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Bosch-Capblanch X, Esu E, Oringanje CM, Dongus S, Jalilian H, Eyers J, Auer C, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies. Environ Int 2024; 187:108612. [PMID: 38640611 DOI: 10.1016/j.envint.2024.108612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, USA.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Mthethwa M, Mbeye NM, Effa E, Arikpo D, Blose N, Brand A, Chibuzor M, Chipojola R, Durao S, Esu E, Kallon II, Kunje G, Lakudzala S, Naude C, Leong TD, Lewin S, Mabetha D, McCaul M, Meremikwu M, Vandvik PO, Kredo T. Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Serv Res 2024; 24:221. [PMID: 38374031 PMCID: PMC10877834 DOI: 10.1186/s12913-024-10682-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child mortality. We aimed to identify and assess the quality of guidelines for newborn and child health published in South Africa, Nigeria and Malawi in the last 5 years (2017-2022). METHODS We searched relevant websites (June-July 2022), for publicly available national and subnational de novo or adapted guidelines, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible guidelines (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised guideline quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. RESULTS We identified 40-guidelines from the three countries. Of these, 8/40 reported being adopted from a parent guideline. More guidelines (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). Guidelines were most often developed by national health ministries (n = 30) and professional societies (n = 14). Eighteen guidelines reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used in 1/7 guidelines that reported assessing certainty of evidence. Overall guidelines scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47-83), and clarity of presentation 81% (67-94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4-32) and editorial independence 6% (0-27). CONCLUSION National ministries and professional societies drive guideline activities in Malawi, Nigeria and South Arica. However, the methods and reporting do not adhere to global standards. We found low AGREE II scores for rigour of guideline development and editorial independence and limited use of GRADE or adaptation methods. This undermines the credibility of available guidelines to support evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen partnerships, capacity, and support for guideline development.
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Affiliation(s)
- Mashudu Mthethwa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nyanyiwe Masingi Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emmanuel Effa
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Solange Durao
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ekpereonne Esu
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Idriss Ibrahim Kallon
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Suzgika Lakudzala
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Trudy D Leong
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Röösli M, Dongus S, Jalilian H, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies. Environ Int 2024; 183:108338. [PMID: 38104437 DOI: 10.1016/j.envint.2023.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). OBJECTIVES The objective is to systematically review the effects of longer-term or repeated local and whole human body radiofrequency electromagnetic field (RF-EMF) exposure on the occurrence of symptoms. Primary hypotheses were tinnitus, migraine and headaches in relation to RF-EMF exposure of the brain, sleep disturbances and composite symptom scores in relation to whole-body RF-EMF exposure. METHODS Eligibility criteria: We included case-control and prospective cohort studies in the general population or workers estimating local or whole-body RF-EMF exposure for at least one week. INFORMATION SOURCES We conducted a systematic literature search in various databases including Web of Science and Medline. Risk of bias: We used the Risk of Bias (RoB) tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS We synthesized studies using random effects meta-analysis. RESULTS Included studies: We included 13 papers from eight distinct cohort and one case-control studies with a total of 486,558 participants conducted exclusively in Europe. Tinnitus is addressed in three papers, migraine in one, headaches in six, sleep disturbances in five, and composite symptom scores in five papers. Only one study addressed occupational exposure. SYNTHESIS OF RESULTS For all five priority hypotheses, available research suggests that RF-EMF exposure below guideline values does not cause symptoms, but the evidence is very uncertain. The very low certainty evidence is due the low number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. In terms of non-priority hypotheses numerous exposure-outcome combinations were addressed in the 13 eligible papers without indication for an association related to a specific symptom or exposure source. DISCUSSION Limitations of evidence: This review topic includes various challenges related to confounding control and exposure assessment. Many of these aspects are inherently present and not easy to be solved in future research. Since near-field exposure from wireless communication devices is related to lifestyle, a particular challenge is to differentiate between potential biophysical effects and other potential effects from extensive use of wireless communication devices that may compete with healthy behaviour such as sleeping or physical activity. Future research needs novel and innovative methods to differentiate between these two hypothetical mechanisms. INTERPRETATION This is currently the best available evidence to underpin safety of RF-EMF. There is no indication that RF-EMF below guideline values causes symptoms. However, inherent limitations of the research results in substantial uncertainty. OTHER Funding: This review was partially funded by the WHO radioprotection programme. REGISTRATION The protocol for this review has been registered in Prospero (reg no CRD42021239432) and published in Environment International (Röösli et al., 2021).
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Borst RAJ, Wehrens R, Nsangou M, Arikpo D, Esu E, Al Metleq A, Hobden O, Meremikwu M, Ongolo-Zogo P, Bal R, Kok MO. What makes knowledge translation work in practice? Lessons from a demand-driven and locally led project in Cameroon, Jordan and Nigeria. Health Res Policy Syst 2023; 21:127. [PMID: 38049826 PMCID: PMC10694879 DOI: 10.1186/s12961-023-01083-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/26/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Over the years, the knowledge translation (KT) field has moved from promoting linearized models to embracing the importance of interaction and learning. Likewise, there is now increased attention on the transfer of KT approaches to new environments. Some scholars, however, have warned that ideas about transferability still hinge on linear thinking and doing. In the current study, we therefore sought to use a more reflexive approach to KT and to study how actors align KT approaches with their local environments. METHODS Our (auto) ethnographic study took place in a wider KT project. This project intended to combine three components: (1) co-organizing demand-driven, locally led and embedded KT cycles in Cameroon, Jordan, and Nigeria, (2) building upon established KT methods and (3) equipping and empowering local teams. We conducted 63 semi-structured interviews with key KT actors, observed 472 h of KT practices, and collected a paper trail of documents. At the same time, we also compiled project exchanges, such as project documents, plans, protocols, field notes, meeting notes and an archive of (email) correspondence between project members. We analysed all data abductively. RESULTS We show that there were numerous moments where the design of our project indeed enabled us to align with local practices and needs. Yet this often did not suffice, and the project design sometimes conflicted with other logics and values. By analysing these tensions, we want to show that doing KT work which acts upon different values and knowledges and is sensitive towards the different effects that it produces demands both structuring projects in a specific way and requires significant alignment work of KT actors in practice. CONCLUSIONS We show that practising KT more reflexively relies on two important conditions. First, KT projects have to be structured with sufficient discretionary space. Second, even though the structure of a project is important, there will be continuous need for alignment work. It is important to facilitate such alignment work and to further support it. In the discussion of this paper, we therefore articulate three design principles and three sensitivities. These elements can be used to make future KT projects more reflexive and sensitive to (social) complexity.
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Affiliation(s)
- Robert A J Borst
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands.
| | - Rik Wehrens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Moustapha Nsangou
- Centre pour le Dévéloppement des Bonnes Pratiques en Santé, Yaoundé, Cameroon
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ali Al Metleq
- The Higher Population Council, General Secretariat, Amman, Jordan
| | - Olivia Hobden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Pierre Ongolo-Zogo
- Centre pour le Dévéloppement des Bonnes Pratiques en Santé, Yaoundé, Cameroon
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
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Figueroa-Romero A, Bissombolo D, Meremikwu M, Ratsimbasoa A, Sacoor C, Arikpo I, Lemba E, Nhama A, Rakotosaona R, Llach M, Pons-Duran C, Sanz S, Ma L, Doderer-Lang C, Maly C, Roman E, Pagnoni F, Mayor A, Menard D, González R, Menéndez C. Prevalence of molecular markers of resistance to sulfadoxine-pyrimethamine before and after community delivery of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa: a multi-country evaluation. Lancet Glob Health 2023; 11:e1765-e1774. [PMID: 37858587 DOI: 10.1016/s2214-109x(23)00414-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND The effectiveness of community delivery of intermittent preventive treatment (C-IPT) of malaria in pregnancy (IPTp) with sulfadoxine-pyrimethamine has been evaluated in selected areas of the Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria. We aimed to assess the effect of C-IPTp on the potential development of Plasmodium falciparum resistance to sulfadoxine-pyrimethamine, since it could threaten the effectiveness of this strategy. METHODS Health facility-based cross-sectional surveys were conducted at baseline and 3 years after C-IPTp implementation in two neighbouring areas per country, one with C-IPTp intervention, and one without, in the four project countries. Dried blood spots from children under five years of age with clinical malaria were collected. Sulfadoxine-pyrimethamine resistance-associated mutations of the P falciparum dhfr (Asn51Ile/Cys59Arg/Ser108Asn/Ile164Leu) and dhps (Ile431Val/Ser436Ala/Ala437Gly/Lys540Glu/Ala581Gly/Ala613Ser) genes were analysed. FINDINGS 2536 children were recruited between June 19 and Oct 10, 2018, during baseline surveys. Endline surveys were conducted among 2447 children between July 26 and Nov 30, 2021. In the Democratic Republic of the Congo, the dhfr/dhps IRNI/ISGEAA inferred haplotype remained lower than 10%, from 2% (5 of 296) at baseline to 8% (24 of 292) at endline, and from 3% (9 of 300) at baseline to 6% (18 of 309) at endline surveys in intervention and non-intervention areas respectively with no significant difference in the change between the areas. In Mozambique, the prevalence of this haplotype remained stable at over 60% (194 [64%] of 302 at baseline to 194 [64%] of 303 at endline, and 187 [61%] of 306 at baseline to 183 [61%] of 301 in endline surveys, in non-intervention and intervention areas respectively). No isolates harbouring the dhps ISGEAA genotype were found in Nigeria. In Madagascar, only five isolates with this haplotype were found in the non-intervention area (2 [>1%] of 300 at baseline and 3 [1%] of 300 at endline surveys). No isolates were found carrying the dhps ISGEGA genotype. INTERPRETATION C-IPTp did not increase the prevalence of molecular markers associated with sulfadoxine-pyrimethamine resistance after three years of programme implementation. These findings reinforce C-IPTp as a strategy to optimise the control of malaria during pregnancy, and support the WHO guidelines for prevention of malaria in pregnancy. FUNDING UNITAID [2017-13-TIPTOP].
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Affiliation(s)
- Antía Figueroa-Romero
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Kinshasa, Democratic Republic of the Congo
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | | | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Iwara Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | - Elsha Lemba
- Medecins d'Afrique, Kinshasa, Democratic Republic of the Congo
| | - Abel Nhama
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique; Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | | | - Mireia Llach
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Clara Pons-Duran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Sergi Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Kinshasa, Democratic Republic of the Congo; Department of Basic Clinical Practice, Faculty of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Laurence Ma
- Institut Pasteur, Université Paris Cité, Biomics Platform, Paris, France
| | - Cécile Doderer-Lang
- Université de Strasbourg, Institute of Parasitology and Tropical Diseases, Strasbourg, France
| | - Christina Maly
- Jhpiego, John Hopkins University Affiliate, Baltimore MD, USA
| | - Elaine Roman
- Jhpiego, John Hopkins University Affiliate, Baltimore MD, USA
| | - Franco Pagnoni
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Alfredo Mayor
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Didier Menard
- Université de Strasbourg, Institute of Parasitology and Tropical Diseases, Strasbourg, France; Malaria Genetics and Resistance Unit, Institut Pasteur, Paris, France; Institut Pasteur, Université Paris Cité, Malaria Parasite Biology and Vaccines Unit, Paris, France; CHU Strasbourg, Laboratory of Parasitology and Medical Mycology, Strasbourg, France
| | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Kinshasa, Democratic Republic of the Congo; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Kinshasa, Democratic Republic of the Congo; Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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Cirera L, Sacoor C, Meremikwu M, Ranaivo L, Manun'Ebo MF, Pons-Duran C, Arikpo D, Ramirez M, Ramponi F, Figueroa-Romero A, Gonzalez R, Maly C, Roman E, Sicuri E, Pagnoni F, Menéndez C. Cost-effectiveness of community-based distribution of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria, and the Democratic Republic of Congo. BMJ Glob Health 2023; 8:e010238. [PMID: 37479498 PMCID: PMC10364184 DOI: 10.1136/bmjgh-2022-010238] [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: 07/23/2022] [Accepted: 07/05/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Malaria in pregnancy is a major driver of maternal and infant mortality in sub-Saharan Africa. The WHO recommends the administration of intermittent preventive treatment with sulfadoxine pyrimethamine (IPTp-SP) at antenatal care (ANC) visits. Despite being a highly cost-effective strategy, IPTp-SP coverage and uptake remains low. A pilot project was conducted to assess the cost-effectiveness (CE) of community-based delivery of IPTp (C-IPTp) in addition to ANC delivery to increase IPTp uptake in the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). METHODS Costs and CE estimates of C-IPTp were calculated according to two scenarios: (1) costs in 'programmatic mode' (ie, costs if C-IPTp was to be implemented by national health systems) and (2) costs from the pilot project. The effectiveness of C-IPTp was obtained through estimates of the averted disability-adjusted life-years (DALYs) associated with maternal clinical malaria and anaemia, low birth weight and neonatal mortality. RESULTS Net incremental costs of C-IPTp ranged between US$6138-US$47 177 (DRC), US$5552-US$31 552 (MDG), US$10 202-US$53 221 (MOZ) and US$667-US$28 645 (NGA) per 1000 pregnant women, under scenarios (1) and (2), respectively. Incremental cost-effectiveness ratios (ICERs) ranged between US$15-US$119 in DRC, US$9-US$53 in MDG, US$104-US$543 in MOZ and US$2-US$66 in NGA per DALY averted, under scenarios (1) and (2), respectively. ICERs fall below the WHO recommended CE threshold based on the gross domestic product per capita. CONCLUSION Findings suggest that C-IPTp is a highly cost-effective intervention. Results can inform policy decisions on adopting and optimising effective interventions for preventing malaria in pregnancy.
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Affiliation(s)
- Laia Cirera
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Louise Ranaivo
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Manu F Manun'Ebo
- Bureau d'Étude et de Gestion de l'Information Statistique (BEGIS), Kinshasa, Congo (the Democratic Republic of the)
| | - Clara Pons-Duran
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
| | - Dachi Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Maximo Ramirez
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
| | - Francesco Ramponi
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
| | - Antia Figueroa-Romero
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
| | - Raquel Gonzalez
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
| | - Christina Maly
- Jhpiego, Johns Hopkins University Affiliate, Baltimore, Maryland, USA
| | - Elaine Roman
- Jhpiego, Johns Hopkins University Affiliate, Baltimore, Maryland, USA
| | - Elisa Sicuri
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Franco Pagnoni
- Maternal, Child and Reproductive Health Initiative, Barcelona Institute for Global Health, Barcelona, Spain
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7
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Christensen RE, Yi MD, Kang BY, Ibrahim SA, Anvery N, Dirr M, Adams S, Amer YS, Bisdorff A, Bradfield L, Brown S, Earley A, Fatheree LA, Fayoux P, Getchius T, Ginex P, Graham A, Green CR, Gresele P, Hanson H, Haynes N, Hegedüs L, Hussein H, Jakhmola P, Kantorova L, Krishnasamy R, Krist A, Landry G, Lease ED, Ley L, Marsden G, Meek T, Meremikwu M, Moga C, Mokrane S, Mujoomdar A, Newton S, O'Flynn N, Perkins GD, Smith EJ, Prematunge C, Rychert J, Saraco M, Schünemann HJ, Senerth E, Sinclair A, Shwayder J, Stec C, Tanni S, Taske N, Temple-Smolkin RL, Thomas L, Thomas S, Tonnessen B, Turner AS, Van Dam A, van Doormaal M, Wan YL, Ventura CB, McFarlane E, Morgan RL, Ogunremi T, Alam M. Development of an international glossary for clinical guidelines collaboration. J Clin Epidemiol 2023; 158:84-91. [PMID: 37019344 DOI: 10.1016/j.jclinepi.2023.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVES Clinical practice guidelines (CPGs) are often created through collaboration among organizations. The use of inconsistent terminology may cause poor communication and delays. This study aimed to develop a glossary of terms related to collaboration in guideline development. STUDY DESIGN AND SETTING A literature review of collaborative guidelines was performed to develop an initial list of terms related to guideline collaboration. The list of terms was presented to the members of the Guideline International Network Guidelines Collaboration Working Group, who provided presumptive definitions for each term and proposed additional terms to be included. The revised list was subsequently reviewed by an international, multidisciplinary panel of expert stakeholders. Recommendations received during this pre-Delphi review were implemented to augment an initial draft glossary. The glossary was then critically evaluated and refined through two rounds of Delphi surveys and a virtual consensus meeting with all panel members as Delphi participants. RESULTS Forty-nine experts participated in the pre-Delphi survey, and 44 participated in the two-round Delphi process. Consensus was reached for 37 terms and definitions. CONCLUSION Uptake and utilization of this guideline collaboration glossary by key organizations and stakeholder groups may facilitate collaboration among guideline-producing organizations by improving communication, minimizing conflicts, and increasing guideline development efficiency.
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Affiliation(s)
- Rachel E Christensen
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Michael D Yi
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland
| | - Bianca Y Kang
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Noor Anvery
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - McKenzie Dirr
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stephanie Adams
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | - Yasser S Amer
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Pediatrics Department and Quality Management Department, King Saud University Medical City, Riyadh, Saudi Arabia; Research Chair for Evidence-Based Health Care and Knowledge Translation, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | - Amy Earley
- Kidney Disease Improving Global Outcomes (KDIGO), Brussels, Belgium
| | - Lisa A Fatheree
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American College of Rheumatology, OH, USA
| | - Pierre Fayoux
- Department of Pediatric Otolaryngology-Head Neck Surgery, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Thomas Getchius
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; American Heart Association/American College of Cardiology, Dallas, Texas, USA
| | - Pamela Ginex
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Stony Brook University School of Nursing, Stony Brook, NY, USA
| | - Amanda Graham
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Courtney R Green
- The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | - Paolo Gresele
- Department of Medicine and Surgery - Head section of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Helen Hanson
- St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Heba Hussein
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Oral Medicine, Oral Diagnosis, and Periodontology Department, Cairo University, Cairo, Egypt
| | - Priya Jakhmola
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lucia Kantorova
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Czech National Centre for Evidence-Based Healthcare and Knowledge Translation, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Rathika Krishnasamy
- Department of Nephrology, Sunshine Coast University Hospital, Australia; The University of Queensland, Australia
| | - Alex Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University, VA, USA
| | - Gregory Landry
- Division of Vascular Surgery, Kootenai Clinic, Coeur d'Alene, ID, USA
| | | | - Luis Ley
- Department of Neurosurgery, Hospital Ramón y Cajal, Madrid, Spain
| | - Gemma Marsden
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Healthcare Infection Society, London UK
| | - Tim Meek
- Association of Anaesthetists, London, UK
| | - Martin Meremikwu
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Carmen Moga
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Saphia Mokrane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; WOREL (Werkgroep Ontwikkeling Richtlijnen Eerste Lijn) - Working Group Development of Primary Care Guidelines, Belgium; Department of Primary Care, Université Libre de Bruxelles, Brussels, Belgium; Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Amol Mujoomdar
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Western University, London, ON, Canada
| | - Skye Newton
- Adelaide Health Technology Assessment, University of Adelaide, Australia
| | | | - Gavin D Perkins
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Emma-Jane Smith
- European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Chatura Prematunge
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jenna Rychert
- Department of Pathology, University of Utah and ARUP Laboratories, Salt Lake City, UT
| | | | - Holger J Schünemann
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Department of Health Research Methods, Evidence, and Impact, Hamilton, Ontario, Canada; Department of Biomedical Sciences, Humanitas University, Milano, Italy
| | - Emily Senerth
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Cardiovascular Angiography & Interventions, Washington, DC, USA
| | | | - James Shwayder
- Department of Pulmonology, Botucatu Medical School-UNESP, São Paulo, Brazil
| | - Carla Stec
- Clinical Practice Guidelines, American Association of Clinical Endocrinology, Jacksonville, FL, USA
| | | | - Nichole Taske
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Robyn L Temple-Smolkin
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; Association for Molecular Pathology, MD, USA
| | - Louise Thomas
- Head of Quality Improvement, Royal College of Obstetricians and Gynaecologists, London, UK
| | | | - Britt Tonnessen
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Amy S Turner
- American College of Rheumatology, OH, USA; American College of Rheumatology, Atlanta, GA, USA
| | - Anne Van Dam
- Canadian Thoracic Society, Ottawa, Ontario, Canada
| | | | - Yung Liang Wan
- Dept. of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Christina B Ventura
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; College of American Pathologists, Northfield, IL, USA
| | - Emma McFarlane
- Guidelines International Network (GIN), Guidelines Collaboration Working Group, Scotland; National Institute for Health and Care Excellence, Manchester, UK
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Toju Ogunremi
- Healthcare Associated Infections and Infection Prevention and Control Section, National Advisory Committee on Infection Prevention and Control, Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Otolaryngology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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8
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Cirera L, Sacoor C, Meremikwu M, Ranaivo L, F. Manun’Ebo M, Arikpo D, Matavele O, Rafaralahy V, Ndombe D, Pons Duran C, Ramirez M, Ramponi F, González R, Maly C, Roman E, Sicuri E, Pagnoni F, Menéndez C. The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries. Gates Open Res 2023; 7:47. [PMID: 37234473 PMCID: PMC10205974 DOI: 10.12688/gatesopenres.14375.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 07/23/2023] Open
Abstract
Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.
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Affiliation(s)
- Laia Cirera
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Louise Ranaivo
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Manu F. Manun’Ebo
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Dachi Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Victor Rafaralahy
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Didier Ndombe
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Clara Pons Duran
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Maximo Ramirez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christina Maly
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elaine Roman
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elisa Sicuri
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- London School of Economics and Political Science, London, UK
| | - Franco Pagnoni
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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9
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Cirera L, Sacoor C, Meremikwu M, Ranaivo L, F. Manun’Ebo M, Arikpo D, Matavele O, Rafaralahy V, Ndombe D, Pons Duran C, Ramirez M, Ramponi F, González R, Maly C, Roman E, Sicuri E, Pagnoni F, Menéndez C. The economic costs of malaria in pregnancy: evidence from four sub-Saharan countries. Gates Open Res 2023; 7:47. [PMID: 37234473 PMCID: PMC10205974 DOI: 10.12688/gatesopenres.14375.2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Background Malaria in pregnancy is a major public health problem in sub-Saharan Africa (SSA), which imposes a significant economic burden. We provide evidence on the costs of malaria care in pregnancy to households and the health system in four high-burden countries in SSA. Methods Household and health system economic costs associated with malaria control in pregnancy were estimated in selected areas of the Democratic Republic of Congo (DRC), Madagascar (MDG), Mozambique (MOZ) and Nigeria (NGA). An exit survey was administered to 2,031 pregnant women when leaving the antenatal care (ANC) clinic from October 2020 to June 2021. Women reported the direct and indirect costs associated to malaria prevention and treatment in pregnancy. To estimate health system costs, we interviewed health workers from 133 randomly selected health facilities. Costs were estimated using an ingredients-based approach. Results Average household costs of malaria prevention per pregnancy were USD6.33 in DRC, USD10.06 in MDG, USD15.03 in MOZ and USD13.33 in NGA. Household costs of treating an episode of uncomplicated/complicated malaria were USD22.78/USD46 in DRC, USD16.65/USD35.65 in MDG, USD30.54/USD61.25 in MOZ and USD18.92/USD44.71 in NGA, respectively. Average health system costs of malaria prevention per pregnancy were USD10.74 in DRC, USD16.95 in MDG, USD11.17 in MOZ and USD15.64 in NGA. Health system costs associated with treating an episode of uncomplicated/complicated malaria were USD4.69/USD101.41 in DRC, USD3.61/USD63.33 in MDG, USD4.68/USD83.70 in MOZ and USD4.09/USD92.64 in NGA. These estimates resulted in societal costs of malaria prevention and treatment per pregnancy of USD31.72 in DRC, USD29.77 in MDG, USD31.98 in MOZ and USD46.16 in NGA. Conclusions Malaria in pregnancy imposes a high economic burden on households and the health system. Findings emphasize the importance of investing in effective strategies that improve access to malaria control and reduce the burden of the infection in pregnancy.
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Affiliation(s)
- Laia Cirera
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - Louise Ranaivo
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Manu F. Manun’Ebo
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Dachi Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | | | - Victor Rafaralahy
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Didier Ndombe
- Bureau d’Étude et de Gestion de l’Information Statistique (BEGIS), Kinshasa, Democratic Republic of the Congo
| | - Clara Pons Duran
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Maximo Ramirez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | | | - Raquel González
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Christina Maly
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elaine Roman
- Jhpiego, a Johns Hopkins University affiliate, Baltimore, USA
| | - Elisa Sicuri
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- London School of Economics and Political Science, London, UK
| | - Franco Pagnoni
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Clara Menéndez
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Manhiça Health Research Center, Manhiça, Mozambique
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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10
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Ochu CL, Ntoimo L, Onoh I, Okonofua F, Meremikwu M, Mba S, Iniobong A, Nwafor O, Dalhat M, Ohonsi C, Arinze C, Esu E, Igumbor EU, Dan-Nwafor C, Ilori E, Adetifa I. Predictors of Lassa fever diagnosis in suspected cases reporting to health facilities in Nigeria. Sci Rep 2023; 13:6545. [PMID: 37085507 PMCID: PMC10121657 DOI: 10.1038/s41598-023-33187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/08/2023] [Indexed: 04/23/2023] Open
Abstract
Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group 40-49 years (aOR = 1.40; 95% CI 1.21-1.62), males (aOR = 1.11; 95% CI 1.03-1.20), those with formal education (aOR = 1.33; 95% CI 1.13-1.56), artisans (aOR = 1.70; 95% CI 1.28-2.27), religious leaders (aOR = 1.62; 95% CI 1.04-2.52), farmers (aOR = 1.48; 95% CI 1.21-1.81), and symptomatic individuals (aOR = 2.36; 95% CI 2.09-2.68). Being a health worker (aOR = 0.69; 95% CI 0.53-0.91), a teacher (aOR = 0.69; 95% CI 0.53-0.89) and cases reporting in the 3rd quarter (aOR = 0.79; 95% CI 0.69-0.92) had lower odds. In a sex-disaggregated analysis, female farmers had higher odds of positivity (aOR = 2.43; 95% CI 1.76-3.38; p < 0.001) than male farmers (aOR = 1.52; 95% CI 1.19-1.96; p < 0.01). Fever (aOR = 2.39; 95% CI 2.00-2.84) and gastrointestinal (GI) symptoms (aOR = 2.15; 95% CI 1.94-2.37) had the highest odds among symptoms. Combination of fever and GI symptoms (aOR = 2.15; 95% CI 1.50-3.10), fever and neurological symptoms (aOR = 6.37; 95% CI 1.49-27.16), fever and musculo-skeletal symptoms (aOR = 2.95; 95% CI 1.37-6.33), fever and cardiopulmonary symptoms (aOR = 1.81; 95% CI 1.24-2.64), and cardiopulmonary and general symptoms (aOR = 1.50; 95% CI 1.19-1.89) were also predictive. Cumulative LF CPR appears high with clearly identified predictors. Targeted interventions with heightened index of suspicion for sociodemographic categories predictive of LF in suspected cases are recommended. Ethnographic and further epidemiological studies could aid better understanding of these associations.
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Affiliation(s)
- Chinwe Lucia Ochu
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Lorretta Ntoimo
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Ikenna Onoh
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Sandra Mba
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Akanimo Iniobong
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Obinna Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Mahmood Dalhat
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna, Kaduna State, Nigeria
| | - Cornelius Ohonsi
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chinedu Arinze
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ehimario Uche Igumbor
- Centre for Infectious Disease Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chioma Dan-Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria.
| | - Elsie Ilori
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ifedayo Adetifa
- The Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
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11
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Alonso Y, Lusengi W, Manun'Ebo MF, Rasoamananjaranahary AM, Rivontsoa NM, Mucavele E, Torres N, Sacoor C, Okebalama H, Agbor UJ, Nwankwo O, Meremikwu M, Roman E, Pagnoni F, Menéndez C, Munguambe K, Enguita-Fernàndez C. The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo. BMJ Glob Health 2022; 7:bmjgh-2022-010079. [PMID: 36319032 PMCID: PMC9628536 DOI: 10.1136/bmjgh-2022-010079] [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: 07/07/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Intermittent preventive treatment in pregnancy with sulphadoxine pyrimethamine (IPTp) is a key malaria prevention strategy in sub-Saharan African countries. We conducted an anthropological study as part of a project aiming to evaluate a community-based approach to the delivery of IPTp (C-IPTp) through community health workers (CHWs) in four countries (the Democratic Republic of Congo, Madagascar, Mozambique and Nigeria), to understand the social context in order to identify key factors that could influence C-IPTp acceptability. METHODS A total of 796 in-depth interviews and 265 focus group discussions were undertaken between 2018 and 2021 in the four countries with pregnant women, women of reproductive age, traditional and facility-based healthcare providers, community leaders, and relatives of pregnant women. These were combined with direct observations (388) including both community-based and facility-based IPTp delivery. Grounded theory guided the overall study design and data collection, and data were analysed following a combination of content and thematic analysis. RESULTS A series of key factors were found to influence acceptability, delivery and uptake of C-IPTp in project countries. Cross-cutting findings include the alignment of the strategy with existing social norms surrounding pregnancy and maternal health-seeking practices, the active involvement of influential and trusted actors in implementation activities, existing and sustained trust in CHWs, the influence of husbands and other relatives in pregnant women's care-seeking decision-making, the working conditions of CHWs, pregnant women's perceptions of SP for IPTp and persistent barriers to facility-based antenatal care access. CONCLUSIONS The findings provide evidence on the reported acceptability of C-IPTp among a wide range of actors, as well as the barriers and facilitators for delivery and uptake of the intervention. Overall, C-IPTp was accepted by the targeted communities, supporting the public health value of community-based interventions, although the barriers identified should be examined if large-scale implementation of the intervention is considered.
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Affiliation(s)
- Yara Alonso
- ISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Wade Lusengi
- Bureau d'Étude et de Gestion de l'Information Statistique (BEGIS), Kinshasa, Congo
| | - Manu F Manun'Ebo
- Bureau d'Étude et de Gestion de l'Information Statistique (BEGIS), Kinshasa, Congo
| | | | | | - Estêvão Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, Mozambique
| | - Neusa Torres
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, Mozambique
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, Mozambique
| | - Hope Okebalama
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ugo James Agbor
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Cross River State, Nigeria
| | - Elaine Roman
- JHPIEGO, a Johns Hopkins University affiliate, Baltimore, Maryland, USA
| | - Franco Pagnoni
- ISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça, Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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Bosch-Capblanch X, Esu E, Dongus S, Oringanje CM, Jalilian H, Eyers J, Oftedal G, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies. Environ Int 2022; 158:106953. [PMID: 34735955 PMCID: PMC8668868 DOI: 10.1016/j.envint.2021.106953] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, United States
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Gunnhild Oftedal
- Department of Electronic Systems, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Röösli M, Dongus S, Jalilian H, Feychting M, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies. Environ Int 2021; 157:106852. [PMID: 34500362 PMCID: PMC8484767 DOI: 10.1016/j.envint.2021.106852] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION PROSPERO CRD42021239432.
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Alam M, Getchius TSD, Schünemann H, Amer YS, Bak A, Fatheree LA, Ginex P, Jakhmola P, Marsden GL, McFarlane E, Meremikwu M, Taske N, Temple-Smolkin RL, Ventura C, Burgers J, Bradfield L, O'Brien MD, Einhaus K, Kopp IB, Munn Z, Scudeller L, Schaefer C, Ibrahim SA, Kang BY, Ogunremi T, Morgan RL. A memorandum of understanding has facilitated guideline development involving collaborating groups. J Clin Epidemiol 2021; 144:8-15. [DOI: 10.1016/j.jclinepi.2021.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
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15
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Udoh E, Nwazuluoke B, Bassey V, Motilewa O, Okorie O, Adesina S, Ejemot-Nwadiaro R, Meremikwu M. Comparison of standardised milk-based, standardised non-milk based and hospital-based formulations on the anthropometric indices of under-fives with moderate acute malnutrition: A randomised clinical trial. J Hum Nutr Diet 2021; 35:523-534. [PMID: 34843141 DOI: 10.1111/jhn.12960] [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: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Moderate acute malnutrition (MAM) causes impaired anthropometry, which can be reversed by supplementary feeding. The present study aimed to compare the effect of a standardised milk-based formulation (SMBF), standardised non-milk based formulation (SNMBF) and hospital-based formulation (HBF) on anthropometric indices of children aged <5 years with MAM. METHODS This was a randomised clinical trial during which eligible children aged 6-59 months with MAM received SMBF, SNMBF or HBF over 4 months. They were followed up on a biweekly basis during which their weight, mid upper arm circumference (MUAC) and length/height were measured. The effect of the formulations was determined at the end of the period by the change in their anthropometric indices using 'per protocol' analysis. p < 0.05 was considered statistically significant. RESULTS There were 157 evaluable participants of whom 54 received the SMBF, 57 received the SNMBF and 46 received the HBF. The overall result showed a significant improvement in the mean weight and MUAC of the children. Subgroup analysis showed a significant improvement in mean weight and MUAC among children aged 6-23 months (p = 0.013) and improvement in MUAC only among those aged 24-59 months (p = 0.03). CONCLUSIONS The formulations significantly improved the mean weight and MUAC of children with MAM.
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Affiliation(s)
- Ekong Udoh
- Paediatrics Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Blessing Nwazuluoke
- Dietetic Unit, Department of Internal Medicine, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Victor Bassey
- Nutrition Division, State Ministry of Health, Uyo, Akwa Ibom State, Nigeria
| | - Olugbemi Motilewa
- Community Health Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Obasi Okorie
- Paediatric Endocrine Unit, Endocrine and Diabetes Center, King Abdulaziz Specialist Hospital, Sakaka, Kingdom of Saudi Arabia
| | - Sunday Adesina
- Paediatrics Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria
| | - Regina Ejemot-Nwadiaro
- Department of Public Health, Faculty of Allied Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Paediatrics Department, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
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Oyo-Ita AE, Hanlon P, Nwankwo O, Bosch-Capblanch X, Arikpo D, Esu E, Auer C, Meremikwu M. Cost-effectiveness analysis of an intervention project engaging Traditional and Religious Leaders to improve uptake of childhood immunization in southern Nigeria. PLoS One 2021; 16:e0257277. [PMID: 34529714 PMCID: PMC8445457 DOI: 10.1371/journal.pone.0257277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Vaccination is a cost-effective public health intervention, yet evidence abounds that vaccination uptake is still poor in many low- and middle-income countries. Traditional and Religious Leaders play a substantial role in improving the uptake of health services such as immunization. However, there is paucity of evidence on the cost-effectiveness of using such strategies. This study aimed to assess the cost-effectiveness of using a multi-faceted intervention that included traditional and religious leaders for community engagement to improve uptake of routine immunisation services in communities in Cross River State, Southern Nigeria. The target population for the intervention was traditional and religious leaders in randomly selected communities in Cross River State. The impact of the intervention on the uptake of routine vaccination among children 0 to 23 months was assessed using a cluster randomized trials. Outcome assessments were performed at the end of the project (36 months).The cost of the intervention was obtained from the accounting records for expenditures incurred in the course of implementing the intervention. Costs were assessed from the health provider perspective. The cost-effectiveness analysis showed that the incremental cost of the initial implementation of the intervention was US$19,357and that the incremental effect was 323 measles cases averted, resulting in an incremental cost-effectiveness ratio (ICER) of US$60/measles case averted. However, for subsequent scale-up of the interventions to new areas not requiring a repeat expenditure of some of the initial capital expenditure the ICER was estimated to be US$34 per measles case averted. Involving the traditional and religious leaders in vaccination is a cost-effective strategy for improving the uptake of childhood routine vaccinations.
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Affiliation(s)
- Angela E. Oyo-Ita
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- * E-mail:
| | - Patrick Hanlon
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ogonna Nwankwo
- Department of Community Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekperonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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17
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Effa E, Arikpo D, Oringanje C, Udo E, Esu E, Sam O, Okoroafor S, Oyo-Ita A, Meremikwu M. Human resources for health governance and leadership strategies for improving health outcomes in low- and middle-income countries: a narrative review. J Public Health (Oxf) 2021; 43:i67-i85. [PMID: 33856463 DOI: 10.1093/pubmed/fdaa264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 09/07/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. METHODS Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done. RESULTS We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resource units. CONCLUSIONS Governance and leadership strategies targeting the HRH crises in LMIC are variable, interdependent and complex. While some show benefits in improving health workforce outcomes, only a few have an impact on population health outcomes.
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Affiliation(s)
- E Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - D Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - C Oringanje
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Udo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - O Sam
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - S Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - A Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - M Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
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18
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Chibuzor M, Arikpo I, Aquaisua E, Esu E, Okoroafor SC, Omar S, Effa E, Oyo-Ita A, Meremikwu M. Implementation of health workforce information systems: a review of eight sub-Saharan country experiences. J Public Health (Oxf) 2021; 43:i27-i40. [PMID: 33856471 DOI: 10.1093/pubmed/fdaa263] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resource planning and policies. There is a lack of evaluative research on the capacity of HWRs to improve health systems. This review aims to assess the effectiveness of HWRs for improving health systems in low- and middle-income countries. METHODS We searched selected electronic databases from inception to 14 April 2020. Two authors independently screened studies and extracted data from included studies. We presented results as a narrative synthesis. RESULTS We included eight studies of moderate-high quality in this review. The results suggest that HWRs can improve the distribution and skill-mix of the health workforce, quality of health workforce data, availability and use of data for policy and planning, and user satisfaction. The evidence was derived from case studies, which limited our ability to infer a causal relationship. CONCLUSION More rigorous research from controlled experimental studies is needed to consolidate the available evidence from observational studies.
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Affiliation(s)
- M Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - I Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria.,Department of Computer Science, University of Calabar, Calabar, Nigeria
| | - E Aquaisua
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - E Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - S C Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - S Omar
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - E Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - A Oyo-Ita
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - M Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
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19
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Esu EB, Chibuzor M, Aquaisua E, Udoh E, Sam O, Okoroafor S, Ongom M, Effa E, Oyo-Ita A, Meremikwu M. Interventions for improving attraction and retention of health workers in rural and underserved areas: a systematic review of systematic reviews. J Public Health (Oxf) 2021; 43:i54-i66. [PMID: 33856468 DOI: 10.1093/pubmed/fdaa235] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/04/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Global health workforce shortages exist with disparities in the skill mix and distribution of health workers. Rural and underserved populations are often disadvantaged in terms of access to health care. METHODS This systematic review summarized all systematic reviews that assessed interventions for improving attraction and retention of health workers in rural and underserved areas. We systematically searched selected electronic databases up to 31 March 2020. The authors independently screened the reviews, extracted data and assessed the certainty of evidence using GRADE. Review quality was assessed using the ROBIS tool. RESULTS There was a paucity of evidence for the effectiveness of the various interventions. Regulatory measures were able to attract health workers to rural and underserved areas, particularly when obligations were attached to incentives. However, health workers were likely to relocate from these areas once their obligations were completed. Recruiting rural students and rural placements improved attraction and retention although most studies were without control groups, which made conclusions on effectiveness difficult. CONCLUSIONS Cost-effective utilization of limited resources and the adoption and implementation of evidence-based health workforce policies and interventions that are tailored to meet national health system contexts and needs are essential.
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Affiliation(s)
- E B Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - M Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Aquaisua
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Cross River Health & Demographic Surveillance System, University of Calabar, Calabar, Nigeria
| | - E Udoh
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Paediatrics Department, University of Uyo Teaching Hospital, Uyo, Akwa Ibom, Nigeria
| | - O Sam
- Universal Health Coverage/Life Course, World Health Organization Inter-Country Support Team, Ouagadougou, Burkina Faso
| | - S Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - M Ongom
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - E Effa
- Department of Internal Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - A Oyo-Ita
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Community Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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20
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Pons-Duran C, Llach M, Sacoor C, Sanz S, Macete E, Arikpo I, Ramírez M, Meremikwu M, Mbombo Ndombe D, Méndez S, Manun'Ebo MF, Ramananjato R, Rabeza VR, Tholandi M, Roman E, Pagnoni F, González R, Menéndez C. Coverage of intermittent preventive treatment of malaria in pregnancy in four sub-Saharan countries: findings from household surveys. Int J Epidemiol 2021; 50:550-559. [PMID: 33349871 PMCID: PMC8128463 DOI: 10.1093/ije/dyaa233] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
Abstract
Background Intermittent preventive treatment in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) is a key malaria prevention strategy in areas with moderate to high transmission. As part of the TIPTOP (Transforming IPT for Optimal Pregnancy) project, baseline information about IPTp coverage was collected in eight districts from four sub-Saharan countries: Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. Methods Cross-sectional household surveys were conducted using a multistage cluster sampling design to estimate the coverage of IPTp and antenatal care attendance. Eligible participants were women of reproductive age who had ended a pregnancy in the 12 months preceding the interview and who had resided in the selected household during at least the past 4 months of pregnancy. Coverage was calculated using percentages and 95% confidence intervals. Results A total of 3911 women were interviewed from March to October 2018. Coverage of at least three doses of IPTp (IPTp3+) was 22% and 24% in DRC project districts; 23% and 12% in Madagascar districts; 11% and 16% in Nigeria local government areas; and 63% and 34% in Mozambique districts. In DRC, Madagascar and Nigeria, more than two-thirds of women attending at least four antenatal care visits during pregnancy received less than three doses of IPTp. Conclusions The IPTp3+ uptake in the survey districts was far from the universal coverage. However, one of the study districts in Mozambique showed a much higher coverage of IPTp3+ than the other areas, which was also higher than the 2018 average national coverage of 41%. The reasons for the high IPTp3+ coverage in this Mozambican district are unclear and require further study.
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Affiliation(s)
- Clara Pons-Duran
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mireia Llach
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Charfudin Sacoor
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Sergi Sanz
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Departament de Fonaments Clínics, Facultat de Medicina, Universitat de Barcelona (UB), Barcelona, Spain
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Iwara Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | - Máximo Ramírez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | - Didier Mbombo Ndombe
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Susana Méndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Manu F Manun'Ebo
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Ranto Ramananjato
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Victor R Rabeza
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | - Maya Tholandi
- Jhpiego, Affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Elaine Roman
- Jhpiego, Affiliate of Johns Hopkins University, Baltimore, MD, USA
| | - Franco Pagnoni
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
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21
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Oyo-Ita A, Bosch-Capblanch X, Ross A, Oku A, Esu E, Ameh S, Oduwole O, Arikpo D, Meremikwu M. Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial. PLoS One 2021; 16:e0248236. [PMID: 33861742 PMCID: PMC8051768 DOI: 10.1371/journal.pone.0248236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccination, timely vaccination for pentavalent and measles vaccines, and pentavalent 1–3 dropout rates were estimated using logistic regression models using random effects to account for the clustered data. Results A total of 2598 children at baseline, 2570 at midline, and 2550 at endline were included. The intervention was effective in increasing the proportion with at least one vaccine (OR 12.13 95% CI 6.03–24.41p<0.001). However, there was no evidence of an impact on the proportion of children up-to-date with vaccination (p = 0.69). It was effective in improving timeliness of Pentavalent 3 (OR 1.55; 95% CI: 1.14, 2.12; p = 0.005) and Measles (OR 2.81; 96% CI: 1.93–4.1; p<0.001) vaccination. The odds of completing Pentavalent vaccination increased (OR = 1.66 95% CI: 1.08,2.55). Conclusion Informal training to enhance the traditional and religious leaders’ knowledge of vaccination and their leadership role can empower them to be good influencers for childhood vaccination. They constitute untapped resources in the community to boost routine immunisation. Pan African Clinical Trial Registry (PACTR) PACTR202008784222254.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- * E-mail:
| | - Xavier Bosch-Capblanch
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Amanda Ross
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Afiong Oku
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ekpereonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Public Health, Faculty of Allied Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Olabisi Oduwole
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Paediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
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22
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Enguita-Fernàndez C, Alonso Y, Lusengi W, Mayembe A, Manun'Ebo MF, Ranaivontiavina S, Rasoamananjaranahary AM, Mucavele E, Macete E, Nwankwo O, Meremikwu M, Roman E, Pagnoni F, Menéndez C, Munguambe K. Trust, community health workers and delivery of intermittent preventive treatment of malaria in pregnancy: a comparative qualitative analysis of four sub-Saharan countries. Glob Public Health 2020; 16:1889-1903. [PMID: 33290172 DOI: 10.1080/17441692.2020.1851742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 10/22/2022]
Abstract
This qualitative study is part of a project aiming to evaluate a community-based approach to the delivery of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP) through community health workers (CHWs) in four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Madagascar, Mozambique and Nigeria. The study aimed to understand the factors that influence the anticipated acceptability of this intervention. A total of 216 in-depth interviews and 62 focus group discussions were carried out in the four country sites with pregnant women, women of reproductive age, community leaders, pregnant women's relatives, CHWs, formal and informal health providers. Grounded theory guided the study design and data collection, and content and thematic analysis was performed through a comparative lens. This paper focuses on one crosscutting theme: trust-building. Two mechanisms that underpin communities' trust in delivery of IPTp via CHWs were identified: 'perceived competence' and 'community and healthcare system integration'. Communities' perception of CHWs' competence shapes their trust in them, which suggests that CHWs' credentials should be made public and that specialised training in maternal health is required for them. Integration depends on the promotion of socially embedded practices and the involvement of formal healthcare systems in CHWs' work.
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Affiliation(s)
| | - Yara Alonso
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Wade Lusengi
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Alain Mayembe
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Manu F Manun'Ebo
- Bureau d'Étude et de Gestion de l'Information Statistique (BÉGIS), Kinshasa, DRC
| | - Sylviane Ranaivontiavina
- Malagasy Associates for Numerical Information and Statistical Analysis (MANISA), Antananarivo, Madagascar
| | | | - Estêvão Mucavele
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - Ogonna Nwankwo
- Department of Community Medicine, University of Calabar, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Cross River Health and Demographic Surveillance System, University of Calabar, Cross River State, Nigeria
| | - Elaine Roman
- Jhpiego, affiliate of Johns Hopkins University, Baltimore, Maryland, USA
| | - Franco Pagnoni
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP)
| | - Khátia Munguambe
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
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23
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Meremikwu M, Zumla A. Isoniazid preventive therapy for children in sub-Saharan Africa. Lancet Respir Med 2020; 7:197-199. [PMID: 30823970 DOI: 10.1016/s2213-2600(19)30037-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 01/11/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Alimuddin Zumla
- Division of Infection and Immunity, University College London, London, UK; National Institute for Health Research Biomedical Research Centre, University College London Hospitals, London NW1 2PG, UK.
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24
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Sowunmi A, Ntadom G, Akano K, Ibironke FO, Ayede AI, Agomo C, Folarin OA, Gbotosho GO, Happi C, Oguche S, Okafor HU, Meremikwu M, Agomo P, Ogala W, Watila I, Mokuolu O, Finomo F, Ebenebe JC, Jiya N, Ambe J, Wammanda R, Emechebe G, Oyibo W, Useh F, Aderoyeje T, Dokunmu TM, Alebiosu OT, Amoo S, Basorun OK, Wewe OA, Okafor C, Akpoborie O, Fatunmbi B, Adewoye EO, Ezeigwe NM, Oduola A. Declining responsiveness of childhood Plasmodium falciparum infections to artemisinin-based combination treatments ten years following deployment as first-line antimalarials in Nigeria. Infect Dis Poverty 2019; 8:69. [PMID: 31383040 PMCID: PMC6683392 DOI: 10.1186/s40249-019-0577-x] [Citation(s) in RCA: 10] [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: 01/22/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background The development and spread of artemisinin-resistant Plasmodium falciparum malaria in Greater Mekong Subregion has created impetus for continuing global monitoring of efficacy of artemisinin-based combination therapies (ACTs). This post analyses is aimed to evaluate changes in early treatment response markers 10 years after the adoption of ACTs as first-line treatments of uncomplicated falciparum malaria in Nigeria. Methods At 14 sentinel sites in six geographical areas of Nigeria, we evaluated treatment responses in 1341 children under 5 years and in additional 360 children under 16 years with uncomplicated malaria enrolled in randomized trials of artemether-lumefantrine versus artesunate-amodiaquine at 5-year interval in 2009–2010 and 2014–2015 and at 2-year interval in 2009–2010 and 2012–2015, respectively after deployment in 2005. Results Asexual parasite positivity 1 day after treatment initiation (APPD1) rose from 54 to 62% and 2 days after treatment initiation from 5 to 26% in 2009–2010 to 2014–2015 (P = 0.002 and P < 0.0001, respectively). Parasite clearance time increased significantly from 1.6 days (95% confidence interval [CI]: 1.55–1.64) to 1.9 days (95% CI, 1.9–2.0) and geometric mean parasite reduction ratio 2 days after treatment initiation decreased significantly from 11 000 to 4700 within the same time period (P < 0.0001 for each). Enrolment parasitaemia > 75 000 μl− 1, haematocrit > 27% 1 day post-treatment initiation, treatment with artemether-lumefantrine and enrolment in 2014–2015 independently predicted APPD1. In parallel, Kaplan-Meier estimated risk of recurrent infections by day 28 rose from 8 to 14% (P = 0.005) and from 9 to 15% (P = 0.02) with artemether-lumefantrine and artesunate-amodiaquine, respectively. Mean asexual parasitaemia half-life increased significantly from 1.1 h to 1.3 h within 2 years (P < 0.0001). Conclusions These data indicate declining parasitological responses through time to the two ACTs may be due to emergence of parasites with reduced susceptibility or decrease in immunity to the infections in these children. Trial registration Pan African Clinical Trial Registration PACTR201508001188143, 3 July 2015; PACTR201508001191898, 7 July 2015 and PACTR201508001193368, 8 July 2015 PACTR201510001189370, 3 July 2015; PACTR201709002064150, 1 March 2017; https://www.pactr.samrca.ac.za Electronic supplementary material The online version of this article (10.1186/s40249-019-0577-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria. .,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria. .,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria. .,Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria.
| | - Godwin Ntadom
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Kazeem Akano
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Folasade O Ibironke
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Chimere Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
| | - Onikepe A Folarin
- Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Grace O Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria.,Institute for Medical Research and Training, University of Ibadan, Ibadan, Nigeria.,Department of Pharmacology and Toxicology, University of Ibadan, Ibadan, Nigeria
| | - Christian Happi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Biological Sciences and African Centre of Excellence for Genomics of Infectious Diseases (ACEGID), Redeemer University, Ede, Nigeria
| | - Stephen Oguche
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Henrietta U Okafor
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Pediatrics, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Martin Meremikwu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Calabar, Calabar, Cross River State, Nigeria
| | - Philip Agomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Nigeria Institute of Medical Research, Lagos, Nigeria
| | - William Ogala
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Ismaila Watila
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Specialist Hospital, Maiduguri, Nigeria
| | - Olugbenga Mokuolu
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics and Child Health, University of Ilorin, Ilorin, Nigeria
| | - Finomo Finomo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Federal Medical Centre, Yenagoa, Nigeria
| | - Joy C Ebenebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Nnamdi Azikiwe University, Awka, Nigeria
| | - Nma Jiya
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Uthman Dan Fodio University, Sokoto, Nigeria
| | - Jose Ambe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, University of Maiduguri, Maiduguri, Nigeria
| | - Robinson Wammanda
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - George Emechebe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Paediatrics, Imo State University Teaching Hospital, Orlu, Nigeria
| | - Wellington Oyibo
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Microbiology and Parasitology, University of Lagos, Lagos, Nigeria
| | - Francis Useh
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,Department of Medical Laboratory Science, University of Calabar, Calabar, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Ibadan, Nigeria
| | | | - Omobolaji T Alebiosu
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Sikiru Amoo
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Oluwabunmi K Basorun
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Olubunmi A Wewe
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Chukwuebuka Okafor
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Odafe Akpoborie
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Bayo Fatunmbi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria.,World Health Organization, Country Office, Kampala, Uganda
| | - Elsie O Adewoye
- Department of Physiology, University of Ibadan, Ibadan, Nigeria
| | - Nnenna M Ezeigwe
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
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25
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Effa EE, Oduwole O, Schoonees A, Hohlfeld A, Durao S, Kredo T, Mbuagbaw L, Meremikwu M, Ongolo-Zogo P, Wiysonge C, Young T. Priority setting for new systematic reviews: processes and lessons learned in three regions in Africa. BMJ Glob Health 2019; 4:e001615. [PMID: 31406592 PMCID: PMC6666801 DOI: 10.1136/bmjgh-2019-001615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/10/2019] [Accepted: 06/29/2019] [Indexed: 12/22/2022] Open
Abstract
Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effectively lead to the identification of region specific priorities. Systematic review workshops including discussion about the role and value of reviews to inform policy and research agendas were a useful part of the engagements. This may also enable relevant stakeholders to contribute towards the priority setting process in meaningful ways. However, certain shared challenges were identified, including that emerging priorities may be overlooked due to differences in burden of disease data and differences in language can hinder effective participation by stakeholders. We found that face-to-face contact is crucial for success and follow-up engagement with stakeholders is critical in driving acceptance of the findings and planning future progress.
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Affiliation(s)
- Emmanuel E Effa
- Internal Medicine, Faculty of Medicine, University of Calabar, Calabar, Nigeria
| | - Olabisi Oduwole
- Cochrane Nigeria, Calabar Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Anel Schoonees
- Centre for Evidence-based Health Care, Department of Global Health, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Ameer Hohlfeld
- Cochrane South Africa, Medical Research Council of South Africa, Tygerberg, South Africa
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Lawrence Mbuagbaw
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | | | - Pierre Ongolo-Zogo
- Centre for Development of Best Practices in Health, Central Hospital of Yaounde, Yaounde, Cameroon
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Tygerberg, South Africa
| | - Taryn Young
- Centre for Evidence-based Health Care, Division Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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26
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Olaleye A, Okusanya BO, Oduwole O, Esu E, Meremikwu M. A systematic review and meta-analysis of dihydroartemisinin-piperaquine versus sulphadoxine-pyrimethamine for malaria prevention in pregnancy. Int J Gynaecol Obstet 2019; 146:43-55. [PMID: 31050803 DOI: 10.1002/ijgo.12835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/23/2019] [Accepted: 05/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recommended for preventing maternal and fetal effects of malaria in pregnancy. Increasing parasite resistance to SP has necessitated the search for an alternative medication. OBJECTIVE To compare dihydroartemisinin-piperaquine (DP) and sulphadoxine-pyrimethamine in preventing malaria during pregnancy. SEARCH STRATEGY Databases including CENTRAL, MEDLINE, and ICTRP were searched until August 2018. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared DP with SP given to pregnant women to prevent adverse maternal or fetal effects of malaria were included. DATA COLLECTION AND ANALYSIS Quality of evidence was determined with GRADE criteria. Effectiveness measures were calculated using odds ratios at 95% confidence intervals. RESULTS Three randomized controlled trials were included. Compared with IPT-SP, moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy. High certainty evidence showed intermittent screening and treatment with DP did not reduce placental malaria or maternal parasitemia at delivery. Effect of DP on low birth weight and adverse birth outcomes was minimal. CONCLUSIONS Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP, and monthly DP is more effective than SP in reducing placental malaria. PROSPERO ID CRD42018084651.
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Affiliation(s)
- Atinuke Olaleye
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Benjamin Carson (Sr) School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Babasola O Okusanya
- Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Ekpereonne Esu
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Martin Meremikwu
- Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Esu E, Berens-Riha N, Pritsch M, Nwachuku N, Loescher T, Meremikwu M. Intermittent screening and treatment with artemether-lumefantrine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria. Malar J 2018; 17:251. [PMID: 29976228 PMCID: PMC6034215 DOI: 10.1186/s12936-018-2394-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 01/02/2018] [Accepted: 06/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background The spread of SP resistance may compromise the effectiveness of intermittent preventive treatment of malaria in pregnancy (MiP) with sulfadoxine–pyrimethamine (IPTp-SP) across Africa. However, there is no recommended alternative medicine for IPTp or alternative strategy for prevention of MiP. This poses problems for the prevention of MiP. This study investigated, whether screening with a rapid diagnostic test for malaria at routine antenatal clinic attendances and treatment of only those who are positive (intermittent screening and treatment) with artemether–lumefantrine is as effective and safe as IPTp-SP in pregnant women. Methods During antenatal clinic sessions at the General Hospital Calabar, Nigeria, held between October 2013 and November 2014, 459 pregnant women were randomized into either the current standard IPTp-SP or intermittent screening and treatment with artemether–lumefantrine (ISTp-AL). All women received a long-lasting insecticide-treated net at enrolment. Study women had a maximum of four scheduled visits following enrolment. Haemoglobin concentration and peripheral parasitaemia were assessed in the third trimester (36–40 weeks of gestation). Birth weight was documented at delivery or within a week for babies delivered at home. Results In the third trimester, the overall prevalence of severe anaemia (Hb < 8 g/dl) and moderate (8–10.9 g/dl) anaemia was 0.8 and 27.7%, respectively, and was similar in both treatment groups (p = 0.204). The risk of third-trimester severe anaemia did not differ significantly between both treatment arms (risk difference − 1.75% [95% CI − 4.16 to 0.66]) although the sample was underpowered for this outcome due to several participants being unavailable to give a blood sample. The risk of third-trimester maternal parasitaemia was significantly lower in the ISTp-AL arm (RD − 3.96% [95% CI − 7.76 to − 0.16]). The risk of low birthweight was significantly lower in the ISTp-AL arm after controlling for maternal age, gravidity and baseline parasitaemia (risk difference − 1.53% [95% CI − 1.54 to − 1.15]). Women in the ISTp-AL arm complained of fever more frequently compared to women in the IPTp-SP arm (p = 0.022). Conclusions The trial results suggest that in an area of high malaria transmission with moderate sulfadoxine–pyrimethamine resistance, ISTp with artemether–lumefantrine may be an effective strategy for controlling malaria in pregnancy. Trial registration PACTR, PACTR201308000543272. Registered 29 April 2013, http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201308000543272 Electronic supplementary material The online version of this article (10.1186/s12936-018-2394-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ekpereonne Esu
- Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Leopoldstraße 7, 80802, Munich, Germany. .,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Nuria Nwachuku
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Thomas Loescher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Ehiri J, Alaofè H, Asaolu I, Chebet J, Esu E, Meremikwu M. Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocol. Syst Rev 2018; 7:65. [PMID: 29695299 PMCID: PMC5922314 DOI: 10.1186/s13643-018-0729-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. METHODS The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. DISCUSSION Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017080092.
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Affiliation(s)
- John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Ibitola Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Joy Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Ekpereonne Esu
- Department of Public Health, University of Calabar Teaching Hospital, Moore Road, Calabar, Cross River State Nigeria
| | - Martin Meremikwu
- Department of Public Health, University of Calabar Teaching Hospital, Moore Road, Calabar, Cross River State Nigeria
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Mbuagbaw L, Zogo PO, Kredo T, Durao S, Young T, Effa E, Meremikwu M, Hohlfeld A, Wiysonge C. Cochrane Africa: a network of evidence-informed health-care decision making across sub-saharan Africa. Pan Afr Med J 2018; 29:196. [PMID: 30061974 PMCID: PMC6061814 DOI: 10.11604/pamj.2018.29.196.14521] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/02/2018] [Indexed: 11/11/2022] Open
Abstract
Cochrane Africa is a network of researchers and health stakeholders who aim to support the use of high quality Cochrane evidence to improve health outcomes in Africa. It comprises a coordinating centre in South Africa, a Francophone hub directed from Cameroon, a Southern and Eastern Africa Hub directed from South Africa and a West Africa Hub directed from Nigeria. The network supports the engagement with healthcare decision makers to guide priorities, production of high quality context-relevant Cochrane systematic reviews, capacity building to conduct and use reviews, dissemination of evidence, knowledge translation, partnerships for evidence-informed healthcare and the creation of opportunities to expand the network.
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Affiliation(s)
- Lawrence Mbuagbaw
- Centre for the Development of Best Practices in Health, Central Hospital, University of Yaoundé 1, Yaoundé, Cameroon.,Department of Health Research Methods, Evidence and Impact McMaster University, Hamilton, Canada.,Biostatistics Unit, Father Sean O'Sullivan Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Pierre Ongolo Zogo
- Centre for the Development of Best Practices in Health, Central Hospital, University of Yaoundé 1, Yaoundé, Cameroon
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa.,Division of Clinical Pharmacology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Solange Durao
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Taryn Young
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa.,Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emmanuel Effa
- Department of Medicine, University of Calabar, Calabar, Nigeria.,Cochrane Nigeria, Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Ameer Hohlfeld
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
| | - Charles Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, Western Cape, South Africa
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Esu E, Tacoli C, Gai P, Berens-Riha N, Pritsch M, Loescher T, Meremikwu M. Prevalence of the Pfdhfr and Pfdhps mutations among asymptomatic pregnant women in Southeast Nigeria. Parasitol Res 2018; 117:801-807. [PMID: 29332155 DOI: 10.1007/s00436-018-5754-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 08/01/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
Sulfadoxine-pyrimethamine (SP) is the recommended drug for intermittent preventive treatment of malaria in pregnancy in most of sub-Saharan Africa. Resistance to SP is related to mutations in the dhfr and dhps gene of Plasmodium falciparum. This study determined the prevalence of Pfdhfr and Pfdhps polymorphisms found in asymptomatic pregnant women attending antenatal care in Calabar, Nigeria. From October 2013 to November 2014, asymptomatic pregnant women attending antenatal care clinics were enrolled after obtaining informed consent. Malaria diagnosis testing was done using thick and thin smears. Dried blood spot filter papers were collected. Parasite DNA was extracted from the filter papers using a chelex extraction. Extraction was followed by nested PCR and restriction enzyme digestion. P. falciparum infection was detected by microscopy in 7% (32/459) participants. Twenty-eight P. falciparum isolates were successfully genotyped. In the Pfdhfr gene, the triple mutation was almost fixed; S108N mutation was (100%), N51I (93%) and C59R mutations (93%), whereas the I164L mutation was absent. The prevalence of Pfdhps S436A, A437G, A581G and A613S mutations was 82.1% (23/28), 96.4% (27/28), 71.4% (20/28) and 71.4% (20/28) respectively. The K540E mutation was absent. The prevalence of the Pfdhfr triple mutation IRNI was 92.9% (26/28). The efficacy of SP as IPTp in Southeast Nigeria may be severely threatened. The continuous monitoring of SP molecular markers of resistance is required to assess thresholds. The evaluation of alternative preventive treatment strategies and drug options for preventing malaria in pregnancy may be necessary.
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Affiliation(s)
- Ekpereonne Esu
- Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Leopoldstraße 7, 80802, Munich, Germany. .,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Costanza Tacoli
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Prabhanjan Gai
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Thomas Loescher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Sowunmi A, Akano K, Ntadom G, Ayede A, Oguche S, Agomo C, Okafor H, Watila I, Meremikwu M, Ogala W, Agomo P, Adowoye E, Fatunmbi B, Aderoyeje T, Happi C, Gbotosho G, Folarin O. Anaemia following Artemisinin-Based Combination Treatments of Uncomplicated Plasmodium falciparum Malaria in Children: Temporal Patterns of Haematocrit and the Use of Uncomplicated Hyperparasitaemia as a Model for Evaluating Late-Appearing Anaemia. Chemotherapy 2017; 62:231-238. [PMID: 28448988 DOI: 10.1159/000449366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 08/22/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND In severe malaria, intravenous artesunate may cause delayed haemolytic anaemia but there has been little evaluation of the propensity of oral artemisinin-based combination treatments (ACTs) to cause late-appearing anaemia. METHODS The frequency of anaemia (haematocrit <30%), and temporal changes in haematocrit were evaluated in 1,191 malarious children following ACTs. "Haematocrit conservation" was evaluated by using the fall in haematocrit/1,000 asexual parasites cleared from the peripheral blood (FIH/1,000 asexual parasites cpb), and the ratio of the average haematocrit (on the first 3 days of starting treatment):total parasitaemia cleared. RESULTS The frequency of anaemia decreased significantly following treatment. FIH/1,000 asexual parasites cpb, average haematocrit:total parasitaemia cleared, and mean haematocrit 5 weeks after treatment began were significantly lower in hyperparasitaemic children than in children without hyperparasitaemia, suggesting haematocrit conservation during treatment followed later by a loss of haematocrit. Asymptomatic late-appearing anaemia occurred in 6% of the children. CONCLUSION Artesunate-amodiaquine and artemether-lumefantrine contribute to haematocrit conservation at high parasitaemias but may cause late-appearing anaemia.
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Affiliation(s)
- Akin Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, National Malaria Elimination Programme, The Federal Ministry of Health, Abuja, Nigeria
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Sowunmi A, Akano K, Ntadom G, Ayede AI, Ibironke FO, Aderoyeje T, Adewoye EO, Fatunmbi B, Oguche S, Okafor HU, Watila I, Meremikwu M, Agomo P, Ogala W, Agomo C, Folarin OA, Gbotosho GO, Happi CT. Therapeutic efficacy and effects of artemisinin-based combination treatments on uncomplicated Plasmodium falciparum malaria -associated anaemia in Nigerian children during seven years of adoption as first-line treatments. Infect Dis Poverty 2017; 6:36. [PMID: 28173853 PMCID: PMC5294876 DOI: 10.1186/s40249-016-0217-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Artemisinin-based combination treatments (ACTs) are the first-line treatments of uncomplicated Plasmodium falciparum malaria in many endemic areas but there are few evaluation of their efficacy in anaemic malarious children. METHODS Therapeutic efficacy of 3-day regimens of artesunate-amodiaquine and artemether-lumefantrine was evaluated in 437 anaemic and 909 non-anaemic malarious children following treatment during a seven-year period (2008-2014). Patterns of temporal changes in haematocrit were classified based on haematocrit values <30% and ≥30%. Kinetics of the disposition of the deficit in haematocrit from 30% following treatment were evaluated using a non-compartment model. RESULTS PCR-corrected parasitological efficacy 28 days after start of treatment was significantly higher in artesunate-amodiaquine- compared to artemether-lumefantrine-treated children [97% (95%CI: 92.8-100) versus 96.4% (95%CI: 91.3-99.4), P = 0.02], but it was similar in non-anaemic and anaemic children. Fall in haematocrit/1 000 asexual parasites cleared from peripheral blood was significantly greater at lower compared to higher parasitaemias (P < 0.0001), and in non-anaemic compared to anaemic children (P = 0.007). In anaemic children at presentation, mean anaemia recovery time (AnRT) was 15.4 days (95%CI: 13.3-17.4) and it did not change over the years. Declines in haematocrit deficits from 30% were monoexponential with mean estimated half-time of 1.4 days (95%CI: 1.2-1.6). Anaemia half-time (t½anaemia) correlated positively with AnRT in the same patients (r = 0.69, P < 0.0001). Bland-Altman analysis of 10 multiples of t½anaemia and AnRT showed narrow limit of agreement with insignificant bias (P = 0.07) suggesting both can be used interchangeably in the same patients. CONCLUSIONS Artesunate-amodiaquine and artemether-lumefantrine remain efficacious treatments of uncomplicated P. falciparum infections in non-anaemic and anaemic Nigerian children in the last 7 years of adoption as first-line treatments. These ACTs may also conserve haematocrit at high parasitaemias and in anaemic children. TRIALS REGISTRATION Pan African Clinical Trial Registry PACTR201508001188143 , 3 July 2015; PACTR201510001189370 , 3 July 2015; PACTR201508001191898 , 7 July 2015 and PACTR201508001193368 , 8 July 2015.
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Affiliation(s)
- Akintunde Sowunmi
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Institute for Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Kazeem Akano
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
| | - Godwin Ntadom
- National Malaria Elimination Programme, Federal Ministry of Health, Abuja, Nigeria
| | | | - Folasade O. Ibironke
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | - Temitope Aderoyeje
- Department of Clinical Pharmacology, University College Hospital, Ibadan, Nigeria
| | | | - Bayo Fatunmbi
- World Health Organization, Regional Office for the Western Pacific, Khan Daun Penh, Phnom Penh Cambodia
| | - Stephen Oguche
- Department of Paediatrics, University of Jos, Jos, Nigeria
| | - Henrietta U. Okafor
- Department of Paediatrics, Institute of Child Health, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ismaila Watila
- Department of Paediatrics, Specialist Hospital, Maiduguri, Borno Sate Nigeria
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Cross Rivers State Nigeria
| | - Philip Agomo
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | - William Ogala
- Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria
| | - Chimere Agomo
- Nigeria Institute of Medical Research, Yaba, Lagos, Nigeria
| | - Onikepe A. Folarin
- Department of Biological Sciences, Redeemer’s University, Ede, Osun State Nigeria
| | - Grace O. Gbotosho
- Department of Pharmacology and Therapeutics, University of Ibadan, Ibadan, Nigeria
- Institute for Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christian T. Happi
- Department of Biological Sciences, Redeemer’s University, Ede, Osun State Nigeria
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Masaninga F, Katepa Bwalya M, Malumo S, Hamainza B, Songolo P, Kamuliwo M, Meremikwu M, Kazembe L, Mufunda J, Babaniyi OA. Increased uptake of intermittent preventive treatment for malaria in pregnant women in Zambia (2006–2012): Potential determinants and highlight of lessons learnt. Asian Pac J Trop Biomed 2016. [DOI: 10.1016/j.apjtb.2016.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Olowu A, Elusiyan JBE, Esangbedo D, Ekure EN, Esezobor C, Falade AG, Osinusi K, Mukhtar-Yola M, Meremikwu M, Ibe B, Johnson WBR, Oviawe O, Bastos I. Management of Community Acquired Pneumonia (CAP) in Children: Clinical Practice Guidelines by the Paediatrics Association of Nigeria (PAN). ACTA ACUST UNITED AC 2015. [DOI: 10.4314/njp.v42i4.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tiono AB, Tinto H, Alao MJ, Meremikwu M, Tshefu A, Ogutu B, Ouedraogo A, Lingani M, Cousin M, Lefèvre G, Jain JP, Duparc S, Hamed K. Increased systemic exposures of artemether and dihydroartemisinin in infants under 5 kg with uncomplicated Plasmodium falciparum malaria treated with artemether-lumefantrine (Coartem®). Malar J 2015; 14:157. [PMID: 25886021 PMCID: PMC4407414 DOI: 10.1186/s12936-015-0682-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 12/29/2014] [Accepted: 03/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background Artemether-lumefantrine (AL) dispersible formulation was developed for the treatment of uncomplicated Plasmodium falciparum malaria in infants and children weighing 5 to <35 kg. However, there are no clinical studies with artemisinin-based combination therapy in infants <5 kg. Methods This multicentre, open-label, single-arm study evaluated the efficacy, safety and pharmacokinetics of AL dispersible in infants aged >28 days and <5 kg of body weight, who were treated with one AL dispersible tablet (20 mg artemether/120 mg lumefantrine) given twice-daily for three days and followed up for six weeks (core follow-up) and at 12 months of age (long-term follow-up). Results A total of 20 patients were enrolled and completed the six-week core study follow-up. In the per protocol population, PCR-corrected cure rate at days 28 and 42 was 100% (95% CI: 79.4, 100). AL dispersible was well tolerated with reported adverse events of mild to moderate severity. Pharmacokinetic data showed that lumefantrine levels were similar, however, artemether and dihydroartemisinin levels were on average two- to three-fold greater than historical values in infants and children ≥5 kg. Conclusions A three-day regimen of AL dispersible formulation was efficacious and generally well tolerated in infants weighing <5 kg with uncomplicated P. falciparum malaria, but artemether and dihydroartemisinin exposures could not be supported by the preclinical safety margins for neurotoxicity. Hence, dosing recommendations cannot be made in infants <5 kg as implications for toxicity are unknown. Trial Registration Clinicaltrials.gov NCT01619878.
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Affiliation(s)
- Alfred B Tiono
- Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, 01 BP 2208, Ouagadougou, Burkina Faso.
| | - Halidou Tinto
- Unité de Recherche Clinique de Nanoro (IRSS-CRUN), BP 218, Ouagadougou, CMS11, Burkina Faso.
| | - Maroufou J Alao
- Service de Pédiatrie, Hôpital de la Mère et de l'Enfant Lagune, Cotonou, 01 BP 107, Benin.
| | - Martin Meremikwu
- Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, PMB 1278, Nigeria.
| | - Antoinette Tshefu
- Kinshasa School of Public Health, University of Kinshasa, 11850, Kinshasa, Democratic Republic of Congo.
| | - Bernhards Ogutu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
| | - Alphonse Ouedraogo
- Centre National de Recherche et de Formation sur le Paludisme, Ministère de la Santé, 01 BP 2208, Ouagadougou, Burkina Faso.
| | - Moussa Lingani
- Unité de Recherche Clinique de Nanoro (IRSS-CRUN), BP 218, Ouagadougou, CMS11, Burkina Faso.
| | - Marc Cousin
- Novartis Pharma AG, CH-4002, Basel, Switzerland.
| | | | | | - Stephan Duparc
- Medicines for Malaria Venture (MMV), Route de Pré-Bois 20, 1215, Meyrin, Switzerland.
| | - Kamal Hamed
- Novartis Pharmaceuticals Corporation, One Health Plaza, East Hanover, NJ, 07936-1080, USA.
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Adjuik MA, Allan R, Anvikar AR, Ashley EA, Ba MS, Barennes H, Barnes KI, Bassat Q, Baudin E, Björkman A, Bompart F, Bonnet M, Borrmann S, Brasseur P, Bukirwa H, Checchi F, Cot M, Dahal P, D'Alessandro U, Deloron P, Desai M, Diap G, Djimde AA, Dorsey G, Doumbo OK, Espié E, Etard JF, Fanello CI, Faucher JF, Faye B, Flegg JA, Gaye O, Gething PW, González R, Grandesso F, Guerin PJ, Guthmann JP, Hamour S, Hasugian AR, Hay SI, Humphreys GS, Jullien V, Juma E, Kamya MR, Karema C, Kiechel JR, Kremsner PG, Krishna S, Lameyre V, Ibrahim LM, Lee SJ, Lell B, Mårtensson A, Massougbodji A, Menan H, Ménard D, Menéndez C, Meremikwu M, Moreira C, Nabasumba C, Nambozi M, Ndiaye JL, Nikiema F, Nsanzabana C, Ntoumi F, Ogutu BR, Olliaro P, Osorio L, Ouédraogo JB, Penali LK, Pene M, Pinoges L, Piola P, Price RN, Roper C, Rosenthal PJ, Rwagacondo CE, Same-Ekobo A, Schramm B, Seck A, Sharma B, Sibley CH, Sinou V, Sirima SB, Smith JJ, Smithuis F, Somé FA, Sow D, Staedke SG, Stepniewska K, Swarthout TD, Sylla K, Talisuna AO, Tarning J, Taylor WRJ, Temu EA, Thwing JI, Tjitra E, Tine RCK, Tinto H, Vaillant MT, Valecha N, Van den Broek I, White NJ, Yeka A, Zongo I. The effect of dosing strategies on the therapeutic efficacy of artesunate-amodiaquine for uncomplicated malaria: a meta-analysis of individual patient data. BMC Med 2015; 13:66. [PMID: 25888957 PMCID: PMC4411752 DOI: 10.1186/s12916-015-0301-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/20/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Artesunate-amodiaquine (AS-AQ) is one of the most widely used artemisinin-based combination therapies (ACTs) to treat uncomplicated Plasmodium falciparum malaria in Africa. We investigated the impact of different dosing strategies on the efficacy of this combination for the treatment of falciparum malaria. METHODS Individual patient data from AS-AQ clinical trials were pooled using the WorldWide Antimalarial Resistance Network (WWARN) standardised methodology. Risk factors for treatment failure were identified using a Cox regression model with shared frailty across study sites. RESULTS Forty-three studies representing 9,106 treatments from 1999-2012 were included in the analysis; 4,138 (45.4%) treatments were with a fixed dose combination with an AQ target dose of 30 mg/kg (FDC), 1,293 (14.2%) with a non-fixed dose combination with an AQ target dose of 25 mg/kg (loose NFDC-25), 2,418 (26.6%) with a non-fixed dose combination with an AQ target dose of 30 mg/kg (loose NFDC-30), and the remaining 1,257 (13.8%) with a co-blistered non-fixed dose combination with an AQ target dose of 30 mg/kg (co-blistered NFDC). The median dose of AQ administered was 32.1 mg/kg [IQR: 25.9-38.2], the highest dose being administered to patients treated with co-blistered NFDC (median = 35.3 mg/kg [IQR: 30.6-43.7]) and the lowest to those treated with loose NFDC-25 (median = 25.0 mg/kg [IQR: 22.7-25.0]). Patients treated with FDC received a median dose of 32.4 mg/kg [IQR: 27-39.0]. After adjusting for reinfections, the corrected antimalarial efficacy on day 28 after treatment was similar for co-blistered NFDC (97.9% [95% confidence interval (CI): 97.0-98.8%]) and FDC (98.1% [95% CI: 97.6%-98.5%]; P = 0.799), but significantly lower for the loose NFDC-25 (93.4% [95% CI: 91.9%-94.9%]), and loose NFDC-30 (95.0% [95% CI: 94.1%-95.9%]) (P < 0.001 for all comparisons). After controlling for age, AQ dose, baseline parasitemia and region; treatment with loose NFDC-25 was associated with a 3.5-fold greater risk of recrudescence by day 28 (adjusted hazard ratio, AHR = 3.51 [95% CI: 2.02-6.12], P < 0.001) compared to FDC, and treatment with loose NFDC-30 was associated with a higher risk of recrudescence at only three sites. CONCLUSIONS There was substantial variation in the total dose of amodiaquine administered in different AS-AQ combination regimens. Fixed dose AS-AQ combinations ensure optimal dosing and provide higher antimalarial treatment efficacy than the loose individual tablets in all age categories.
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Oguche S, Okafor HU, Watila I, Meremikwu M, Agomo P, Ogala W, Agomo C, Ntadom G, Banjo O, Okuboyejo T, Ogunrinde G, Odey F, Aina O, Sofola T, Sowunmi A. Efficacy of artemisinin-based combination treatments of uncomplicated falciparum malaria in under-five-year-old Nigerian children. Am J Trop Med Hyg 2014; 91:925-935. [PMID: 25246693 PMCID: PMC4228889 DOI: 10.4269/ajtmh.13-0248] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/10/2014] [Indexed: 11/10/2022] Open
Abstract
The efficacy of 3-day regimens of artemether-lumefantrine and artesunate-amodiaquine were evaluated in 747 children < 5 years of age with uncomplicated malaria from six geographical areas of Nigeria. Fever clearance was significantly faster (P = 0.006) and the proportion of children with parasitemia 1 day after treatment began was significantly lower (P = 0.016) in artesunate-amodiaquine-compared with artemether-lumefantrine-treated children. Parasite clearance times were similar with both treatments. Overall efficacy was 96.3% (95% confidence interval [CI] 94.5-97.6%), and was similar for both regimens. Polymerase chain reaction-corrected parasitologic cure rates on Day 28 were 96.9% (95% CI 93.9-98.2%) and 98.3% (95% CI 96.1-99.3%) for artemether-lumefantrine and artesunate-amodiaquine, respectively. Gametocyte carriage post treatment was significantly lower than pretreatment (P < 0.0001). In anemic children, mean time to recovery from anemia was 10 days (95% CI 9.04-10.9) and was similar for both regimens. Both treatments were well tolerated and are safe and efficacious treatments of uncomplicated falciparum malaria in young Nigerian children.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Akintunde Sowunmi
- Antimalarial Therapeutic Efficacy Monitoring Group, The Federal Ministry of Health, Abuja, Nigeria
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Kajungu DK, Erhart A, Talisuna AO, Bassat Q, Karema C, Nabasumba C, Nambozi M, Tinto H, Kremsner P, Meremikwu M, D’Alessandro U, Speybroeck N. Paediatric pharmacovigilance: use of pharmacovigilance data mining algorithms for signal detection in a safety dataset of a paediatric clinical study conducted in seven African countries. PLoS One 2014; 9:e96388. [PMID: 24787710 PMCID: PMC4006882 DOI: 10.1371/journal.pone.0096388] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 04/07/2014] [Indexed: 11/18/2022] Open
Abstract
Background Pharmacovigilance programmes monitor and help ensuring the safe use of medicines which is critical to the success of public health programmes. The commonest method used for discovering previously unknown safety risks is spontaneous notifications. In this study we examine the use of data mining algorithms to identify signals from adverse events reported in a phase IIIb/IV clinical trial evaluating the efficacy and safety of several Artemisinin-based combination therapies (ACTs) for treatment of uncomplicated malaria in African children. Methods We used paediatric safety data from a multi-site, multi-country clinical study conducted in seven African countries (Burkina Faso, Gabon, Nigeria, Rwanda, Uganda, Zambia, and Mozambique). Each site compared three out of four ACTs, namely amodiaquine-artesunate (ASAQ), dihydroartemisinin-piperaquine (DHAPQ), artemether-lumefantrine (AL) or chlorproguanil/dapsone and artesunate (CD+A). We examine two pharmacovigilance signal detection methods, namely proportional reporting ratio and Bayesian Confidence Propagation Neural Network on the clinical safety dataset. Results Among the 4,116 children (6–59 months old) enrolled and followed up for 28 days post treatment, a total of 6,238 adverse events were reported resulting into 346 drug-event combinations. Nine signals were generated both by proportional reporting ratio and Bayesian Confidence Propagation Neural Network. A review of the manufacturer package leaflets, an online Multi-Drug Symptom/Interaction Checker (DoubleCheckMD) and further by therapeutic area experts reduced the number of signals to five. The ranking of some drug-adverse reaction pairs on the basis of their signal index differed between the two methods. Conclusions Our two data mining methods were equally able to generate suspected signals using the pooled safety data from a phase IIIb/IV clinical trial. This analysis demonstrated the possibility of utilising clinical studies safety data for key pharmacovigilance activities like signal detection and evaluation. This approach can be applied to complement the spontaneous reporting systems which are limited by under reporting.
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Affiliation(s)
- Dan K. Kajungu
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
- Uganda Malaria Surveillance project/Infectious Disease Research Collaboration, Kampala, Uganda
- Santé Stat. and Analytical Research Institute (SSARI), Kampala, Uganda
- * E-mail:
| | | | - Ambrose Otau Talisuna
- Malaria Public Health Department, University of Oxford-KEMRI-Wellcome Trust Programme, Nairobi, Kenya
- Uganda Malaria Surveillance project/Infectious Disease Research Collaboration, Kampala, Uganda
| | - Quique Bassat
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique/Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Barcelona, Spain
| | - Corine Karema
- National Malaria Control Program–TRAC Plus, Ministry of Health, Kigali, Rwanda
| | - Carolyn Nabasumba
- Epicentre, Paris, France/Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | | | - Halidou Tinto
- Institut de Recherches en Sciences de la Santé, Bobo Dioulasso, Burkina Faso/Centre Muraz, Bobo Dioulasso, Burkina Faso
| | - Peter Kremsner
- Institut für Tropenmedizin, Universität Tübingen, Germany and Centre de Recherches Médicales de Lambaréné, Lambaréné, Gabon
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria/Institute of Tropical Diseases Research & Prevention, Calabar, Nigeria
| | - Umberto D’Alessandro
- Institute of Tropical Medicine, Antwerp, Belgium
- Medical Research Council Unit, Fajara, The Gambia
| | - Niko Speybroeck
- Research Institute of Health and Society (IRSS), Université catholique de Louvain, Brussels, Belgium
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Esu E, Effa E, Udoh E, Oduwole O, Odey F, Chibuzor M, Oyo-Ita A, Meremikwu M. Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria. Res Rep Trop Med 2013; 4:29-35. [PMID: 30890873 PMCID: PMC6065562 DOI: 10.2147/rrtm.s47677] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist. Results A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%. Conclusion There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.
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Affiliation(s)
- Ekpereonne Esu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Emmanuel Effa
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Ekong Udoh
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Olabisi Oduwole
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Friday Odey
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Moriam Chibuzor
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria,
| | - Angela Oyo-Ita
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Martin Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
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Alao MJ, Gbadoé AD, Meremikwu M, Tshefu A, Tiono AB, Cousin M, Hamed K. Plasmodium falciparum malaria in infants under 5 kg: retrospective surveillance of hospital records in five sub-saharan African countries. J Trop Pediatr 2013; 59:154-9. [PMID: 23243081 DOI: 10.1093/tropej/fms069] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To investigate the disease burden, clinical features, treatment and outcomes of Plasmodium falciparum malaria in neonates and infants weighing <5 kg in five sub-Saharan African countries. METHODS Pediatric hospital records were retrospectively reviewed for relevant cases. Details of clinical features, treatment and clinical outcomes were collected, and a descriptive analysis of data was carried out. RESULTS The annual number of malaria cases ranged from 12 to 120 cases across hospitals and calendar years. The most frequent reason for seeking care was fever. Parasite density was low. Quinine was the most common treatment, followed by artemisinin-based combination therapy. The majority of patients recovered from their illness following treatment. CONCLUSION Plasmodium falciparum malaria exists in this subpopulation. Further epidemiological data are needed to estimate malaria morbidity and mortality in young infants. Moreover, clinical evidence on the efficacy and safety of artemisinin-based combination therapies in this subpopulation is warranted.
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Affiliation(s)
- Maroufou J Alao
- Service de Pédiatrie, Hôpital de la Mère et de l'Enfant Lagune, Cotonou 01 BP 107, Bénin
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Ravinetto RM, Talisuna A, De Crop M, van Loen H, Menten J, Van Overmeir C, Tinto H, Gonzalez R, Meremikwu M, Nabasuma C, Ngoma GM, Karema C, Adoke Y, Chaponda M, Van Geertruyden JP, D'Alessandro U. Challenges of non-commercial multicentre North-South collaborative clinical trials. Trop Med Int Health 2012; 18:237-41. [PMID: 23217117 DOI: 10.1111/tmi.12036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The last decade has witnessed a substantial increase of multi-centre, public health-oriented clinical trials in poor countries. However, non-commercial research groups have less staff and financial resources than traditional commercial sponsors, so the trial teams have to be creative to comply with Good Clinical Practices (GCP) requirements. According to the recent experience of a large multicentre trial on antimalarials, major challenges result from the complexity of multiple ethical review, the costs of in-depth monitoring at several sites, setting up an adequate Good Clinical Laboratory Practices (GCLP) framework, lack of insurers in host countries, and lack of adequate non-commercial data management software. Public research funding agencies need to consider these challenges in their funding policies. They also could support common spaces where North-South collaborative research groups may share critical information, such as on research insurance and open-source, GCP-compliant software. WHO should update its GCP guidelines, which date back to 1995, to incorporate the perspectives and needs of non-commercial clinical research.
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Alao MJ, Gbadoè AD, Tshefu AK, Meremikwu M, Tiono AB, Cousin M, Harried K. Uncomplicated Plasmodium falciparum malaria in infants <5 kg: retrospective surveillance of hospital records in five Sub-Saharan African countries. Malar J 2012. [PMCID: PMC3472702 DOI: 10.1186/1475-2875-11-s1-p4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Affiliation(s)
- Lisa Hartling
- Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, Alberta, Canada
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Oduwole OA, Ejezie GC, Odey FA, Oringanje CM, Nwakanma D, Bello S, Oriero E, Okebe J, Alaribe AA, Etuk S, Meremikwu M. Congenital malaria in Calabar, Nigeria: the molecular perspective. Am J Trop Med Hyg 2011; 84:386-9. [PMID: 21363974 DOI: 10.4269/ajtmh.2011.10-0253] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Polymerase chain reaction (PCR) has been shown to be more sensitive in detecting low-level parasitemia than conventional blood film microscopy. We estimated the prevalence of congenital malaria using nested PCR amplification of the small subunit 18S RNA gene to detect low-level parasitemia and identify Plasmodium species in 204 mother-neonate pairs. Cord-blood parasitemia was detected in four babies by PCR, giving a prevalence of 2.0%. The newborns of primidgravidae were more susceptible to congenital malaria than those of multigravidae (P < 0.0001). There was a strong correlation between placental malaria and congenital malaria (odds ratio = 10.1, 95% confidence interval = 1.3-76.1, P = 0.0487). We conclude that the prevalence of congenital malaria in Calabar detected by PCR is lower than has been reported in this environment through microscopy.
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Affiliation(s)
- Olabisi A Oduwole
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Cross River State, Calabar, Nigeria.
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Meremikwu M, Udoh E, Nwagbara B, Effa E, Oringanje C, Edet B, Nwagbara E, Bello S, Eke F. Priority setting for systematic review of health care interventions in Nigeria. Health Policy 2011; 99:244-9. [PMID: 21131092 DOI: 10.1016/j.healthpol.2010.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 11/06/2010] [Accepted: 11/07/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES In an era of evidence based medicine and systematic review, this study seeks to identify priority systematic review topics that address common health problems in Nigeria. METHODS Firstly, a primary list of health problems was compiled from the National Health Management Information Systems and information from key informants (health professionals, researchers and NGOs) drawn from the six geo-political zones in Nigeria. Key steps included compilation and ranking of a comprehensive list of health problems into 4 categories: adult communicable, non-communicable, maternal and child health; searching the Cochrane Library and electronic databases for systematic reviews on identified priority problems, analysis of search outputs to identify gaps; listing and ranking of new priority systematic review topics using pre-determined criteria. RESULTS Eighteen questions made the final list of priorities systematic reviews and 9 of them were related to malaria. There were 7 additional issues that the panelists identified as crucial cross-cutting issues that need to be addressed in systematic reviews. CONCLUSION Identification and prioritization of systematic reviews relevant to health care in Nigeria will improve the opportunity to deliver evidence-based and equitable health care to the people. These topics are likely to be also important for health care decision in other resource-poor settings.
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Affiliation(s)
- Martin Meremikwu
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
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Abstract
Malaria transmission is high and perennial in south-east Nigeria and is associated with a high burden of morbidity and mortality in children under 5 years and pregnant women. It is associated with maternal anemia, placental infection, intrauterine growth retardation and low birth weight. To evaluate the status of malaria in pregnancy in Cross River State, Nigeria, we assessed the prevalence rates of maternal, cord and placental malaria parasitemia in the dry and rainy seasons for 626 consecutively recruited pregnant women who delivered at two rural and two urban health facilities. Demographic data were obtained at delivery and maternal, placental and cord blood samples were collected and examined for malaria parasites by light microscopy. Of the mother and infant pairs, 120 (19.2%), 69 (14.7%) and 62 (13.5%), respectively, had positive maternal, placental and cord blood parasitemia. Parasitemia rates in the rainy season were higher than in the dry season (p < 0.05). There were no significant differences in maternal, placental and cord parasitemia between urban and rural areas. The prevalence rates of parasitemia at delivery indicate high malaria transmission and poor control during pregnancy.
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Affiliation(s)
- Chioma Oringanje
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
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Meremikwu M, Okomo U, Nwachukwu C, Oyo-Ita A, Eke-Njoku J, Okebe J, Oyo-Ita E, Garner P. Antimalarial drug prescribing practice in private and public health facilities in South-east Nigeria: a descriptive study. Malar J 2007; 6:55. [PMID: 17480216 PMCID: PMC1867820 DOI: 10.1186/1475-2875-6-55] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 05/04/2007] [Indexed: 11/16/2022] Open
Abstract
Background Nigeria's national standard has recently moved to artemisinin combination treatments for malaria. As clinicians in the private sector are responsible for attending a large proportion of the population ill with malaria, this study compared prescribing in the private and public sector in one State in Nigeria prior to promoting ACTs. Objective To assess prescribing for uncomplicated malaria in government and private health facilities in Cross River State. Method Audit of 665 patient records at six private and seven government health facilities in 2003. Results Clinicians in the private sector were less likely to record history or physical examination than those in public facilities, but otherwise practice and prescribing were similar. Overall, 45% of patients had a diagnostic blood slides; 77% were prescribed monotherapy, either chloroquine (30.2%), sulphadoxine-pyrimethamine (22.7%) or artemisinin derivatives alone (15.8%). Some 20.8% were prescribed combination therapy; the commonest was chloroquine with sulphadoxine-pyrimethamine. A few patients (3.5%) were prescribed sulphadoxine-pyrimethamine-mefloquine in the private sector, and only 3.0% patients were prescribed artemisinin combination treatments. Conclusion Malaria treatments were varied, but there were not large differences between the public and private sector. Very few are following current WHO guidelines. Monotherapy with artemisinin derivatives is relatively common.
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Affiliation(s)
- Martin Meremikwu
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - Uduak Okomo
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - Chukwuemeka Nwachukwu
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - Angela Oyo-Ita
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - John Eke-Njoku
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - Joseph Okebe
- Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, GPO Box 1211, Nigeria
| | - Esu Oyo-Ita
- Department of Medical Services, Cross River State Ministry of Health Headquarters, Calabar
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Meremikwu M. Sickle cell disease. Clin Evid 2006:45-59. [PMID: 16973005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Affiliation(s)
- Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Meremikwu M, Alaribe A, Ejemot R, Oyo-Ita A, Ekenjoku J, Nwachukwu C, Ordu D, Ezedinachi E. Artemether-lumefantrine versus artesunate plus amodiaquine for treating uncomplicated childhood malaria in Nigeria: randomized controlled trial. Malar J 2006; 5:43. [PMID: 16704735 PMCID: PMC1475595 DOI: 10.1186/1475-2875-5-43] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 05/16/2006] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The therapeutic efficacy of artesunate plus amodiaquine and artemether/lumefantrine were assessed in an area of Nigeria with high levels of Plasmodium falciparum resistance to chloroquine and sulphadoxine-pyrimethamine. PARTICIPANTS Children aged 6 to 59 months with uncomplicated P. falciparum infection and parasite density 1,000 to 200,000 parasites/microL enrolled following informed consent by parents. METHODS Eligible children were randomly assigned to receive either a 3-day course of artesunate (4 mg/kg) plus amodiaquine (10 mg/kg) or 6-dose course of artemether/lumefantrine (20/120 mg tablets) over three days. Patients were followed up with clinical and laboratory assessments until day 14 using standard WHO in-vivo antimalarial drug test protocol. RESULTS A total 119 eligible children were enrolled but 111 completed the study. Adequate clinical and parasitological response (ACPR) was 47 (87.0%) and 47 (82.5%) for artemether-lumefantrine (AL) and artesunate+amodiaquine (AAMQ) respectively (OR 0.7, 95% confidence interval 0.22 to 2.22). Early treatment failure (ETF) occurred in one participant (1.8%) treated with AAQ but in none of those with AL. Two (3.7%) patients in the AL group and none in the AAQ group had late clinical failure. Late parasitological failure was observed in 9 (15.8) and 5 (9.3%) of patients treated with AAQ and AL respectively. None of participants had a serious adverse event. CONCLUSION Artemether-lumenfantrine and artesunate plus amodiaquine have high and comparable cure rates and tolerability among under-five children in Calabar, Nigeria.
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Affiliation(s)
- Martin Meremikwu
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | - Ambrose Alaribe
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | - Regina Ejemot
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | - Angela Oyo-Ita
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | - John Ekenjoku
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | - Chukwuemeka Nwachukwu
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
| | | | - Emmanuel Ezedinachi
- Calabar Institute of Tropical Disease Research & Prevention, GPO Box 1211, Calabar, Nigeria
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Meremikwu M. Sickle cell disease. Clin Evid 2005:15-28. [PMID: 16620399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Affiliation(s)
- Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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