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Gorman D, Sim J, Nygaard Mottelson I, Sodemann M, Nielsen D. 3.5-O2Interpreters’ perspectives on their working condition – A comparable qualitative study between Scotland and Denmark. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - J Sim
- Edinburgh University, Scotland
| | | | - M Sodemann
- Migrant Health Clinic, University of Southern Denmark, Odense, Denmark
| | - D Nielsen
- Migrant Health Clinic, University of Southern Denmark, Odense, Denmark
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Nielsen D, Rehling C, Korsholm K, Buch S, Nguyen N, Hermansen M, Sodemann M. 4.5-O4Multidisciplinary network meetings improve patients’ course of treatment – a clinical study in Denmark. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D Nielsen
- University of Southern Denmark, Odense, Denmark
| | - C Rehling
- University of Southern Denmark, Odense, Denmark
- Migrant Health Clinic, Odense University Hospital, Denmark
| | - K Korsholm
- Migrant Health Clinic, Odense University Hospital, Denmark
| | - S Buch
- Migrant Health Clinic, Odense University Hospital, Denmark
| | - N Nguyen
- Migrant Health Clinic, Odense University Hospital, Denmark
| | - M Hermansen
- Migrant Health Clinic, Odense University Hospital, Denmark
| | - M Sodemann
- University of Southern Denmark, Odense, Denmark
- Migrant Health Clinic, Odense University Hospital, Denmark
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3
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Nielsen D, Korsholm K, Rehling C, Sodemann M. 2.3-O7How to do patient involvement in a migrant health clinic – a clinical study in Denmark. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky047.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- D Nielsen
- University of Southern Denmark, Odense, Denmark
| | - K Korsholm
- University of Southern Denmark, Odense, Denmark
| | - C Rehling
- University of Southern Denmark, Odense, Denmark
| | - M Sodemann
- University of Southern Denmark, Odense, Denmark
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4
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Jelenkovic A, Yokoyama Y, Sund R, Hur YM, Harris JR, Brandt I, Nilsen TS, Ooki S, Ullemar V, Almqvist C, Magnusson PKE, Saudino KJ, Stazi MA, Fagnani C, Brescianini S, Nelson TL, Whitfield KE, Knafo-Noam A, Mankuta D, Abramson L, Cutler TL, Hopper JL, Llewellyn CH, Fisher A, Corley RP, Huibregtse BM, Derom CA, Vlietinck RF, Bjerregaard-Andersen M, Beck-Nielsen H, Sodemann M, Krueger RF, McGue M, Pahlen S, Alexandra Burt S, Klump KL, Dubois L, Boivin M, Brendgen M, Dionne G, Vitaro F, Willemsen G, Bartels M, van Beijsterveld CEM, Craig JM, Saffery R, Rasmussen F, Tynelius P, Heikkilä K, Pietiläinen KH, Bayasgalan G, Narandalai D, Haworth CMA, Plomin R, Ji F, Ning F, Pang Z, Rebato E, Tarnoki AD, Tarnoki DL, Kim J, Lee J, Lee S, Sung J, Loos RJF, Boomsma DI, Sørensen TIA, Kaprio J, Silventoinen K. Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project. Early Hum Dev 2018; 120:53-60. [PMID: 29656171 PMCID: PMC6532975 DOI: 10.1016/j.earlhumdev.2018.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 04/06/2018] [Accepted: 04/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment. AIM To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors. METHODS This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses. RESULTS Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length. CONCLUSION Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight.
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Affiliation(s)
- A Jelenkovic
- Department of Social Research, University of Helsinki, Helsinki, Finland, Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Y Yokoyama
- Department of Public Health Nursing, Osaka City University, Osaka, Japan
| | - R Sund
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - YM Hur
- Department of Education, Mokpo National University, Jeonnam, South Korea
| | - JR Harris
- Norwegian Institute of Public Health, Oslo, Norway
| | - I Brandt
- Norwegian Institute of Public Health, Oslo, Norway
| | - TS Nilsen
- Norwegian Institute of Public Health, Oslo, Norway
| | - S Ooki
- Department of Health Science, Ishikawa Prefectural Nursing University, Kahoku, Ishikawa, Japan
| | - V Ullemar
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - C Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden, Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - PKE Magnusson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - KJ Saudino
- Boston University, Department of Psychological and Brain Sciences, Boston, MA, USA
| | - MA Stazi
- Istituto Superiore di Sanità - Centre for Behavioural Sciences and Mental Health, Rome, Italy
| | - C Fagnani
- Istituto Superiore di Sanità - Centre for Behavioural Sciences and Mental Health, Rome, Italy
| | - S Brescianini
- Istituto Superiore di Sanità - Centre for Behavioural Sciences and Mental Health, Rome, Italy
| | - TL Nelson
- Department of Health and Exercise Sciences, Colorado School of Public Health, Colorado State University, USA
| | - KE Whitfield
- Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - A Knafo-Noam
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Mankuta
- Hadassah Hospital Obstetrics and Gynecology Department, Hebrew University Medical School, Jerusalem, Israel
| | - L Abramson
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | - TL Cutler
- The Australian Twin Registry, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia
| | - JL Hopper
- The Australian Twin Registry, Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia, Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - CH Llewellyn
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - A Fisher
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - RP Corley
- Institute of Behavioral Science, University of Colorado, Boulder, CO, USA
| | - BM Huibregtse
- Institute of Behavioral Science, University of Colorado, Boulder, CO, USA
| | - CA Derom
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium, Department of Obstetrics and Gynaecology, Ghent University Hospitals, Ghent, Belgium
| | - RF Vlietinck
- Centre of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - M Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau, Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - H Beck-Nielsen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - M Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - RF Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - M McGue
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - S Pahlen
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - KL Klump
- Michigan State University, East Lansing, MI, USA
| | - L Dubois
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - M Boivin
- École de psychologie, Université Laval, Québec, Canada, Institute of Genetic, Neurobiological, and Social Foundations of Child Development, Tomsk State University, Russian Federation
| | - M Brendgen
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - G Dionne
- École de psychologie, Université Laval, Québec, Canada
| | - F Vitaro
- École de psychoéducation, Université de Montréal, Montréal, Québec, Canada
| | - G Willemsen
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - M Bartels
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - CEM van Beijsterveld
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - JM Craig
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - R Saffery
- Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - F Rasmussen
- Department of Health Sciences, Lund University, Sweden
| | - P Tynelius
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - K Heikkilä
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - KH Pietiläinen
- Obesity Research Unit, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - G Bayasgalan
- Healthy Twin Association of Mongolia, Ulaanbaatar, Mongolia
| | - D Narandalai
- Healthy Twin Association of Mongolia, Ulaanbaatar, Mongolia, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - CMA Haworth
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - R Plomin
- King’s College London, MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - F Ji
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - F Ning
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - Z Pang
- Department of Noncommunicable Diseases Prevention, Qingdao Centers for Disease Control and Prevention, Qingdao, China
| | - E Rebato
- Department of Genetics, Physical Anthropology and Animal Physiology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - AD Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary, Hungarian Twin Registry, Budapest, Hungary
| | - DL Tarnoki
- Department of Radiology, Semmelweis University, Budapest, Hungary, Hungarian Twin Registry, Budapest, Hungary
| | - J Kim
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - J Lee
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - S Lee
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea
| | - J Sung
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea, Institute of Health and Environment, Seoul National University, Seoul, South Korea
| | - RJF Loos
- The Charles Bronfman Institute for Personalized Medicine, The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - DI Boomsma
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, Netherlands
| | - TIA Sørensen
- Novo Nordisk Foundation Centre for Basic Metabolic Research (Section of Metabolic Genetics), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark, Department of Public Health (Section of Epidemiology), Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Kaprio
- Department of Public Health, University of Helsinki, Helsinki, Finland, Institute for Molecular Medicine FIMM, Helsinki, Finland
| | - K Silventoinen
- Department of Social Research, University of Helsinki, Helsinki, Finland, Osaka University Graduate School of Medicine, Osaka University, Osaka, Japan
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Rodkjaer L, Gabel C, Laursen T, Slot M, Leutscher P, Christensen N, Holmskov J, Sodemann M. Simple and practical screening approach to identify HIV-infected individuals with depression or at risk of developing depression. HIV Med 2017; 17:749-757. [PMID: 27186956 DOI: 10.1111/hiv.12381] [Citation(s) in RCA: 5] [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] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Studies have shown that depression and other mental illnesses are under-diagnosed among HIV-infected individuals. The aim of this study was to evaluate the use of mental health history and questionnaire-based screening instruments to identify HIV-infected individuals at risk of depression. METHODS The Beck Depression Inventory II (BDI-II) was used to assess the prevalence and severity of depressive symptoms among HIV-infected individuals attending two out-patient clinics in Denmark. HIV-infected individuals with a BDI-II score ≥ 20 were offered a clinical evaluation by a consultant psychiatrist. The BDI-II score was compared to the outcome of mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool. RESULTS A total of 501 HIV-infected individuals were included in the study. Symptoms of moderate/major depression (BDI-II score ≥ 20) were observed in 111 patients (22%); 65 of these patients consulted a psychiatrist, of whom 71% were diagnosed with a co-existing disorder. The BDI-II score was compared to the outcome of a mental health history review, and to results obtained using the European AIDS Clinical Society (EACS) two-item depression screening tool. The two questions showed a sensitivity and specificity of 95% and 68%, respectively, for diagnosis of current depression or risk of depression. A previous psychiatric history and substance abuse were independently associated with an increased risk of depression. CONCLUSIONS We suggest that the mental health of HIV-infected individuals should be reviewed and a "risk-flag" three-step approach should be used (1) to screen routinely with the two verbal questions suggested by the EACS, (2) to identify whether there is a risk of depression and then screen with the BDI-II, and (3) to identify whether there is still a risk and then perform a full evaluation and obtain an accurate psychiatric diagnosis by a psychiatrist.
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Affiliation(s)
- L Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.
| | - C Gabel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - T Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - M Slot
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - P Leutscher
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - N Christensen
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - J Holmskov
- Department of Psychiatric Diseases, Odense University Hospital, Odense, Denmark
| | - M Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Slot M, Sodemann M, Gabel C, Holmskov J, Laursen T, Rodkjaer L. Factors associated with risk of depression and relevant predictors of screening for depression in clinical practice: a cross-sectional study among HIV-infected individuals in Denmark. HIV Med 2015; 16:393-402. [PMID: 25585857 DOI: 10.1111/hiv.12223] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Depression and psychiatric disorders are frequent among HIV-infected individuals. The aim of this study was to determine the prevalence of depression and describe the psychiatric history of HIV-infected individuals in an out-patient clinic in Denmark and to identify factors of clinical importance that may be used to identify patients at risk of depression. METHODS In 2013, 212 HIV-infected patients were included in a questionnaire study. We used the Beck Depression Inventory II (BDI-II) to assess the prevalence and severity of depressive symptoms. Patients with a BDI-II score ≥ 20 were offered a clinical evaluation by a consultant psychiatrist. Logistic regression was used to determine predictors associated with risk of depression. RESULTS Symptoms of depression (BDI-II score ≥ 14) were observed in 75 patients (35%), and symptoms of moderate to major depression (BDI-II score ≥ 20) in 55 patients (26%). There was also a high prevalence of co-occurring mental illness. In a multivariate model, self-reported stress, self-reported perception that HIV infection affects all aspects of life, self-reported poor health, not being satisfied with one's current life situation, previous alcohol abuse, nonadherence to antiretroviral therapy and previously having sought help because of psychological problems were independently associated with risk of depression. CONCLUSIONS Symptoms of depression and co-occurring mental illness are under-diagnosed and under-treated among HIV-infected individuals. We recommend that screening of depression should be conducted regularly to provide a full psychiatric profile to decrease the risk of depression and improve adherence and quality of life in this population.
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Affiliation(s)
- M Slot
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - C Gabel
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J Holmskov
- Department of Psychiatric Diseases, Odense University Hospital, Odense, Denmark
| | - T Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - L Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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7
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Bjerregaard-Andersen M, Biering-Sørensen S, Gomes GM, Bidonga A, Jensen DM, Rodrigues A, Christensen K, Aaby P, Beck-Nielsen H, Benn CS, Sodemann M. Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau. Trop Med Int Health 2014; 19:1477-87. [PMID: 25244312 DOI: 10.1111/tmi.12388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau. METHODS The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register at the National Hospital. RESULTS About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.09-4.07). In a multivariable analysis among twins only, birth weight <2000 g [3.32, (1.36-8.07)], death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection was strongly associated with twin mortality [3.16, (1.24-8.05)]. Death occurred at home for 60% of twins and 67% of singletons. During follow-up, 90 first-time hospital admissions were registered, with similar rates observed for twins (139/1000) and singletons (143/1000) [0.97, (0.61-1.52)]. CONCLUSION The post-perinatal infant mortality rate of twins was double that of singletons. No excess in twin hospitalisations was observed, possibly implying obstacles to hospital admission for twins in case of severe illness.
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Affiliation(s)
- M Bjerregaard-Andersen
- Bandim Health Project, INDEPTH Network, Bissau, Guinea-Bissau; Research Center for Vitamins and Vaccines, Statens Serum Institute, Copenhagen, Denmark
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8
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Lemvik G, Rudolf F, Vieira F, Sodemann M, Østergaard L, Rodrigues A, Gomes V, Aaby P, Wejse C. Decline in overall, smear-negative and HIV-positive TB incidence while smear-positive incidence stays stable in Guinea-Bissau 2004-2011. Trop Med Int Health 2014; 19:1367-76. [PMID: 25145557 DOI: 10.1111/tmi.12378] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To calculate Tuberculosis (TB) incidence rates in Guinea-Bissau over an 8-year period. METHODS Since 2003, a surveillance system has registered all TB cases in six suburban districts of Bissau. In this population-based prospective follow-up study, 1205 cases of pulmonary TB were identified between January 2004 and December 2011. Incidence rates were calculated using census data from the Bandim Health and Demographic Surveillance System (HDSS). RESULTS The overall incidence of pulmonary TB was 279 per 100,000 person-years of observation; the male incidence being 385, and the female 191. TB incidence rates increased significantly with age in both sexes, regardless of smear or HIV status. Despite a peak with unknown cause of 352 per 100,000 in 2007, the overall incidence of pulmonary TB declined over the period. The incidence of HIV infected TB cases declined significantly from 108 to 39 per 100,000, while the incidence of smear-positive TB cases remained stable; the overall figure was 188 per 100,000. CONCLUSIONS Overall incidence of pulmonary TB in Guinea-Bissau has declined from 2004 to 2011. The decline was also seen in the subgroups of smear-negative and HIV-positive TB cases, probably due to antiretroviral treatment. Smear-positive TB incidence remains stable over the period.
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Affiliation(s)
- G Lemvik
- Bandim Health Project, INDEPTH network, Bissau, Guinea-Bissau; Bandim Health Project, Statens Serum Institut, Copenhagen, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
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9
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Rodkjaer L, Chesney M, Lomborg K, Ostergaard L, Laursen T, Sodemann M. HIV-infected individuals with high coping self-efficacy are less likely to report depressive symptoms: a cross-sectional study from Denmark. Int J Infect Dis 2014; 22:67-72. [DOI: 10.1016/j.ijid.2013.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 12/04/2013] [Accepted: 12/07/2013] [Indexed: 01/28/2023] Open
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10
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Suleiman MMA, Sahal N, Sodemann M, Elsony A, Aro AR. Tuberculosis awareness in Gezira, Sudan: knowledge, attitude and practice case-control survey. East Mediterr Health J 2014; 20:120-129. [PMID: 24945561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 05/07/2013] [Indexed: 06/03/2023]
Abstract
This case-control study aimed to assess tuberculosis (TB) awareness and its associated sociodemographic characteristics in Gezira, Sudan. New smear-positive TB patients registered in Gezira in 2010 (n = 425) and age-matched controls who attended the same health facilities for other reasons (n = 850) formed the study sample. Awareness was measured using a modified standard World Health Organization TB knowledge, attitude and practice instrument. There was no significant difference between TB cases and the controls in overall levels of TB awareness. About two-thirds of TB cases and controls had good TB awareness. Respondents' sex was associated with awareness among the controls. Age, level of education, type of residence and type of occupation were significantly associated with TB awareness, whereas marital status had no effect. The good level of TB awareness found among TB cases and controls is a baseline for further TB awareness-raising among the Gezira population.
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Affiliation(s)
- M M A Suleiman
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - N Sahal
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
| | - M Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - A Elsony
- Epidemiological Laboratory, Khartoum, Sudan
| | - A R Aro
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark
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11
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Suleiman M, Sahal N, Sodemann M, Elsony A, Aro A. Tuberculosis awareness in Gezira, Sudan: knowledge, attitude and practice case-control survey. East Mediterr Health J 2014. [DOI: 10.26719/2014.20.2.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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12
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Ahmed Suleiman MM, Sahal N, Sodemann M, El Sony A, Aro AR. Tuberculosis stigma in Gezira State, Sudan: a case-control study. Int J Tuberc Lung Dis 2013; 17:388-93. [PMID: 23407228 DOI: 10.5588/ijtld.12.0654] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of tuberculosis (TB) stigma and to determine the relation between socio-demographic characteristics and TB stigma among TB cases and their controls in Gezira State, Sudan. METHODS A case-control study design was used. New smear-positive TB patients registered in Gezira State in 2010 (n = 425) and controls who attended the same health facility for other reasons (n < 850) formed the study population. Stigma was measured using a standard modified World Health Organization TB KAP (knowledge, attitudes, practice) instrument. RESULTS TB stigma did not differ between TB cases and controls; mild stigma was found in both groups. The higher degree of stigma among both groups was significantly associated with higher age, lower level of education, residence in rural areas, unemployment and poor TB awareness, while sex had no association with the degree of stigma in either group. CONCLUSION Although TB stigma among the Gezira population was found to be mild, it can affect treatment adherence. Empowering both TB patients and communities by increasing their knowledge through proper education programmes could effectively contribute to the effort of controlling TB in the state.
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Affiliation(s)
- M M Ahmed Suleiman
- Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark.
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Wejse C, Furtado A, Camara C, Lüneborg-Nielsen M, Sodemann M, Gerstoft J, Katzenstein TL. Impact of tuberculosis treatment on CD4 cell count, HIV RNA, and p24 antigen in patients with HIV and tuberculosis. Int J Infect Dis 2013; 17:e907-12. [PMID: 23816410 DOI: 10.1016/j.ijid.2013.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 05/08/2013] [Accepted: 05/09/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe HIV RNA levels during tuberculosis (TB) infection in patients co-infected with TB and HIV. Moreover, to examine the p24 antigen profile during TB treatment. METHODS We examined the changes in CD4 cell count, HIV RNA, and p24 levels during anti-tuberculous therapy in a group of TB/HIV-1 co-infected and HIV-untreated patients from Guinea-Bissau. RESULTS A total of 365 TB patients were enrolled, of whom 76 were co-infected with HIV-1 and 19 were dually infected with HIV-1 + HIV-2. No significant changes in CD4, HIV RNA, or p24 levels were found during 8 months of TB treatment. HIV RNA levels correlated well with p24 (Spearman's R(2)=0.52, p<0.00001) and both markers were strong predictors of mortality. Initial HIV RNA levels correlated with a clinical TB severity index--the TBscore (Spearman's R(2)=0.23, p=0.02)--and the TBscore decreased dramatically during TB treatment although HIV RNA levels remained unchanged. CONCLUSION We found no significant changes in CD4, HIV RNA, or p24 antigen levels during 8 months of TB treatment among TB/HIV co-infected individuals, who did not receive antiretroviral treatment. The markers were unaffected by a strong improvement in TBscore and all three markers showed predictive capacity for mortality risk.
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Affiliation(s)
- C Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Brendstrupgaardsvej, 8200 Aarhus N, Denmark; GloHAU, Center for Global Health, School of Public Health, Aarhus University, Aarhus, Denmark.
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Rasmussen J, Andersen A, Fisker AB, Ravn H, Sodemann M, Rodrigues A, Benn CS, Aaby P. Mid-upper-arm-circumference and mid-upper-arm circumference z-score: the best predictor of mortality? Eur J Clin Nutr 2012; 66:998-1003. [DOI: 10.1038/ejcn.2012.95] [Citation(s) in RCA: 34] [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] [Indexed: 11/09/2022]
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15
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16
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Kristoffersen KB, Søgaard OS, Wejse C, Black FT, Greve T, Tarp B, Storgaard M, Sodemann M. Antibiotic treatment interruption of suspected lower respiratory tract infections based on a single procalcitonin measurement at hospital admission--a randomized trial. Clin Microbiol Infect 2009; 15:481-7. [PMID: 19416298 DOI: 10.1111/j.1469-0691.2009.02709.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Recent studies have suggested that procalcitonin (PCT) is a safe marker for the discrimination between bacterial and viral infection, and that PCT-guided treatment may lead to substantial reductions in antibiotic use. The present objective was to evaluate the effect of a single PCT measurement on antibiotic use in suspected lower respiratory tract infections (LRTIs) in a Danish hospital setting. In a randomized, controlled intervention study, 223 adult patients admitted to the hospital because of suspicion of LRTI were included with 210 patients available for analysis. Patients were randomized to either PCT-guided treatment or standard treatment. Antibiotic treatment duration in the PCT group was based on the serum PCT value at admission. The cut-off point for recommending antibiotic treatment was PCT > or =0.25 microg/L. Physicians could overrule treatment guidelines. The mean duration of hospital stay was 5.9 days in the PCT group vs. 6.7 days in the control group (p 0.22). The mean duration of antibiotic treatment during hospitalization in the PCT group was 5.1 days on average, as compared to 6.8 days in the control group (p 0.007). In a subgroup analysis of chronic obstructive pulmonary disease patients, the mean length of stay was reduced from 7.1 days in the control group to 4.8 days in the PCT group (p 0.009). It was concluded that the determination of a single PCT value at admission in patients with suspected LRTIs can lead to a reduction in the duration of antibiotic treatment by 25% without compromising outcome. No effect on the length of hospital stay was found.
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Affiliation(s)
- K B Kristoffersen
- Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus N., Denmark.
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17
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Abstract
Background: Tuberculosis (TB) is among the top ten causes of global mortality. Sudan is among the countries with high TB prevalence; with an estimated incidence of 90/100,000 smear-positive cases. In 1993, the Khartoum State tuberculosis control programme was established. Since its establishment, however, the programme has never been adequately assessed. Aim: To evaluate and describe the tuberculosis control programme in Khartoum State, Sudan in 2006; to find out if the programme achieved its global targeted goals; and to identify the challenges and needs for performing a good standard tuberculosis control programme. Methods: A descriptive cross-sectional and retrospective study design was used. The study population was tuberculosis control departments at the levels of the state (n = 1), localities (n = 7), health areas (n = 19) and health facilities (n = 42). Records review and group interviews were used to collect the required data. Results: The study found that the TB control programme in Khartoum State achieved a 77.2% case detection rate of the smear-postive cases, and 73.5% treatment success rate, and a case fatality rate of 2.2%, treatment failure rate of 2.2%, and default rate of 14.1%. There was no system to detect the prevalence of MDR-TB (multi-drug resistant TB) or HIV (human immunodeficiency virus) among the TB cases. The programme was not well implemented at locality or health area levels. Conversely, drugs and laboratory supply systems were functioning well. Conclusions: The tuberculosis control programme in Khartoum State is centralized, not updated, and does not achieve the targeted goals.
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Affiliation(s)
- M.M. Ahmed Suleiman
- Unit for Health Promotion Research, University of Southern Denmark (SDU), Esbjerg, Denmark,
| | - A.R. Aro
- Unit for Health Promotion Research, University of Southern Denmark (SDU), Esbjerg, Denmark
| | - M. Sodemann
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Suleiman MA, Aro A, Sodemann M. OL-003 Evaluation of tuberculosis control programme in Khartoum state for the year 2006. Int J Infect Dis 2008. [DOI: 10.1016/s1201-9712(09)60100-4] [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: 11/28/2022] Open
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Rodkjaer LO, Laursen T, Balle N, Sodemann M. Depression in HIV patients is associated with low adherence: a cross-sectional study among HIV patients in Denmark. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p174] [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] Open
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20
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Olesen R, Wejse C, Velez DR, Bisseye C, Sodemann M, Aaby P, Rabna P, Worwui A, Chapman H, Diatta M, Adegbola RA, Hill PC, Østergaard L, Williams SM, Sirugo G. DC-SIGN (CD209), pentraxin 3 and vitamin D receptor gene variants associate with pulmonary tuberculosis risk in West Africans. Genes Immun 2007; 8:456-67. [PMID: 17611589 DOI: 10.1038/sj.gene.6364410] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We investigated the role of DC-SIGN (CD209), long pentraxin 3 (PTX3) and vitamin D receptor (VDR) gene single nucleotide polymorphisms (SNPs) in susceptibility to pulmonary tuberculosis (TB) in 321 TB cases and 347 healthy controls from Guinea-Bissau. Five additional, functionally relevant SNPs within toll-like receptors (TLRs) 2, 4 and 9 were typed but found, when polymorphic, not to affect host vulnerability to pulmonary TB. We did not replicate an association between SNPs in the DC-SIGN promoter and TB. However, we found that two polymorphisms, one in DC-SIGN and one in VDR, were associated in a nonadditive model with disease risk when analyzed in combination with ethnicity (P=0.03 for DC-SIGN and P=0.003 for VDR). In addition, PTX3 haplotype frequencies significantly differed in cases compared to controls and a protective effect was found in association with a specific haplotype (OR 0.78, 95% CI 0.63-0.98). Our findings support previous data showing that VDR SNPs modulate the risk for TB in West Africans and suggest that variation within DC-SIGN and PTX3 also affect the disease outcome.
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Affiliation(s)
- R Olesen
- MRC Laboratories, Banjul, The Gambia
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21
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Affiliation(s)
- M S Jakobsen
- Projecto de Saude de Bandim, Bissau, Guinea Bissau
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Sodemann M, Biai S, Jakobsen MS, Aaby P. Knowing a medical doctor is associated with reduced mortality among sick children consulting a paediatric ward in Guinea-Bissau, West Africa. Trop Med Int Health 2006; 11:1868-77. [PMID: 17176352 DOI: 10.1111/j.1365-3156.2006.01744.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [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
BACKGROUND To examine equity in access to public health services in Guinea-Bissau. METHODS The study was conducted in 2000-2001 at the emergency clinic of the only paediatric ward in Bissau. Mothers of all children from the study area were interviewed about previous care seeking and relations with anybody working in the health sector. All management actions in the emergency clinic were registered. In-hospital and subsequent community mortality was ascertained through community surveillance. The measured outcome was mortality risk within 30 days of first consultation. RESULTS We followed 1572 children with a first consultation. Of these, 8.2% died within 30 days. Acquaintance with a physician reduced 30-day mortality risk by 48% (95% CI: 18-66). The effect was strongest among post-neonatal children (54%; 95% CI: 18-74). Mortality within 30 days of consultation was also independently predicted by consultation after 7 PM, nurse team on duty, day of week and young mother. In a multivariate model, socioeconomic status and school education were not associated with 30-day mortality when acquaintance with a medical doctor was taken into account. CONCLUSION Favouritism may be a significant factor for quality of care and child mortality in developing countries. Interventions to improve hospital and health worker performance should be given high priority.
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Affiliation(s)
- M Sodemann
- Projécto de Saúde Bandim, Bissau, Guinea-Bissau.
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23
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Sodemann M, Veirum J, Biai S, Nielsen J, Bale C, Skytte Jakobsen M, Gustafson P, Aaby P. Reduced case fatality among hospitalized children during a war in Guinea-Bissau: a lesson in equity. Acta Paediatr 2004; 93:959-64. [PMID: 15303813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND During a recent armed conflict in Guinea-Bissau, we observed a marked decline in the case fatality among hospitalized children at the only paediatric department in the country. AIM To analyse the causes behind the observed fall in case fatality. MATERIAL All children hospitalized at the only paediatric department in the capital of Guinea-Bissau. The war cohort comprised all children hospitalized during the war, which lasted from June 1998 to May 1999, and the peace cohort comprised all children hospitalized in the year preceding the war. As part of a longitudinal community study, we also registered all children being hospitalized from the Bandim Health Project's study area, including routinely collected information on socio-economic background factors. METHODS The war cohort was compared with the peace cohort in terms of determinants for hospital case fatality. Through information in the community register, we examined post-hospital mortality in the 2 wk after discharge as well as socio-economic differences in recruitment during the war. Hospital case fatality was estimated by odds ratios and compared by multiple logistic regression. Community mortality risk was estimated by deaths per person years. RESULTS The case fatality among children aged 0-14 y fell during the war (age-adjusted OR = 0.58; 95% CI: 0.50-0.68). There was a uniform reduction in case fatality among children hospitalized less than 7 d, while we observed no decline among children hospitalized longer. There were more children per bed during the war and mean hospitalization time was shorter, and post-discharge mortality also fell (mortality ratio (MR) = 0.57; 95% CI: 0.40-0.83). Adjustment for socio-economic confounders in recruitment during the war period made no difference to the estimated decline in case fatality. The decline in case fatality at the hospital was not explained by a general decline in mortality. Compared with the preceding year, the mortality ratio was 1.34 (1.20-1.51) in the Bandim Health Project's study area during the war. Adjusted for age, the decline in case fatality at the hospital was most marked for disadvantaged groups. For example, the general reduction in case fatality was 42% (95% CI: 11-63); however, children of mothers without any schooling experienced a reduction of 73% (95% CI: 27-90%), whereas the reduction was only 33% (95% CI: 14-61%) for children of mothers with school education. CONCLUSION The decline in case fatality could be explained neither by a general decline in childhood mortality nor by changes in recruitment or discharge policy. The decline was therefore most likely due to improved treatment as a result of better availability of drugs funded by humanitarian aid and the presence of dedicated staff, which was offered relief food as compensation. Interventions improving case management may have a proportionately larger effect for poor families.
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Affiliation(s)
- M Sodemann
- Projécto de Saúde Bandim, Guinea-Bissau.
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24
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Jakobsen MS, Sodemann M, Mølbak K, Alvarenga IJ, Nielsen J, Aaby P. Termination of breastfeeding after 12 months of age due to a new pregnancy and other causes is associated with increased mortality in Guinea-Bissau. Int J Epidemiol 2003; 32:92-6. [PMID: 12690017 DOI: 10.1093/ije/dyg006] [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: 11/14/2022] Open
Abstract
BACKGROUND As part of an assessment of breastfeeding and child health in Guinea-Bissau, we investigated the impact of mother's reason for weaning on subsequent child mortality. METHODS Children were identified and followed by the demographic health surveillance system of the Bandim Health Project in Guinea-Bissau. Breastfeeding status and survival were ascertained by 3-monthly follow-up home visits. At termination of breastfeeding mothers were interviewed about her reasons for weaning. In all, 1423 children who terminated breastfeeding after 12 months of age were followed to 3 years of age. RESULTS Median length of breastfeeding was 22 months. Following termination of breastfeeding, 66 children died before 36 months of age. In all, 62% (879/1423) were weaned because they were 'healthy'. Compared with the 'healthy' children, all other causes of weaning were associated with a higher mortality (mortality ratio [MR] = 2.97, 95% CI: 1.54-5.73). For 237 children weaned due to a new pregnancy the MR was 3.25 (95% CI: 1.45-7.30). Seventy-five children weaned because of illness had a 2.98 (95% CI: 0.95-9.39) fold excess mortality compared with children considered healthy. Excess deaths in the 'non-healthy' group accounted for 44% (29/66) of post-weaning deaths. Median length of spacing between an index child and a new sibling was 28 months irrespective of whether the index child survived or died before 3 years of age. The majority of the deaths occurred before birth of the new sibling. CONCLUSION Popular rationalizations of abstinence during breastfeeding emphasizes, as we observed, that weaning due to new pregnancy of the mother is associated with higher mortality. This was not due to a shorter breastfeeding period of the child weaned due to a new pregnancy. Generally children weaned for other reasons than 'being healthy' had higher mortality. The mother's reason for weaning could potentially be used as screening criteria in child monitoring programmes in areas with high mortality.
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Affiliation(s)
- M S Jakobsen
- Projecto de Saude de Bandim, Apartado 861, Bissau, Guinea-Bissau.
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25
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Perch M, Sodemann M, Jakobsen MS, Valentiner-Branth P, Steinsland H, Fischer TK, Lopes DD, Aaby P, Mølbak K. Seven years' experience with Cryptosporidium parvum in Guinea-Bissau, West Africa. Ann Trop Paediatr 2001; 21:313-8. [PMID: 11732149 DOI: 10.1080/07430170120093490] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In community-based studies conducted from 1991 to 1997 in Guinea-Bissau, West Africa, stool specimens from children aged less than 5 years with diarrhoea were routinely examined for enteric parasites. Cryptosporidium parvum, found in 7.7% of 4,922 samples, was the second most common parasite, exceeded only by Giardia lamblia which was found in 14.8% of the samples. The highest prevalence of cryptosporidium was found in children aged 6-11 months, whereas the prevalence of other enteric parasites increased with age. Cryptosporidiosis showed a marked seasonal variation, with peak prevalences found consistently at the beginning of or just before the rainy seasons, May through July. By contrast, no seasonality was found for the enteric parasites Giardia lamblia or Entamoeba histolytica. We conclude that Cryptosporidium parvum is an important pathogen in children with diarrhoea.
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Affiliation(s)
- M Perch
- Department of Epidemiology Research, Danish Epidemiology Science Centre, Statens Serum Institut, Denmark.
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26
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Sodemann M, Jakobsen MS, Mølbak K, Alvarenga IC, Martins C, Aaby P. Malaria parasitemia and childhood diarrhea in a peri-urban area of Guinea-Bissau. Am J Trop Med Hyg 1999; 61:336-8. [PMID: 10463690 DOI: 10.4269/ajtmh.1999.61.336] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
To examine the association between diarrhea in early childhood and malaria parasitemia, we conducted a nested case-control study in Guinea-Bissau of 297 children with diarrhea and a similar number of children without diarrhea matched for age, season, and residential area. There were no associations between diarrhea and parasite rate, parasite density, or clinical malaria. However, anti-malarials were easily available and frequently used, which was reflected by a 0.7% prevalence of children with a parasite density > 100/200 leukocytes. Thus, the findings do not preclude that diarrhea may be a sign of clinical malaria or high-parasite density in endemic areas with lower use of antimalarials.
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Affiliation(s)
- M Sodemann
- Projecto de Saúde de Bandim, Bissau, Guinea-Bissau
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27
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Jakobsen MS, Sodemann M, Mølbak K, Alvarenga I, Aaby P. Promoting breastfeeding through health education at the time of immunizations: a randomized trial from Guinea Bissau. Acta Paediatr 1999; 88:741-7. [PMID: 10447133 DOI: 10.1080/08035259950169026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Abstract
As an intervention against diarrhoea, promotion of breastfeeding has been suggested by the World Health Organization (WHO). In the present study from Guinea Bissau we tested the possibilities of promoting breastfeeding at a local health centre. A total of 1250 children were allocated randomly into two groups. Mothers in the intervention group were given health education according to WHO's recommendations; about exclusive breastfeeding for at least the first 4 mo, prolonged breastfeeding and family planning methods. At 4 mo of age introduction of weaning food was delayed in the intervention group (risk rate 1.18 (95% CI 1.03-1.38) and more mothers had an IUD inserted (risk rate 2.45 (1.27-4.70). The median length of breastfeeding was 23 mo in both groups. There was no difference in the number of children weaned early. Although exclusive breastfeeding was promoted by the intervention, early weaning of children in special risk groups was not avoided. An evaluation of the impact of the WHO recommendations in different settings is warranted.
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Affiliation(s)
- M S Jakobsen
- Projecto de Saude de Bandim, Bissau, Guinea Bissau
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Sodemann M, Jakobsen MS, Mølbak K, Martins C, Aaby P. Episode-specific risk factors for progression of acute diarrhoea to persistent diarrhoea in west African children. Trans R Soc Trop Med Hyg 1999; 93:65-8. [PMID: 10492794 DOI: 10.1016/s0035-9203(99)90183-9] [Citation(s) in RCA: 17] [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] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The aim of the present study, carried out in Guinea-Bissau, West Africa, was to identify episode-specific risk factors for persistent diarrhoea (PD) related to clinical observations and management efforts. We followed 319 episodes of childhood diarrhoea by repeated household interviews until the episode stopped or after 14 days with diarrhoea. Children who still had diarrhoea after 14 days (n = 40, 12.5% of episodes) were regarded as suffering from PD. Clinical signs, perceived by the mother, were recorded together with care-seeking behaviour and management actions. Tired and rapid breathing prior (OR = 6.52 (95% CI 1.69-25.1)), mother had to force breast feeding (OR = 8.01 (2.99-21.5)) and current infection with Cryptosporidium (OR = 5.53 (2.10-14.6)) were the most important independent risk factors for the development of PD. Late consultation (> 48 h) was associated with PD, reflecting that these episodes initially were less acute. Use of oral rehydration salts did not have an impact on development of PD, whereas home medication tended to increase the risk of PD. Our study confirms the close association between systemic illness and PD as well as the importance of cryptosporidiosis as a cause of PD. We were unable to identify management factors with a significant influence on the risk of developing PD.
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Affiliation(s)
- M Sodemann
- Department of Epidemiological Research, Danish Epidemiology Science Centre, Statens Serum Institut, Copenhagen, Denmark
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Sodemann M, Jakobsen MS, Mølbak K, Martins C, Aaby P. Management of childhood diarrhea and use of oral rehydration salts in a suburban West African community. Am J Trop Med Hyg 1999; 60:167-71. [PMID: 9988343 DOI: 10.4269/ajtmh.1999.60.167] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [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] [Indexed: 11/07/2022] Open
Abstract
In a household survey in Guinea-Bissau, 319 episodes of diarrhea in children were followed by interviews every second day with the aim of investigating perceived morbidity and subsequent actions taken. The majority of the mothers had good knowledge of oral rehydration salts (ORS). However, only 58% of the episodes were treated with ORS and the amount given was insufficient. Mothers with no knowledge of ORS did not use it during the observed attack of diarrhea regardless of contact with a health center, which suggests that maternal knowledge is an important determinant of whether health personnel provide ORS. Children with diarrhea considered to be caused by teething were less likely to receive ORS in the acute phase (risk ratio = 0.6, 95% confidence interval [CI] = 0.5-0.9). Univariate analyses showed that the use of ORS was related to number of reported symptoms, the mother being the care taker, consultations, previous use of ORS, good knowledge of ORS, and having ORS sachets at home. Multivariate Cox regression analyses showed that the presence of ORS sachets at home at the onset of diarrhea was the strongest predictor of use (hazard ratio = 3.3, 95% CI = 1.9-3.6). Improved health education should focus more on the quantity of ORS needed, early signs of dehydration, treatment of teething diarrhea, and breast feeding, and address mothers who have no prior knowledge of ORS. Management of diarrhea may be improved by a more liberal distribution of ORS sachets.
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Affiliation(s)
- M Sodemann
- Projecto de Saúde de Bandim, Bissau, Guinea-Bissau
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Mølbak K, Andersen M, Aaby P, Højlyng N, Jakobsen M, Sodemann M, da Silva AP. Cryptosporidium infection in infancy as a cause of malnutrition: a community study from Guinea-Bissau, west Africa. Am J Clin Nutr 1997; 65:149-52. [PMID: 8988927 DOI: 10.1093/ajcn/65.1.149] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.4] [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: 02/03/2023] Open
Abstract
Cryptosporidium parvum causes persistent diarrhea in young children in developing countries. To determine the interaction between nutritional status and cryptosporidiosis, an open cohort of 1064 children younger than 3 y of age was followed for 1441 child-years by weekly diarrhea recall visits. A total of 5072 weight and 4264 height measurements was made. There were no tendencies of low weight (P = 0.38) or height (P = 0.16) in children who acquired cryptosporidiosis. Cryptosporidiosis in infancy was accompanied by an estimated weight loss of 392 g (95% CI: 247, 538 g) in boys and 294 g (95% CI: 109, 479 g) in girls, corresponding to 3.7% and 2.9% of mean weight, respectively, at 2 y of age. No significant catch-up growth covered for this loss in weight. A similar effect in linear growth was shown (P = 0.02). Although it has been suggested that the effect of infections on nutrition is usually transient because of catch-up growth, the present study suggests that cryptosporidiosis in infancy has a permanent effect on growth.
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Affiliation(s)
- K Mølbak
- Epidemiology Research Unit, Danish Epidemiology Science Centre, Copenhagen, Denmark.
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Sodemann M, Jakobsen MS, Mølbak K, Alvarenga IC, Aaby P. High mortality despite good care-seeking behaviour: a community study of childhood deaths in Guinea-Bissau. Bull World Health Organ 1997; 75:205-12. [PMID: 9277007 PMCID: PMC2486955] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from disease onset to first consultation between children who died and matched surviving controls indicated that the interval was shorter for children who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill children, 56 were hospitalized. A total of 20 children died on the way to hospital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for improved hospital admission criteria, improved recognition of the symptoms of serious illness, better discharge criteria, and the implementation of quality assurance systems for health services.
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Affiliation(s)
- M Sodemann
- Department of Epidemiology and Social Medicine, University of Aarhus, Denmark
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33
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Abstract
With the aim of investigating perceived morbidity and care seeking behaviour, a household survey was conducted, where 319 episodes of diarrhoea were followed by interviews every second day. The chance of consultation increased with the number of symptoms reported by the mother. The appearance of the eyes and how the child breastfed were early warnings that mothers recognized best. By contrast, there was an 80% reduction in the likelihood of seeking consultation when the mother perceived the diarrhoea as caused by teeth eruption (n = 96). Children with "teething diarrhoea" were, however, just as likely to develop signs of dehydration as children with non-teething diarrhoea. We conclude that health education concerning diarrhoea should emphasize early signs of dehydration and the discouragement of "teething" as an explanation of natural diarrhoea.
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Affiliation(s)
- M Sodemann
- Epidemiology Research Unit, Danish Epidemiology Science Centre, Statens Seruminstitut, Denmark
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34
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Abstract
BACKGROUND In third world countries the length of breastfeeding often has a major influence on child mortality, morbidity and nutritional status. When evaluating the impact of length of breastfeeding the reason why a mother terminates breastfeeding is usually not taken into consideration. METHODS Risk factors for termination of breastfeeding were studied in a prospective community study following 1678 children in Guinea Bissau, West Africa from birth to cessation of breastfeeding, migration or death. RESULTS The median weaning age was 22.6 months. Illness of the child, new pregnancy of the mother and illness of the mother were associated with significantly shorter lactation period compared with children weaned because they were 'healthy' or 'old enough'. These explanations had an impact independent of other determinants for weaning, including ethnic group, mother's age, mother's education, birth order and number of dead siblings. Weaning before 12 months of age was only associated with illness of the mother or child and new pregnancy and not with any socioeconomic or cultural factors. CONCLUSIONS Health workers should pay special attention to the encouragement of breastfeeding in connection with illness of the mother or child; these considerations may also be important in the planning of breastfeeding promotion campaigns. Since premature termination of breastfeeding is associated with new pregnancy, family planning should be part of any breastfeeding promotion programme.
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Affiliation(s)
- M S Jakobsen
- Danish Epidemiology Science Centre, Statens Seruminstitut, Copenhagen, Denmark
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35
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Aaby P, Andersen M, Sodemann M, Jakobsen M, Gomes J, Fernandes M. [Measles vaccination and age]. Ugeskr Laeger 1994; 156:5857-5861. [PMID: 7985279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Recent studies have found administration of high-titre measles vaccine before 9 months of age to be associated with reduced survival. Since this suggests that early immunization could be unsafe, we examined the results of immunization campaigns with Schwarz standard measles vaccine carried out in 1980-1983 in three areas of Guinea-Bissau. Children were followed to death, migration or the age of five years. Children immunized at 4-8 months of age, of whom many were later re-immunized, had lower mortality between nine months and five years of age compared with children vaccinated at 9-11 months of age. The improved survival was unrelated to better protection against measles. There was no sign of socio-cultural differences between children immunized at different ages. Vaccination before 9 months of age is apparently safe and it may reduce childhood mortality compared with the currently recommended strategy of immunizing from nine months of age. Randomized trials are needed to confirm these observations which may have implications for the measles immunization strategy for developing countries.
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Affiliation(s)
- P Aaby
- Statens Seruminstitut, København
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36
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Jensen TG, Whittle H, Mordhorst CH, Pedersen IR, Thaarup J, Poulsen A, Sodemann M, Jakobsen M, Brink L, Gansted U. Trials of Edmonston-Zagreb measles vaccine in Guinea-Bissau: serological responses following vaccination with Edmonston-Zagreb strain at 4-8 months versus vaccination with Schwarz strain at 9-12 months of age. Vaccine 1994; 12:1026-31. [PMID: 7975843 DOI: 10.1016/0264-410x(94)90340-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In two trials of measles vaccination in Guinea-Bissau, children were randomized to receive either the Edmonston-Zagreb (EZ) virus at age 4-8 months or, as a control group, a standard dose (5000 p.f.u.) of the Schwarz (SW) virus at 9-12 months. In the first trial a medium dose of EZ virus (40,000 p.f.u.) was used and in the later trial a high dose (150,000 p.f.u.). Pre- and postvaccination blood samples were analysed with a haemagglutination inhibition (HAI) test and an enzyme-linked immunosorbent assay (ELISA). For the ELISA the blood samples were collected on filter paper. Of 362 prevaccination specimens, 18 and 55%, respectively, were positive in the ELISA and HAI tests. At 18-20 months, the children who had received the EZ vaccine had a seropositivity of 91% by the ELISA method and one of 89% by the HAI method. The equivalent values for the SW group of children were 100 and 96% respectively. Antibody levels in the EZ group, as measured by either method, were significantly lower than the levels in the SW group. The serological results of the present study suggest that lowering the age at measles vaccination to below 9 months is feasible. However, further studies are needed to determine which virus strain, dosage and age at vaccination will prove to be optimal in countries where severe measles is common before the age of 9 months.
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Affiliation(s)
- T G Jensen
- International Medical Cooperation Committee, Denmark
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37
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Aaby P, Lisse IM, Whittle H, Knudsen K, Thaarup J, Poulsen A, Sodemann M, Jakobsen M, Brink L, Gansted U. Long-term survival in trial of medium-titre Edmonston-Zagreb measles vaccine in Guinea-Bissau: five-year follow-up. Epidemiol Infect 1994; 112:413-20. [PMID: 8150016 PMCID: PMC2271462 DOI: 10.1017/s0950268800057836] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [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] [Indexed: 01/29/2023] Open
Abstract
A trial of protective efficacy which compared medium-titre Edmonston-Zagreb (EZ) measles vaccine (10(4.6) p.f.u.) from the age of 4 months with the standard Schwarz (SW) measles vaccine given from the age of 9 months was started in an urban community in Guinea-Bissau in 1985. Because trials of high-titre measles vaccine have found increased mortality among female recipients, we examined whether EZ medium-titre vaccine was associated with any long-term impact on mortality, suppression of T-cells, or growth. The mortality rate ratio over 5 years of follow-up was 1.12 for EZ children compared with children in the standard group (P = 0.63). Seventy-five percent of the children still residing in the area at 5 years of age took part in an immunological and anthropometric examination. There was no difference in T-cell subsets between the two groups. There was no difference in mid-upper-arm circumference, but EZ children were significantly shorter than the children in the standard group. In conclusion, medium-titre EZ was not associated with reduced survival or persistent immunosuppression.
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Affiliation(s)
- P Aaby
- Epidemiology Research Unit, Statens Seruminstitut, Copenhagen, Denmark
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38
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Aaby P, Andersen M, Sodemann M, Jakobsen M, Gomes J, Fernandes M. Reduced childhood mortality after standard measles vaccination at 4-8 months compared with 9-11 months of age. BMJ 1993; 307:1308-11. [PMID: 8257884 PMCID: PMC1679462 DOI: 10.1136/bmj.307.6915.1308] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To evaluate the impact on mortality of standard Schwarz measles immunisation before 9 months of age. DESIGN Children vaccinated in 1980-3 at 4-5, 6-8, and 9-11 months of age were followed to migration, death, or the age of 5 years. SETTING One urban district and nine villages in two rural areas of Guinea-Bissau. SUBJECT 307 children vaccinated at 4-8 months and 256 at 9-11 months. MAIN OUTCOME MEASURES Mortality from 9 months to 5 years of age for children immunised at 4-5, 6-8, and 9-11 months. RESULTS Mortality was significantly lower in children vaccinated at 6-8 months than at 9-11 months (mortality ratio = 0.63, (95% confidence interval 0.41 to 0.97), p = 0.047). As vaccination was provided in semiannual or annual campaigns it is unlikely that age at vaccination reflected a selection bias. The trend was the same in all three study areas. Improved survival after early immunisation was not related to better protection against measles infection. With a Cox multivariate regression model to adjust for age, sex, season at risk, season at birth, measles infection, and region, children vaccinated at 4-8 months had a mortality ratio of 0.61 (0.40 to 0.92, p = 0.020) compared with children vaccinated at 9-11 months. Reimmunised children tended to have lower mortality than children who received only one vaccine (0.59 (0.28 to 1.27, p = 0.176)). CONCLUSION Standard measles vaccination before 9 months is not associated with higher childhood mortality than is the currently recommended strategy of immunising from 9 months, and it may reduce mortality. This has implications for measles immunisation strategy in developing countries.
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Affiliation(s)
- P Aaby
- Epidemiology Research Unit, Statens Seruminstitut, Copenhagen, Denmark
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39
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Aaby P, Knudsen K, Whittle H, Lisse IM, Thaarup J, Poulsen A, Sodemann M, Jakobsen M, Brink L, Gansted U. Long-term survival after Edmonston-Zagreb measles vaccination in Guinea-Bissau: increased female mortality rate. J Pediatr 1993; 122:904-8. [PMID: 8501567 DOI: 10.1016/s0022-3476(09)90015-4] [Citation(s) in RCA: 85] [Impact Index Per Article: 2.7] [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: 01/31/2023]
Abstract
In an urban area of Guinea-Bissau, 384 children were enrolled in a randomized trial comparing morbidity and mortality rates after receiving high-titer Edmonston-Zagreb (EZ) measles vaccine administered from 4 months of age, with a control group receiving inactivated poliomyelitis vaccine at 4 months of age and the standard Schwarz vaccine from 9 months of age. Children were followed to the age of at least 3 years. The mortality ratio of the EZ vaccinees compared with control subjects was 1.79 (range, 1.06 to 3.02; p = 0.027) if children were excluded at the time of migration; if deaths after migration were included, the mortality ratio was 1.53 (range, 0.94 to 2.49; p = 0.087). Girls in the EZ group had significantly higher mortality rates than girls in the control group (mortality ratio = 1.95; range, 1.07 to 3.56; p = 0.027); there was no difference for the boys (mortality ratio = 0.98; range, 0.41 to 2.30). Adjustment for background factors in a Cox regression model did not modify these estimates. Furthermore, female recipients of EZ vaccine had more days with diarrhea (relative risk = 1.35; range, 1.17 to 1.56; p = 0.00003) and were more likely than control subjects to visit a health center in the month after vaccination (relative risk = 1.86; range, 1.05 to 3.31; p = 0.027); those who consulted were more likely to die subsequently (mortality ratio = 2.31; range, 0.99 to 5.41; p = 0.054). These observations were unplanned and require confirmation in larger studies.
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Affiliation(s)
- P Aaby
- Epidemiological Research Unit, Statens Seruminstitut, Copenhagen, Denmark
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40
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Aaby P, Knudsen K, Jensen TG, Thårup J, Poulsen A, Sodemann M, da Silva MC, Whittle H. Measles incidence, vaccine efficacy, and mortality in two urban African areas with high vaccination coverage. J Infect Dis 1990; 162:1043-8. [PMID: 2230232 DOI: 10.1093/infdis/162.5.1043] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.4] [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: 12/30/2022] Open
Abstract
Measles incidence, vaccine efficacy, and mortality were examined prospectively in two districts in Bissau where vaccine coverage for children aged 12-23 months was 81% (Bandim 1) and 61% (Bandim 2). There was little difference in cumulative measles incidence before 9 months of age (6.1% and 7.6%, respectively). Between 9 months and 2 years of age, however, 6.1% contracted measles in Bandim 1 and 13.7% in Bandim 2. Even adjusting for vaccination status, incidence was significantly higher in Bandim 2 (relative risk 1.6, P = .04). Even though 95% of the children had measles antibodies after vaccination, vaccine efficacy was not more than 68% (95% confidence interval [CI] 39%-84%) and was unrelated to age at vaccination. Unvaccinated children had a mortality hazard ratio of 3.0 compared with vaccinated children (P = .002), indicating a protective efficacy against death of 66% (CI 32%-83%) of measles vaccination. These data suggest that it will be necessary to vaccinate before age 9 months to control measles in hyperendemic urban African areas.
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Affiliation(s)
- P Aaby
- Institute of Anthropology, University of Copenhagen, Denmark
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41
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Aaby P, Pedersen IR, Knudsen K, da Silva MC, Mordhorst CH, Helm-Petersen NC, Hansen BS, Thårup J, Poulsen A, Sodemann M. Child mortality related to seroconversion or lack of seroconversion after measles vaccination. Pediatr Infect Dis J 1989; 8:197-200. [PMID: 2717273] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
When blood samples were analyzed for seroconversion after measles vaccination, it was discovered that the vaccine had been ineffective for a certain period. During the 2 years between vaccination and the time of seroanalysis, nonseroconverters had a significantly higher mortality than seroconverters (P less than 0.05). The incidence of measles among nonseroconverters was 30% during the period. Between 9 months and 3 years of age, cumulative mortality was 15.1% for nonseroconverters and 4.5% for seroconverters. The difference in mortality was larger when high risk groups (twins, motherless children) were excluded from the analysis (P less than 0.01). The difference in mortality was particularly marked among children vaccinated in the age group 9 to 11 months. This as well as other community studies suggest that measles vaccination reduces child mortality from the age of vaccination by at least 30%.
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Affiliation(s)
- P Aaby
- Institute of Anthropology, University of Copenhagen, Denmark
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42
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Aaby P, Jensen TG, Hansen HL, Kristiansen H, Thårup J, Poulsen A, Sodemann M, Jakobsen M, Knudsen K, Clotilde da Silva M. Trial of high-dose Edmonston-Zagreb measles vaccine in Guinea-Bissau: protective efficacy. Lancet 1988; 2:809-11. [PMID: 2902263 DOI: 10.1016/s0140-6736(88)92780-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.
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Affiliation(s)
- P Aaby
- Institute of Ethnology and Anthropology, University of Copenhagen, Denmark
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