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Sokemawu Freeman AY, Ganizani A, Mwale AC, Manda IK, Chitete J, Phiri G, Stambuli B, Chimulambe E, Koslengar M, Kimambo NR, Bita A, Apolot RR, Mponda H, Mungwira RG, Chapotera G, Yur CT, Yatich NJ, Totah T, Mantchombe F, Chamla DD, Olu OO. Analyses of drinking water quality during a protracted cholera epidemic in Malawi - a cross-sectional study of key physicochemical and microbiological parameters. J Water Health 2024; 22:510-521. [PMID: 38557567 DOI: 10.2166/wh.2024.283] [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] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024]
Abstract
Anecdotal evidence and available literature indicated that contaminated water played a major role in spreading the prolonged cholera epidemic in Malawi from 2022 to 2023. This study assessed drinking water quality in 17 cholera-affected Malawi districts from February to April 2023. Six hundred and thirty-three records were analysed. The median counts/100 ml for thermotolerant coliform was 98 (interquartile range (IQR): 4-100) and that for Escherichia coli was 0 (IQR: 0-9). The drinking water in all (except one) districts was contaminated by thermotolerant coliform, while six districts had their drinking water sources contaminated by E. coli. The percentage of contaminated drinking water sources was significantly higher in shallow unprotected wells (80.0% for E. coli and 95.0% for thermotolerant coliform) and in households (55.8% for E. coli and 86.0% for thermotolerant coliform). Logistic regression showed that household water has three times more risk of being contaminated by E. coli and two and a half times more risk of being contaminated by thermotolerant coliform compared to other water sources. This study demonstrated widespread contamination of drinking water sources during a cholera epidemic in Malawi, which may be the plausible reason for the protracted nature of the epidemic.
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Affiliation(s)
| | | | | | | | | | - Gift Phiri
- Ministry of Water and Sanitation, Lilongwe, Malawi
| | | | | | | | | | - Alisa Bita
- World Health Organization Country Office, Lilongwe, Malawi
| | | | - Hamid Mponda
- World Health Organization Country Office, Lilongwe, Malawi
| | | | | | - Chol Thabo Yur
- World Health Organization Emergency Preparedness and Response Hub, Nairobi, Kenya
| | | | - Terence Totah
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Freddie Mantchombe
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Dick Damas Chamla
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Olushayo Oluseun Olu
- World Health Organization Regional Office for Africa, Brazzaville, Congo E-mail:
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2
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Theu JA, Kabaghe AN, Bello G, Chitsa-Banda E, Kagoli M, Auld A, Mkungudza J, O'Malley G, Bangara FF, Peacocke EF, Babaye Y, Ng'ambi W, Saussier C, MacLachlan E, Chapotera G, Phiri MD, Kim E, Chiwaula M, Payne D, Wadonda-Kabondo N, Chauma-Mwale A, Divala TH. SARS-CoV-2 Prevalence in Malawi Based on Data from Survey of Communities and Health Workers in 5 High-Burden Districts, October 2020. Emerg Infect Dis 2022; 28:S76-S84. [PMID: 36502413 DOI: 10.3201/eid2813.212348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
To determine early COVID-19 burden in Malawi, we conducted a multistage cluster survey in 5 districts. During October-December 2020, we recruited 5,010 community members (median age 32 years, interquartile range 21-43 years) and 1,021 health facility staff (HFS) (median age 35 years, interquartile range 28-43 years). Real-time PCR-confirmed SARS-CoV-2 infection prevalence was 0.3% (95% CI 0.2%-0.5%) among community and 0.5% (95% CI 0.1%-1.2%) among HFS participants; seroprevalence was 7.8% (95% CI 6.3%-9.6%) among community and 9.7% (95% CI 6.4%-14.5%) among HFS participants. Most seropositive community (84.7%) and HFS (76.0%) participants were asymptomatic. Seroprevalence was higher among urban community (12.6% vs. 3.1%) and HFS (14.5% vs. 7.4%) than among rural community participants. Cumulative infection findings 113-fold higher from this survey than national statistics (486,771 vs. 4,319) and predominantly asymptomatic infections highlight a need to identify alternative surveillance approaches and predictors of severe disease to inform national response.
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Hood RB, Norris AH, Huber-Krum S, Garver S, Chapotera G, Turner AN. Food insecurity and adverse pregnancy outcomes among rural Malawian women. Int J Gynaecol Obstet 2022; 156:309-315. [PMID: 33507564 PMCID: PMC9808894 DOI: 10.1002/ijgo.13630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/09/2020] [Accepted: 01/25/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether food insecurity is associated with adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal mortality among women in rural Malawi. METHODS We analyzed data from the baseline (July 2014 to February 2015) and follow-up (January 2018 to May 2018) waves of a longitudinal study of reproductive-age women in rural Malawi. We sampled women from villages from the catchment area of a community hospital in rural Lilongwe district of Malawi using stratified cluster sampling. We classified women as food secure or insecure at baseline. Using unadjusted and adjusted log-binomial models, we used baseline data to examine the cross-sectional association between food insecurity and ever experiencing an adverse pregnancy outcome. We used baseline and follow-up data to assess the longitudinal association between food insecurity and experiencing a new adverse pregnancy outcome during follow-up. In a subgroup analysis, we repeated the longitudinal analysis after restricting the sample to women who had no adverse pregnancy outcomes at baseline. RESULTS We observed no significant cross-sectional association between baseline food insecurity and ever experiencing an adverse pregnancy outcome (adjusted prevalence ratio: 1.09; 95% confidence interval [CI]: 0.78-1.53). Baseline food insecurity was not associated with experiencing a new adverse pregnancy outcome during follow-up (adjusted risk ratio [aRR]: 1.14, 95% CI: 0.60-2.20) or in the subgroup analysis (aRR: 1.52, 95% CI: 0.78-2.96). CONCLUSIONS While food insecurity is a critical issue, in this cohort of rural Malawian women, food insecurity was not associated with adverse pregnancy outcomes.
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Affiliation(s)
- Robert B Hood
- The Ohio State University College of Public Health, Columbus, OH, USA
| | - Alison H Norris
- The Ohio State University College of Public Health, Columbus, OH, USA,The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | | | - Abigail N Turner
- The Ohio State University College of Public Health, Columbus, OH, USA,The Ohio State University College of Medicine, Columbus, OH, USA
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4
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Patson N, Mukaka M, D'Alessandro U, Chapotera G, Mwapasa V, Mathanga D, Kazembe L, Laufer MK, Chirwa T. Joint modelling of multivariate longitudinal clinical laboratory safety outcomes, concomitant medication and clinical adverse events: application to artemisinin-based treatment during pregnancy clinical trial. BMC Med Res Methodol 2021; 21:208. [PMID: 34627141 PMCID: PMC8501924 DOI: 10.1186/s12874-021-01412-9] [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: 03/22/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background In drug trials, clinical adverse events (AEs), concomitant medication and laboratory safety outcomes are repeatedly collected to support drug safety evidence. Despite the potential correlation of these outcomes, they are typically analysed separately, potentially leading to misinformation and inefficient estimates due to partial assessment of safety data. Using joint modelling, we investigated whether clinical AEs vary by treatment and how laboratory outcomes (alanine amino-transferase, total bilirubin) and concomitant medication are associated with clinical AEs over time following artemisinin-based antimalarial therapy. Methods We used data from a trial of artemisinin-based treatments for malaria during pregnancy that randomized 870 women to receive artemether–lumefantrine (AL), amodiaquine–artesunate (ASAQ) and dihydroartemisinin–piperaquine (DHAPQ). We fitted a joint model containing four sub-models from four outcomes: longitudinal sub-model for alanine aminotransferase, longitudinal sub-model for total bilirubin, Poisson sub-model for concomitant medication and Poisson sub-model for clinical AEs. Since the clinical AEs was our primary outcome, the longitudinal sub-models and concomitant medication sub-model were linked to the clinical AEs sub-model via current value and random effects association structures respectively. We fitted a conventional Poisson model for clinical AEs to assess if the effect of treatment on clinical AEs (i.e. incidence rate ratio (IRR)) estimates differed between the conventional Poisson and the joint models, where AL was reference treatment. Results Out of the 870 women, 564 (65%) experienced at least one AE. Using joint model, AEs were associated with the concomitant medication (log IRR 1.7487; 95% CI: 1.5471, 1.9503; p < 0.001) but not the total bilirubin (log IRR: -0.0288; 95% CI: − 0.5045, 0.4469; p = 0.906) and alanine aminotransferase (log IRR: 0.1153; 95% CI: − 0.0889, 0.3194; p = 0.269). The Poisson model underestimated the effects of treatment on AE incidence such that log IRR for ASAQ was 0.2118 (95% CI: 0.0082, 0.4154; p = 0.041) for joint model compared to 0.1838 (95% CI: 0.0574, 0.3102; p = 0.004) for Poisson model. Conclusion We demonstrated that although the AEs did not vary across the treatments, the joint model yielded efficient AE incidence estimates compared to the Poisson model. The joint model showed a positive relationship between the AEs and concomitant medication but not with laboratory outcomes. Trial registration ClinicalTrials.gov: NCT00852423
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Affiliation(s)
- Noel Patson
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. .,School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi.
| | - Mavuto Mukaka
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit, The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, Gambia
| | - Gertrude Chapotera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Victor Mwapasa
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Don Mathanga
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Lawrence Kazembe
- Department of Biostatistics, University of Namibia, Windhoek, Namibia
| | - Miriam K Laufer
- Center for Vaccine Development and Global Health, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Tobias Chirwa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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5
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Huber-Krum S, Bornstein M, Garver S, Gipson J, Chapotera G, Norris AH. Are rural Malawian women using their preferred contraceptive method and that of their male partners? Contraception 2021; 104:132-138. [PMID: 33823139 DOI: 10.1016/j.contraception.2021.03.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To measure the agreement between women's current contraceptive use and her preferred method, as well as her partner's preferred method. STUDY DESIGN We used the fourth wave of survey data (2017-2018) from the Umoyo wa Thanzi (UTHA) cohort study of sexual and reproductive health decision making. The prevalence of concordance between women's current method and her preferred method was calculated (n = 818). Among partnered women, we calculated prevalence of concordance between women's current method and her partner's preferred method (n = 719). We used multivariate logistic regression analyses to assess the relationship between women's characteristics and the outcomes. RESULTS Despite high prevalence of modern contraceptive use (74.4%), many women were using methods that did not match their preferences (62.6%) or those of their partners (62.3%). Fifty-five percent of women with preference-use discordance preferred methods that were more effective than theirs. Satisfaction with current family planning choice (adjusted odds ratio [aOR], > 5.5 each) and pregnancy desires (aOR, >1.5 each) were strong predictors of both concordance between women's current method and her preferred method and her partner's preferred method. Women who reported higher sexual frequency in past month had elevated odds of concordance between her current and preferred method (aOR: 1.97 for 9+times in past months) than women who had not had sex. CONCLUSIONS Many Malawian women are not using methods they or their partners prefer. Women desiring pregnancy, women reporting infrequent sex, and women who are not satisfied with their method are likely to prefer a different method than the one they are currently using. IMPLICATIONS Understanding women's preferences can assist with family planning service provision. Health care providers and researchers should consider the specific methods that women and their partners prefer to use, besides whether they are using any method.
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Affiliation(s)
- Sarah Huber-Krum
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States.
| | - Marta Bornstein
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Jessica Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | | | - Alison H Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States
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6
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Okop KJ, Murphy K, Lambert EV, Kedir K, Getachew H, Howe R, Niyibizi JB, Ntawuyirushintege S, Bavuma C, Rulisa S, Kasenda S, Chipeta E, Bunn C, Crampin AC, Chapotera G, King AC, Banchoff A, Winter SJ, Levitt NS. Community-driven citizen science approach to explore cardiovascular disease risk perception, and develop prevention advocacy strategies in sub-Saharan Africa: a programme protocol. Res Involv Engagem 2021; 7:11. [PMID: 33637131 PMCID: PMC7907793 DOI: 10.1186/s40900-020-00246-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 12/09/2020] [Indexed: 05/06/2023]
Abstract
BACKGROUND In sub-Saharan Africa (SSA), which experiences a disproportionately high cardiovascular disease (CVD) burden, population-based screening and prevention measures are hampered by low levels of knowledge about CVD and associated risk factors, and inaccurate perceptions of severity of risk. METHODS This protocol describes the planned processes for implementing community-driven participatory research, using a citizen science method to explore CVD risk perceptions and to develop community-specific advocacy and prevention strategies in the rural and urban SSA settings. Multi-disciplinary research teams in four selected African countries will engage with and train community members living in rural and urban communities as citizen scientists to facilitate conceptualization, co-designing of research, data gathering, and co-creation of knowledge that can lead to a shared agenda to support collaborative participation in community-engaged science. The emphasis is on robust community engagement, using mobile technology to support data gathering, participatory learning, and co-creation of knowledge and disease prevention advocacy. DISCUSSION Contextual processes applied and lessons learned in specific settings will support redefining or disassembling boundaries in participatory science to foster effective implementation of sustainable prevention intervention programmes in Low- and Middle-income countries.
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Affiliation(s)
- Kufre Joseph Okop
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa.
| | - Kathy Murphy
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Estelle Victoria Lambert
- UCT Research Centre for Health through Physical Activity, Lifestyle and Sport, Division of Exercise Science and Sports Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kiya Kedir
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | - Rawleigh Howe
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | - Charlotte Bavuma
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Rulisa
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Stephen Kasenda
- School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Effie Chipeta
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- Centre for Reproductive Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Christopher Bunn
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
- College of Social Sciences, University of Glasgow, Glasgow, UK
| | - Amelia C Crampin
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Gertrude Chapotera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Zomba, Malawi
| | - Abby C King
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Ann Banchoff
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Sandra J Winter
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Naomi S Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
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7
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Kamoto A, Chapotera G, Suleman F. Knowledge, attitude and perception on antimicrobial use and antimicrobial resistance among final year medical students in the College of Medicine, Malawi. Malawi Med J 2021; 32:120-123. [PMID: 33488982 PMCID: PMC7812150 DOI: 10.4314/mmj.v32i3.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Medical curricula need to provide adequate knowledge on antimicrobial medicine use and antimicrobial resistance (AMR). Such knowledge is critical in shaping correct attitudes and perceptions among future prescribers. However, the extent of preparation provided by medical curricula remains unknown. Aim The current study sought to determine knowledge, attitude and perception on antimicrobial use and AMR among final year medical students in Malawi. Methods A descriptive cross-sectional study was undertaken among all final year medical students at the College of Medicine, University of Malawi in 2016. Total population sampling and self-administered questionnaires were used. Data were entered using Microsoft Excel and analysed with Epi info. Descriptive analysis for categorical data was done using frequencies and proportions, and for continuous data using measures of central tendency. Results The response rate in this study was 95%. The mean and median aggregated scores were 7.2 and 7, respectively, for the 11 knowledge questions. Over 88% of the respondents answered more than half of the knowledge questions correctly. Respondents agreed that antimicrobials are overused both at national (50; 69%) and at hospital (52; 72%) levels. Conclusion This study reports high aggregated knowledge scores on antimicrobial use and resistance with wide variations on correct knowledge scores per question. The study further shows varying level in attitudes and perceptions among medical students. Overall, there were gaps on antimicrobial use and knowledge of AMR which the medical curriculum should addresses.
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Affiliation(s)
- Alfred Kamoto
- Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Gertrude Chapotera
- Department of Public Health, School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
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8
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Pfadenhauer LM, Grath T, Delobelle P, Jessani N, Meerpohl JJ, Rohwer A, Schmidt BM, Toews I, Akiteng AR, Chapotera G, Kredo T, Levitt N, Ntawuyirushintege S, Sell K, Rehfuess EA. Mixed method evaluation of the CEBHA+ integrated knowledge translation approach: a protocol. Health Res Policy Syst 2021; 19:7. [PMID: 33461592 PMCID: PMC7813167 DOI: 10.1186/s12961-020-00675-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 11/24/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
Background The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) is a research consortium concerned with the prevention, diagnosis and treatment of non-communicable diseases. CEBHA+ seeks to engage policymakers and practitioners throughout the research process in order to build lasting relationships, enhance evidence uptake, and create long-term capacity among partner institutions in Ethiopia, Malawi, Rwanda, South Africa and Uganda in collaboration with two German universities. This integrated knowledge translation (IKT) approach includes the formal development, implementation and evaluation of country specific IKT strategies. Methods We have conceptualised the CEBHA+ IKT approach as a complex intervention in a complex system. We will employ a comparative case study (CCS) design and mixed methods to facilitate an in-depth evaluation. We will use quantitative surveys, qualitative interviews, quarterly updates, and a policy document analysis to capture the process and outcomes of IKT across the African CEBHA+ partner sites. We will conduct an early stage (early 2020) and a late-stage evaluation (early 2022), triangulate the data collected with various methods at each site and subsequently compare our findings across the five sites. Discussion Evaluating a complex intervention such as the CEBHA+ IKT approach is complicated, even more so when undertaken across five diverse countries. Despite conceptual, methodological and practical challenges, our comparative case study addresses important evidence gaps: While involving decision-makers in the research process is gaining traction worldwide, we still know very little regarding (i) whether this approach really makes a difference to evidence uptake, (ii) the mechanisms that make IKT successful, and (iii) relevant differences across socio-cultural contexts. The evaluation described here is intended to provide relevant insights on all of these aspects, notably in countries in Sub-Saharan Africa, and is expected to contribute to the science of IKT overall.
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Affiliation(s)
- Lisa M Pfadenhauer
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany. .,Pettenkofer School of Public Health, Munich, Germany.
| | - Tanja Grath
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Peter Delobelle
- Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa.,Department of Public Health, Vrije Universiteit Brussel, Laarbeeklaan 103, Jette, 1090, Brussels, Belgium
| | - Nasreen Jessani
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow, Cape Town, 7500, South Africa.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, 21205, USA
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 86, 79110, Freiburg Im Breigau, Germany.,Cochrane Germany, Cochrane Germany Foundation, Berliner Allee 2, 79110, Freiburg im Breisgau, Germany
| | - Anke Rohwer
- Centre for Evidence Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Parow, Cape Town, 7500, South Africa
| | - Bey-Marrié Schmidt
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerburg, 7500, South Africa
| | - Ingrid Toews
- Cochrane Germany, Cochrane Germany Foundation, Berliner Allee 2, 79110, Freiburg im Breisgau, Germany
| | - Ann R Akiteng
- College of Health Sciences, Makerere University, Plot 1 Upper Mulago Hill Road, Kampala, Uganda
| | - Gertrude Chapotera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Mahatma Gandhi Road, Private Bag 360, Blantyre, Malawi
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Francie van Zijl Drive, Parow Valley, Tygerburg, 7500, South Africa.,Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Naomi Levitt
- Chronic Disease Initiative for Africa (CDIA), University of Cape Town, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa
| | | | - Kerstin Sell
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
| | - Eva A Rehfuess
- Institute for Medical Information Processing, Biometry and Epidemiology, LMU Munich, Elisabeth-Winterhalter-Weg 6, 81377, Munich, Germany.,Pettenkofer School of Public Health, Munich, Germany
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9
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Sell K, Pfadenhauer LM, Jessani N, Schmidt BM, Levitt N, Chapotera G, Akiteng AR, Mpando T, Ntawuyirushintege S, Rehfuess EA. Collaborative strategies for knowledge translation: the African-German CEBHA+ research network. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The Collaboration for Evidence-based Healthcare and Public Health in Africa (CEBHA+) is an NCD research consortium that seeks to engage policy-makers and practitioners throughout the research process in order to build lasting relationships, enhance evidence uptake and build long-term capacity among partner institutions in Ethiopia, Malawi, Rwanda, South Africa and Uganda. This integrated knowledge translation (IKT) approach includes the formal development and implementation of country-specific engagement strategies.
Methods
An early-stage evaluation is taking place in Mid-2020. Online surveys and qualitative interviews with researchers and policy-and-practice partners will inform adaptation of country-specific strategies, advance the initial programme theory and contribute to the science of IKT.
Results
We present three pertinent observations based on the development and implementation of an overarching CEBHA+ IKT approach and five country-specific strategies over the last two years: Despite being informed by an overarching IKT programme theory, the site-specific strategies and resulting partnerships vary markedly, representing the whole continuum of integrated knowledge translation.The diversity of approaches is due to different understandings of IKT, discontinuity of staff, lack of IKT training, and perceptions of usefulness (compared to ongoing research activities) among CEBHA+ researchers.The individual, dynamic and often pre-existing relationships of researchers and partners from policy and practice are central to IKT, but capturing these within the programme theory and monitoring them remains challenging.
Conclusions
These observations are useful to guide further evaluation and cross-country comparison. Close examination of relationships and conceptualisation of IKT as a continuum may provide valuable insights into the circumstances that make IKT efforts worthwhile.
Key messages
Translating evidence into policy and practice is reliant on partnerships between researchers and policy-and-practice partners. These can be formalised but the relationships remain complex and dynamic.
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Affiliation(s)
- K Sell
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - L M Pfadenhauer
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - N Jessani
- Department of Global Health, Faculty of Medicine and Health Sciences, Centre for Evidence-Based Health Care, Stellenbosch University, Cape Town, South Africa
| | - B M Schmidt
- Cochrane Centre, South African Medical Research Council, Cape Town, South Africa
| | - N Levitt
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - G Chapotera
- School of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - A R Akiteng
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - T Mpando
- School of Public Health, College of Medicine, University of Malawi, Blantyre, Malawi
| | - S Ntawuyirushintege
- College of Medicine and Health Sciences School of PH, University of Rwanda, Kigali, Rwanda
| | - E A Rehfuess
- IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
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10
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Unger H, Thriemer K, Ley B, Tinto H, Traoré M, Valea I, Tagbor H, Antwi G, Gbekor P, Nambozi M, Kabuya JBB, Mulenga M, Mwapasa V, Chapotera G, Madanitsa M, Rulisa S, de Crop M, Claeys Y, Ravinetto R, D’Alessandro U. The assessment of gestational age: a comparison of different methods from a malaria pregnancy cohort in sub-Saharan Africa. BMC Pregnancy Childbirth 2019; 19:12. [PMID: 30621604 PMCID: PMC6323786 DOI: 10.1186/s12884-018-2128-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determining gestational age in resource-poor settings is challenging because of limited availability of ultrasound technology and late first presentation to antenatal clinic. Last menstrual period (LMP), symphysio-pubis fundal height (SFH) and Ballard Score (BS) at delivery are therefore often used. We assessed the accuracy of LMP, SFH, and BS to estimate gestational age at delivery and preterm birth compared to ultrasound (US) using a large dataset derived from a randomized controlled trial in pregnant malaria patients in four African countries. METHODS Mean and median gestational age for US, LMP, SFH and BS were calculated for the entire study population and stratified by country. Correlation coefficients were calculated using Pearson's rho, and Bland Altman plots were used to calculate mean differences in findings with 95% limit of agreements. Sensitivity, specificity, positive predictive value and negative predictive value were calculated considering US as reference method to identify term and preterm babies. RESULTS A total of 1630 women with P. falciparum infection and a gestational age > 24 weeks determined by ultrasound at enrolment were included in the analysis. The mean gestational age at delivery using US was 38.7 weeks (95%CI: 38.6-38.8), by LMP, 38.4 weeks (95%CI: 38.0-38.9), by SFH, 38.3 weeks (95%CI: 38.2-38.5), and by BS 38.0 weeks (95%CI: 37.9-38.1) (p < 0.001). Correlation between US and any of the other three methods was poor to moderate. Sensitivity and specificity to determine prematurity were 0.63 (95%CI 0.50-0.75) and 0.72 (95%CI, 0.66-0.76) for LMP, 0.80 (95%CI 0.74-0.85) and 0.74 (95%CI 0.72-0.76) for SFH and 0.42 (95%CI 0.35-0.49) and 0.77 (95%CI 0.74-0.79) for BS. CONCLUSIONS In settings with limited access to ultrasound, and in women who had been treated with P. falciparum malaria, SFH may be the most useful antenatal tool to date a pregnancy when women present first in second and third trimester. The Ballard postnatal maturation assessment has a limited role and lacks precision. Improving ultrasound facilities and skills, and early attendance, together with the development of new technologies such as automated image analysis and new postnatal methods to assess gestational age, are essential for the study and management of preterm birth in low-income settings.
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Affiliation(s)
- Holger Unger
- Department of Obstetrics and Gynaecology, Simpson Centre for Reproductive Health, Edinburgh Royal Infirmary, Edinburgh, UK
- Department of Medicine at the Doherty Institute, The University of Melbourne, Melbourne, Australia
| | - Kamala Thriemer
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Benedikt Ley
- Institute of Tropical Medicine, Antwerp, Belgium
- Menzies School of Health Research, Darwin, Australia
| | - Halidou Tinto
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Maminata Traoré
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Innocent Valea
- Institut de Recherche en Sciences de la Santé - Clinical Trial Unit of Nanoro (IRSS-CRUN), Nanoro, Burkina Faso
| | - Harry Tagbor
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | - Gifty Antwi
- School of Medicine, University of Health and Allied Sciences, Hohoe, Ghana
| | | | | | | | | | - Victor Mwapasa
- Department of Public Health, College of Medicine, Blantyre, Malawi
| | | | | | - Stephen Rulisa
- University of Rwanda, School of Medicine and Pharmacy, Kigali, Rwanda
| | | | - Yves Claeys
- Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Umberto D’Alessandro
- MRC Unit The Gambia at the London School of Hygiene and Tropical Medicine, London, UK
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Jayachandran V, Chapotera G, Stones W. Quality of facility-based family planning services for adolescents in Malawi: Findings from a national census of health facilities. Malawi Med J 2017; 28:48-52. [PMID: 27895828 DOI: 10.4314/mmj.v28i2.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The main objective of this study was to describe the quality, in terms of provision and experience of care, of facility-based family planning services for adolescents compared to older clients in Malawi. METHODS Secondary data analysis was performed on data obtained from the Service Provision Assessment survey 2013-14, a census of all formal health facilities in the country. For the present study the inclusion criterion was that the client's age was recorded in the data set, which gave a weighted total of 1388 observations of consultations, reflecting provision of care, and client exit interviews, reflecting experience of care. RESULTS The youngest clients (age group 13 to 19 years) had twice the odds of reporting a better experience of care compared to clients aged 26 and older (odds ratio [OR] 2.03, 95% confidence interval [CI] 1.15 to 3.54, P = 0.013). The standard of observed provision was low, typically with half or more of the mandated elements of care omitted. Compared with clients aged over 25, provision of care was slightly better for adolescents, with a coefficient of 4.56 on a percentage scale (95% CI 0.90 to 8.23, P = 0.015) and a coefficient of 2.33 for those aged 20-25 (95% CI 0.21 to 4.44, P = 0.032). Clients seen in facilities under nongovernmental management had better provision of care compared to government facilities, with a coefficient of 12.35 (95% CI 6.70 to 18.01, P < 0.001); care was worse for clients seen in clinics compared to hospitals (coefficient -6.88, 95% CI -11.41 to -2.35, P = 0.003) and also for clients seen by health surveillance assistants compared to those seen by a clinician (coefficient -9.41, 95% CI -15.53 to -3.29, P = 0.003). CONCLUSIONS Quality of care for adolescents attending facility-based family planning services was slightly better than for older clients, but this is overshadowed by the finding of a low standard of care overall. Health system strengthening, especially at the clinic level, is a policy and programming priority that will contribute to adolescent reproductive health in Malawi.
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Affiliation(s)
- Vinitha Jayachandran
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - Gertrude Chapotera
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
| | - William Stones
- School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi; Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, University of St Andrews, Fife, United Kingdom
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