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Van der Heyden J, Leclercq V, Duysburgh E, Cornelissen L, Desombere I, Roukaerts I, Gisle L. Prevalence of SARS-CoV-2 antibodies and associated factors in the adult population of Belgium: a general population cohort study between March 2021 and April 2022. Arch Public Health 2024; 82:72. [PMID: 38750563 PMCID: PMC11094959 DOI: 10.1186/s13690-024-01298-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/29/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND This study assessed seroprevalence trends of SARS-CoV-2 antibodies in the Belgian adult population between March 2021 and April 2022, and explored factors associated with seropositivity and seroreversion among the vaccinated and unvaccinated population. METHODS A prospective longitudinal surveillance study was conducted within a random sample of the general population (18 + years) in Belgium, selected from the national register through a multistage sampling design. Participants provided a saliva sample and completed a survey questionnaire on three occasions: at baseline and in two follow-up waves. Outcome variables included (1) seropositivity, defined as the presence of SARS-CoV-2 antibodies, assessed with a semi-quantitative measure of anti-RBD (Receptor Binding Domain) IgG ELISA and (2) seroreversion, defined as passing from a positive to a negative antibody test between two measurements. Trends in SARS-CoV-2 antibody prevalence were assessed using binary logistic regression with contrasts applying post-stratification. Potential determinants of seropositivity were assessed through multilevel logistic regressions. RESULTS In total 6,178 valid observations were obtained from 2,768 individuals. SARS-CoV-2 antibody prevalence increased from 25.1% in the beginning of the study period to 92.3% at the end. Among the vaccinated population, factors significantly associated with higher seropositivity rates were being younger, having a bachelor diploma, living with others, having had a vaccine in the last 3 months and having received a nucleic-acid vaccine or a combination. Lower seropositivity rates were observed among vaccinated people with a neurological disease and transplant patients. Factors significantly associated with higher seropositivity rates among the unvaccinated population were having non-O blood type and being non-smoker. Among vaccinated people, the seroreversion rate was much lower (0.3%) in those who had received their latest vaccine in the last 3 months compared to those who had received their latest vaccine more than 3 months ago (2.7%) (OR 0.13; 95%CI 0.04-0.42). CONCLUSIONS The rapid increase in antibody seropositivity in the general adult population in Belgium during the study period was driven by the vaccination campaign which ran at full speed during this period. Among vaccinated people, seropositivity varied in function of the time since last vaccine, the type of vaccine, sociodemographic features and health status.
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Affiliation(s)
- Johan Van der Heyden
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium.
| | - Victoria Leclercq
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | - Els Duysburgh
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | - Laura Cornelissen
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
| | | | | | - Lydia Gisle
- Epidemiology and public health, Sciensano Juliette Wytsmanstraat 14, Sciensano, Brussels, 1050, Belgium
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Digregorio M, Van Ngoc P, Delogne S, Meyers E, Deschepper E, Dardenne N, Duysburgh E, De Rop L, De Burghgraeve T, Coen A, De Clercq N, De Sutter A, Verbakel JY, Cools P, Heytens S, Buret L, Scholtes B. Vaccine hesitancy for the COVID-19 vaccine booster dose among nursing home staff fully vaccinated with the primary vaccination course in Belgium. Vaccine X 2024; 16:100453. [PMID: 38361529 PMCID: PMC10867438 DOI: 10.1016/j.jvacx.2024.100453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
In Belgium, nursing home (NH) staff (NHS) and residents were prioritised for the initial COVID-19 vaccination and successive booster doses. The vaccination campaign for the first booster started in September 2021 in Belgian NH. Our first study about vaccine hesitancy towards the COVID-19 vaccine in Belgian NHS already showed a degree of fear for the primary vaccination course (T1). This new study aims to evaluate vaccine hesitancy to get the first booster (T2) in a population of fully vaccinated (with two doses) NHS. A random stratified sample of NHS who received the primary vaccination course (N = 954) completed an online questionnaire on COVID-19 booster hesitancy (between 25/11/2021 and 22/01/2022). NHS who hesitated or refused the booster were asked for the main reason for their hesitation/refusal. Overall, 21.0 % of our population hesitated before, were still hesitating or refused the booster, NHS that were not hesitant at T1 being 5.7 times less likely to hesitate to get the first booster dose (Adjusted OR 0.179, 95 % CI: 0.120, 0.267). Although there was a slight reduction (23.5 % to 20.1 %) in the proportion of NHS who hesitated/refused vaccination at T1 compared to T2 (p = 0.034), the fear of unknown effects was the principal reason for hesitation/refusal, already mentioned in our first study. NHS were not reassured concerning their initial fears. Given the likelihood that booster vaccinations will be necessary over the coming years, a communication strategy specific to NHS should be implemented.
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Affiliation(s)
- Marina Digregorio
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Pauline Van Ngoc
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Simon Delogne
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Eline Meyers
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ellen Deschepper
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nadia Dardenne
- Biostatistics and Research Method Center, University of Liege, Liege Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Liselore De Rop
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Tine De Burghgraeve
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Anja Coen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele De Clercq
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jan Y. Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- NIHR Community Healthcare Medtech and IVD cooperative, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laëtitia Buret
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
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Callies M, Kabouche I, Desombere I, Merckx J, Roelants M, Vermeulen M, Duysburgh E. SARS-CoV-2 infection prevention and control measures in Belgian schools between December 2020 and June 2021 and their association with seroprevalence: a cross-sectional analysis of a prospective cohort study. BMC Public Health 2023; 23:898. [PMID: 37194008 DOI: 10.1186/s12889-023-15806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/04/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND To protect school-aged children from the potential consequences of a new viral infection, public health authorities recommended to implement infection prevention and control (IPC) measures in school settings. Few studies evaluated the implementation of these measures and their effect on SARS-CoV-2 infection rates among pupils and staff. The aim of this study was to describe the implementation of infection prevention and control (IPC) measures in Belgian schools and assess its relation to the prevalence of anti-SARS-CoV-2 antibodies among pupils and staff. METHODS We conducted a prospective cohort study in a representative sample of primary and secondary schools in Belgium between December 2020 and June 2021. The implementation of IPC measures in schools was assessed using a questionnaire. Schools were classified according to their compliance with the implementation of IPC measures as 'poor', 'moderate' or 'thorough'. Saliva samples were collected from pupils and staff to determine the SARS-CoV-2 seroprevalence. To assess the association between the strength of implementation of IPC measures and SARS-CoV-2 seroprevalence among pupils and staff, we conducted a cross-sectional analysis using the data collected in December 2020/January 2021. RESULTS A variety of IPC measures (ventilation, hygiene and physical distancing) was implemented by more than 60% of schools, with most attention placed on hygiene measures. In January 2021, poor implementation of IPC measures was associated with an increase in anti-SARS-CoV-2 antibody prevalence among pupils from 8.6% (95%CI: 4.5 - 16.6) to 16.7% (95%CI: 10.2 - 27.4) and staff from 11.5% (95%CI: 8.1 - 16.4) to 17.6% (95%CI: 11.5 - 27.0). This association was only statistically significant for the assessment of all IPC measures together in the population comprised of pupils and staff. CONCLUSIONS Belgian schools were relatively compliant with recommended IPC measures at the school level. Higher SARS-CoV-2 seroprevalence among pupils and staff was found in schools with poor implementation of IPC measures, compared to schools with thorough implementation. TRIAL REGISTRATION This trial is registered under the NCT04613817 ClinicalTrials.gov Identifier on November 3, 2020.
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Affiliation(s)
- Milena Callies
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
| | - Ines Kabouche
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Immune Response, Sciensano, Brussels, Belgium
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, University of Leuven, Louvain, KU, Belgium
| | - Melissa Vermeulen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Domen J, Verbakel JYJ, Adriaenssens N, Scholtes B, Peeters B, Bruyndonckx R, De Sutter A, Heytens S, Van den Bruel A, Desombere I, Van Damme P, Goossens H, Buret L, Duysburgh E, Coenen S. Validation of a rapid SARS-CoV-2 antibody test in general practice. BMJ Open 2023; 13:e069997. [PMID: 37130685 PMCID: PMC10163333 DOI: 10.1136/bmjopen-2022-069997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To validate a rapid serological test (RST) for SARS-CoV-2 antibodies used in seroprevalence studies in healthcare providers, including primary healthcare providers (PHCPs) in Belgium. DESIGN A phase III validation study of the RST (OrientGene) within a prospective cohort study. SETTING Primary care in Belgium. PARTICIPANTS Any general practitioner (GP) working in primary care in Belgium and any other PHCP from the same GP practice who physically manages patients were eligible in the seroprevalence study. For the validation study, all participants who tested positive (376) on the RST at the first testing timepoint (T1) and a random sample of those who tested negative (790) and unclear (24) were included. INTERVENTION At T2, 4 weeks later, PHCPs performed the RST with fingerprick blood (index test) immediately after providing a serum sample to be analysed for the presence of SARS-CoV-2 immunoglobulin G antibodies using a two-out-of-three assay (reference test). PRIMARY AND SECONDARY OUTCOME MEASURES The RST accuracy was estimated using inverse probability weighting to correct for missing reference test data, and considering unclear RST results as negative for the sensitivity and positive for the specificity. Using these conservative estimates, the true seroprevalence was estimated both for T2 and RST-based prevalence values found in a cohort study with PHCPs in Belgium. RESULTS 1073 paired tests (403 positive on the reference test) were included. A sensitivity of 73% (a specificity of 92%) was found considering unclear RST results as negative (positive). For an RST-based prevalence at T1 (13.9), T2 (24.9) and T7 (70.21), the true prevalence was estimated to be 9.1%, 25.9% and 95.7%, respectively. CONCLUSION The RST sensitivity (73%) and specificity (92%) make an RST-based seroprevalence below (above) 23% overestimate (underestimate) the true seroprevalence. TRIAL REGISTRATION NUMBER NCT04779424.
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Affiliation(s)
- Julie Domen
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
| | - Jan Yvan Jos Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Niels Adriaenssens
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
| | - Beatrice Scholtes
- General Practice Department-Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Bart Peeters
- Department of Laboratory Medicine, University Hospital Antwerp, Edegem, Belgium
| | - Robin Bruyndonckx
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Hasselt, Belgium
- Epidemiology & Pharmavigilance, P95, Leuven, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, EPI-Centre, KU Leuven, Leuven, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Pierre Van Damme
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, University of Antwerp Faculty of Medicine and Health Sciences, Antwerpen (Wilrijk, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
| | - Laetitia Buret
- General Practice Department-Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP), Centre for General Practice, University of Antwerp, Antwerpen, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
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5
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Merckx J, Callies M, Kabouche I, Desombere I, Duysburgh E, Roelants M. SARS-CoV-2 seroprevalence and determinants for salivary seropositivity among pupils and school staff: A prospective cohort study. Epidemiol Infect 2023; 151:e75. [PMID: 37092673 DOI: 10.1017/s0950268823000584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Abstract
Representative school data on SARS-CoV-2 past-infection are scarce, and differences between pupils and staff remain ambiguous. We performed a nation-wide prospective seroprevalence study among pupils and staff over time and in relation to determinants of infection using Poisson regression and generalised estimating equations. A cluster random sample was selected with allocation by region and sociodemographic (SES) background. Surveys and saliva samples were collected in December 2020, March, and June 2021, and also in October and December 2021 for primary pupils. We recruited 885 primary and 569 secondary pupils and 799 staff in 84 schools. Cumulative seroprevalence (95% CI) among primary pupils increased from 11.0% (7.6; 15.9) at baseline to 60.4% (53.4; 68.3) in December 2021. Group estimates were similar at baseline; however, in June they were significantly higher among primary staff (38.9% (32.5; 46.4)) compared to pupils and secondary staff (24.2% (20.3; 28.8)). Infections were asymptomatic in 48-56% of pupils and 28% of staff. Seropositivity was associated with individual SES in pupils, and with school level, school SES and language network in staff in June. Associations with behavioural characteristics were inconsistent. Seroconversion rates increased two- to four-fold after self-reported high-risk contacts, especially with adults. Seroprevalence studies using non-invasive sampling can inform public health management.
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Meyers E, De Rop L, Deschepper E, Duysburgh E, De Burghgraeve T, Van Ngoc P, Digregorio M, Delogne S, Coen A, De Clercq N, Buret L, Coenen S, De Sutter A, Scholtes B, Verbakel JY, Cools P, Heytens S. Prevalence of SARS-CoV-2 antibodies among Belgian nursing home residents and staff during the primary COVID-19 vaccination campaign. Eur J Gen Pract 2022:1-9. [DOI: 10.1080/13814788.2022.2149732] [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: 11/29/2022] Open
Affiliation(s)
- Eline Meyers
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Liselore De Rop
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
| | - Ellen Deschepper
- Faculty of Medicine and Health Sciences, Biostatistics Unit, Ghent University, Ghent, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Tine De Burghgraeve
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
| | - Pauline Van Ngoc
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Marina Digregorio
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Simon Delogne
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Anja Coen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Nele De Clercq
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Laëtitia Buret
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP) and Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Beatrice Scholtes
- Department of General Medicine, Faculty of Medicine, Research Unit of Primary Care and Health, University of Liège, Liège, Belgium
| | - Jan Y. Verbakel
- Department of Public Health and Primary Care, EPI-Centre, ACHG, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Adriaenssens N, Scholtes B, Bruyndonckx R, Van Ngoc P, Verbakel JYJ, De Sutter A, Heytens S, Van Den Bruel A, Desombere I, Van Damme P, Goossens H, Buret L, Duysburgh E, Coenen S. Prevalence, incidence and longevity of antibodies against SARS-CoV-2 among primary healthcare providers in Belgium: a prospective cohort study with 12 months of follow-up. BMJ Open 2022; 12:e065897. [PMID: 36123069 PMCID: PMC9485641 DOI: 10.1136/bmjopen-2022-065897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To estimate the prevalence, incidence and longevity of antibodies against SARS-CoV-2 among primary healthcare providers (PHCPs). DESIGN Prospective cohort study with 12 months of follow-up. SETTING Primary care in Belgium. PARTICIPANTS Any general practitioner (GP) working in primary care in Belgium and any other PHCP from the same GP practice who physically manages (examines, tests, treats) patients were eligible. A convenience sample of 3648 eligible PHCPs from 2001 GP practices registered for this study (3044 and 604 to start in December 2020 and January 2021, respectively). 3390 PHCPs (92,9%) participated in their first testing time point (2820 and 565, respectively) and 2557 PHCPs (70,1%) in the last testing time point (December 2021). INTERVENTIONS Participants were asked to perform a rapid serological test targeting IgM and IgG against the receptor binding domain of SARS-CoV-2 and to complete an online questionnaire at each of maximum eight testing time points. PRIMARY AND SECONDARY OUTCOME MEASURES The prevalence, incidence and longevity of antibodies against SARS-CoV-2 both after natural infection and after vaccination. RESULTS Among all participants, 67% were women and 77% GPs. Median age was 43 years. The seroprevalence in December 2020 (before vaccination availability) was 15.1% (95% CI 13.5% to 16.6%), increased to 84.2% (95% CI 82.9% to 85.5%) in March 2021 (after vaccination availability) and reached 93.9% (95% CI 92.9% to 94.9%) in December 2021 (during booster vaccination availability and fourth (delta variant dominant) COVID-19 wave). Among not (yet) vaccinated participants the first monthly incidence of antibodies against SARS-CoV-2 was estimated to be 2.91% (95% CI 1.80% to 4.01%). The longevity of antibodies is higher in PHCPs with self-reported COVID-19 infection. CONCLUSIONS This study confirms that occupational health measures provided sufficient protection when managing patients. High uptake of vaccination resulted in high seroprevalence of SARS-CoV-2 antibodies in PHCPs in Belgium. Longevity of antibodies was supported by booster vaccination and virus circulation. TRIAL REGISTRATION NUMBER NCT04779424.
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Affiliation(s)
- Niels Adriaenssens
- Family Medicine & Population Health, Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp (Wilrijk), Belgium
| | - Beatrice Scholtes
- General Practice Department, Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BIOSTAT), Hasselt University, Hasselt, Limburg, Belgium
- Epidemiology & Pharmacovigilance, P95, Leuven, Belgium
- Vaccine & Infectious Disease Institute, Laboratory of Medical Microbiology, University of Antwerp, Antwerp (Wilrijk), Belgium
| | - Pauline Van Ngoc
- General Practice Department, Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Jan Yvan Jos Verbakel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
| | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Ann Van Den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Pierre Van Damme
- Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp (Wilrijk), Belgium
| | - Herman Goossens
- Vaccine & Infectious Disease Institute, Laboratory of Medical Microbiology, University of Antwerp, Antwerp (Wilrijk), Belgium
| | - Laetitia Buret
- General Practice Department, Primary Care and Health Research Unit, Liege University, Liege, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Samuel Coenen
- Family Medicine & Population Health, Centre for General Practice, University of Antwerp Faculty of Medicine and Health Sciences, Antwerp (Wilrijk), Belgium
- Vaccine & Infectious Disease Institute, Laboratory of Medical Microbiology, University of Antwerp, Antwerp (Wilrijk), Belgium
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8
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Digregorio M, Van Ngoc P, Delogne S, Meyers E, Deschepper E, Duysburgh E, De Rop L, De Burghgraeve T, Coen A, De Clercq N, Sutter AD, Verbakel JY, Cools P, Heytens S, Buret L, Scholtes B. Vaccine Hesitancy towards the COVID-19 Vaccine in a Random National Sample of Belgian Nursing Home Staff Members. Vaccines (Basel) 2022; 10:vaccines10040598. [PMID: 35455347 PMCID: PMC9028198 DOI: 10.3390/vaccines10040598] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/10/2022] [Indexed: 02/01/2023] Open
Abstract
In Belgium, nursing home staff (NHS) and residents were prioritised for COVID-19 vaccination. However, vaccine hesitancy may have impacted vaccination rates. In this study, a random stratified sample of NHS (N = 1142), vaccinated and unvaccinated, completed an online questionnaire on COVID-19 vaccine hesitancy (between 31 July and 15 November 2021). NHS who hesitated or refused the vaccine were asked for the main reason for their hesitation/refusal. Those who hesitated, but eventually accepted vaccination, were asked why they changed their minds. Overall, 29.5% of all respondents hesitated before accepting vaccination, were still hesitating, or refused vaccination. Principal reasons were fear of unknown future effects (55.1% of vaccinated participants that hesitated and 19.5% who refused), fear of side-effects (12.7% of vaccinated participants that hesitated and 12.2% who refused), and mistrust in vaccination (10.5% of vaccinated participants that hesitated and 12.2% who refused). For vaccinated participants who hesitated initially, protecting the vulnerable was the main reason they changed their minds. Given this degree of fear and proposals to mandate vaccination among healthcare workers, communicating with NHS on the safety and efficacy of the vaccine should be prioritised.
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Affiliation(s)
- Marina Digregorio
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, 4000 Liège, Belgium; (S.D.); (L.B.); (B.S.)
- Correspondence: (M.D.); (P.V.N.)
| | - Pauline Van Ngoc
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, 4000 Liège, Belgium; (S.D.); (L.B.); (B.S.)
- Correspondence: (M.D.); (P.V.N.)
| | - Simon Delogne
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, 4000 Liège, Belgium; (S.D.); (L.B.); (B.S.)
| | - Eline Meyers
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (E.M.); (P.C.)
| | - Ellen Deschepper
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium;
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium;
| | - Liselore De Rop
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium; (L.D.R.); (T.D.B.); (J.Y.V.)
| | - Tine De Burghgraeve
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium; (L.D.R.); (T.D.B.); (J.Y.V.)
| | - Anja Coen
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (A.C.); (N.D.C.); (A.D.S.); (S.H.)
| | - Nele De Clercq
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (A.C.); (N.D.C.); (A.D.S.); (S.H.)
| | - An De Sutter
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (A.C.); (N.D.C.); (A.D.S.); (S.H.)
| | - Jan Y. Verbakel
- EPI-Centre, Department of Public Health and Primary Care, KU Leuven, 3000 Leuven, Belgium; (L.D.R.); (T.D.B.); (J.Y.V.)
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX2 6GG, UK
| | - Piet Cools
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (E.M.); (P.C.)
| | - Stefan Heytens
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium; (A.C.); (N.D.C.); (A.D.S.); (S.H.)
| | - Laëtitia Buret
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, 4000 Liège, Belgium; (S.D.); (L.B.); (B.S.)
| | - Beatrice Scholtes
- Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, 4000 Liège, Belgium; (S.D.); (L.B.); (B.S.)
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9
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Adriaenssens N, Scholtes B, Bruyndonckx R, Verbakel JY, De Sutter A, Heytens S, Van den Bruel A, Desombere I, Van Damme P, Goossens H, Buret L, Duysburgh E, Coenen S. Prevalence and incidence of antibodies against SARS-CoV-2 among primary healthcare providers in Belgium during 1 year of the COVID-19 epidemic: prospective cohort study protocol. BMJ Open 2022; 12:e054688. [PMID: 35105642 PMCID: PMC8804304 DOI: 10.1136/bmjopen-2021-054688] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION National SARS-CoV-2 seroprevalence data provide essential information about population exposure to the virus and help predict the future course of the epidemic. Early cohort studies have suggested declines in levels of antibodies in individuals associated with, for example, illness severity, age and comorbidities. This protocol focuses on the seroprevalence among primary healthcare providers (PHCPs) in Belgium. PHCPs manage the vast majority of (COVID-19) patients and therefore play an essential role in the efficient organisation of healthcare. Currently, evidence is lacking on (1) how many PHCPs get infected with SARS-CoV-2 in Belgium, (2) the rate at which this happens, (3) their clinical spectrum, (4) their risk factors, (5) the effectiveness of the measures to prevent infection and (6) the accuracy of the serology-based point-of-care test (POCT) in a primary care setting. METHODS AND ANALYSIS This study will be set up as a prospective cohort study. General practitioners (GPs) and other PHCPs (working in a GP practice) will be recruited via professional networks and professional media outlets to register online to participate. Registered GPs and other PHCPs will be asked at each testing point (n=9) to perform a capillary blood sample antibody POCT targeting IgM and IgG against the receptor-binding domain of SARS-CoV-2 and complete an online questionnaire. The primary outcomes are the prevalence and incidence of antibodies against SARS-CoV-2 in PHCPs during a 12-month follow-up period. Secondary outcomes include the longevity of antibodies against SARS-CoV-2. ETHICS AND DISSEMINATION Ethical approval has been granted by the ethics committee of the University Hospital of Antwerp/University of Antwerp (Belgian registration number: 3002020000237). Alongside journal publications, dissemination activities include the publication of monthly reports to be shared with the participants and the general population through the publicly available website of the Belgian health authorities (Sciensano). TRIAL REGISTRATION NUMBER NCT04779424.
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Affiliation(s)
- Niels Adriaenssens
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerpen, Belgium
| | - Beatrice Scholtes
- Département des Sciences Cliniques, University of Liege, Liege, Belgium
| | - Robin Bruyndonckx
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), Data Science Institute, Hasselt University, Hasselt, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
| | - Jan Y Verbakel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, Oxford University, Oxford, UK
| | - An De Sutter
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Stefan Heytens
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
| | - Ann Van den Bruel
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, Brussel, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
| | - Laëtitia Buret
- Département des Sciences Cliniques, University of Liege, Liege, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussel, Belgium
| | - Samuel Coenen
- Department of Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerpen, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerpen, Belgium
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10
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Boey L, Roelants M, Merckx J, Hens N, Desombere I, Duysburgh E, Vandermeulen C. Age-dependent seroprevalence of SARS-CoV-2 antibodies in school-aged children from areas with low and high community transmission. Eur J Pediatr 2022; 181:571-578. [PMID: 34455523 PMCID: PMC8402965 DOI: 10.1007/s00431-021-04222-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/01/2021] [Accepted: 07/26/2021] [Indexed: 12/20/2022]
Abstract
It is not yet clear to what extent SARS-CoV-2 infection rates in children reflect community transmission, nor whether infection rates differ between primary schoolchildren and young teenagers. A cross-sectional serosurvey compared the SARS-CoV2 attack-rate in a sample of 362 children recruited from September 21 to October 6, 2020, in primary (ages 6-12) or lower secondary school (ages 12-15) in a municipality with low community transmission (Pelt) to a municipality with high community transmission (Alken) in Belgium. Children were equally distributed over grades and regions. Blood samples were tested for the presence of antibodies to SARS-CoV-2 with an enzyme-linked immunosorbent assay. We found anti-SARS-CoV-2 antibodies in 4.4% of children in the low transmission region and in 14.4% of children in the high transmission region. None of the primary schoolchildren were seropositive in the low transmission region, whereas the seroprevalence among primary and secondary schoolchildren did not differ significantly in the high transmission region. None of the seropositive children suffered from severe disease. Children who were in contact with a confirmed case (RR 2.9; 95%CI 1.6-4.5), who participated in extracurricular activities (RR 5.6; 95%CI 1.2-25.3), or whose caregiver is a healthcare worker who had contact with COVID-19 patients (RR 2.2; 95%CI 1.0-4.6) were at higher risk of seropositivity. If SARS-CoV2 circulation in the community is high, this will be reflected in the pediatric population with similar infection rates in children aged 6-12 years and 12-15 years. What is Known: •Children are generally less affected by COVID-19 than adults but SARS-CoV2 infection rates among children are not well known. •There were large regional differences in infection rates during the first wave of the SARS-CoV2 pandemic. What is New: •None of the primary schoolchildren (6-12 years) were seropositive for SARS-CoV2 in an area with a low community transmission, but infection rates were higher in adolescents (12-15 years). •In an area with high community transmission, seroprevalence rates in younger children were more comparable to those in adolescents.
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Affiliation(s)
- Lise Boey
- Environment and Health, Department of Public Health and Primary Care, Leuven University Vaccinology Center, KU Leuven, Leuven, Belgium.
| | - Mathieu Roelants
- Environment and Health, Department of Public Health and Primary Care, Leuven University Vaccinology Center, KU Leuven, Leuven, Belgium
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC Canada
| | - Niel Hens
- Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium ,Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, Centre for Health Economic Research, University of Antwerp, Antwerp, Belgium
| | - Isabelle Desombere
- Infectious Diseases in Humans, Sciensano (Public Health Belgium), Brussels, Belgium
| | - Els Duysburgh
- Epidemiology and Public Health, Sciensano (Public Health Belgium), Brussels, Belgium
| | - Corinne Vandermeulen
- Environment and Health, Department of Public Health and Primary Care, Leuven University Vaccinology Center, KU Leuven, Leuven, Belgium
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11
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Mortgat L, Verdonck K, Hutse V, Thomas I, Barbezange C, Heyndrickx L, Fischer N, Vuylsteke B, Kabouche I, Ariën KK, Desombere I, Duysburgh E. Prevalence and incidence of anti-SARS-CoV-2 antibodies among healthcare workers in Belgian hospitals before vaccination: a prospective cohort study. BMJ Open 2021; 11:e050824. [PMID: 34187832 PMCID: PMC8245288 DOI: 10.1136/bmjopen-2021-050824] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To describe prevalence and incidence of anti-SARS-CoV-2 antibodies among Belgian hospital healthcare workers (HCW) in April-December 2020. DESIGN Prospective cohort study. Follow-up was originally planned until September and later extended. SETTING Multicentre study, 17 hospitals. PARTICIPANTS 50 HCW were randomly selected per hospital. HCW employed beyond the end of the study and whose profession involved contact with patients were eligible. 850 HCW entered the study in April-May 2020, 673 HCW (79%) attended the September visit and 308 (36%) the December visit. OUTCOME MEASURES A semiquantitative ELISA was used to detect IgG against SARS-CoV-2 in serum (Euroimmun) at 10 time points. In seropositive samples, neutralising antibodies were measured using a virus neutralisation test. Real-time reverse transcription PCR (RT-qPCR) was performed to detect SARS-CoV-2 on nasopharyngeal swabs. Participant characteristics and the presence of symptoms were collected via an online questionnaire. RESULTS Among all participants, 80% were women, 60% nurses and 21% physicians. Median age was 40 years. The seroprevalence remained relatively stable from April (7.7% (95% CI: 4.8% to 12.1%) to September (8.2% (95% CI: 5.7% to 11.6%)) and increased thereafter, reaching 19.7% (95% CI: 12.0% to 30.6%) in December 2020. 76 of 778 initially seronegative participants seroconverted during the follow-up (incidence: 205/1000 person-years). Among all seropositive individuals, 118/148 (80%) had a positive neutralisation test, 83/147 (56%) presented or reported a positive RT-qPCR, and 130/147 (88%) reported COVID-19-compatible symptoms at least once. However, only 46/73 (63%) of the seroconverters presented COVID-19-compatible symptoms in the month prior to seroconversion. CONCLUSIONS The seroprevalence among hospital HCW was slightly higher than that of the general Belgian population but followed a similar evolution, suggesting that infection prevention and control measures were effective and should be strictly maintained. After two SARS-CoV-2 waves, 80% of HCW remained seronegative, justifying their prioritisation in the vaccination strategy. TRIAL REGISTRATION NUMBER NCT04373889.
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Affiliation(s)
- Laure Mortgat
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- European Programme for Intervention Epidemiology Training (EPIET), ECDC, Solna, Sweden
| | - Kristien Verdonck
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veronik Hutse
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Isabelle Thomas
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Cyril Barbezange
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Leo Heyndrickx
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Natalie Fischer
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
- European Public Health Microbiology Training (EUPHEM), ECDC, Solna, Sweden
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Ines Kabouche
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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12
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Mariën J, Ceulemans A, Michiels J, Heyndrickx L, Kerkhof K, Foque N, Widdowson MA, Mortgat L, Duysburgh E, Desombere I, Jansens H, Van Esbroeck M, Ariën KK. Evaluating SARS-CoV-2 spike and nucleocapsid proteins as targets for antibody detection in severe and mild COVID-19 cases using a Luminex bead-based assay. J Virol Methods 2021; 288:114025. [PMID: 33227340 PMCID: PMC7678438 DOI: 10.1016/j.jviromet.2020.114025] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/09/2023]
Abstract
Large-scale serosurveillance of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) will only be possible if serological tests are sufficiently reliable, rapid and affordable. Many assays are either labour-intensive and require specialised facilities (e.g. virus neutralization assays), or are expensive with suboptimal specificity (e.g. commercial ELISAs and RDTs). Bead-based assays offer a cost-effective alternative and allow for multiplexing to test for antibodies against multiple antigens and against other pathogens. Here, we compare the performance of spike (S) and nucleocapsid (NP) antigens for the detection of SARS-CoV-2 specific IgG, IgM and IgA antibodies in a panel of sera that includes recent (up to six weeks after symptom onset, severe n = 44; and mild cases n = 52) and old infections (five months after symptom onset, mild n = 104), using a Luminex-bead based assay and comparison to a virus neutralization test. While we show that neutralizing antibody levels are significantly lower in mild than in severe cases, we demonstrate that a combination of the recombinant nucleocapsid protein (NP) and receptor-binding domain (RBD) results in highly specific (99 %) IgG antibody detection five months after infection in 96 % of cases. Although most severe Covid-19 cases developed a clear IgM and IgA response, titers fell below the detection threshold in more than 20 % of mild cases in our bead-based assay. In conclusion, our data supports the use of RBD and NP for the development of SARS-CoV-2 serological IgG bead-based assays.
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Affiliation(s)
- Joachim Mariën
- Outbreak Research Team, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Ann Ceulemans
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Johan Michiels
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Leo Heyndrickx
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Karen Kerkhof
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Nikki Foque
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Laure Mortgat
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | | | - Marjan Van Esbroeck
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Virology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium.
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13
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Abstract
IntroductionThe number of patients and clinical conditions treated in home healthcare (HHC) is increasing. Care in home settings presents many challenges, including healthcare-associated infections (HAI). Currently, in Belgium, data and guidelines on the topic are lacking.AimTo develop a definition of HAI in HHC and investigate associated risk factors and recommendations for infection prevention and control (IPC).MethodsThe study included three components: a scoping literature review, in-depth interviews with individuals involved in HHC and a two-round Delphi survey to reach consensus among key informants on the previous steps' results.ResultsThe literature review included 47 publications. We conducted 21 in-depth interviews. The Delphi survey's two rounds had 21 and 23 participants, respectively. No standard definition was broadly accepted or known. Evidence on associated risk factors was impacted by methodological limitations and recommendations were inconsistent. Agreement was reached on defining HAI in HHC as any infection specifically linked with providing care that develops in a patient receiving HHC from a professional healthcare worker and occurs ≥ 48 hours after starting HHC. Risk factors were hand hygiene, untrained patients and caregivers, patients' hygiene and presence and management of invasive devices. Agreed recommendations were to adapt and standardise existing IPC guidelines to HHC and to perform a national point prevalence study to measure the burden of HAI in HHC.ConclusionsThis study offers an overview of available evidence and field knowledge of HAI in HHC. It provides a framework for a prevalence study, future monitoring policies and guidelines on IPC in Belgium.
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Affiliation(s)
- Ana Hoxha
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laure Mortgat
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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14
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Klamer S, Van Goethem N, Thomas D, Duysburgh E, Braeye T, Quoilin S. Prioritisation for future surveillance, prevention and control of 98 communicable diseases in Belgium: a 2018 multi-criteria decision analysis study. BMC Public Health 2021; 21:192. [PMID: 33482767 PMCID: PMC7820105 DOI: 10.1186/s12889-020-09566-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 09/18/2020] [Indexed: 12/03/2022] Open
Abstract
Background National public health agencies are required to prioritise infectious diseases for prevention and control. We applied the prioritisation method recommended by the European Centre for Disease Prevention and Control to rank infectious diseases, according to their relative importance for surveillance and public health, to inform future public health action in Belgium. Methods We applied the multi-criteria-decision-analysis approach. A working group of epidemiologists and statisticians from Belgium (n = 6) designed a balanced set of prioritisation criteria. A panel of Belgian experts (n = 80) allocated in an online survey each criteria a weight, according to perceived relative importance. Next, experts (n = 37) scored each disease against each criteria in an online survey, guided by disease-specific factsheets referring the period 2010–2016 in Belgium. The weighted sum of the criteria’s scores composed the final weighted score per disease, on which the ranking was based. Sensitivity analyses quantified the impact of eight alternative analysis scenarios on the top-20 ranked diseases. We identified criteria and diseases associated with data-gaps as those with the highest number of blank answers in the scoring survey. Principle components of the final weighted score were identified. Results Working groups selected 98 diseases and 18 criteria, structured in five criteria groups. The diseases ranked highest were (in order) pertussis, human immunodeficiency virus infection, hepatitis C and hepatitis B. Among the five criteria groups, overall the highest weights were assigned to ‘impact on the patient’, followed by ‘impact on public health’, while different perceptions were identified between clinicians, microbiologists and epidemiologists. Among the 18 individual criteria, ‘spreading potential’ and ‘events requiring public health action’ were assigned the highest weights. Principle components clustered with thematic disease groups. Notable data gaps were found among hospital-related diseases. Conclusions We ranked infectious diseases using a standardised reproducible approach. The diseases ranked highest are included in current public health programs, but additional reflection for example about needs among risk groups is recommended. Cross-reference of the obtained ranking with current programs is needed to verify whether resources and activities map priority areas. We recommend to implement this method in a recurrent evaluation cycle of national public health priorities.
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Affiliation(s)
- Sofieke Klamer
- Epidemiology and public health, Epidemiology of infectious diseases, Sciensano, Brussels, Belgium. .,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
| | - Nina Van Goethem
- Epidemiology and public health, Epidemiology of infectious diseases, Sciensano, Brussels, Belgium
| | | | | | - Daniel Thomas
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.,Communicable Disease Surveillance Centre, Public Health Wales, Cardiff, Wales
| | - Els Duysburgh
- Epidemiology and public health, Healthcare-associated infections, Sciensano, Brussels, Belgium
| | - Toon Braeye
- Epidemiology and public health, Epidemiology of infectious diseases, Sciensano, Brussels, Belgium
| | - Sophie Quoilin
- Epidemiology and public health, Epidemiology of infectious diseases, Sciensano, Brussels, Belgium
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15
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Duysburgh E, Mortgat L, Barbezange C, Dierick K, Fischer N, Heyndrickx L, Hutse V, Thomas I, Van Gucht S, Vuylsteke B, Ariën KK, Desombere I. Persistence of IgG response to SARS-CoV-2. Lancet Infect Dis 2020; 21:163-164. [PMID: 33341124 PMCID: PMC7833610 DOI: 10.1016/s1473-3099(20)30943-9] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023]
Affiliation(s)
- Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium.
| | - Laure Mortgat
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium; European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Cyril Barbezange
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
| | - Katelijne Dierick
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
| | - Natalie Fischer
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium; European Public Health Microbiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Leo Heyndrickx
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Veronik Hutse
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
| | - Isabelle Thomas
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
| | - Steven Van Gucht
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Kevin K Ariën
- Department of Biomedical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - Isabelle Desombere
- Department of Infectious Diseases in Humans, Sciensano, 1050 Brussels, Belgium
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16
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Catteau L, Dauby N, Montourcy M, Bottieau E, Hautekiet J, Goetghebeur E, van Ierssel S, Duysburgh E, Van Oyen H, Wyndham-Thomas C, Van Beckhoven D. Low-dose hydroxychloroquine therapy and mortality in hospitalised patients with COVID-19: a nationwide observational study of 8075 participants. Int J Antimicrob Agents 2020; 56:106144. [PMID: 32853673 PMCID: PMC7444610 DOI: 10.1016/j.ijantimicag.2020.106144] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/19/2020] [Indexed: 02/07/2023]
Abstract
Hydroxychloroquine (HCQ) 2400 mg over 5 days was used in Belgium for COVID-19. Impact of HCQ on mortality among 8075 patients with COVID-19 was assessed. Lower mortality in HCQ-treated patients as compared to supportive care. Lower mortality was irrespective of symptom duration.
Hydroxychloroquine (HCQ) has been largely used and investigated as therapy for COVID-19 across various settings at a total dose usually ranging from 2400 mg to 9600 mg. In Belgium, off-label use of low-dose HCQ (total 2400 mg over 5 days) was recommended for hospitalised patients with COVID-19. We conducted a retrospective analysis of in-hospital mortality in the Belgian national COVID-19 hospital surveillance data. Patients treated either with HCQ monotherapy and supportive care (HCQ group) were compared with patients treated with supportive care only (no-HCQ group) using a competing risks proportional hazards regression with discharge alive as competing risk, adjusted for demographic and clinical features with robust standard errors. Of 8075 patients with complete discharge data on 24 May 2020 and diagnosed before 1 May 2020, 4542 received HCQ in monotherapy and 3533 were in the no-HCQ group. Death was reported in 804/4542 (17.7%) and 957/3533 (27.1%), respectively. In the multivariable analysis, mortality was lower in the HCQ group compared with the no-HCQ group [adjusted hazard ratio (aHR) = 0.684, 95% confidence interval (CI) 0.617–0.758]. Compared with the no-HCQ group, mortality in the HCQ group was reduced both in patients diagnosed ≤5 days (n = 3975) and >5 days (n = 3487) after symptom onset [aHR = 0.701 (95% CI 0.617–0.796) and aHR = 0.647 (95% CI 0.525–0.797), respectively]. Compared with supportive care only, low-dose HCQ monotherapy was independently associated with lower mortality in hospitalised patients with COVID-19 diagnosed and treated early or later after symptom onset.
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Affiliation(s)
- Lucy Catteau
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Nicolas Dauby
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium; Institute for Medical Immunology, Université Libre de Bruxelles (ULB), Brussels, Belgium; Environmental Health Research Centre, Public Health School, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Marion Montourcy
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Joris Hautekiet
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Els Goetghebeur
- Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Sabrina van Ierssel
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp (UZA), Edegem, Belgium
| | - Els Duysburgh
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium; Public Health and Primary Care, Gent University, Gent, Belgium
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Soetaert K, Subissi L, Ceyssens PJ, Vanfleteren B, Chantrenne M, Asikainen T, Duysburgh E, Mathys V. Strong increase of true and false positive mycobacterial cultures sent to the National Reference Centre in Belgium, 2007 to 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 30892180 PMCID: PMC6425549 DOI: 10.2807/1560-7917.es.2019.24.11.1800205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction In 2007, a new federal legislation in Belgium prohibited non-biosafety level 3 laboratories to process culture tubes suspected of containing mycobacteria. Aim To present mycobacterial surveillance/diagnosis data from the Belgian National Reference Centre for mycobacteria (NRC) from 2007 to 2016. Methods This retrospective observational study investigated the numbers of analyses at the NRC and false positive cultures (interpreted as containing mycobacteria at referring clinical laboratories, but with no mycobacterial DNA detected by PCR in the NRC). We reviewed mycobacterial species identified and assessed trends over time of proportions of nontuberculous mycobacteria (NTM) vs Mycobacterium tuberculosis complex (MTBc), and false positive cultures vs NTM. Results From 2007 to 2016, analyses requests to the NRC doubled from 12.6 to 25.3 per 100,000 inhabitants. A small but significant increase occurred in NTM vs MTBc proportions, from 57.9% (587/1,014) to 60.3% (867/1,437) (p < 0.001). Although NTM infection notification is not mandatory in Belgium, we annually received up to 8.6 NTM per 100,000 inhabitants. M. avium predominated (ca 20% of NTM cultures), but M. intracellulare culture numbers rose significantly, from 13.0% (74/587) of NTM cultures in 2007 to 21.0% (178/867) in 2016 (RR: 1.05; 95% CI: 1.03–1.07). The number of false positive cultures also increased, reaching 43.3% (1,097/2,534) of all samples in 2016. Conclusion We recommend inclusion of NTM in sentinel programmes. The large increase of false positive cultures is hypothesised to result from processing issues prior to arrival at the NRC, highlighting the importance of sample decontamination/transport and equipment calibration in peripheral laboratories.
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Affiliation(s)
- Karine Soetaert
- Unit Bacterial Diseases Service, Infectious diseases in Humans, Sciensano, Brussels, Belgium
| | - Lorenzo Subissi
- European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.,Unit Bacterial Diseases Service, Infectious diseases in Humans, Sciensano, Brussels, Belgium
| | - Pieter-Jan Ceyssens
- Unit Bacterial Diseases Service, Infectious diseases in Humans, Sciensano, Brussels, Belgium
| | - Brigitte Vanfleteren
- Unit Bacterial Diseases Service, Infectious diseases in Humans, Sciensano, Brussels, Belgium
| | | | - Tommi Asikainen
- Epidemiology of Infectious Diseases, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Healthcare-associated infections and antimicrobial resistance, Sciensano, Brussels, Belgium
| | - Vanessa Mathys
- Unit Bacterial Diseases Service, Infectious diseases in Humans, Sciensano, Brussels, Belgium
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18
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Yugbaré Belemsaga D, Goujon A, Degomme O, Nassa T, Duysburgh E, Kouanda S, Temmerman M. Assessing changes in costs of maternal postpartum services between 2013 and 2014 in Burkina Faso. Int J Equity Health 2019; 18:154. [PMID: 31615526 PMCID: PMC6794858 DOI: 10.1186/s12939-019-1064-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/30/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction In Africa, a majority of women bring their infant to health services for immunization, but few are checked in the postpartum (PP) period. The Missed opportunities for maternal and infant health (MOMI) EU-funded project has implemented a package of interventions at community and facility levels to uptake maternal and infant postpartum care (PPC). One of these interventions is the integration of maternal PPC in child clinics and infant immunization services, which proved to be successful for improving maternal and infant PPC. Aim Taking stock of the progress achieved in terms of PPC with the implementation of the interventions, this paper assesses the economic cost of maternal PPC services, for health services and households, before and after the project start in Kaya health district (Burkina Faso). Methods PPC costs to health services are estimated using secondary data on personnel and infrastructure and primary data on time allocation. Data from two household surveys collected before and after one year intervention among mothers within one year PP are used to estimate the household cost of maternal PPC visits. We also compare PPC costs for households and health services with or without integration. We focus on the costs of the PPC intervention at days 6–10 that was most successful. Results The average unit cost of health services for days 6–10 maternal PPC decreased from 4.6 USD before the intervention in 2013 (Jan-June) to 3.5 USD after the intervention implementation in 2014. Maternal PPC utilization increased with the implementation of the interventions but so did days 6–10 household mean costs. Similarly, the household costs increased with the integration of maternal PPC to BCG immunization. Conclusion In the context of growing reproductive health expenditures from many funding sources in Burkina Faso, the uptake of maternal PPC led to a cost reduction, as shown for days 6–10, at health services level. Further research should determine whether the increase in costs for households would be deterrent to the use of integrated maternal and infant PPC.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B. P 7192, Ouagadougou, 03, Burkina Faso. .,Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium
| | - Tchichihouenichidah Nassa
- Direction générale des études et des statistiques sectorielles (DGESS), Ministère de la santé, Ouagadougou, Burkina Faso
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium
| | - Seni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B. P 7192, Ouagadougou, 03, Burkina Faso.,African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of public health and primary care, Ghent University, Ghent, Belgium.,Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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19
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Yugbaré Belemsaga D, Goujon A, Bado A, Kouanda S, Duysburgh E, Temmerman M, Degomme O. Integration of postpartum care into child health and immunization services in Burkina Faso: findings from a cross-sectional study. Reprod Health 2018; 15:171. [PMID: 30305123 PMCID: PMC6180606 DOI: 10.1186/s12978-018-0602-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Missed Opportunities for Maternal and Infant Health (MOMI) project, which aimed at upgrading maternal and infant postpartum care (PPC), implemented a package of interventions including the integration of maternal PPC in infant immunization services in 12 health facilities in Kaya Health district in Burkina Faso from 2013 to 2015. This paper assesses the coverage and the quality of combined mother-infant PPC in reproductive, maternal, newborn and child health services (RMNCH). METHODS We conducted a mixed methods study with cross-sectional surveys before and after the intervention in the Kaya health and demographic surveillance system. On the quantitative side, two household surveys were performed in 2012 (N = 757) and in 2014 (N = 754) among mothers within one year postpartum. The analysis examines the result of the intervention by the date of delivery at three key time points in the PPC schedule: the first 48 h, days 6-10 and during weeks 6-8 and beyond. On the qualitative side, in depth interviews, focus group discussions and observations were conducted in four health facilities in 2012 and 2015. They involved mothers in the postpartum period, facility and community health workers, and other stakeholders. We performed a descriptive analysis and a two-sample test of proportions of the quantitative data. The qualitative data were recorded, transcribed and analysed along the themes relevant for the intervention. RESULTS The findings show that the WHO guidelines, in terms of content and improvement of maternal PPC, were followed for physical examinations and consultations. They also show a significant increase in the coverage of maternal PPC services from 50% (372/752) before the intervention to 81% (544/672) one year after the start of the intervention. However, more women were assessed at days 6-10 than at later visits. Integration of maternal PPC was low, with little improvements in history taking and physical examination of mothers in immunization services. While health workers are polyvalent, difficulties in restructuring and organizing services hindered the integration. CONCLUSION Unless a comprehensive strategy of integration within RMNCH services is implemented to address the primary health care challenges within the health system, integration will not yield the desired results.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Aristide Bado
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
| | - Seni Kouanda
- Département Biomédical et santé publique, Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P 7192, Ouagadougou 03, Burkina Faso
- African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
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20
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Yugbaré Belemsaga D, Goujon A, Tougri H, Coulibaly A, Degomme O, Duysburgh E, Temmerman M, Kouanda S. Integration of maternal postpartum services in maternal and child health services in Kaya health district (Burkina Faso): an intervention time trend analysis. BMC Health Serv Res 2018; 18:298. [PMID: 29685138 PMCID: PMC5914017 DOI: 10.1186/s12913-018-3098-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 04/05/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Danielle Yugbaré Belemsaga
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B.P 7192, Ouagadougou 03, Burkina Faso. .,Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria.
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/OAW, WU), Vienna, Austria
| | - Halima Tougri
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B.P 7192, Ouagadougou 03, Burkina Faso
| | - Abou Coulibaly
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B.P 7192, Ouagadougou 03, Burkina Faso
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences, Department of Uro-Gynaecology, Ghent University, Ghent, Belgium.,Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Seni Kouanda
- Biomedical and Public Health Department, Institut de Recherche en Sciences de la Santé, 03 B.P 7192, Ouagadougou 03, Burkina Faso.,African Institute of Public Health, Ouagadougou, Burkina Faso
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21
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Djellouli N, Mann S, Nambiar B, Meireles P, Miranda D, Barros H, Bocoum FY, Yaméogo WME, Yaméogo C, Belemkoabga S, Tougri H, Coulibaly A, Kouanda S, Mochache V, Mwakusema OK, Irungu E, Gichangi P, Dembo Z, Kadzakumanja A, Makwenda CV, Timóteo J, Cossa MG, de Melo M, Griffin S, Osman NB, Foia S, Ogbe E, Duysburgh E, Colbourn T. Improving postpartum care delivery and uptake by implementing context-specific interventions in four countries in Africa: a realist evaluation of the Missed Opportunities in Maternal and Infant Health (MOMI) project. BMJ Glob Health 2017; 2:e000408. [PMID: 29225949 PMCID: PMC5717926 DOI: 10.1136/bmjgh-2017-000408] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 11/11/2022] Open
Abstract
Postpartum care (PPC) has remained relatively neglected in many interventions designed to improve maternal and neonatal health in sub-Saharan Africa. The Missed Opportunities in Maternal and Infant Health project developed and implemented a context-specific package of health system strengthening and demand generation in four African countries, aiming to improve access and quality of PPC. A realist evaluation was conducted to enable nuanced understanding of the influence of different contextual factors on both the implementation and impacts of the interventions. Mixed methods were used to collect data and test hypothesised context–mechanism–outcome configurations: 16 case studies (including interviews, observations, monitoring data on key healthcare processes and outcomes), monitoring data for all study health facilities and communities, document analysis and participatory evaluation workshops. After evaluation in individual countries, a cross-country analysis was conducted that led to the development of four middle-range theories. Community health workers (CHWs) were key assets in shifting demand for PPC by ‘bridging’ communities and facilities. Because they were chosen from the community they served, they gained trust from the community and an intrinsic sense of responsibility. Furthermore, if a critical mass of women seek postpartum healthcare as a result of the CHWs bridging function, a ‘buzz’ for change is created, leading eventually to the acceptability and perceived value of attending for PPC that outweighs the costs of attending the health facility. On the supply side, rigid vertical hierarchies and defined roles for health facility workers (HFWs) impede integration of maternal and infant health services. Additionally, HFWs fear being judged negatively which overrides the self-efficacy that could potentially be gained from PPC training. Instead the main driver of HFWs’ motivation to provide comprehensive PPC is dependent on accountability systems for delivering PPC created by other programmes. The realist evaluation offers insights into some of the contextual factors that can be pivotal in enabling the community-level and service-level interventions to be effective.
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Affiliation(s)
| | - Sue Mann
- UCL Institute for Global Health, London, UK
| | | | - Paula Meireles
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Diana Miranda
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Henrique Barros
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Fadima Y Bocoum
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - W Maurice E Yaméogo
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Clarisse Yaméogo
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Sylvie Belemkoabga
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Halima Tougri
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Abou Coulibaly
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Seni Kouanda
- Institutde Recherche en Sciences de la Santé (IRSS), Ouagadougou, Burkina Faso
| | - Vernon Mochache
- International Centre for Reproductive Health-Kenya (ICRHK), Mombasa, Kenya
| | - Omar K Mwakusema
- International Centre for Reproductive Health-Kenya (ICRHK), Mombasa, Kenya
| | - Eunice Irungu
- International Centre for Reproductive Health-Kenya (ICRHK), Mombasa, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya (ICRHK), Mombasa, Kenya
| | - Zione Dembo
- Parent and Child Health Initiative (PACHI), Lilongwe, Malawi
| | | | | | - Judite Timóteo
- International Centre for Reproductive Health-Mozambique (ICRHM), Maputo, Mozambique
| | - Misete G Cossa
- International Centre for Reproductive Health-Mozambique (ICRHM), Maputo, Mozambique
| | - Malica de Melo
- International Centre for Reproductive Health-Mozambique (ICRHM), Maputo, Mozambique
| | - Sally Griffin
- International Centre for Reproductive Health-Mozambique (ICRHM), Maputo, Mozambique
| | - Nafissa B Osman
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique
| | - Severiano Foia
- Faculdade de Medicina, Universidade Eduardo Mondlane (UEM), Maputo, Mozambique.,Chiúta District Health Department, Tete, Mozambique
| | - Emilomo Ogbe
- International Centre for Reproductive Health of the Ghent University (UG-ICRH), Ghent, Belgium
| | - Els Duysburgh
- International Centre for Reproductive Health of the Ghent University (UG-ICRH), Ghent, Belgium
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Saronga HP, Duysburgh E, Massawe S, Dalaba MA, Wangwe P, Sukums F, Leshabari M, Blank A, Sauerborn R, Loukanova S. Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study. BMC Health Serv Res 2017; 17:537. [PMID: 28784130 PMCID: PMC5547541 DOI: 10.1186/s12913-017-2457-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 07/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. METHODS This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. RESULTS Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. CONCLUSIONS Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. TRIAL REGISTRATION Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.
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Affiliation(s)
- Happiness Pius Saronga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Siriel Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Maxwell Ayindenaba Dalaba
- Navrongo Health Research Centre, Navrongo, Ghana
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Peter Wangwe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Felix Sukums
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | | | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany
| | - Rainer Sauerborn
- Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Svetla Loukanova
- Department of General Medicine and Implementation Research, University of Heidelberg, Heidelberg, Germany
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23
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Yugbaré Belemsaga D, Bado A, Goujon A, Duysburgh E, Degomme O, Kouanda S, Temmerman M. A cross-sectional mixed study of the opportunity to improve maternal postpartum care in reproductive, maternal, newborn, and child health services in the Kaya health district of Burkina Faso. Int J Gynaecol Obstet 2017; 135 Suppl 1:S20-S26. [PMID: 27836080 DOI: 10.1016/j.ijgo.2016.08.005] [Citation(s) in RCA: 7] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To propose a rationale to improve maternal postpartum care in reproductive, maternal, newborn, and child health (RMNCH) services. METHODS We conducted a cross-sectional mixed study in the Kaya health district in Burkina Faso based on two data collection exercises conducted between December 2012 and May 2013. A household survey of 757 mothers in their first year after delivery was processed. It was complemented with a qualitative analysis using in-depth interviews with key informants, focus group discussions with mothers, and participant observation. RESULTS Postpartum services showed serious weaknesses. Overall, 52% (n=384) of mothers did not receive any maternal postpartum care; however among them, 47% (n= 349) received infant postpartum care. CONCLUSION We suggest the integration of maternal postpartum care in RMNCH services as a key step to improving postpartum care. The intervention would require the overcoming of challenges related to the quality and cost of services, and to reaching the poor populations with low education and a high parity.
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Affiliation(s)
- Danielle Yugbaré Belemsaga
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso; Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria.
| | - Aristide Bado
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Anne Goujon
- Wittgenstein Centre for Demography and Global Human Capital (IIASA, VID/ÖAW, WU), Vienna, Austria
| | - Els Duysburgh
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Olivier Degomme
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
| | - Seni Kouanda
- Biomedical and Public Health Department, Research Institute of Health Sciences, Ouagadougou, Burkina Faso; African Institute of Public Health, Ouagadougou, Burkina Faso
| | - Marleen Temmerman
- International Centre for Reproductive Health, Faculty of Medicine and Health Sciences Department of Uro-Gynaecology, Ghent University, Ghent, Belgium; Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
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Guieu A, Zhang WH, Lafort Y, Decat P, De Meyer S, Wang S, Kerstens B, Duysburgh E. Practical lessons for bringing policy-makers on board in sexual and reproductive health research. BMC Health Serv Res 2016; 16:649. [PMID: 27835973 PMCID: PMC5106764 DOI: 10.1186/s12913-016-1889-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The need to translate research into policy, i.e. making research findings a driving force in agenda-setting and policy change, is increasingly acknowledged. However, little is known about translation mechanisms in the field of sexual and reproductive health (SRH) outside North American or European contexts. This paper seeks to give an overview of the existing knowledge on this topic as well as to document practical challenges and remedies from the perspectives of researchers involved in four SRH research consortium projects in Latin America, sub-Saharan Africa, China and India. METHODS A literature review and relevant project documents were used to develop an interview guide through which researchers could reflect on their experiences in engaging with policy-makers, and particularly on the obstacles met and the strategies deployed by the four project consortia to circumvent them. RESULTS Our findings confirm current recommendations on an early and steady involvement of policy-makers, however they also suggest that local barriers between researchers and policy-making spheres and individuals can represent major hindrances to the realization of translation objectives. Although many of the challenges might be common to different contexts, creating locally-adapted responses is deemed key to overcome them. Researchers' experiences also indicate that - although inevitable - recognizing and addressing these challenges is a difficult, time- and energy-consuming process for all partners involved. Despite a lack of existing knowledge on translation efforts in SRH research outside North American or European contexts, and more particularly in low and middle-income countries, it is clear that existing pressure on health and policy systems in these settings further complicates them. CONCLUSIONS This article brings together literature findings and researchers' own experiences in translating research results into policy and highlights the major challenges research conducted on sexual and reproductive health outside North American or European contexts can meet. Future SRH projects should be particularly attentive to these potential obstacles in order to tailor appropriate and consistent strategies within their existing resources.
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Affiliation(s)
- Aurore Guieu
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium. .,MOMI consortium, . .,DIFFER consortium, .
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium.,INPAC consortium
| | - Yves Lafort
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,DIFFER consortium
| | - Peter Decat
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,CERCA consortium
| | - Sara De Meyer
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,CERCA consortium
| | - Shuchen Wang
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,INPAC consortium
| | - Birgit Kerstens
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium
| | - Els Duysburgh
- International Centre for Reproductive Health, Ghent University, De Pintelaan 185, UZP114, Ghent, 9000, Belgium.,MOMI consortium
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Duysburgh E, Temmerman M, Yé M, Williams A, Massawe S, Williams J, Mpembeni R, Loukanova S, Haefeli WE, Blank A. Quality of antenatal and childbirth care in rural health facilities in Burkina Faso, Ghana and Tanzania: an intervention study. Trop Med Int Health 2015; 21:70-83. [PMID: 26503485 DOI: 10.1111/tmi.12627] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 12/01/2022]
Abstract
OBJECTIVE To assess the impact of an intervention consisting of a computer-assisted clinical decision support system and performance-based incentives, aiming at improving quality of antenatal and childbirth care. METHODS Intervention study in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania. In each country, six intervention and six non-intervention PHC facilities, located in one intervention and one non-intervention rural districts, were selected. Quality was assessed in each facility by health facility surveys, direct observation of antenatal and childbirth care, exit interviews, and reviews of patient records and maternal and child health registers. Findings of pre- and post-intervention and of intervention and non-intervention health facility quality assessments were analysed and assessed for significant (P < 0.05) quality of care differences. RESULTS Post-intervention quality scores do not show a clear difference to pre-intervention scores and scores at non-intervention facilities. Only a few variables had a statistically significant better post-intervention quality score and when this is the case this is mostly observed in only one study-arm, being pre-/post-intervention or intervention/non-intervention. Post-intervention care shows similar deficiencies in quality of antenatal and childbirth care and in detection, prevention, and management of obstetric complications as at baseline and non-intervention study facilities. CONCLUSION Our intervention study did not show a significant improvement in quality of care during the study period. However, the use of new technology seems acceptable and feasible in rural PHC facilities in resource-constrained settings, creating the opportunity to use this technology to improve quality of care.
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Affiliation(s)
- Els Duysburgh
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Marleen Temmerman
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium
| | - Maurice Yé
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Siriel Massawe
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Rose Mpembeni
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Svetla Loukanova
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg, Germany
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Sukums F, Mensah N, Mpembeni R, Massawe S, Duysburgh E, Williams A, Kaltschmidt J, Loukanova S, Haefeli WE, Blank A. Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience. Int J Med Inform 2015; 84:647-57. [DOI: 10.1016/j.ijmedinf.2015.05.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/04/2014] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
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Duysburgh E, Kerstens B, Kouanda S, Kaboré CP, Belemsaga Yugbare D, Gichangi P, Masache G, Crahay B, Gondola Sitefane G, Bique Osman N, Foia S, Barros H, Castro Lopes S, Mann S, Nambiar B, Colbourn T, Temmerman M. Opportunities to improve postpartum care for mothers and infants: design of context-specific packages of postpartum interventions in rural districts in four sub-Saharan African countries. BMC Pregnancy Childbirth 2015; 15:131. [PMID: 26038100 PMCID: PMC4453099 DOI: 10.1186/s12884-015-0562-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 05/18/2015] [Indexed: 12/04/2022] Open
Abstract
Background Postpartum maternal and infant mortality is high in sub-Saharan Africa and improving postpartum care as a strategy to enhance maternal and infant health has been neglected. We describe the design and selection of suitable, context-specific interventions that have the potential to improve postpartum care. Methods The study is implemented in rural districts in Burkina Faso, Kenya, Malawi and Mozambique. We used the four steps ‘systems thinking’ approach to design and select interventions: 1) we conducted a stakeholder analysis to identify and convene stakeholders; 2) we organised stakeholders causal analysis workshops in which the local postpartum situation and challenges and possible interventions were discussed; 3) based on comprehensive needs assessment findings, inputs from the stakeholders and existing knowledge regarding good postpartum care, a list of potential interventions was designed, and; 4) the stakeholders selected and agreed upon final context-specific intervention packages to be implemented to improve postpartum care. Results Needs assessment findings showed that in all study countries maternal, newborn and child health is a national priority but specific policies for postpartum care are weak and there is very little evidence of effective postpartum care implementation. In the study districts few women received postpartum care during the first week after childbirth (25 % in Burkina Faso, 33 % in Kenya, 41 % in Malawi, 40 % in Mozambique). Based on these findings the interventions selected by stakeholders mainly focused on increasing the availability and provision of postpartum services and improving the quality of postpartum care through strengthening postpartum services and care at facility and community level. This includes the introduction of postpartum home visits, strengthening postpartum outreach services, integration of postpartum services for the mother in child immunisation clinics, distribution of postpartum care guidelines among health workers and upgrading postpartum care knowledge and skills through training. Conclusion There are extensive gaps in availability and provision of postpartum care for mothers and infants. Acknowledging these gaps and involving relevant stakeholders are important to design and select sustainable, context-specific packages of interventions to improve postpartum care.
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Affiliation(s)
- Els Duysburgh
- International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium.
| | - Birgit Kerstens
- International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium.
| | - Seni Kouanda
- Institut de Recherche en Sciences et de la Santé, P.O. Box 7192, Ouagadougou, 03, Burkina Faso.
| | - Charles Paulin Kaboré
- Institut de Recherche en Sciences et de la Santé, P.O. Box 7192, Ouagadougou, 03, Burkina Faso.
| | | | - Peter Gichangi
- International Centre of Reproductive Health Kenya, Obote Avenue - Tudor Estate, P.O. Box 91109, 80103, Mombasa, Kenya.
| | - Gibson Masache
- Parent and Child Health Initiative Trust, P.O. Box 31686, Lilongwe, 3, Malawi.
| | - Beatrice Crahay
- International Centre of Reproductive Health Mozambique, Av. Maquiguana, Praceta 1607, Prédio 100, 1 Andar, Maputo, Mozambique.
| | - Gilda Gondola Sitefane
- International Centre of Reproductive Health Mozambique, Av. Maquiguana, Praceta 1607, Prédio 100, 1 Andar, Maputo, Mozambique.
| | - Nafissa Bique Osman
- Eduardo Mondlane University, Faculdade de Medicina, Av. Salvador Allende 702, Maputo, Mozambique.
| | - Severiano Foia
- Eduardo Mondlane University, Faculdade de Medicina, Av. Salvador Allende 702, Maputo, Mozambique.
| | - Henrique Barros
- Department of Hygiene and Epidemiology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
| | - Sofia Castro Lopes
- Department of Hygiene and Epidemiology, Faculdade de Medicina da Universidade do Porto, Alameda Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
| | - Susan Mann
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Bejoy Nambiar
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Tim Colbourn
- Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Marleen Temmerman
- International Centre for Reproductive Health, Department of uro-gynaecology, Ghent University, De Pintelaan 185 P3, 9000, Ghent, Belgium. .,Department of Reproductive Health and Research, World Health Organisation, Avenue Appia 20, 1211, Geneva, 27, Switzerland.
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Duysburgh E, Williams A, Williams J, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in northern Ghana. BJOG 2014; 121 Suppl 4:117-26. [PMID: 25236645 DOI: 10.1111/1471-0528.12905] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 04/17/2014] [Indexed: 12/01/2022]
Abstract
The QUALMAT research project aims to improve maternal and newborn health by improving the quality of antenatal and childbirth care provided in primary healthcare facilities. Within the frame of this project, a comprehensive quality assessment took place in selected health centres in northern Ghana. The results of this assessment showed that overall quality of routine antenatal and childbirth care was satisfactory, although some critical gaps were identified. Counselling and health education practices need to be improved; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are often not used and poorly completed; and equipment to provide assisted vaginal deliveries was absent.
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Affiliation(s)
- E Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
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Loukanova S, Prytherch H, Blank A, Duysburgh E, Tomson G, Gustafsson LL, Sié A, Williams J, Leshabari M, Haefeli WE, Sauerborn R, Fonn S. Nesting doctoral students in collaborative North-South partnerships for health systems research. Glob Health Action 2014; 7:24070. [PMID: 25030216 PMCID: PMC4101456 DOI: 10.3402/gha.v7.24070] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 06/16/2014] [Accepted: 06/20/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Union (EU) supports North-South Partnerships and collaborative research projects through its Framework Programmes and Horizon 2020. There is limited research on how such projects can be harnessed to provide a structured platform for doctoral level studies as a way of strengthening health system research capacity in sub-Saharan Africa (SSA). OBJECTIVE The aim of this study was to explore the challenges of, and facilitating factors for, 'nesting' doctoral students in North-South collaborative research projects. The term nesting refers to the embedding of the processes of recruiting, supervising, and coordinating doctoral students in the overall research plan and processes. DESIGN This cross-sectional qualitative study was undertaken by the EU-funded QUALMAT Project. A questionnaire was implemented with doctoral students, supervisors, and country principal investigators (PIs), and content analysis was undertaken. RESULTS Completed questionnaires were received from nine doctoral students, six supervisors, and three country PIs (86% responses rate). The doctoral students from SSA described high expectations about the input they would receive (administrative support, equipment, training, supervision). This contrasted with the expectations of the supervisors for proactivity and self-management on the part of the students. The rationale for candidate selection, and understandings of the purpose of the doctoral students in the project were areas of considerable divergence. There were some challenges associated with the use of the country PIs as co-supervisors. Doctoral student progress was at times impeded by delays in the release of funding instalments from the EU. The paper provides a checklist of essential requirements and a set of recommendations for effective nesting of doctoral students in joint North-South projects. CONCLUSION There are considerable challenges to the effective nesting of doctoral students within major collaborative research projects. However, ways can be found to overcome them. The nesting process ultimately helped the institutions involved in this example to take better advantage of the opportunities that collaborative projects offer to foster North-South partnerships as a contribution to the strengthening of local research capacity.
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Affiliation(s)
- Svetla Loukanova
- Department of Public Health, University of Heidelberg, Heidelberg, Germany;
| | - Helen Prytherch
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Antje Blank
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, Ghent, Belgium
| | - Göran Tomson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre (MMC), Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Melkizedeck Leshabari
- Department of Behavioral Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Internal Medicine Department, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Department of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Sharon Fonn
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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Duysburgh E, Kerstens B, Diaz M, Fardhdiani V, Reyes KAV, Phommachanh K, Temmerman M, Rodriques B, Zaka N. Newborn care in Indonesia, Lao People's Democratic Republic and the Philippines: a comprehensive needs assessment. BMC Pediatr 2014; 14:46. [PMID: 24528519 PMCID: PMC3928581 DOI: 10.1186/1471-2431-14-46] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 02/11/2014] [Indexed: 12/05/2022] Open
Abstract
Background Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, Lao People’s Democratic Republic (PDR) and the Philippines. Methods We assessed newborn health policies, services and care in the three countries through document review, interviews and health facility visits. Findings were triangulated to describe newborns’ health status, the health policy and the health system context for newborn care and the equity situation regarding newborn survival. Results Main findings: (1) In the three countries, decline of neonatal mortality is lagging behind compared to that of under-five mortality. (2) Comprehensive newborn policies in line with international standards exist, although implementation remains poor. An important factor hampering implementation is decentralisation of the health sector, which created confusion regarding roles and responsibilities. Management capacity and skills at decentralised level were often found to be limited. (3) Quality of newborn care provided at primary healthcare and referral level is generally substandard. Limited knowledge and skills among providers of newborn care are contributing to poor quality of care. (4) Socio-economic and geographic inequities in newborn care are considerable. Conclusions Similar important challenges for newborn care have been identified in Indonesia, Lao PDR and the Philippines. There is an urgent need to address weak leadership and governance regarding newborn care, quality of newborn care provided and inequities in newborn care. Child survival programmes focussed on children over four weeks of age have shown to have positive outcomes. Similar efforts as those used in these programmes should be considered in newborn care.
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Affiliation(s)
- Els Duysburgh
- International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 UZP114, 9000 Ghent, Belgium.
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Duysburgh E, Ye M, Williams A, Massawe S, Sié A, Williams J, Mpembeni R, Loukanova S, Temmerman M. Counselling on and women's awareness of pregnancy danger signs in selected rural health facilities in Burkina Faso, Ghana and Tanzania. Trop Med Int Health 2013; 18:1498-509. [PMID: 24118565 DOI: 10.1111/tmi.12214] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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 The aims of this study were to (i) assess healthcare workers' counselling practices concerning danger signs during antenatal consultations in rural primary healthcare (PHC) facilities in Burkina Faso, Ghana and Tanzania; to (ii) assess pregnant women's awareness of these danger signs; and (iii) to identify factors affecting counselling practices and women's awareness. METHODS Cross-sectional study in rural PHC facilities in Burkina Faso, Ghana and Tanzania. In each country, 12 facilities were randomly selected. WHO guidelines were used as standard for good counselling. We assessed providers' counselling practice on seven danger signs through direct observation study (35 observations/facility). Exit interviews (63 interviews/facility) were used to assess women's awareness of the same seven danger signs. We used negative binomial regression to assess associations with health services' and socio-demographic characteristics and to estimate per study site the average number of danger signs on which counselling was provided and the average number of danger signs mentioned by women. RESULTS About one in three women was not informed of any danger sign. For most danger signs, fewer than half of the women were counselled. Vaginal bleeding and severe abdominal pain were the signs most counselled on (between 52% and 66%). At study facilities in Burkina Faso, 58% of the pregnant women were not able to mention a danger sign, in Ghana this was 22% and in Tanzania 30%. Fever, vaginal bleeding and severe abdominal pain were the danger signs most frequently mentioned. The type of health worker (depending on the training they received) was significantly associated with counselling practices. Depending on the study site, characteristics significantly associated with awareness of signs were women's age, gestational age, gravidity and educational level. CONCLUSION Counselling practice is poor and not very efficient. A new approach of informing pregnant women on danger signs is needed. However, as effects of antenatal care education remain largely unknown, it is very well possible that improved counselling will not affect maternal and newborn mortality and morbidity.
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Affiliation(s)
- Els Duysburgh
- International Centre for Reproductive Health, Department of Uro-Gynaecology, Ghent University, Ghent, Belgium
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Duysburgh E, Zhang WH, Ye M, Williams A, Massawe S, Sié A, Williams J, Mpembeni R, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in selected rural health facilities in Burkina Faso, Ghana and Tanzania: similar finding. Trop Med Int Health 2013; 18:534-47. [PMID: 23398053 DOI: 10.1111/tmi.12076] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To measure pre-intervention quality of routine antenatal and childbirth care in rural districts of Burkina Faso, Ghana and Tanzania and to identify shortcomings. METHODS In each country, we selected two adjoining rural districts. Within each district, we randomly sampled 6 primary healthcare facilities. Quality of care was assessed through health facility surveys, direct observation of antenatal and childbirth care, exit interviews and review of patient records. RESULTS By and large, quality of antenatal and childbirth care in the six districts was satisfactory, but we did identify some critical gaps common to the study sites in all three countries. Counselling and health education practices are poor; laboratory investigations are often not performed; examination and monitoring of mother and newborn during childbirth are inadequate; partographs are not used. Equipment required to provide assisted vaginal deliveries (vacuum extractor or forceps) was absent in all surveyed facilities. CONCLUSION Quality of care in the three study sites can be improved with the available human resources and without major investments. This improvement could reduce maternal and neonatal mortality and morbidity.
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Affiliation(s)
- E Duysburgh
- International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
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