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Aguolu OG, Kiti MC, Nelson K, Liu CY, Sundaram M, Gramacho S, Jenness S, Melegaro A, Sacoor C, Bardaji A, Macicame I, Jose A, Cavele N, Amosse F, Uamba M, Jamisse E, Tchavana C, Briones HGM, Jarquín C, Ajsivinac M, Pischel L, Ahmed N, Mohan VR, Srinivasan R, Samuel P, John G, Ellington K, Joaquim OA, Zelaya A, Kim S, Chen H, Kazi M, Malik F, Yildirim I, Lopman B, Omer SB. Comprehensive profiling of social mixing patterns in resource poor countries: a mixed methods research protocol. medRxiv 2023:2023.12.05.23299472. [PMID: 38105989 PMCID: PMC10723497 DOI: 10.1101/2023.12.05.23299472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Low-and-middle-income countries (LMICs) bear a disproportionate burden of communicable diseases. Social interaction data inform infectious disease models and disease prevention strategies. The variations in demographics and contact patterns across ages, cultures, and locations significantly impact infectious disease dynamics and pathogen transmission. LMICs lack sufficient social interaction data for infectious disease modeling. Methods To address this gap, we will collect qualitative and quantitative data from eight study sites (encompassing both rural and urban settings) across Guatemala, India, Pakistan, and Mozambique. We will conduct focus group discussions and cognitive interviews to assess the feasibility and acceptability of our data collection tools at each site. Thematic and rapid analyses will help to identify key themes and categories through coding, guiding the design of quantitative data collection tools (enrollment survey, contact diaries, exit survey, and wearable proximity sensors) and the implementation of study procedures.We will create three age-specific contact matrices (physical, nonphysical, and both) at each study site using data from standardized contact diaries to characterize the patterns of social mixing. Regression analysis will be conducted to identify key drivers of contacts. We will comprehensively profile the frequency, duration, and intensity of infants' interactions with household members using high resolution data from the proximity sensors and calculating infants' proximity score (fraction of time spent by each household member in proximity with the infant, over the total infant contact time) for each household member. Discussion Our qualitative data yielded insights into the perceptions and acceptability of contact diaries and wearable proximity sensors for collecting social mixing data in LMICs. The quantitative data will allow a more accurate representation of human interactions that lead to the transmission of pathogens through close contact in LMICs. Our findings will provide more appropriate social mixing data for parameterizing mathematical models of LMIC populations. Our study tools could be adapted for other studies.
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Affiliation(s)
| | | | - Kristin Nelson
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Carol Y. Liu
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Maria Sundaram
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Sergio Gramacho
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Samuel Jenness
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Alessia Melegaro
- DONDENA Centre for Research in Social Dynamics and Public Policy, Bocconi University, Italy
| | | | - Azucena Bardaji
- Manhiça Health Research Centre, Manhica, Mozambique
- ISGlobal, Hospital Clinic – Universitat de Barcelona, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Ivalda Macicame
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | - Americo Jose
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | - Nilzio Cavele
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | | | - Migdalia Uamba
- Polana Caniço Health Research and Training Centre, CISPOC, Mozambique
| | | | | | | | - Claudia Jarquín
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala
| | - María Ajsivinac
- Centro de Estudios en Salud (CES), Universidad del Valle de Guatemala
| | - Lauren Pischel
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Noureen Ahmed
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
| | | | | | | | - Gifta John
- Christian Medical College Vellore, India
| | - Kye Ellington
- Rollins School of Public Health, Emory University, Georgia, USA
| | | | - Alana Zelaya
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Sara Kim
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Holin Chen
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Momin Kazi
- The Aga Khan University, Karachi, Pakistán
| | - Fauzia Malik
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
| | - Inci Yildirim
- Yale School of Medicine, Yale University, Connecticut, USA
| | - Benjamin Lopman
- Rollins School of Public Health, Emory University, Georgia, USA
| | - Saad B. Omer
- Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center, Dallas, Texas
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Amosse F, Kinshella MLW, Boene H, Sharma S, Nhamirre Z, Tchavana C, Magee LA, von Dadelszen P, Sevene E, Vidler M, Munguambe K. The development and implementation of a community engagement strategy to improve maternal health in southern Mozambique. PLOS Glob Public Health 2023; 3:e0001106. [PMID: 36962956 PMCID: PMC10021229 DOI: 10.1371/journal.pgph.0001106] [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] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/03/2023] [Indexed: 02/01/2023]
Abstract
Delays to seek medical help can contribute to maternal deaths particularly in community settings at home or on the road to a health facility. Community engagement (CE) can improve care-seeking behaviours and complements community-based interventions strengthening maternal health. The purpose of this paper is to describe the process undertaken to develop and implement a large-scale community engagement strategy in rural southern Mozambique. The CE strategy was developed within the context of the "Community-Level Interventions for Pre-eclampsia" (NCT01911494) conducted between 2015-2017 in southern Mozambique. Key CE messages included pregnancy complications and their warning signs, including pre-eclampsia and eclampsia, as well as emergency readiness, birth preparedness, decision-making mechanisms, transport options and information about the trial. CE meeting logs were used to record quantitative and qualitative information on demographic data and feedback. Quantitative data was analyzed using RStudio (RStudio Inc, Boston, United States) and community feedback was qualitatively analyzed on NVivo12 (QSR International, Melbourne, Australia). CE activities reached 19,169 participants during 4,239 meetings. CE activities were reported to be well received by community members though there was a relatively lower participation of men (3565 /18.6%). The use of recognized local leaders and personnel, such as community leaders, nurses and community health workers, allowed for greater acceptance of CE activities and maximized coverage of health messages in the community setting. Our CE strategy was effective in integrating maternal health promoting activities in routine care of community health workers and nurses in the area. Understanding district differences, engaging husbands, partners, mothers-in-law and community-level decision-makers to build local support for maternal health and flexibility to tailor messages to local needs were important in developing sustainable forms of CE. Better strategies are needed to effectively engage men in maternal health promotion who were less available due to working outside of the home or neighbourhoods.
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Affiliation(s)
| | - Mai-Lei Woo Kinshella
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women & Children's Health, King's Collage London, London, United Kingdom
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Women & Children's Health, King's Collage London, London, United Kingdom
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Khatia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
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Sevene E, Sharma S, Munguambe K, Sacoor C, Vala A, Macuacua S, Boene H, Mark Ansermino J, Augusto O, Bique C, Bone J, Dunsmuir DT, Lee T, Li J, Macete E, Singer J, Wong H, Nathan HL, Payne BA, Sidat M, Shennan AH, Tchavana C, Tu DK, Vidler M, Bhutta ZA, Magee LA, von Dadelszen P. Community-level interventions for pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertens 2020; 21:96-105. [PMID: 32464527 PMCID: PMC7471842 DOI: 10.1016/j.preghy.2020.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/28/2020] [Accepted: 05/09/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Pregnancy hypertension is the third leading cause of maternal mortality in Mozambique and contributes significantly to fetal and neonatal mortality. The objective of this trial was to assess whether task-sharing care might reduce adverse pregnancy outcomes related to delays in triage, transport, and treatment. STUDY DESIGN The Mozambique Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised controlled trial (NCT01911494) recruited pregnant women in 12 administrative posts (clusters) in Maputo and Gaza Provinces. The CLIP intervention (6 clusters) consisted of community engagement, community health worker-provided mobile health-guided clinical assessment, initial treatment, and referral to facility either urgently (<4hrs) or non-urgently (<24hrs), dependent on algorithm-defined risk. Treatment effect was estimated by multi-level logistic regression modelling, adjusted for prognostically-significant baseline variables. Predefined secondary analyses included safety and evaluation of the intensity of CLIP contacts. MAIN OUTCOME MEASURES 20% reduction in composite of maternal, fetal, and newborn mortality and major morbidity. RESULTS 15,013 women (15,123 pregnancies) were recruited in intervention (N = 7930; 2·0% loss to follow-up (LTFU)) and control (N = 7190; 2·8% LTFU) clusters. The primary outcome did not differ between intervention and control clusters (adjusted odds ratio (aOR) 1·31, 95% confidence interval (CI) [0·70, 2·48]; p = 0·40). Compared with intervention arm women without CLIP contacts, those with ≥8 contacts experienced fewer primary outcomes (aOR 0·79 (95% CI 0·63, 0·99); p = 0·041), primarily due to improved maternal outcomes (aOR 0·72 (95% CI 0·53, 0·97); p = 0·033). INTERPRETATION As generally implemented, the CLIP intervention did not improve pregnancy outcomes; community implementation of the WHO eight contact model may be beneficial. FUNDING The University of British Columbia (PRE-EMPT), a grantee of the Bill & Melinda Gates Foundation (OPP1017337).
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Affiliation(s)
- Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique.
| | - Sumedha Sharma
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Anifa Vala
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Salésio Macuacua
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Direcção Provincial de Saúde, Ministério da Saúde, Av. Eduardo Mondlane n(o) 1008, CP 264 Maputo, Mozambique
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - J Mark Ansermino
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Orvalho Augusto
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Cassimo Bique
- Departamento de Ginecologia e Obstetrícia, Hospital Central de Maputo, Av. Agostinho Neto n(o) 167, CP 1164 Maputo, Mozambique
| | - Jeffrey Bone
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Dustin T Dunsmuir
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Tang Lee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Jing Li
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Eusébio Macete
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique; Instituto Nacional de Saúde, Ministério da Saúde, Distrito de Marracuene, Estrada Nacional N(o) 1, Maputo, Mozambique
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, University of British Columbia, 588 - 1081 Burrard Street, St. Paul's Hospital, Vancouver V6Z 1Y6, Canada
| | - Hannah L Nathan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Beth A Payne
- Centre for International Child Health, University of British Columbia, 305 - 4088 Cambie Street, Vancouver V5Z 2X8, Canada
| | - Mohsin Sidat
- Faculdade de Medicina, Universidade Eduardo Mondlane, Av. Salvador Allende nr. 702, Maputo, Mozambique
| | - Andrew H Shennan
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Corssino Tchavana
- Centro de Investigação em Saúde da Manhiça (CISM), Rua 12, Cambeve, Manhiça, CP 1929 Maputo, Mozambique
| | - Domena K Tu
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, 525 University Avenue, Suite 702, Toronto M5G 2L3, Canada
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Suite 930, 1125 Howe Street, Vancouver V6Z 2K8, Canada; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Medicine and Life Sciences, King's College London, 1 Lambeth Place Road, London SE1 7EH, UK
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Magee LA, Strang A, Li L, Tu D, Tumtaweetikul W, Craik R, Daniele M, Etyang AK, D’Alessandro U, Ogochukwu O, Roca A, Sevene E, Chin P, Tchavana C, Temmerman M, von Dadelszen P. The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) database: open-access data collection in maternal and newborn health. Reprod Health 2020; 17:50. [PMID: 32354365 PMCID: PMC7191679 DOI: 10.1186/s12978-020-0873-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for 'deep phenotyping' based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal co-morbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience.
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Affiliation(s)
- Laura A. Magee
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Amber Strang
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Larry Li
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Domena Tu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Warancha Tumtaweetikul
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachel Craik
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Marina Daniele
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Angela Koech Etyang
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ofordile Ogochukwu
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esperança Sevene
- Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Paulo Chin
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | | | - Marleen Temmerman
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
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5
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Sevene E, Munguambe K, Sacoor C, Vala A, Boene H, Sharma S, Bone J, Payne BA, Vidler M, Li J, Tu DK, Lee T, Ansermino MA, Dunsmuir DT, Singer J, Tchavana C, Shennan A, Nathan H, Macete E, Bhutta ZA, Magee LA, von Dadelszen P, Clip Trials Working Group. 255 Community Level Interventions for Pre-eclampsia (CLIP) in Mozambique: A cluster randomised controlled trial. Pregnancy Hypertens 2018. [DOI: 10.1016/j.preghy.2018.08.106] [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: 11/16/2022]
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