neighborhoods where cases of human rabies resided. This investigation included collection of clinical, demographic and epidemiological information and a case control study to investigate the risk factors associated with human rabies. Fourteen cases of human rabies were detected in Maputo (n = 10) and Matola (n = 3) cities and neighbouring Boane district (n = 1) between April and August 2014, all of whom had been admitted to hospital. All had a recent history of dog bite. Of the 14 rabid dogs, only one had been immunized. 819 cases of animal bites were registered, of which 64.6% (529/819) were from Maputo City. Dogs were responsible for 97.8% (801/819) of all animal bites, but only 27.0% (126/467) were immunized. Factors significantly associated with human rabies were: age <15 years (p = 0.05), bite by stray dog (p = 0.002), deep wound (p = 0.02), bite in the head (p = 0.001), bite by unimmunized dog (p = 0.01), no use of soap and water (p = 0.001), and no post-exposure prophylaxis (p = 0.01). Conclusions/Significance Implementation of control measures for rabies is poor in Maputo and Matola cities, where cases of human rabies were strongly associated with bites by stray and unvaccinated dogs and irregular implementation of post-exposure measures. Rabies is a deadly neglected virus that causes an estimated 59,000 deaths each year worldwide. In 2014, an outbreak of human rabies in adjacent Maputo and Matola cities prompted us to investigate the epidemiology and risk factors of human rabies and animal bites in the two cities. We reviewed cases of human rabies and animal bites through both health facility and community investigations and carried out a case control study in affected neighborhoods. We found a total of 14 unreported human rabies cases in a four month period, and 819 cases of animal bites in a three month retrospective review of records. Dogs were responsible for all rabid bites and for 97.8% of animal bites. None of the rabid dogs had been vaccinated. Factors significantly associated with human rabies were: age <15 years, bite by a stray dog, deep wound, bite in the head, bite by an unimmunized dog, failure to use soap and water to cleanse the wound, and to vaccinate after the bite. We concluded that the poor implementation of control measures for rabies had led to the outbreak and recommended strengthening implementation, particularly in rapidly urbanizing areas.
Collapse
Affiliation(s)
- Cristolde Salomão
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
- * E-mail:
| | - Amílcar Nacima
- Field Epidemiology and Laboratory Training Program, National Institute of Health, Maputo, Mozambique
| | - Lutero Cuamba
- Maputo City Health Directorate, Ministry of Health, Maputo, Mozambique
| | - Lorna Gujral
- Department of Epidemiology, National Directorate of Public Health, Ministry of Health, Maputo, Mozambique
| | - Olga Amiel
- Department of Neglected Tropical Diseases Program, National Directorate of Public Health, Maputo, Mozambique
| | - Cynthia Baltazar
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
| | - Julie Cliff
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Samo Gudo
- Department of Surveillance, National Institute of Health, Maputo, Mozambique
| |
Collapse
|
15
|
Taibo CLA, Cliff J, Rosling H, Hall CD, Park MM, Frimpong JA. An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique. Pan Afr Med J 2017; 27:6. [PMID: 28721170 PMCID: PMC5500942 DOI: 10.11604/pamj.supp.2017.27.1.12623] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/05/2017] [Indexed: 11/30/2022] Open
Abstract
This case study is based on a real-life outbreak investigation undertaken in Mozambique in 1981. This case study describes and promotes one particular approach to unknown disease outbreak investigation. Investigational procedures, however, may vary depending on location and outbreak. It is anticipated that the epidemiologist investigating an unknown disease outbreak will work within the framework of a “multidisciplinary investigation team”. It is through the collaborative efforts of this team, with each member playing a critical role, that outbreak investigations are successfully completed. Some aspects of the original outbreak and investigation have, however, been altered to assist in meeting the desired teaching objectives and to allow completion of the case study in less than 3 hours.
Collapse
Affiliation(s)
- Cátia Luciana Abdulfattáhe Taibo
- Microbiology Department, Eduardo Mondlane University, Maputo, Mozambique.,Mozambique Field Epidemiology and Laboratory Training Program, Mozambique
| | | | - Hans Rosling
- Nacala District Health Department, Nacala, Mozambique
| | | | | | | |
Collapse
|
16
|
Kaufman J, Ames H, Bosch-Capblanch X, Cartier Y, Cliff J, Glenton C, Lewin S, Muloliwa AM, Oku A, Oyo-Ita A, Rada G, Hill S. The comprehensive 'Communicate to Vaccinate' taxonomy of communication interventions for childhood vaccination in routine and campaign contexts. BMC Public Health 2017; 17:423. [PMID: 28486956 PMCID: PMC5424416 DOI: 10.1186/s12889-017-4320-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 08/18/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
Background Communication can be used to generate demand for vaccination or address vaccine hesitancy, and is crucial to successful childhood vaccination programmes. Research efforts have primarily focused on communication for routine vaccination. However, vaccination campaigns, particularly in low- or middle-income countries (LMICs), also use communication in diverse ways. Without a comprehensive framework integrating communication interventions from routine and campaign contexts, it is not possible to conceptualise the full range of possible vaccination communication interventions. Therefore, vaccine programme managers may be unaware of potential communication options and researchers may not focus on building evidence for interventions used in practice. In this paper, we broaden the scope of our existing taxonomy of communication interventions for routine vaccination to include communication used in campaigns, and integrate these into a comprehensive taxonomy of vaccination communication interventions. Methods Building on our taxonomy of communication for routine vaccination, we identified communication interventions used in vaccination campaigns through a targeted literature search; observation of vaccination activities in Cameroon, Mozambique and Nigeria; and stakeholder consultations. We added these interventions to descriptions of routine vaccination communication and categorised the interventions according to their intended purposes, building from an earlier taxonomy of communication related to routine vaccination. Results The comprehensive taxonomy groups communication used in campaigns and routine childhood vaccination into seven purpose categories: ‘Inform or Educate’; ‘Remind or Recall’; ‘Enhance Community Ownership’; ‘Teach Skills’; ‘Provide Support’; ‘Facilitate Decision Making’ and ‘Enable Communication’. Consultations with LMIC stakeholders and experts informed the taxonomy’s definitions and structure and established its potential uses. Conclusions This taxonomy provides a standardised way to think and speak about vaccination communication. It is categorised by purpose to help conceptualise communication interventions as potential solutions to address needs or problems. It can be utilised by programme planners, implementers, researchers and funders to see the range of communication interventions used in practice, facilitate evidence synthesis and identify evidence gaps. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4320-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jessica Kaufman
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
| | - Heather Ames
- Norwegian Institute of Public Health, Oslo, Norway
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, Saint-Maurice Cedex, France
| | - Julie Cliff
- Eduardo Mondlane University, Maputo, Mozambique
| | | | - Simon Lewin
- Norwegian Institute of Public Health, Oslo, Norway.,South African Medical Research Council, Cape Town, South Africa
| | | | | | | | - Gabriel Rada
- Pontifical Catholic University of Chile, Santiago, Chile
| | - Sophie Hill
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
17
|
Kaufman J, Ryan R, Glenton C, Lewin S, Bosch-Capblanch X, Cartier Y, Cliff J, Oyo-Ita A, Ames H, Muloliwa AM, Oku A, Rada G, Hill S. Childhood vaccination communication outcomes unpacked and organized in a taxonomy to facilitate core outcome establishment. J Clin Epidemiol 2017; 84:173-184. [PMID: 28238788 DOI: 10.1016/j.jclinepi.2017.02.007] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/11/2017] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We present a comprehensive taxonomy of outcomes for childhood vaccination communication interventions. Adding to our earlier map of trial outcomes, we aimed to (1) identify relevant outcomes not measured in trials, (2) identify outcomes from stakeholder focus groups, and (3) organize outcomes into a taxonomy. STUDY DESIGN AND SETTING We identified additional outcomes from nonvaccination health communication literature and through parent and health care professional focus groups. We organized outcomes into the taxonomy through iterative discussion and informed by organizational principles established by leaders in core outcome research. RESULTS The taxonomy includes three overarching core areas, divided into eight domains and then into outcomes. Core area one is psychosocial impact, including the domains "knowledge or understanding," "attitudes or beliefs," and "decision-making." Core area two is health impact, covering "vaccination status and behaviors" and "health status and well-being." Core area three is community, social, or health system impact, containing "intervention design and implementation," "community participation," and "resource use." CONCLUSION To our knowledge, this taxonomy is the first attempt to conceptualize the range of potential outcomes for vaccination communication. It can be used by researchers selecting outcomes for complex communication interventions. We will also present the taxonomy to stakeholders to establish core outcome domains.
Collapse
Affiliation(s)
- Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia.
| | - Rebecca Ryan
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
| | - Claire Glenton
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Simon Lewin
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway; Health Systems Research Unit, South African Medical Research Council, PO Box 19070, Tygerberg 7505, Cape Town, South Africa
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, P.O. Box CH-4002, Basel, Switzerland; Universität Basel, Petersplatz 1, CH-4003, Basel, Switzerland
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 boulevard de la Libération, Saint-Denis 93203, France
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo CP 257, Mozambique
| | - Angela Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Knowledge Centre for the Health Services, Norwegian Institute of Public Health, PO Box 4404, Nydalen, Oslo N-0403, Norway
| | - Artur Manuel Muloliwa
- Provincial Directorate of Health, Av. Samora Machel n(º) 1016 R/C, C.P. N(º) 14, Nampula, Mozambique
| | - Afiong Oku
- Department of Community Medicine, University of Calabar, Calabar PMB 1115, Cross River State, Nigeria
| | - Gabriel Rada
- Evidence Based Health Care Program, Faculty of Medicine, Pontificia Universidad Católica de Chile, Avda, Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Rm 412, Bundoora, Victoria 3086, Australia
| |
Collapse
|
18
|
Oku A, Oyo-Ita A, Glenton C, Fretheim A, Eteng G, Ames H, Muloliwa A, Kaufman J, Hill S, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Factors affecting the implementation of childhood vaccination communication strategies in Nigeria: a qualitative study. BMC Public Health 2017; 17:200. [PMID: 28202001 PMCID: PMC5311723 DOI: 10.1186/s12889-017-4020-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The role of health communication in vaccination programmes cannot be overemphasized: it has contributed significantly to creating and sustaining demand for vaccination services and improving vaccination coverage. In Nigeria, numerous communication approaches have been deployed but these interventions are not without challenges. We therefore aimed to explore factors affecting the delivery of vaccination communication in Nigeria. METHODS We used a qualitative approach and conducted the study in two states: Bauchi and Cross River States in northern and southern Nigeria respectively. We identified factors affecting the implementation of communication interventions through interviews with relevant stakeholders involved in vaccination communication in the health services. We also reviewed relevant documents. Data generated were transcribed verbatim and analysed using thematic analysis. RESULTS We used the SURE framework to organise the identified factors (barriers and facilitators) affecting vaccination communication delivery. We then grouped these into health systems and community level factors. Some of the commonly reported health system barriers amongst stakeholders interviewed included: funding constraints, human resource factors (health worker shortages, training deficiencies, poor attitude of health workers and vaccination teams), inadequate infrastructure and equipment and weak political will. Community level factors included the attitudes of community stakeholders and of parents and caregivers. We also identified factors that appeared to facilitate communication activities. These included political support, engagement of traditional and religious institutions and the use of organised communication committees. CONCLUSIONS Communication activities are a crucial element of immunization programmes. It is therefore important for policy makers and programme managers to understand the barriers and facilitators affecting the delivery of vaccination communication so as to be able to implement communication interventions more effectively.
Collapse
Affiliation(s)
- Afiong Oku
- Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Angela Oyo-Ita
- Community Medicine Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Claire Glenton
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway
| | - Atle Fretheim
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway.,Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318, Oslo, Norway
| | - Glory Eteng
- Sociology Department, University of Calabar, P.M.B 1115, Calabar Municipality, Cross River State, Nigeria
| | - Heather Ames
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway
| | - Artur Muloliwa
- Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Av. SamoraMachel n° 1016 R/C, C.P. N° 14, Nampula, Mozambique
| | - Jessica Kaufman
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia
| | - Sophie Hill
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Health Sciences 2, Victoria, 3086, Australia
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Blvd. de la Libération, 95203, St. Denis, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland.,University of Basel, Petersplatz 1, 4003, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile
| | - Simon Lewin
- Norwegian Institute of Public Health, Postboks 4404 Nydalen, 0403, Oslo, Norway. .,Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, PO Box 19070, 7505, Tygerberg, South Africa.
| |
Collapse
|
19
|
Affiliation(s)
- Eduardo Samo Gudo
- Virus Isolation Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
- * E-mail:
| | - Kerstin I. Falk
- Department of Microbiology, The Public Health Agency of Sweden, Solna, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Solna, Sweden
| | - Sadia Ali
- Virus Isolation Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | - Vanessa Monteiro
- Virus Isolation Laboratory, National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Julie Cliff
- Community Health Department, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| |
Collapse
|
20
|
Hemminki E, Nwaru BI, Salomé G, Parkkali S, Abacassamo F, Augusto O, Cliff J, Regushevskaya E, Dgedge M, Sousa C, Chilundo B. Is selective prenatal iron prophylaxis better than routine prophylaxis: final results of a trial (PROFEG) in Maputo, Mozambique. BMJ Open 2016; 6:e011280. [PMID: 27297013 PMCID: PMC4916582 DOI: 10.1136/bmjopen-2016-011280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To compare routine versus selective (ie, screening and treatment for anaemia) prenatal iron prophylaxis in a malaria-endemic and HIV-prevalent setting, an extended analysis including previously missing data. DESIGN A pragmatic randomised controlled clinical trial. SETTING 2 health centres in Maputo, Mozambique. PARTICIPANTS Pregnant women (≥18 years old; non-high-risk pregnancy) were randomly allocated to routine iron (n=2184) and selective iron (n=2142) groups. INTERVENTIONS In the routine group, women received 60 mg ferrous sulfate plus 400 μg folic acid daily. In the selective group, women received 1 mg of folic acid daily and haemoglobin (Hb) screening at each visit; with low Hb (cut-off 9 g/dL) treatment (120 mg+800 μg of folic acid daily) for a month. PRIMARY OUTCOMES preterm birth, low birth weight; secondary outcomes: self-reported malaria, labour complications, caesarean section, perinatal death, woman's death. Nurses collected pregnancy data. Birth data were abstracted from hospital records for 52% of women and traced using various methods and linked with probabilistic matching for 24%. Women's deaths were collected from death registers. RESULTS Birth data were available for 3301 (76%) of the women. Outcomes were similar in the two groups: preterm births (27.1% in the selective vs 25.3% in the routine group), low birthweight infants (11.0% vs 11.7%), perinatal deaths (2.4% vs 2.4%) and caesarean sections (4.0% vs 4.5%). Women's deaths during pregnancy or <42 days postpartum were more common in the selective group (0.8% among the two best matched women) than in the routine group (0.4%). Extra deaths could not be explained by the cause of death, Hb level or HIV status at recruitment. CONCLUSIONS Birth outcomes were similar in the two iron groups. There might have been more women's deaths in the selective iron group, but it is unclear whether this was due to the intervention, other factors or chance finding. TRIAL REGISTRATION NUMBER NCT00488579.
Collapse
Affiliation(s)
- Elina Hemminki
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| | - Bright I Nwaru
- Centre for Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, UK
- School of Health Sciences, University of Tampere, Tampere, Finland
| | - Graca Salomé
- Medical Faculty, Department of Physiological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Saara Parkkali
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| | - Fatima Abacassamo
- Medical Faculty, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Orvalho Augusto
- Medical Faculty, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Julie Cliff
- Medical Faculty, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Elena Regushevskaya
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Cesar Sousa
- Medical Faculty, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Baltazar Chilundo
- Medical Faculty, Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| |
Collapse
|
21
|
Oku A, Oyo-Ita A, Glenton C, Fretheim A, Ames H, Muloliwa A, Kaufman J, Hill S, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Lewin S. Communication strategies to promote the uptake of childhood vaccination in Nigeria: a systematic map. Glob Health Action 2016; 9:30337. [PMID: 26880154 PMCID: PMC4754015 DOI: 10.3402/gha.v9.30337] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 12/29/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Effective communication is a critical component in ensuring that children are fully vaccinated. Although numerous communication interventions have been proposed and implemented in various parts of Nigeria, the range of communication strategies used has not yet been mapped systematically. This study forms part of the 'Communicate to vaccinate' (COMMVAC) project, an initiative aimed at building research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. OBJECTIVE This study aims to: 1) identify the communication strategies used in two states in Nigeria; 2) map these strategies against the existing COMMVAC taxonomy, a global taxonomy of vaccination communication interventions; 3) create a specific Nigerian country map of interventions organised by purpose and target; and 4) analyse gaps between the COMMVAC taxonomy and the Nigerian map. DESIGN We conducted the study in two Nigerian states: Bauchi State in Northern Nigeria and Cross River State in Southern Nigeria. We identified vaccination communication interventions through interviews carried out among purposively selected stakeholders in the health services and relevant agencies involved in vaccination information delivery; through observations and through relevant documents. We used the COMMVAC taxonomy to organise the interventions we identified based on the intended purpose of the communication and the group to which the intervention was targeted. RESULTS The Nigerian map revealed that most of the communication strategies identified aimed to inform and educate and remind or recall. Few aimed to teach skills, enhance community ownership, and enable communication. We did not identify any intervention that aimed to provide support or facilitate decision-making. Many interventions had more than one purpose. The main targets for most interventions were caregivers and community members, with few interventions directed at health workers. Most interventions identified were used in the context of campaigns rather than routine immunisation programmes. CONCLUSIONS The identification and development of the Nigerian vaccination communication interventions map could assist programme managers to identify gaps in vaccination communication. The map may be a useful tool as part of efforts to address vaccine hesitancy and improve vaccination coverage in Nigeria and similar settings.
Collapse
Affiliation(s)
- Afiong Oku
- Community Medicine Department, University of Calabar, Calabar, Nigeria;
| | - Angela Oyo-Ita
- Community Medicine Department, University of Calabar, Calabar, Nigeria
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Atle Fretheim
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Heather Ames
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | - Artur Muloliwa
- Departamento de Saúde, Direcção Provincial de Saúde de Nampula, Nampula, Mozambique
| | - Jessica Kaufman
- Department of Human Biosciences, Centre for Health Communication and Participation, College of Science, Health and Engineering La Trobe University, Melbourne, Australia
| | - Sophie Hill
- Department of Human Biosciences, Centre for Health Communication and Participation, College of Science, Health and Engineering La Trobe University, Melbourne, Australia
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Yuri Cartier
- International Union for Health Promotion and Education, Cedex, France
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Oslo, Norway
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| |
Collapse
|
22
|
Ames H, Njang DM, Glenton C, Fretheim A, Kaufman J, Hill S, Oku A, Cliff J, Cartier Y, Bosch-Capblanch X, Rada G, Muloliwa A, Oyo-Ita A, Lewin S. Mapping how information about childhood vaccination is communicated in two regions of Cameroon: What is done and where are the gaps? BMC Public Health 2015; 15:1264. [PMID: 26691846 PMCID: PMC4687068 DOI: 10.1186/s12889-015-2557-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 07/16/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022] Open
Abstract
Background The ‘Communicate to vaccinate’ (COMMVAC) project builds research evidence for improving communication with parents and communities about childhood vaccinations in low- and middle-income countries. Understanding and mapping the range of vaccination communication strategies used in different settings is an important component of this work. In this part of the COMMVAC project, our objectives were: (1) to identify the vaccination communication interventions used in two regions of Cameroon; (2) to apply the COMMVAC taxonomy, a global taxonomy of vaccination communication interventions, to these communication interventions to help us classify these interventions, including their purposes and target audiences; and identify whether gaps in purpose or target audiences exist; (3) to assess the COMMVAC taxonomy as a research tool for data collection and analysis. Methods We used the following qualitative methods to identify communication strategies in the Central and North West Regions of Cameroon in the first half of 2014: interviews with program managers, non-governmental organizations, vaccinators, parents and community members; observations and informal conversations during routine immunization clinics and three rounds of the National Polio Immunization Campaign; and document analysis of reports and mass media communications about vaccination. A survey of parents and caregivers was also done. We organised the strategies using the COMMVAC taxonomy and produced a map of Cameroon-specific interventions, which we presented to local stakeholders for feedback. Results Our map of the interventions used in Cameroon suggests that most childhood vaccination communication interventions focus on national campaigns against polio rather than routine immunisation. The map also indicates that most communication interventions target communities more broadly, rather than parents, and that very few interventions target health workers. The majority of the communication interventions aimed to inform or educate or remind or recall members of the community about vaccination. The COMMVAC taxonomy provided a useful framework for quickly and simply mapping existing vaccination communication strategies. Conclusions By identifying the interventions used in Cameroon and developing an intervention map, we allowed stakeholders to see where they were concentrating their communication efforts and where gaps exist, allowing them to reflect on whether changes are needed to the communication strategies they are using. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2557-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Heather Ames
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway.
| | - Diangha Mabel Njang
- Department of Anthropology, University of Yaoundé 1, BP 337, Yaoundé, Central Province, Cameroon, Africa.
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway.
| | - Atle Fretheim
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway. .,Institute of Health and Society, University of Oslo, P.O box 1130 Blindern 0318, Oslo, Norway.
| | - Jessica Kaufman
- Centre for Health Communication and Participation, C/o Department of Human Biosciences, College of Science, Health and Engineering, La Trobe University, Melbourne campus, 3086, VIC, Australia.
| | - Sophie Hill
- Centre for Health Communication and Participation, C/o Department of Human Biosciences, College of Science, Health and Engineering, La Trobe University, Melbourne campus, 3086, VIC, Australia.
| | - Afiong Oku
- University of Calabar, Nigeria, P.M.B 1115, Calabar Municipal, Cross River State, Nigeria.
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique, Africa.
| | - Yuri Cartier
- International Union for Health Promotion and Education, 42 Blvd. de la Libération, 95203 St, Denis, Cedex, France.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, 4051, Basel, Switzerland. .,University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
| | - Gabriel Rada
- Evidence-based Healthcare Program, Pontificia Universidad Católica de Chile, Avda. Libertador Bernardo O'Higgins 340, Santiago, Chile.
| | - Artur Muloliwa
- Direcção Provincial de Saúde de Nampula, Departamento de Saúde, Av. Samora Machel n° 1016 R/C, C.P. N° 14, Nampula-Moçambique, Africa.
| | - Angela Oyo-Ita
- University of Calabar, Nigeria, P.M.B 1115, Calabar Municipal, Cross River State, Nigeria.
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre for the Health Services, Boks 7004, St Olavs plass, N/0130, Oslo, Norway. .,Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, PO Box 19070, 7505, Tygerberg, South Africa.
| |
Collapse
|
23
|
Massangaie M, Pinto G, Padama F, Chambe G, da Silva M, Mate I, Chirindza C, Ali S, Agostinho S, Chilaule D, Weyer J, le Roux C, Abilio AP, Baltazar C, Doyle TJ, Cliff J, Paweska J, Gudo ES. Clinical and Epidemiological Characterization of the First Recognized Outbreak of Dengue Virus-Type 2 in Mozambique, 2014. Am J Trop Med Hyg 2015; 94:413-6. [PMID: 26643534 DOI: 10.4269/ajtmh.15-0543] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 10/12/2015] [Indexed: 12/18/2022] Open
Abstract
Since the first reported epidemic of dengue in Pemba, the capital of Cabo Delgado province, in 1984-1985, no further cases have been reported in Mozambique. In March 2014, the Provincial Health Directorate of Cabo Delgado reported a suspected dengue outbreak in Pemba, associated with a recent increase in the frequency of patients with nonmalarial febrile illness. An investigation conducted between March and June detected a total of 193 clinically suspected dengue patients in Pemba and Nampula, the capital of neighboring Nampula Province. Dengue virus-type 2 (DENV-2) was detected by reverse transcriptase polymerase chain reaction in sera from three patients, and 97 others were classified as probable cases based on the presence of DENV nonstructural protein 1 antigen or anti-DENV immunoglobulin M antibody. Entomological investigations demonstrated the presence of Aedes aegypti mosquitos in both Pemba and Nampula cities.
Collapse
Affiliation(s)
- Marilia Massangaie
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Gabriela Pinto
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Fernando Padama
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Geraldo Chambe
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Mariana da Silva
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Inocêncio Mate
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Celia Chirindza
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sadia Ali
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sãozinha Agostinho
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Daniel Chilaule
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Jacqueline Weyer
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Chantel le Roux
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Ana Paula Abilio
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Cynthia Baltazar
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Timothy J Doyle
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Julie Cliff
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Janusz Paweska
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Eduardo Samo Gudo
- National Directorate of Public Health, Ministry of Health, Maputo, Mozambique; National Institute of Health, Ministry of Health, Maputo, Mozambique; Cabo Delgado Provincial Health Directorate, Pemba, Mozambique; Nampula Provincial Health Directorate, Nampula, Mozambique; Centre for Emerging and Zoonotic Diseases, National Institute of Communicable Disease, Johannesburg, South Africa; Center for Global Health, Centers for Disease Control and Prevention, Maputo, Mozambique; Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| |
Collapse
|
24
|
Gibb H, Devleesschauwer B, Bolger PM, Wu F, Ezendam J, Cliff J, Zeilmaker M, Verger P, Pitt J, Baines J, Adegoke G, Afshari R, Liu Y, Bokkers B, van Loveren H, Mengelers M, Brandon E, Havelaar AH, Bellinger D. World Health Organization estimates of the global and regional disease burden of four foodborne chemical toxins, 2010: a data synthesis. F1000Res 2015; 4:1393. [PMID: 26918123 PMCID: PMC4755404 DOI: 10.12688/f1000research.7340.1] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 01/07/2023] Open
Abstract
Background Chemical exposures have been associated with a variety of health effects; however, little is known about the global disease burden from foodborne chemicals. Food can be a major pathway for the general population's exposure to chemicals, and for some chemicals, it accounts for almost 100% of exposure. Methods and Findings Groups of foodborne chemicals, both natural and anthropogenic, were evaluated for their ability to contribute to the burden of disease. The results of the analyses on four chemicals are presented here - cyanide in cassava, peanut allergen, aflatoxin, and dioxin. Systematic reviews of the literature were conducted to develop age- and sex-specific disease incidence and mortality estimates due to these chemicals. From these estimates, the numbers of cases, deaths and disability adjusted life years (DALYs) were calculated. For these four chemicals combined, the total number of illnesses, deaths, and DALYs in 2010 is estimated to be 339,000 (95% uncertainty interval [UI]: 186,000-1,239,000); 20,000 (95% UI: 8,000-52,000); and 1,012,000 (95% UI: 562,000-2,822,000), respectively. Both cyanide in cassava and aflatoxin are associated with diseases with high case-fatality ratios. Virtually all human exposure to these four chemicals is through the food supply. Conclusion Chemicals in the food supply, as evidenced by the results for only four chemicals, can have a significant impact on the global burden of disease. The case-fatality rates for these four chemicals range from low (e.g., peanut allergen) to extremely high (aflatoxin and liver cancer). The effects associated with these four chemicals are neurologic (cyanide in cassava), cancer (aflatoxin), allergic response (peanut allergen), endocrine (dioxin), and reproductive (dioxin).
Collapse
Affiliation(s)
- Herman Gibb
- Gibb Epidemiology Consulting LLC, Arlington, VA, USA
| | - Brecht Devleesschauwer
- Department of Virology, Parasitology and Immunology, Ghent University, Merelbeke, Belgium
- Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
- Emerging Pathogens Institute and Animal Sciences Department, University of Florida, Gainesville, FL, USA
| | - P. Michael Bolger
- Exponent, Center for Chemical Regulation and Food Safety, Washington, DC, USA
| | - Felicia Wu
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, MI, USA
| | - Janine Ezendam
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marco Zeilmaker
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Philippe Verger
- Department of Food Safety and Zoonoses, World Health Organization, Geneva, Switzerland
| | - John Pitt
- CSIRO Food and Nutrition Flagship, North Ryde, Australia
| | - Janis Baines
- Food Data Analysis Section, Food Standards Australia New Zealand, Canberra, Australia
| | - Gabriel Adegoke
- Department of Food Technology, University of Ibadan, Ibadan, Nigeria
| | - Reza Afshari
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Yan Liu
- INTERTEK, Oak Brook, IL, USA
| | - Bas Bokkers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Henk van Loveren
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Marcel Mengelers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Esther Brandon
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Arie H. Havelaar
- National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
- Emerging Pathogens Institute and Animal Sciences Department, University of Florida, Gainesville, FL, USA
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands
| | - David Bellinger
- Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
25
|
Nhassico D, Bradbury JH, Cliff J, Majonda R, Cuambe C, Denton IC, Foster MP, Martins A, Cumbane A, Sitoe L, Pedro J, Muquingue H. Use of the wetting method on cassava flour in three konzo villages in Mozambique reduces cyanide intake and may prevent konzo in future droughts. Food Sci Nutr 2015; 4:555-61. [PMID: 27386105 PMCID: PMC4930499 DOI: 10.1002/fsn3.317] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 10/05/2015] [Accepted: 10/15/2015] [Indexed: 11/06/2022] Open
Abstract
Konzo is an irreversible paralysis of the legs that occurs mainly in children and young women associated with large cyanide intake from bitter cassava coupled with malnutrition. In East Africa outbreaks occur during drought, when cassava plants produce much more cyanogens than normal. A wetting method that removes cyanogens from cassava flour was taught to the women of three konzo villages in Mozambique, to prevent sporadic konzo and konzo outbreaks in the next drought. The intervention was in three villages with 72 konzo cases and mean konzo prevalence of 1.2%. The percentage of children with high (>350 μmol/L) urinary thiocyanate content and at risk of contracting konzo in Cava, Acordos de Lusaka, and Mujocojo reduced from 52, 10, and 6 at baseline to 17, 0, and 4 at conclusion of the intervention. Cassava flour showed large reductions in total cyanide over the intervention. The percentage of households using the wetting method was 30-40% in Acordos de Lusaka and Mujocojo and less in Cava. If the wetting method is used extensively by households during drought it should prevent konzo outbreaks and chronic cyanide intoxication. We recommend that the wetting method be taught in all konzo areas in East Africa.
Collapse
Affiliation(s)
- Dulce Nhassico
- Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique
| | - James Howard Bradbury
- EEG Research School of Biology Australian National University Canberra ACT 2601 Australia
| | - Julie Cliff
- Department of Community Health Faculdade de Medicina Unversidade Eduardo Mondlane Maputo Mozambique
| | - Rita Majonda
- Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique
| | - Constantino Cuambe
- Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique
| | - Ian C Denton
- EEG Research School of Biology Australian National University Canberra ACT 2601 Australia
| | - Matthew P Foster
- EEG Research School of Biology Australian National University Canberra ACT 2601 Australia
| | | | - Adelaide Cumbane
- Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique
| | - Luis Sitoe
- Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique
| | - Joao Pedro
- Instituto de Investigacao Agraria de Mocambique (IIAM) Nampula Mozambique
| | - Humberto Muquingue
- Department of Biochemistry Faculdade de Medicina Universidade Eduardo Mondlane Maputo Mozambique
| |
Collapse
|
26
|
Gudo ES, Pinto G, Vene S, Mandlaze A, Muianga AF, Cliff J, Falk K. Serological Evidence of Chikungunya Virus among Acute Febrile Patients in Southern Mozambique. PLoS Negl Trop Dis 2015; 9:e0004146. [PMID: 26473605 PMCID: PMC4608817 DOI: 10.1371/journal.pntd.0004146] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 09/16/2015] [Indexed: 11/29/2022] Open
Abstract
Background In the last two decades, chikungunya virus (CHIKV) has rapidly expanded to several geographical areas, causing frequent outbreaks in sub-Saharan Africa, South East Asia, South America, and Europe. Therefore, the disease remains heavily neglected in Mozambique, and no recent study has been conducted. Methods Between January and September 2013, acute febrile patients with no other evident cause of fever and attending a health center in a suburban area of Maputo city, Mozambique, were consecutively invited to participate. Paired acute and convalescent serum samples were requested from each participant. Convalescent samples were initially screened for anti-CHIKV IgG using a commercial indirect immunofluorescence test, and if positive, the corresponding acute sample was screened using the same test. Results Four hundred patients were enrolled. The median age of study participants was 26 years (IQR: 21–33 years) and 57.5% (224/391) were female. Paired blood samples were obtained from 209 patients, of which 26.4% (55/208) were presented anti-CHIKV IgG antibodies in the convalescent sample. Seroconversion or a four-fold titer rise was confirmed in 9 (4.3%) patients. Conclusion The results of this study strongly suggest that CHIKV is circulating in southern Mozambique. We recommend that CHIKV should be considered in the differential diagnosis of acute febrile illness in Mozambique and that systematic surveillance for CHIKV should be implemented. Chikungunya virus (CHIKV) is an emerging arbovirus that remains heavily neglected in Mozambique, and no recent study has been conducted. Between January and September 2013, four hundred acute febrile patients with no other evident cause of fever and attending a health center in a suburban area of Maputo city, Mozambique, were consecutively invited to participate. Paired acute and convalescent serum samples were drawn from each participant. Convalescent samples were initially screened for anti-CHIKV IgG, and if positive the corresponding acute sample was screened using the same test. Of the 209 patients from which paired samples was obtained, 26.4% (55/208) presented anti-CHIKV IgG antibodies in the convalescent sample. Seroconversion or a four-fold titer rise was confirmed in 9 (4.3%) patients. Overall our findings demonstrate that CHIKV is circulating in southern Mozambique and suggest that CHIKV should be considered in the differential diagnosis of acute febrile illness.
Collapse
Affiliation(s)
- Eduardo Samo Gudo
- National Institute of Health, Ministry of Health, Maputo, Mozambique
- * E-mail:
| | - Gabriela Pinto
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | - Sirkka Vene
- The Public Health Agency of Sweden, Solna, Stockholm, Sweden
| | - Arcildo Mandlaze
- National Institute of Health, Ministry of Health, Maputo, Mozambique
| | | | - Julie Cliff
- Eduardo Mondlane University, Faculty of Medicine, Maputo, Mozambique
| | - Kerstin Falk
- The Public Health Agency of Sweden, Solna, Stockholm, Sweden
- Karolinska Institutet, Solna, Stockholm, Sweden
| |
Collapse
|
27
|
Hemminki E, Parkkali S, Salome G, Augusto O, Cliff J, Nwaru B. Influence of HIV- infection on pregnant women's subsequent mortality in Maputo Mozambique 2007-2010. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv168.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
28
|
Bennett S, George A, Rodriguez D, Shearer J, Diallo B, Konate M, Dalglish S, Juma P, Namakhoma I, Banda H, Chilundo B, Mariano A, Cliff J. Policy challenges facing integrated community case management in Sub-Saharan Africa. Trop Med Int Health 2014; 19:872-82. [PMID: 24750516 PMCID: PMC4282431 DOI: 10.1111/tmi.12319] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [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] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To report an in-depth analysis of policy change for integrated community case management of childhood illness (iCCM) in six sub-Saharan African countries. We analysed how iCCM policies developed and the barriers and facilitators to policy change. METHODS Qualitative retrospective case studies drawing from document reviews, semi-structured interviews and in-country validation workshops were conducted in Burkina Faso, Kenya, Malawi, Mali, Mozambique and Niger. These countries were selected to maximise variation in iCCM policy status, community health worker (CHW) models and different African regions. RESULTS Country iCCM policies evolved in an ad hoc fashion, but were substantially influenced by the history of primary health care and the nature of CHW programmes. Technical officers within Ministries of Health led iCCM policy change with support from international donors, but neither communities nor political leadership was mobilised. Concerns about achieving the Millennium Development Goals, together with recognition of the shortcomings of existing child health programmes, led to the adoption of iCCM policies. Availability of external financing played a critical role in facilitating policy change. CONCLUSIONS iCCM policy change has been promoted by international agencies, but national governments have struggled to align iCCM with country health systems. Greater investment is needed in tailoring global policy initiatives to match country needs. High-level, political ownership of iCCM policies could facilitate policy change, as could clearer strategies for ensuring the long-term sustainability of such policies.
Collapse
Affiliation(s)
- Sara Bennett
- Johns Hopkins School of Public Health, Baltimore, MD, USA
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Murdoch B, Buchanan J, Cliff J. Temporomandibular joint replacement: a New Zealand perspective. Int J Oral Maxillofac Surg 2013; 43:595-9. [PMID: 24332584 DOI: 10.1016/j.ijom.2013.11.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [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: 12/20/2012] [Revised: 08/23/2013] [Accepted: 11/06/2013] [Indexed: 11/19/2022]
Abstract
Alloplastic total temporomandibular joint replacement (TMJ TJR) has been performed in New Zealand utilizing the TMJ Concepts patient-fitted system since 2000. The data analysed in this study were collected retrospectively from questionnaires sent to all maxillofacial surgeons in New Zealand who had implanted TMJ Concepts devices between 2000 and 2011. A total of 63 devices were implanted in 42 patients (13 males, 29 females) during this 12-year period. The primary indication for TMJ TJR was end-stage joint disease resulting from ankylosis and arthritis. The mean age of the patients was 47 years (range 7-80 years). The most common complication reported was transient facial nerve impairment in 4.8% of the patients. Objective results, measured as the maximal incisional opening, improved by a mean of 17.3mm (P<0.01); 90% of patients reported improved quality of life. New Zealand oral and maxillofacial surgeons have concluded that TMJ TJR using the TMJ Concepts prosthesis is a reliable treatment option for the management of end-stage TMJ disease.
Collapse
Affiliation(s)
- B Murdoch
- Broadway Surgical Clinic, Palmerston North, New Zealand.
| | - J Buchanan
- Middlemore Hospital, Auckland, New Zealand
| | - J Cliff
- Palmerston North Hospital, MidCentral DHB, Palmerston North, New Zealand
| |
Collapse
|
30
|
Parkkali S, Abacassamo F, Nwaru BI, Salomé G, Augusto O, Regushevskaya E, Dgedge M, Sousa C, Cliff J, Chilundo B, Hemminki E. Comparison of routine prenatal iron prophylaxis and screening and treatment for anaemia: pregnancy results and preliminary birth results from a pragmatic randomised controlled trial (PROFEG) in Maputo, Mozambique. BMJ Open 2013; 3:bmjopen-2012-001948. [PMID: 23396557 PMCID: PMC3585968 DOI: 10.1136/bmjopen-2012-001948] [Citation(s) in RCA: 6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To present the pregnancy results and interim birth results of a pragmatic randomised controlled trial comparing routine iron prophylaxis with screening and treatment for anaemia during pregnancy in a setting of endemic malaria and HIV. DESIGN A pragmatic randomised controlled trial. SETTING Two health centres (1° de Maio and Machava) in Maputo, Mozambique, a setting of endemic malaria and high prevalence of HIV. PARTICIPANTS Pregnant women (≥18-year-olds; non-high-risk pregnancy, n=4326) attending prenatal care consultation at the two health centres were recruited to the trial. INTERVENTIONS The women were randomly allocated to either Routine iron (n=2184; 60 mg ferrous sulfate plus 400 μg of folic acid daily throughout pregnancy) or Selective iron (n=2142; screening and treatment for anaemia and daily intake of 1 mg of folic acid). OUTCOME MEASURES The primary outcomes were preterm delivery (delivery <37 weeks of gestation) and low birth weight (<2500 g). The secondary outcomes were symptoms suggestive of malaria and self-reported malaria during pregnancy; birth length; caesarean section; maternal and child health status after delivery. RESULTS The number of follow-up visits was similar in the two groups. Between the first and fifth visits, the two groups were similar regarding the occurrence of fever, headache, cold/chills, nausea/vomiting and body aches. There was a suggestion of increased incidence of self-reported malaria during pregnancy (OR 1.37, 95% CI 0.98 to1.92) in the Routine iron group. Birth data were available for 1109 (51%) in the Routine iron group and for 1149 (54%) in the Selective iron group. The birth outcomes were relatively similar in the two groups. However, there was a suggestion (statistically non-significant) of poorer outcomes in the Routine iron group with regard to long hospital stay after birth (relative risk (RR) 1.43, 95% CI 0.97 to 1.26; risk difference (RD) 0.02, 95% CI -0.00 to 0.03) and unavailability of delivery data (RR 1.06, 95% CI 1.00 to 1.13; RD 0.03, 95% CI -0.01 to 0.07). CONCLUSIONS These interim results suggest that routine iron prophylaxis during pregnancy did not confer advantage over screening and treatment for anaemia regarding maternal and child health. Complete data on birth outcomes are being collected for firmer conclusions. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov, number NCT00488579 (June 2007). The first women were randomised to the trial proper April 2007-March 2008. The pilot was November 2006-March 2008. The 3-month lag was due to technical difficulties in completing trial registration.
Collapse
Affiliation(s)
- Saara Parkkali
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| | - Fatima Abacassamo
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Graca Salomé
- Department of Physiological Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Orvalho Augusto
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Elena Regushevskaya
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Cesar Sousa
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Julie Cliff
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Baltazar Chilundo
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique
| | - Elina Hemminki
- Health Services and Policy Research, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
31
|
Mahoque R, Cliff J, Lynch C, Wright D, Click L, Sasser S, Macleod J. An epidemiologic profile of trauma patients admitted to maputo central hospital, maputo-mozambique. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590b.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
32
|
Nwaru BI, Parkkali S, Abacassamo F, Salomé G, Chilundo B, Augusto O, Cliff J, Dgedge M, Regushevskaya E, Nikula M, Hemminki E. A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success. Matern Child Nutr 2012; 11:146-63. [PMID: 23020829 DOI: 10.1111/mcn.12006] [Citation(s) in RCA: 3] [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] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The effects of prophylactic iron during pregnancy on maternal and child health in developing settings with endemic malaria and high prevalence of HIV remain unclear. This paper describes the rationale, implementation and success of a pragmatic randomised controlled trial comparing routine iron supplementation vs. screening and treatment for anaemia during pregnancy. The setting was two health centres in Maputo, Mozambique. Pregnant women (≥ 12-week gestation; ≥ 18 years old; and not with a high-risk pregnancy, n=4326) were recruited. The main outcomes are preterm delivery and low birthweight. The women were randomly assigned to one of two iron administration policies: a routine iron group (n=2184) received 60 mg of ferrous sulphate plus 400 μg of folic acid daily while a selective iron group (n=2142) had screening and treatment for anaemia and a daily intake of 1 mg of folic acid. The recruitment, follow-up, and collection of follow-up data were successful; both groups were similar to each other in all the trial stages. Collection of delivery data was challenging and data on about 40% of births is missing. These are currently being traced through different hospitals and health centres. The compliance of the study personnel and the women with regard to regular measurement of haemoglobin and intake of the iron and folic acid tablets was high and similar in both trial arms. Taking into account the various constraints encountered, the stages of the present trial prior to delivery were carried out well.
Collapse
Affiliation(s)
- Bright I Nwaru
- School of Health Sciences, University of Tampere, Tampere, Finland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Nkonki L, Cliff J, Sanders D. Lay health worker attrition: important but often ignored. Bull World Health Organ 2011; 89:919-23. [PMID: 22271950 PMCID: PMC3260896 DOI: 10.2471/blt.11.087825] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 08/15/2011] [Accepted: 08/23/2011] [Indexed: 11/27/2022] Open
Abstract
Lay health workers are key to achieving universal health-care coverage, therefore measuring worker attrition and identifying its determinants should be an integral part of any lay health worker programme. Both published and unpublished research on lay health workers has largely focused on the types of interventions they can deliver effectively. This is an imperative since the main objective of these programmes is to improve health outcomes. However, high attrition rates can undermine the effectiveness of these programmes. There is a lack of research on lay health worker attrition. Research that aims to answer the following three key questions would help address this knowledge gap: what is the magnitude of attrition in programmes? What are the determinants of attrition? What are the most successful ways of reducing attrition? With community-based interventions and task shifting high on the United Nations Millennium Development Goals' policy agenda, research on lay health worker attrition and its determinants requires urgent attention.
Collapse
Affiliation(s)
- Lungiswa Nkonki
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa.
| | | | | |
Collapse
|
34
|
Abstract
Konzo is a distinct neurological entity with selective upper motor neuron damage, characterized by an abrupt onset of an irreversible, non-progressive, and symmetrical spastic para/tetraparesis. Despite its severity, konzo remains a neglected disease. The disease is associated with high dietary cyanogen consumption from insufficiently processed roots of bitter cassava combined with a protein-deficient diet. Epidemics occur when these conditions coincide at times of severe food shortage. Up to 1993, outbreaks in poor rural areas in Africa contributed to more than 3,700 cases of konzo. The number of affected people is underestimated. From unofficial reports, the number of cases was estimated to be at least 100,000 in 2000, in contrast to the 6,788 cases reported up to 2009 from published papers.
Collapse
|
35
|
Bradbury JH, Cliff J, Denton IC. Uptake of wetting method in Africa to reduce cyanide poisoning and konzo from cassava. Food Chem Toxicol 2011; 49:539-42. [DOI: 10.1016/j.fct.2010.04.049] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 03/18/2010] [Accepted: 04/24/2010] [Indexed: 11/16/2022]
|
36
|
Cliff J, Muquingue H, Nhassico D, Nzwalo H, Bradbury JH. Konzo and continuing cyanide intoxication from cassava in Mozambique. Food Chem Toxicol 2010; 49:631-5. [PMID: 20654676 DOI: 10.1016/j.fct.2010.06.056] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 06/16/2010] [Accepted: 06/18/2010] [Indexed: 11/26/2022]
Abstract
In Mozambique, epidemics of the cassava-associated paralytic disease, konzo, have been reported in association with drought or war: over 1100 cases in 1981, over 600 cases in 1992-1993, and over 100 cases in 2005. Smaller epidemics and sporadic cases have also been reported. Large epidemics have occurred at times of agricultural crisis, during the cassava harvest, when the population has been dependent on a diet of insufficiently processed bitter cassava. Konzo mostly affects women of child-bearing age and children over 2 years of age. When measured, serum or urinary thiocyanate concentrations, indicative of cyanide poisoning, have been high in konzo patients during epidemics and in succeeding years. Monitoring of urinary thiocyanate concentrations in schoolchildren in konzo areas has shown persistently high concentrations at the time of the cassava harvest. Inorganic sulphate concentrations have been low during and soon after epidemics. Programmes to prevent konzo have focused on distributing less toxic varieties of cassava and disseminating new processing methods, such as grating and the flour wetting method. Attention should be given to the wider question of agricultural development and food security in the regions of Africa where dependence on bitter cassava results in chronic cyanide intoxication and persistent and emerging konzo.
Collapse
Affiliation(s)
- J Cliff
- Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.
| | | | | | | | | |
Collapse
|
37
|
Cliff J, Lewin S, Woelk G, Fernandes B, Mariano A, Sevene E, Daniels K, Matinhure S, Oxman A, Lavis J. Policy development in malaria vector management in Mozambique, South Africa and Zimbabwe. Health Policy Plan 2010; 25:372-83. [PMID: 20176574 PMCID: PMC3072826 DOI: 10.1093/heapol/czq008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Indoor residual spraying (IRS) and insecticide-treated nets (ITNs), two principal malaria control strategies, are similar in cost and efficacy. We aimed to describe recent policy development regarding their use in Mozambique, South Africa and Zimbabwe. METHODS Using a qualitative case study methodology, we undertook semi-structured interviews of key informants from May 2004 to March 2005, carried out document reviews and developed timelines of key events. We used an analytical framework that distinguished three broad categories: interests, ideas and events. RESULTS A disparate mix of interests and ideas slowed the uptake of ITNs in Mozambique and Zimbabwe and prevented uptake in South Africa. Most respondents strongly favoured one strategy over the other. In all three countries, national policy makers favoured IRS, and only in Mozambique did national researchers support ITNs. Outside interests in favour of IRS included manufacturers who supplied the insecticides and groups opposing environmental regulation. International research networks, multilateral organizations, bilateral donors and international NGOs supported ITNs. Research evidence, local conditions, logistic feasibility, past experience, reaction to outside ideas, community acceptability, the role of government and NGOs, and harm from insecticides used in spraying influenced the choice of strategy. The end of apartheid permitted a strongly pro-IRS South Africa to influence the region, and in Mozambique and Zimbabwe, floods provided conditions conducive to ITN distribution. CONCLUSIONS Both IRS and ITNs have a place in integrated malaria vector management, but pro-IRS interests and ideas slowed or prevented the uptake of ITNs. Policy makers needed more than evidence from trials to change from the time-honoured IRS strategy that they perceived was working. Those intending to promote new policies such as ITNs should examine the interests and ideas motivating key stakeholders and their own institutions, and identify where shifts in thinking or coalitions among the like-minded may be possible.
Collapse
Affiliation(s)
- Julie Cliff
- Department of Community Health, Eduardo Mondlane University, Maputo, Mozambique.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Woelk G, Daniels K, Cliff J, Lewin S, Sevene E, Fernandes B, Mariano A, Matinhure S, Oxman AD, Lavis JN, Lundborg CS. Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries. Health Res Policy Syst 2009; 7:31. [PMID: 20042117 PMCID: PMC2809043 DOI: 10.1186/1478-4505-7-31] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [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: 08/28/2009] [Accepted: 12/30/2009] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Little is known about the process of knowledge translation in low- and middle-income countries. We studied policymaking processes in Mozambique, South Africa and Zimbabwe to understand the factors affecting the use of research evidence in national policy development, with a particular focus on the findings from randomized control trials (RCTs). We examined two cases: the use of magnesium sulphate (MgSO(4)) in the treatment of eclampsia in pregnancy (a clinical case); and the use of insecticide treated bed nets and indoor residual household spraying for malaria vector control (a public health case). METHODS We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data. FINDINGS Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO(4 )and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO(4 )than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO(4), and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries. CONCLUSION Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups.
Collapse
Affiliation(s)
- Godfrey Woelk
- Department of Community Medicine, University of Zimbabwe, PO Box A178 Avondale, Harare, Zimbabwe.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Paula Cardoso A, Ernesto M, Nicala D, Mirione E, Chavane L, N'zwalo H, Chikumba S, Cliff J, Paulo Mabota A, Rezaul Haque M, Howard Bradbury J. Combination of cassava flour cyanide and urinary thiocyanate measurements of school children in Mozambique. Int J Food Sci Nutr 2009; 55:183-90. [PMID: 15223594 DOI: 10.1080/09637480410001725265] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The maximum daily cassava flour intake of children may be calculated from determination of the total cyanide content of cassava flour and urinary thiocyanate levels of school children in samples collected at the same time and place. Four sites, two with and two without recent konzo cases, were chosen for study. In two sites with recent konzo cases, 84% and 93% of school children consumed cassava the previous day, and the calculated maximum daily consumption of cassava was over 700 g. In two sites without recent konzo cases, about 50% of school children consumed cassava the previous day and the calculated daily consumption of cassava flour was less than 150 g. By measurements of cyanide in flour and urinary thiocyanate we are therefore able to distinguish between communities whose diet is almost totally reliant on cassava, and who are therefore susceptible to konzo, and those who have a broader diet and are free from konzo. In another calculation it is shown that 4-23% of the essential S-containing amino acids in the cassava flour consumed by children is used up to detoxify and flour cyanide to thiocyanate. This depletion of methionine and cystine may leads to protein deficiency and may contribute to onset of konzo.
Collapse
Affiliation(s)
- A Paula Cardoso
- Ministerio da Saude Laboratorio Nacional de Higiene de Alimentos e Aguas CP 264 Maputo, Mozambique
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Sevene E, Lewin S, Mariano A, Woelk G, Oxman AD, Matinhure S, Cliff J, Fernandes B, Daniels K. System and market failures: the unavailability of magnesium sulphate for the treatment of eclampsia and pre-eclampsia in Mozambique and Zimbabwe. BMJ 2005; 331:765-9. [PMID: 16195297 PMCID: PMC1239984 DOI: 10.1136/bmj.331.7519.765] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [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] [Indexed: 11/03/2022]
Abstract
Low cost and effective drugs, such as magnesium sulphate, need to be included in initiatives to improve access to essential medicines in Africa
Collapse
Affiliation(s)
- E Sevene
- Department of Pharmacology, Faculty of Medicine, Eduardo Mondlane University, Mozambique
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Cardoso A, Mirione E, Ernesto M, Massaza F, Cliff J, Rezaul Haque M, Bradbury J. Processing of cassava roots to remove cyanogens. J Food Compost Anal 2005. [DOI: 10.1016/j.jfca.2004.04.002] [Citation(s) in RCA: 148] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Cliff J, Walt G, Nhatave I. What's in a Name? Policy transfer in Mozambique: DOTS for tuberculosis and syndromic management for sexually transmitted infections. J Public Health Policy 2004; 25:38-55. [PMID: 15134131 DOI: 10.1057/palgrave.jphp.3190003] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A common assumption is that international health policies are imposed on developing countries, owing to their high level of dependence on international aid. In reality, the process is likely to be complex. Drawing on analytical frameworks developed to study policy transfer between jurisdictions, this paper explores how far two globally promoted infectious disease policies (DOTS for tuberculosis and syndromic management for sexually transmitted infections) were voluntarily or coercively transferred in one particular setting, Mozambique. The paper suggests that guidelines emanating from these policies were not imposed, but evolved in the 1980s through technical networks of national and international experts. Further, that it was experience at the country level that fed into the globally promoted policies of the 1990s. By the time the policies were transferred by WHO and other international organisations to developing countries in the 1990s, Mozambique had already adopted their guidelines for good practice.
Collapse
Affiliation(s)
- Julie Cliff
- Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | | | | |
Collapse
|
44
|
Cliff J, Simango A, Augusto O, Van Der Paal L, Biellik R. Failure of targeted urban supplemental measles vaccination campaigns (1997-1999) to prevent measles epidemics in Mozambique (1998-2001). J Infect Dis 2003; 187 Suppl 1:S51-7. [PMID: 12721891 DOI: 10.1086/368058] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This study assessed the effect of urban supplemental measles vaccination campaigns (1997-1999) in Mozambique that targeted children aged 9-59 months. Reported measles cases were analyzed to the end of 2001 to determine campaign impact. Hospital inpatient data were collected in the national capital and in three provincial capitals where epidemics occurred the year after the campaigns. Measles epidemics followed campaigns in the capital city, in 4 of 9 provincial capitals, and in 39 of 126 districts. Reasons for limited campaign impact included a low proportion of urban dwellers, the geographic location of some provincial capitals, the limited target age group, and low routine and campaign coverage. Routine immunization and disease surveillance should be strengthened and campaigns must achieve >90% coverage and target wider age groups and geographic areas in order to reach a high proportion of persons susceptible to measles.
Collapse
Affiliation(s)
- Julie Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
| | | | | | | | | |
Collapse
|
45
|
Cliff J, Turshen M. African Women's Health. J Public Health Policy 2003. [DOI: 10.2307/3343394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
46
|
Ernesto M, Cardoso AP, Nicala D, Mirione E, Massaza F, Cliff J, Haque MR, Bradbury JH. Persistent konzo and cyanogen toxicity from cassava in northern Mozambique. Acta Trop 2002; 82:357-62. [PMID: 12039675 DOI: 10.1016/s0001-706x(02)00042-6] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We aimed to detect new cases of konzo and monitor cyanogen exposure from cassava flour in communities previously affected by konzo epidemics in Nampula Province, northern Mozambique. Other objectives were to detect subclinical upper motor neuron damage in schoolchildren and test a new kit to measure urinary thiocyanate concentration. In 1999 and 2000, we carried out active and passive case detection for konzo in Memba and Mogincual Districts. In July and October, 1999, we collected cassava flour from 30 houses in three communities and measured cyanogen concentrations with a picrate kit. In October 1999, we examined all schoolchildren in three communities for ankle clonus and measured urinary thiocyanate concentration in thirty schoolchildren in each of five communities with a picrate kit. We found 27 new cases of konzo in Mogincual District. Mean total cyanogen concentrations in cassava flour varied between both seasons and years, but were always high, ranging from 26 to 186 ppm. Very high mean levels at three sites in November 1998 and July 1999 were probably due to low rainfall in the 1997-1998 season. The proportion of schoolchildren with ankle clonus varied from 8 to 17%. The new picrate kit for urinary thiocyanate worked well; mean concentrations in schoolchildren ranged from 225 to 384 micromol x l(-1). Konzo and sub-clinical upper motor neuron damage persist in poor rural communities in northern Mozambique, associated with high cyanogen concentrations in cassava flour and high urinary thiocyanate concentrations in schoolchildren.
Collapse
Affiliation(s)
- Mario Ernesto
- Direcção Provincial da Saúde, CP 14, Nampula, Mozambique
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Dgedge M, Novoa A, Macassa G, Sacarlal J, Black J, Michaud C, Cliff J. The burden of disease in Maputo City, Mozambique: registered and autopsied deaths in 1994. Bull World Health Organ 2001; 79:546-52. [PMID: 11436477 PMCID: PMC2566439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
Abstract
OBJECTIVE To classify the causes of death in Maputo City, Mozambique, using the methods of the Global Burden of Disease study, in order to provide information for health policy-makers and to obtain a baseline for future studies in Maputo City and provincial capitals. METHODS Data were taken from the Maputo City death register and autopsy records for 1994. FINDINGS A total of 9011 deaths were recorded in the death register, representing a coverage of approximately 86%. Of these, 8114 deaths (92%) were classified by cause. Communicable, maternal, perinatal, and nutritional disorders accounted for 5319 deaths; noncommunicable diseases for 1834; and injuries for 961. The 10 leading causes of registered deaths were perinatal disorders (1643 deaths); malaria (928); diarrhoeal diseases (814); tuberculosis (456); lower respiratory infections (416); road-traffic accidents (371); anaemia (269); cerebrovascular diseases (269); homicide (188); and bacterial meningitis (178). CONCLUSIONS Infectious diseases of all types, injuries, and cerebrovascular disease ranked as leading causes of death, according to both the autopsy records and the city death register. AIDS-related deaths were underreported. With HIV infection increasing rapidly, AIDS will add to the already high burden of infectious diseases and premature mortality in Maputo City. The results of the study indicate that cause of death is a useful outcome indicator for disease control programmes.
Collapse
|
48
|
Cliff J, Turshen M. Privatizing Health Services in Africa. J Public Health Policy 2000. [DOI: 10.2307/3343480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
49
|
Logie D, Bergstrom S, Cliff J. Debt relief and health charges in Mozambique. Lancet 1999; 353:2077-8. [PMID: 10376660 DOI: 10.1016/s0140-6736(05)77906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Cliff J, Nicala D, Saute F, Givragy R, Azambuja G, Taela A, Chavane L, Gani A. Ankle clonus and thiocyanate, linamarin, and inorganic sulphate excretion in school children in communities with Konzo, Mozambique. J Trop Pediatr 1999; 45:139-42. [PMID: 10401190 DOI: 10.1093/tropej/45.3.139] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [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] [Indexed: 11/12/2022]
Abstract
We examined 397 school children for ankle clonus in five communities in three districts affected by konzo, spastic paraparesis associated with cassava consumption. From a subsample of 131 children, we analysed urine specimens for urinary thiocyanate, linamarin, and inorganic sulphate. The proportion of children with clonus varied between sites, ranging from 4 to 22 per cent. Geometric mean thiocyanate, linamarin, and inorganic sulphate concentrations were 163 and 60 mumol/l and 4.4 mmol/l, respectively. Children with ankle clonus had higher urinary thiocyanate concentrations. We recommend prevention to reduce cyanide exposure and further monitoring of cyanide exposure and neurological damage in these communities.
Collapse
Affiliation(s)
- J Cliff
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.
| | | | | | | | | | | | | | | |
Collapse
|