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Gerber AK, Feuz U, Zimmermann K, Mitterer S, Simon M, von der Weid N, Bergsträsser E. Work-related quality of life in professionals involved in pediatric palliative care: a repeated cross-sectional comparative effectiveness study. Palliat Care Soc Pract 2024; 18:26323524241247857. [PMID: 38737405 PMCID: PMC11085006 DOI: 10.1177/26323524241247857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/22/2024] [Indexed: 05/14/2024] Open
Abstract
Background Working in pediatric palliative care (PPC) impacts healthcare and allied professionals' work-related quality of life (QoL). Professionals who lack specific PPC training but who regularly provide services to the affected children have articulated their need for support from specialized PPC (SPPC) teams. Objectives This study had two objectives: (1) to evaluate whether the availability of a SPPC team impacted the work-related QoL of professionals not specialized in PPC; and (2) to explore the work-related QoL of professionals working in PPC without specialized training. Design Repeated cross-sectional comparative effectiveness design. Methods One hospital with an established SPPC program and affiliated institutions provided the intervention group (IG). Three hospitals and affiliated institutions where generalist PPC was offered provided the comparison group (CG). Data were collected by paper-pencil questionnaire in 2021 and 2022. The Professional Quality of Life (ProQOL 5) questionnaire was used to assess work-related QoL, yielding separate scores for burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS). A descriptive statistical analysis was performed and general estimation equations were modelled. To increase the comparability of the IG and CG, participants were matched by propensity scores. Results The 301 participating non-PPC-specialized professionals had overall low to moderate levels of BO and STS and moderate to high levels of CS. However, none of these scores (BO: p = 0.36; STS: p = 0.20; CS: p = 0.65) correlated significantly with support from an SPPC team. Compared to nurses, physicians showed higher levels of BO (1.70; p = 0.02) and STS (2.69; p ⩽ 0.001). Conclusion Although the study sample's overall work-related QoL was satisfactory, it showed a considerable proportion of moderate BO and STS, as well as moderate CS. To provide tailored support to professionals working in PPC, evidence regarding key SPPC support elements and their effectiveness is needed. Trial registration ClinicalTrials.gov ID, NCT04236180.
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Affiliation(s)
| | - Ursula Feuz
- Institute of Nursing Science, University of Basel, Basel, Switzerland
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Karin Zimmermann
- Institute of Nursing Science, University of Basel, Bernoullistrasse 28, Basel 4056, Switzerland
- Division of Pediatric Palliative Care and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Stefan Mitterer
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Nicolas von der Weid
- Division of Haematology–Oncology, University Children’s Hospital beider Basel (UKBB), Basel, Switzerland
| | - Eva Bergsträsser
- Division of Pediatric Palliative Care and Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
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Alvarado-Castro VM, Vargas-De-León C, Paredes-Solis S, Li-Martin A, Nava-Aguilera E, Morales-Pérez A, Legorreta-Soberanis J, Sánchez-Gervacio BM, Cockcroft A, Andersson N. The influence of gender and temephos exposure on community participation in dengue prevention: a compartmental mathematical model. BMC Infect Dis 2024; 24:463. [PMID: 38698345 PMCID: PMC11067291 DOI: 10.1186/s12879-024-09341-w] [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: 05/30/2023] [Accepted: 04/22/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND The use of temephos, the most common intervention for the chemical control of Aedes aegypti over the last half century, has disappointing results in control of the infection. The footprint of Aedes and the diseases it carries have spread relentlessly despite massive volumes of temephos. Recent advances in community participation show this might be more effective and sustainable for the control of the dengue vector. METHODS Using data from the Camino Verde cluster randomized controlled trial, a compartmental mathematical model examines the dynamics of dengue infection with different levels of community participation, taking account of gender of respondent and exposure to temephos. RESULTS Simulation of dengue endemicity showed community participation affected the basic reproductive number of infected people. The greatest short-term effect, in terms of people infected with the virus, was the combination of temephos intervention and community participation. There was no evidence of a protective effect of temephos 220 days after the onset of the spread of dengue. CONCLUSIONS Male responses about community participation did not significantly affect modelled numbers of infected people and infectious mosquitoes. Our model suggests that, in the long term, community participation alone may have the best results. Adding temephos to community participation does not improve the effect of community participation alone.
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Affiliation(s)
- Víctor Manuel Alvarado-Castro
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
| | - Cruz Vargas-De-León
- División de Investigación, Hospital Juárez de México, Ciudad de Mexico, 07760, México
- Sección de Estudios de Posgrado, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de Mexico, 11340, México
| | - Sergio Paredes-Solis
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México.
| | - Alian Li-Martin
- Facultad de Matemáticas, Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, C.P. 39017, México
| | - Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
| | - Arcadio Morales-Pérez
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
| | - José Legorreta-Soberanis
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
| | - Belén Madeline Sánchez-Gervacio
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, P.C. H3S 1Z1, Canada
| | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Acapulco, Guerrero, C.P. 39640, México
- Department of Family Medicine, McGill University, Montreal, P.C. H3S 1Z1, Canada
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3
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Yuen VL, Zhang XJ, Ling X, Zhang Y, Kam KW, Chen LJ, Ip P, Tham CC, Cheung CY, Pang CP, Yam JC. Effects of firsthand tobacco smoking on retinal vessel caliber: a systematic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 2024; 262:1397-1407. [PMID: 37682335 DOI: 10.1007/s00417-023-06223-w] [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: 06/12/2023] [Revised: 08/21/2023] [Accepted: 08/26/2023] [Indexed: 09/09/2023] Open
Abstract
PURPOSE To review the effects of firsthand tobacco smoking on central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) of firsthand tobacco smokers. METHODS We performed a search on EMBASE and PubMed for studies up to 15th July 2022. Two independent reviewers selected studies with baseline data of CRAE and CRVE of current smokers, nonsmokers, and former smokers. Initial search identified 893 studies, of which 10 were included in the meta-analysis. Two independent reviewers extracted data from the included studies. The quality of studies was assessed by the Newcastle-Ottawa Scale. RESULTS In this meta-analysis, 7431 nonsmokers, 2448 current smokers and 5786 former smokers, as well as 7404 nonsmokers, 2430 current smokers and 5763 former smokers were included in CRAE and CRVE analysis respectively. Nonsmokers had narrower CRVE (Weighted mean difference [WMD], -12.15; 95% CI, -17.33 - -6.96) and CRAE (WMD, -4.77; 95% CI, -7.96 - -1.57) than current smokers, and narrower CRVE (WMD, -3.08; 95% CI, -6.06 - -0.11) than former smokers. Current smokers had wider CRVE (WMD, 10.42; 95% CI, 7.80 - 13.04) and CRAE (WMD, 7.05; 95% CI, 6.65 - 7.46) than former smokers. Subgroup analysis and sensitivity analysis were performed. CONCLUSION Firsthand tobacco smoking resulted in wider CRAE and CRVE in current and former smokers, particularly in CRVE, and such changes may not be reversible after smoking cessation. Therefore, retinal vessel caliber may reflect the effects of firsthand tobacco smoking and be used to estimate the risk of cardiovascular diseases.
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Affiliation(s)
- Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiangtian Ling
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Eye Hospital, Hong Kong SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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Jockers D, Ngafuan R, Baernighausen T, Kessley A, White EE, Kenny A, Kraemer J, Geedeh J, Rozelle J, Holmes L, Obaje H, Wheh S, Pedersen J, Siedner MJ, Mendin S, Subah M, Hirschhorn LR. Under-five mortality before and after implementation of the Liberia National Community Health Assistant (NCHA) program: A study protocol. PLoS One 2024; 19:e0272172. [PMID: 38427671 PMCID: PMC10906894 DOI: 10.1371/journal.pone.0272172] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 01/25/2024] [Indexed: 03/03/2024] Open
Abstract
Between 2018 and 2022 the Liberian Government implemented the National Community Health Assistant (NCHA) program to improve provision of maternal and child health care to underserved rural areas of the country. Whereas the contributions of this and similar community health worker (CHW) based healthcare programs have been associated with improved process measures, the impact of a governmental CHW program at scale on child mortality has not been fully established. We will conduct a cluster sampled, community-based survey with landmark event calendars to retrospectively assess child births and deaths among all children born to women in the Grand Bassa District of Liberia. We will use a mixed effects Cox proportional hazards model, taking advantage of the staggered program implementation in Grand Bassa districts over a period of 4 years to compare rates of under-5 child mortality between the pre- and post-NCHA program implementation periods. This study will be the first to estimate the impact of the Liberian NCHA program on under-5 mortality.
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Affiliation(s)
- Dominik Jockers
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Till Baernighausen
- Institute of Global Health, University Hospital Heidelberg, Heidelberg, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- Africa Health Research Institute (AHRI), KwaZulu-Natal, Durban, South Africa
| | | | - Emily E. White
- Last Mile Health, Boston, Massachusetts, United States of America
| | - Avi Kenny
- Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, United States of America
| | - John Kraemer
- Department of Health Management and Policy, Georgetown University School of Health, Washington, D.C., United States of America
| | - John Geedeh
- Grand Bassa County Health Team, Buchanan, Liberia
| | - Jeffrey Rozelle
- Last Mile Health, Boston, Massachusetts, United States of America
| | - Leah Holmes
- Last Mile Health, Boston, Massachusetts, United States of America
| | | | | | | | - Mark J. Siedner
- Africa Health Research Institute (AHRI), KwaZulu-Natal, Durban, South Africa
- Last Mile Health, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | | | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States of America
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Wadagni ACA, Yao TAK, Diez G, Balle FH, Koffi AP, Aoulou P, Zahiri MH, Djossou P, Barogui YT, Assé H, Houezo JG, Sopoh GE, Nichter M, Johnson RC. Community based integrated wound care: Results of a pilot formative research conducted in Benin and Côte d'Ivoire, West Africa. PLOS Glob Public Health 2024; 4:e0002889. [PMID: 38335227 PMCID: PMC10857723 DOI: 10.1371/journal.pgph.0002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 01/16/2024] [Indexed: 02/12/2024]
Abstract
Appropriate treatment of chronic wounds is priority in the management of Neglected Tropical Skin Diseases (NTSDs) and non-communicable diseases. We describe an integrated, community-based wound care pilot project carried out in Benin and Cote d'Ivoire that entailed both outreach education and evidence based wound care training for nurses staffing rural clinics. This research was carried out by a transdisciplinary research. Following the collection of baseline data on wound care at home and in clinics, an innovative pilot project was developed based on a critical assessment of baseline data in three parts: a pragmatic nurse training program; mass community cultural sensitive outreach programs and a mobile consultation. It came out from our investigation that several dangerous homecare and inappropriate wound treatment practices in clinics, gaps in knowledge about Neglected Tropical Skin Diseases (NTSDs), and little health staff communication with patients about appropriate wound care. Nurse training covered 11 modules including general principles of wound management and advice specific to endemic NTSDs. Nurse pre-post training knowledge scores increased substantially. Eight mass community outreach programs were conducted, followed by mobile clinics at which 850 people with skin conditions were screened. Three hundred and three (35.65%) of these people presented with wounds of which 64% were simple, 20% moderate, and 16% severe cases. Patients were followed for ten weeks to assess adherence with wound hygiene messages presented in outreach programs and repeated by nurses during screening. Over 90% of simple and moderate cases were managed appropriately at home and 98% of wounds were healed. Of the 47 cases referred to the health center, 87% came for and adhered to wound care advice. In 90% of cases, wounds healed. This pilot study provides a model for introducing integrated community based wound care in Africa.
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Affiliation(s)
| | - Théodore Ange Kouakou Yao
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | | | | | - Aboa Paul Koffi
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Paulin Aoulou
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Marie-Hélène Zahiri
- National Leprosy Elimination Program, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Parfait Djossou
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey-Calavi, Abomey-Calavi, Benin
| | - Yves Thierry Barogui
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Henry Assé
- National Buruli Ulcer Control Programs, Ministry of Health and Public Hygiene, Abidjan, Côte d’Ivoire
| | - Jean-Gabin Houezo
- National Buruli Ulcer and Leprosy Control Programs, Ministry of Health, Cotonou, Bénin
| | - Ghislain Emmanuel Sopoh
- Regional Institute of Public Health Comlan Alfred Quenum of Ouidah, University of Abomey-Calavi, Abomey-Calavi, Bénin
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, AZ, United States of America
| | - Roch Christian Johnson
- Centre Interfacultaire de Formation et de Recherche en Environnement pour le Développement Durable, Université d’Abomey-Calavi, Abomey-Calavi, Benin
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6
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Cheung CY, Zhang XJ, Chan HN, Zhang Y, Yuen VL, Hsu W, Lee ML, Xu D, Wong J, Tang FY, Kam KW, Young A, Ng MP, Ip P, Chen LJ, Wong TY, Pang CP, Tham CC, Yam JC. Influence of secondhand smoke exposure on the retinal vasculature of children in Hong Kong. Commun Med (Lond) 2023; 3:155. [PMID: 37884789 PMCID: PMC10603154 DOI: 10.1038/s43856-023-00389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND A recent prospective demonstrated that cardiovascular risk factors in early childhood were associated with later cardiovascular events. However, the impact of secondhand smoke (SHS) on children is unclear. The aims of this study is to determine the effects of SHS exposure on the retinal vasculature of children. METHODS This is a population-based cross-sectional study of children aged 6 to 8 years. All participants received comprehensive ophthalmic examinations and retinal photography. Data on SHS exposure was derived from a validated questionnaire. A validated deep-learning system was used to automatically estimate retinal arteriolar and venular calibers from retinal photographs. Associations of quantitative retinal vessel caliber values with SHS exposure, number of smokers in the household, and total number of cigarettes smoked were determined by analyses of covariance (ANCOVA) after adjusting for potential confounders. Test of trend was determined by treating categorical risk factors as continuous ordinal variables. RESULTS Here we show children exposed to SHS have wider retinal arteriolar (CRAE 152.1 µm vs. 151.3 µm, p < 0.001) and venular (CRVE 216.7 µm vs. 215.5 µm, p < 0.001) calibers compared to those in smoke-free homes, after adjustment for different factors. Wider arteriolar and venular calibers are also associated with increasing number of smokers in the family (p trend < 0.001) and more cigarettes smoked among family smokers (p trend<0.001). CONCLUSIONS Exposure to SHS at home is associated with changes in retinal vasculature among children. This reinforces the adverse effect of secondhand smoking around children though further research incorporating comprehensive assessment of potential confounders is necessary.
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Affiliation(s)
- Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiu Juan Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Hei-Nga Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuzhou Zhang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Vincent L Yuen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Wynne Hsu
- School of Computing, National University of, Singapore, Singapore
| | - Mong Li Lee
- School of Computing, National University of, Singapore, Singapore
| | - Dejiang Xu
- School of Computing, National University of, Singapore, Singapore
| | - Jason Wong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fang Yao Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kai Wai Kam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Alvin Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
| | - Mandy P Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Patrick Ip
- Department of Paediatrics and Adolescent Medicine, University of Hong Kong, Hong Kong SAR, China
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Tien Y Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore, Singapore
- Tsinghua Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chi Pui Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Clement C Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China.
- Hong Kong Eye Hospital, Kowloon, Hong Kong SAR, China.
- Department of Ophthalmology, Hong Kong Children's Hospital, Hong Kong SAR, China.
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7
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Anago R, Forzy T, Guei S, Pelras C, Ramde S, Tevenart C, Vera Rueda J, Macours K. Piloting, testing and scaling parental training: a multi-partnership approach in Côte d'Ivoire. Front Public Health 2023; 11:1106565. [PMID: 37655283 PMCID: PMC10466389 DOI: 10.3389/fpubh.2023.1106565] [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: 11/23/2022] [Accepted: 07/26/2023] [Indexed: 09/02/2023] Open
Abstract
Background and objectives Early Childhood Development is high on the policy agenda in Côte d'Ivoire, where the government has identified it as part of its overall approach to improve human capital outcomes. This paper describes a multi-partner approach to piloting, monitoring, adaption, testing and scaling of parental training for ECD. It discusses the learnings from the pilots, and present early evaluation results from two RCTs, focusing on parental participation in trainings and acceptability of messages, with the objective to inform national scaling strategies. As such, this paper illustrates how "MEL systems contributed to ensuring that positive early childhood development (ECD) outcomes were improved as interventions were seeking to achieve scale," one of the research questions outlined in the call description for the special issue. The paper further provides a real-world example of "How MEL systems can support contributions and buy-in from a variety of stakeholders as ECD interventions (seek to) achieve impacts at scale (e.g., through the public system)? Methods Five training approaches to improve caregivers' knowledge and practices around nutrition, preventive health, stimulation, and disciplining were piloted at small scale between 2018 and 2020. An intensive process evaluation was embedded to identify strengths and weaknesses, adapt through an iterative phase, and ultimately make recommendations for their scale up against 11 defined criteria. In early 2021, the two most promising approaches were scaled through two clustered randomized control trials to more than 150 villages each. A cost-effectiveness study was designed in consultation with government stakeholders, centered around targeting different caregivers and decision makers in the household and the extended family and on enhancing community interactions around ECD. Results The evaluation of the five pilots identified one model recommended to be scaled, and one other model to scale after further adaptations. Monitoring and evaluation data from the two models at scale show high levels of participation and acceptability of core messages. Experimental variations involving community champions and fathers increase participation. Conclusion The iterative and multi-partner process led to two models of parenting training that have wide acceptability. Future work will analyze impacts on cognitive and socio-emotional outcomes, together with cost analysis.
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Affiliation(s)
- Romuald Anago
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | - Sosthene Guei
- Transformer L’éducation Dans Les Communautés de Cacao, Abidjan, Côte d'Ivoire
| | | | - Samuel Ramde
- Innovation for Poverty Action, Abidjan, Côte d'Ivoire
| | | | | | - Karen Macours
- Paris School of Economics, Paris, France
- Institut National de Recherche Pour L’agriculture, L’alimentation et L’environnement (INRAE), Paris, France
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8
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Ng CSY, Chan CHY, Fung YL, Chau PSY, Luk DCK, Cheng JWCH, Tsang YP, Lam YY, Chu AKY. Impact of comorbid allergic diseases on health-related quality of life of Hong Kong schoolchildren. Pediatr Allergy Immunol 2023; 34:e13953. [PMID: 37232280 DOI: 10.1111/pai.13953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/20/2023] [Accepted: 04/11/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Studies on the relationship between childhood allergic disease and health-related quality of life (HRQOL) have mostly been confined to a single allergic condition. Therefore, a composite allergic score (CAS) was derived to assess the accumulated effect of eczema, asthma, and allergic rhinitis on HRQOL in Hong Kong schoolchildren. METHODS Parents of grade one/two or grade eight/nine schoolchildren completed a questionnaire assessing the prevalence and severity of eczema (POEM), asthma (C-ACT/ACT), and allergic rhinitis (VAS) and schoolchildren's HRQOL (PedsQL). Three rounds of recruitment were conducted. A total of 19 primary and 25 secondary schools agreed to participate. RESULTS Data from 1140 caregivers of grade one/two schoolchildren and 1048 grade eight/nine schoolchildren were imputed and analyzed. The proportion of female respondents were lower in grade one/two (37.7%) but higher in grade eight/nine (57.3%). 63.8% of grade one/two and 58.1% of grade eight/nine schoolchildren reported having at least one allergic disease. In general, greater disease severity was significantly associated with lower HRQOL. After controlling for age, gender, and allergic comorbidity in hierarchical regressions, CAS significantly predicted all HRQOL outcomes in both grade one/two and grade eight/nine schoolchildren. Female grade eight/nine schoolchildren reported lower HRQOL outcomes. CONCLUSION Composite allergic score may be a practical tool to evaluate allergic comorbidity and the effectiveness of treatments targeting common pathological mechanisms of allergic diseases. Non-pharmaceutical approaches should be considered, especially for patients with more than one allergic disease and greater severity.
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Affiliation(s)
- Christina Sum Yi Ng
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Pokfulam, Hong Kong
| | - Celia Hoi Yan Chan
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Pokfulam, Hong Kong
- Centre on Behavioral Health, Faculty of Social Sciences, University of Hong Kong, Hong Kong, Pokfulam, Hong Kong
| | - Yat Lui Fung
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Pokfulam, Hong Kong
| | - Priscilla Sin Ying Chau
- Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, Pokfulam, Hong Kong
| | - David Chi Kong Luk
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, Hong Kong
| | | | - Yuk Ping Tsang
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, Hong Kong
| | - Ying Yin Lam
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, Hong Kong
| | - Ashleigh Ka Ying Chu
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Hong Kong, Hong Kong
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Nasrin S, Tariqujjaman M, Sultana M, Zaman RA, Ali S, Chisti MJ, Faruque ASG, Ahmed T, Fuchs GJ, Gyr N, Alam NH. Factors associated with community acquired severe pneumonia among under five children in Dhaka, Bangladesh: A case control analysis. PLoS One 2022; 17:e0265871. [PMID: 35320317 PMCID: PMC8942236 DOI: 10.1371/journal.pone.0265871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pneumonia is the leading cause of death in children globally with the majority of these deaths observed in resource-limited settings. Globally, the annual incidence of clinical pneumonia in under-five children is approximately 152 million, mostly in the low- and middle-income countries. Of these, 8.7% progressed to severe pneumonia requiring hospitalization. However, data to predict children at the greatest risk to develop severe pneumonia from pneumonia are limited. Method Secondary data analysis was performed after extracting relevant data from a prospective cluster randomized controlled clinical trial; children of either sex, aged two months to five years with pneumonia or severe pneumonia acquired in the community were enrolled over a period of three years in 16 clusters in urban Dhaka city. Results The analysis comprised of 2,597 children aged 2–59 months. Of these, 904 and 1693 were categorized as pneumonia (controls) and severe pneumonia (cases), respectively based on WHO criteria. The median age of children was 9.2 months (inter quartile range, 5.1–17.1) and 1,576 (60%) were male. After adjustment for covariates, children with temperature ≥38°C, duration of illness ≥3 days, male sex, received prior medical care and severe stunting showed a significantly increased likelihood of developing severe pneumonia compared to those with pneumonia. Severe pneumonia in children occurred more often in older children who presented commonly from wealthy quintile families, and who often sought care from private facilities in urban settings. Conclusion and recommendation Male sex, longer duration of illness, fever, received prior medical care, and severe stunting were significantly associated with development of WHO-defined severe childhood pneumonia in our population. The results of this study may help to develop interventions target to reduce childhood morbidity and mortality of children suffering from severe pneumonia.
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Affiliation(s)
- Sabiha Nasrin
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md. Tariqujjaman
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Rifat A. Zaman
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahjahan Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Abu S. G. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - George J. Fuchs
- Department of Pediatrics, College of Medicine and Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, Kentucky, United States of America
| | - Niklaus Gyr
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Nur H. Alam
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
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Chang W, Cohen J, Mwesigwa B, Waiswa P, Rokicki S. Impact of reliable light and electricity on job satisfaction among maternity health workers in Uganda: A cluster randomized trial. Hum Resour Health 2022; 20:30. [PMID: 35351147 PMCID: PMC8966259 DOI: 10.1186/s12960-022-00722-3] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Maintaining a motivated health workforce is critical to health system effectiveness and quality of care. Scant evidence exists on whether interventions aimed to strengthen health infrastructure in low-resource settings affect health workers. This study evaluated the impact of an intervention providing solar light and electricity to rural maternity facilities in Uganda on health workers' job satisfaction. METHODS We used a mixed-methods design embedded in a cluster randomized trial to evaluate whether and how the We Care Solar Suitcase intervention, a solar electric system providing lighting and power, affected health workers in rural Ugandan maternity facilities with unreliable light. Facilities were randomly assigned to receive the intervention or not without blinding in a cluster-randomized controlled trial. Outcomes were assessed through two rounds of surveys with health workers. We used regression analyses to examine the intervention's impact on job satisfaction. We used an inductive approach to analyze qualitative data to understand the study context and interpret quantitative findings. RESULTS We interviewed 85 health workers across 30 facilities, the majority of whom were midwives or nurses. Qualitative reports indicated that unreliable light made it difficult to provide care, worsened facility conditions, and harmed health workers and patients. Before the intervention, only 4% of health workers were satisfied with their access to light and electricity. After the installation, satisfaction with light increased by 76 percentage points [95% confidence interval (CI): 61-92 percentage points], although satisfaction with electricity did not change. Experience of negative impacts of lack of overhead light also significantly decreased and the intervention modestly increased job satisfaction. Qualitative evidence illustrated how the intervention may have strengthened health workers' sense of job security and confidence in providing high-quality care while pointing towards implementation challenges and other barriers health workers faced. CONCLUSIONS Reliable access to light and electricity directly affects health workers' ability to provide maternal and neonatal care and modestly improves job satisfaction. Policy makers should invest in health infrastructure as part of multifaceted policy strategies to strengthen human resources for health and to improve maternal and newborn health services. Trial registration socialscienceregistry.org: AEARCTR-0003078. Registered June 12, 2018, https://www.socialscienceregistry.org/trials/3078 Additionally registered on: ClinicalTrials.gov: NCT03589625, Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03589625 ).
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Affiliation(s)
- Wei Chang
- Harvard T.H. Chan School of Public Health, 90 Smith St, 3rd Floor, Boston, MA 02120 United States of America
| | - Jessica Cohen
- Harvard T.H. Chan School of Public Health, 90 Smith St, 3rd Floor, Boston, MA 02120 United States of America
| | | | - Peter Waiswa
- School of Public Health, Makerere University, Kampala, Uganda
| | - Slawa Rokicki
- Rutgers School of Public Health, Piscataway, United States of America
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11
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Devries K, Balliet M, Thornhill K, Knight L, Procureur F, N'Djoré YAB, N'Guessan DGF, Merrill KG, Dally M, Allen E, Hossain M, Cislaghi B, Tanton C, Quintero L. Can the 'Learn in peace, educate without violence' intervention in Cote d'Ivoire reduce teacher violence? Development of a theory of change and formative evaluation results. BMJ Open 2021; 11:e044645. [PMID: 34758988 PMCID: PMC8587474 DOI: 10.1136/bmjopen-2020-044645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To gather evidence on whether a brief intervention (Apprendre en paix et éduquer sans violence, developed by the Ivorian Ministry of Education and Graines de Paix) to promote peace in primary schools by reducing teacher violence perpetration and improving pedagogical techniques was acceptable to teachers and affected change in intermediate outcomes. DESIGN Mixed-methods formative research. SETTING Primary schools in Tonkpi region, Cote d'Ivoire. PARTICIPANTS 160 teachers participating in the peace training, surveyed three times during implementation; qualitative in-depth interviews with 19 teachers and teacher-counsellors. INTERVENTIONS Learn in peace, educate without violence-a brief intervention with primary school teachers designed to promote peace in primary schools. OUTCOMES For survey data, we generated composite measures of intermediate outcomes (teachers' awareness of consequences of violence, self-efficacy in applying positive classroom management methods, acceptance of physical discipline practices in school) and used random intercept linear mixed-effects models to compare responses over time. Qualitative research included open-ended questions about acceptability and perceived need for such an intervention. A framework analysis was undertaken. RESULTS Four-months post-training (vs pretraining), teachers had higher self-efficacy in applying positive classroom management methods (pre-mean=26.1; post-mean=27.5; p<0.001) and borderline lower acceptance of physical discipline practices (premean=4.2; postmean=3.6; p=0.10). We found no change in teacher awareness of the consequences of violence. Qualitatively, teachers found the intervention acceptable and understandable, perceiving it as useful because it provided methods for non-violent discipline. Teachers had mixed views about whether the techniques improved classroom dynamics. CONCLUSIONS Data suggest that the intervention is acceptable and leads to change in intermediate outcomes for teachers. Further evaluation in a randomised controlled trial is warranted.
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Affiliation(s)
- Karen Devries
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Manuela Balliet
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kerrie Thornhill
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Louise Knight
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Fanny Procureur
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Katherine G Merrill
- Bloomburg School of Public Health Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Mazeda Hossain
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Clare Tanton
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Halili S, Grant JR, Pilotte N, Gordon CA, Williams SA. Development of a novel real-time polymerase chain reaction assay for the sensitive detection of Schistosoma japonicum in human stool. PLoS Negl Trop Dis 2021; 15:e0009877. [PMID: 34695134 PMCID: PMC8568117 DOI: 10.1371/journal.pntd.0009877] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 11/04/2021] [Accepted: 10/06/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Elimination and control of Schistosoma japonicum, the most virulent of the schistosomiasis-causing blood flukes, requires the development of sensitive and specific diagnostic tools capable of providing an accurate measurement of the infection prevalence in endemic areas. Typically, detection of S. japonicum has occurred using the Kato-Katz technique, but this methodology, which requires skilled microscopists, has been shown to radically underestimate levels of infection. With the ever-improving capabilities of next-generation sequencing and bioinformatic analysis tools, identification of satellite sequences and other highly repetitive genomic elements for use as real-time PCR diagnostic targets is becoming increasingly common. Assays developed using these targets have the ability to improve the sensitivity and specificity of results for epidemiological studies that can in turn be used to inform mass drug administration and programmatic decision making. METHODOLOGY/PRINCIPAL FINDINGS Utilizing Tandem Repeat Analyzer (TAREAN) and RepeatExplorer2, a cluster-based analysis of the S. japonicum genome was performed and a tandemly arranged genomic repeat, which we named SjTR1 (Schistosoma japonicum Tandem Repeat 1), was selected as the target for a real-time PCR diagnostic assay. Based on these analyses, a primer/probe set was designed and the assay was optimized. The resulting real-time PCR test was shown to reliably detect as little as 200 ag of S. japonicum genomic DNA and as little as 1 egg per gram of human stool. Based on these results, the index assay reported in this manuscript is more sensitive than previously published real-time PCR assays for the detection of S. japonicum. CONCLUSIONS/SIGNIFICANCE The extremely sensitive and specific diagnostic assay described in this manuscript will facilitate the accurate detection of S. japonicum, particularly in regions with low levels of endemicity. This assay will be useful in providing data to inform programmatic decision makers, aiding disease control and elimination efforts.
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Affiliation(s)
- Sara Halili
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Program in Biochemistry, Smith College, Northampton, Massachusetts, United States of America
| | - Jessica R. Grant
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
| | - Nils Pilotte
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Department of Biological Sciences, Quinnipiac University, Hamden, Connecticut, United States of America
| | - Catherine A. Gordon
- QIMR Berghofer Institute of Medical Research, Molecular Parasitology Laboratory, Brisbane, Australia
| | - Steven A. Williams
- Department of Biological Sciences, Smith College, Northampton, Massachusetts, United States of America
- Program in Biochemistry, Smith College, Northampton, Massachusetts, United States of America
- Molecular and Cellular Biology Program, University of Massachusetts, Amherst, Massachusetts, United States of America
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13
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Ablordey A, Ahotor E, Narh CA, King SA, Cruz I, Ndung'u JM, de Souza DK. Evaluation of different DNA extraction methods and loop-mediated isothermal amplification primers for the detection of Mycobacterium ulcerans in clinical specimens. BMC Infect Dis 2021; 21:598. [PMID: 34162342 PMCID: PMC8220662 DOI: 10.1186/s12879-021-06308-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 06/10/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Early diagnosis and treatment of Buruli ulcer is critical in order to avoid the debilitating effects of the disease. In this regard, the development of new diagnostic and point of care tools is encouraged. The loop-mediated isothermal amplification for the detection of Mycobacterium ulcerans represents one of the new tools with a good potential of being developed into a point of care test. There is however the need to standardize the assays, reduce sample preparation times, improve the detection/visualization system and optimize them for high-throughput screening, adaptable to low resourced laboratories. METHODS In this study, we assessed two DNA extraction protocols (modified Boom and EasyNAT methods), three previously published LAMP primer sets (BURULI, MU 2404 and BU-LAMP), and compared the sensitivity and specificity of LAMP assays on three DNA amplification platforms. RESULTS Our results show that Buruli ulcer diagnosis using primers targeting IS2404 for the LAMP method is sensitive (73.75-91.49%), depending on the DNA extraction method used. Even though the modified Boom DNA extraction method provided the best results, its instrumentation requirement prevent it from being field applicable. The EasyNAT method on the other hand is simpler and may represent the best method for DNA extraction in less resourced settings. CONCLUSIONS For further work on the development and use of LAMP tests for Buruli diagnosis, it is recommended that the BURULI sets of primers be used, as these yielded the best results in terms of sensitivity (87.50-91.49%) and specificity (89.23-100%), depending on the DNA extraction methods used.
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Affiliation(s)
- Anthony Ablordey
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana.
| | - Evans Ahotor
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Charles A Narh
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Sandra A King
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Isra Cruz
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Dziedzom K de Souza
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Foundation for Innovative New Diagnostics, Geneva, Switzerland
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14
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Jo Y, LeFevre AE, Ali H, Mehra S, Alland K, Shaikh S, Haque R, Pak ES, Chowdhury M, Labrique AB. mCARE, a digital health intervention package on pregnancy surveillance and care-seeking reminders from 2018 to 2027 in Bangladesh: a model-based cost-effectiveness analysis. BMJ Open 2021; 11:e042553. [PMID: 33795294 PMCID: PMC8021757 DOI: 10.1136/bmjopen-2020-042553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We estimated the cost-effectiveness of a digital health intervention package (mCARE) for community health workers, on pregnancy surveillance and care-seeking reminders compared with the existing paper-based status quo, from 2018 to 2027, in Bangladesh. INTERVENTIONS The mCARE programme involved digitally enhanced pregnancy surveillance, individually targeted text messages and in-person home-visit to pregnant women for care-seeking reminders for antenatal care, child delivery and postnatal care. STUDY DESIGN We developed a model to project population and service coverage increases with annual geographical expansion (from 1 million to 10 million population over 10 years) of the mCARE programme and the status quo. MAJOR OUTCOMES For this modelling study, we used Lives Saved Tool to estimate the number of deaths and disability-adjusted life years (DALYs) that would be averted by 2027, if the coverage of health interventions was increased in mCARE programme and the status quo, respectively. Economic costs were captured from a societal perspective using an ingredients approach and expressed in 2018 US dollars. Probabilistic sensitivity analysis was undertaken to account for parameter uncertainties. RESULTS We estimated the mCARE programme to avert 3076 deaths by 2027 at an incremental cost of $43 million relative to the status quo, which is translated to $462 per DALY averted. The societal costs were estimated to be $115 million for mCARE programme (48% of which are programme costs, 35% user costs and 17% provider costs). With the continued implementation and geographical scaling-up, the mCARE programme improved its cost-effectiveness from $1152 to $462 per DALY averted from 5 to 10 years. CONCLUSION Mobile phone-based pregnancy surveillance systems with individually scheduled text messages and home-visit reminder strategies can be highly cost-effective in Bangladesh. The cost-effectiveness may improve as it promotes facility-based child delivery and achieves greater programme cost efficiency with programme scale and sustainability.
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Affiliation(s)
- Youngji Jo
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Hasmot Ali
- JiVitA program, Johns Hopkins Bloomberg School of Public Health, Rangpur, Bangladesh
| | - Sucheta Mehra
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kelsey Alland
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Saijuddin Shaikh
- JiVitA program, Johns Hopkins Bloomberg School of Public Health, Rangpur, Bangladesh
| | - Rezwanul Haque
- JiVitA program, Johns Hopkins Bloomberg School of Public Health, Rangpur, Bangladesh
| | - Esther Semee Pak
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Alain B Labrique
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Luong-Thanh BY, Nguyen LH, Murray L, Eisner M, Valdebenito S, Hoang TD, Phuc Do H, Vo TV. Depression and its associated factors among pregnant women in central Vietnam. Health Psychol Open 2021; 8:2055102920988445. [PMID: 33598304 PMCID: PMC7841685 DOI: 10.1177/2055102920988445] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
To date, little attention has been given to prenatal depression, especially in low and middle-income countries. The aim of this research was to assess the prevalence of depression and its associated factors amongst pregnant women in a central Vietnamese city. This cross-sectional study included 150 pregnant women from 29 to 40 weeks of gestation, from eight wards of Hue city, via quota sampling from February to May 2019. We employed the Patient Health Questionnaire (PHQ-9) to assess depression. Findings suggest the need to provide routine screening of pregnant women in primary care for depressive symptoms and other mental health problems.
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Affiliation(s)
- Bao-Yen Luong-Thanh
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Lan Hoang Nguyen
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Linda Murray
- College of Health Sciences, Massey University, New Zealand
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Sara Valdebenito
- Institute of Criminology, University of Cambridge, United Kingdom
| | - Tuyen Dinh Hoang
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
| | - Huyen Phuc Do
- School of Public Health and Social Work, Queensland University of Technology (QUT), Australia
| | - Thang Van Vo
- Faculty of Public Health and Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Vietnam
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16
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Morales-Pérez A, Nava-Aguilera E, Hernández-Alvarez C, Alvarado-Castro VM, Arosteguí J, Legorreta-Soberanis J, Flores-Moreno M, Morales-Nava L, Harris E, Ledogar RJ, Andersson N, Cockcroft A. Utility of entomological indices for predicting transmission of dengue virus: secondary analysis of data from the Camino Verde trial in Mexico and Nicaragua. PLoS Negl Trop Dis 2020; 14:e0008768. [PMID: 33104693 PMCID: PMC7588090 DOI: 10.1371/journal.pntd.0008768] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/31/2020] [Indexed: 12/22/2022] Open
Abstract
Dengue vector entomological indices are widely used to monitor vector density and disease control activities. But the value of these indices as predictors of dengue infection is not established. We used data from the impact assessment of a trial of community mobilization for dengue prevention (Camino Verde) to examine the associations between vector indices and evidence of dengue infection and their value for predicting dengue infection levels. In 150 clusters in Mexico and Nicaragua, two entomological surveys, three months apart, allowed calculation of the mean Container Index, Breteau index, Pupae per Household Index, and Pupae per Container Index across the two surveys. We measured recent dengue virus infection in children, indicated by a doubling of dengue antibodies in paired saliva samples over the three-month period. We examined the associations between each of the vector indices and evidence of dengue infection at household level and at cluster level, accounting for trial intervention status. To examine the predictive value for dengue infection, we constructed receiver operating characteristic (ROC) curves at household and cluster level, considering the four vector indices as continuous variables, and calculated the positive and negative likelihood ratios for different levels of the indices. None of the vector indices was associated with recent dengue infection at household level. The Breteau Index was associated with recent infection at cluster level (Odds ratio 1.36, 95% confidence interval 1.14–1.61). The ROC curve confirmed the weak predictive value for dengue infection of the Breteau Index at cluster level. Other indices showed no predictive value. Conventional vector indices were not useful in predicting dengue infection in Mexico and Nicaragua. The findings are compatible with the idea of sources of infection outside the household which were tackled by community action in the Camino Verde trial. Vector control is the basis of preventing dengue virus infection. Measurement of dengue vector indices is widely used to monitor dengue control activities, but their utility as predictors of dengue infection is not clear. We used data about vector indices and evidence of recent dengue virus infection from a trial of community mobilization for dengue prevention in Mexico and Nicaragua (Camino Verde), to examine how four standard vector indices could predict dengue infection. Only the Breteau index was associated with evidence of dengue infection, and that only at cluster level. Receiver operating characteristic (ROC) curves confirmed the Breteau Index was only a weak predictor of infection at cluster level; none of the other indices had predictive value. These findings indicate that the four entomological indices studied were not useful predictors of dengue infection. The results are compatible with the idea of sources of infection outside the household which were tackled by community action in the Camino Verde trial.
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Affiliation(s)
- Arcadio Morales-Pérez
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Elizabeth Nava-Aguilera
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
- * E-mail:
| | | | - Víctor Manuel Alvarado-Castro
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | | | - José Legorreta-Soberanis
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Miguel Flores-Moreno
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Liliana Morales-Nava
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
| | - Eva Harris
- Division of Infectious Diseases and Vaccinology, School of Public Health, University of California, Berkeley, United States of America
| | | | - Neil Andersson
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Acapulco, Guerrero, México
- Department of Family Medicine, McGill University, Montreal, Canada
| | - Anne Cockcroft
- Department of Family Medicine, McGill University, Montreal, Canada
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Valdebenito S, Murray A, Hughes C, Băban A, Fernando AD, Madrid BJ, Ward C, Osafo J, Dunne M, Sikander S, Walker SP, Thang VV, Tomlinson M, Fearon P, Shenderovich Y, Marlow M, Chathurika D, Taut D, Eisner M. Evidence for Better Lives Study: a comparative birth-cohort study on child exposure to violence and other adversities in eight low- and middle-income countries - foundational research (study protocol). BMJ Open 2020; 10:e034986. [PMID: 33039982 PMCID: PMC7552842 DOI: 10.1136/bmjopen-2019-034986] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Violence against children is a health, human rights and social problem affecting approximately half of the world's children. Its effects begin at prenatal stages with long-lasting impacts on later health and well-being. The Evidence for Better Lives Study (EBLS) aims to produce high-quality longitudinal data from cities in eight low- and middle-income countries-Ghana, Jamaica, Pakistan, the Philippines, Romania, South Africa, Sri Lanka and Vietnam-to support effective intervention to reduce violence against children. EBLS-Foundational Research (EBLS-FR) tests critical aspects of the planned EBLS, including participant recruitment and retention, data collection and analysis. Alongside epidemiological estimates of levels and predictors of exposure to violence and adversity during pregnancy, we plan to explore mechanisms that may link exposure to violence to mothers' biological stress markers and subjective well-being. METHODS AND ANALYSES EBLS-FR is a short longitudinal study with a sample of 1200 pregnant women. Data are collected during the last trimester of pregnancy and 2 to 6 months after birth. The questionnaire for participating women has been translated into nine languages. Measures obtained from mothers will include, among others, mental and physical health, attitudes to corporal punishment, adverse childhood experiences, prenatal intimate partner violence, substance use and social/community support. Hair and dry blood spot samples are collected from the pregnant women to measure stress markers. To explore research participation among fathers, EBLS-FR is recruiting 300 fathers in the Philippines and Sri Lanka. ETHICS AND DISSEMINATION The study received ethical approvals at all recruiting sites and universities in the project. Results will be disseminated through journal publications, conferences and seminar presentations involving local communities, health services and other stakeholders. Findings from this work will help to adjust the subsequent stages of the EBLS project.
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Affiliation(s)
- Sara Valdebenito
- Institute of Criminology, University of Cambridge, Cambridge, UK
| | - Aja Murray
- Department of Psychology, The University of Edinburgh, Edinburgh, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Adriana Băban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | | | - Bernadette J Madrid
- Child Protection Unit, University of the Philippines Manila, Manila, Philippines
| | - Catherine Ward
- Department of Psychology, University of Cape Town, Rondebosch, South Africa
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Legon, Greater Accra, Ghana
| | - Michael Dunne
- School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - Siham Sikander
- Global Health Department, Health Services Academy, Islamabad, Pakistan
| | - Susan P Walker
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Vo Van Thang
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Thừa Thiên-Huế, Viet Nam
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Marguerite Marlow
- Department of Psychology, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | | | - Diana Taut
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Cambridge, UK
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Angrist N, Bergman P, Evans DK, Hares S, Jukes MCH, Letsomo T. Practical lessons for phone-based assessments of learning. BMJ Glob Health 2020; 5:e003030. [PMID: 32699155 PMCID: PMC7380711 DOI: 10.1136/bmjgh-2020-003030] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/16/2022] Open
Abstract
School closures affecting more than 1.5 billion children are designed to prevent the spread of current public health risks from the COVID-19 pandemic, but they simultaneously introduce new short-term and long-term health risks through lost education. Measuring these effects in real time is critical to inform effective public health responses, and remote phone-based approaches are one of the only viable options with extreme social distancing in place. However, both the health and education literature are sparse on guidance for phone-based assessments. In this article, we draw on our pilot testing of phone-based assessments in Botswana, along with the existing literature on oral testing of reading and mathematics, to propose a series of preliminary practical lessons to guide researchers and service providers as they try phone-based learning assessments. We provide preliminary evidence that phone-based assessments can accurately capture basic numeracy skills. We provide guidance to help teams (1) ensure that children are not put at risk, (2) test the reliability and validity of phone-based measures, (3) use simple instructions and practice items to ensure the assessment is focused on the target skill, not general language and test-taking skills, (4) adapt the items from oral assessments that will be most effective in phone-based assessments, (5) keep assessments brief while still gathering meaningful learning data, (6) use effective strategies to encourage respondents to pick up the phone, (7) build rapport with adult caregivers and youth respondents, (8) choose the most cost-effective medium and (9) account for potential bias in samples.
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Affiliation(s)
- Noam Angrist
- University of Oxford, Oxford, Oxfordshire, UK
- Young 1ove, Gaborone, Botswana
| | - Peter Bergman
- Teachers College of Columbia University, New York, New York, USA
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Nguela RL, Bigoga JD, Armel TN, Esther T, Line D, Boris NA, Frederic T, Kazi R, Williams P, Mbacham WF, Leke RGF. The effect of improved housing on indoor mosquito density and exposure to malaria in the rural community of Minkoameyos, Centre Region of Cameroon. Malar J 2020; 19:172. [PMID: 32362282 PMCID: PMC7197188 DOI: 10.1186/s12936-020-03232-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND This study evaluated the effectiveness of improved housing on indoor residual mosquito density and exposure to infected Anophelines in Minkoameyos, a rural community in southern forested Cameroon. METHODS Following the identification of housing factors affecting malaria prevalence in 2013, 218 houses were improved by screening the doors and windows, installing plywood ceilings on open eaves and closing holes on walls and doors. Monthly entomological surveys were conducted in a sample of 21 improved and 21 non-improved houses from November 2014 to October 2015. Mosquitoes sampled from night collections on human volunteers were identified morphologically and their parity status determined. Mosquito infectivity was verified through Plasmodium falciparum CSP ELISA and the average entomological inoculation rates determined. A Reduction Factor (RF), defined as the ratio of the values for mosquitoes collected outdoor to those collected indoor was calculated in improved houses (RFI) and non-improved houses (RFN). An Intervention Effect (IE = RFI/RFN) measured the true effect of the intervention. Chi square test was used to determine variable significance. The threshold for statistical significance was set at P < 0.05. RESULTS A total of 1113 mosquitoes were collected comprising Anopheles sp (58.6%), Culex sp (36.4%), Aedes sp (2.5%), Mansonia sp (2.4%) and Coquillettidia sp (0.2%). Amongst the Anophelines were Anopheles gambiae sensu lato (s.l.) (95.2%), Anopheles funestus (2.9%), Anopheles ziemanni (0.2%), Anopheles brohieri (1.2%) and Anopheles paludis (0.5%). Anopheles gambiae sensu stricto (s.s.) was the only An. gambiae sibling species found. The intervention reduced the indoor Anopheles density by 1.8-fold (RFI = 3.99; RFN = 2.21; P = 0.001). The indoor density of parous Anopheles was reduced by 1.7-fold (RFI = 3.99; RFN = 2.21; P = 0.04) and that of infected Anopheles by 1.8-fold (RFI = 3.26; RFN = 1.78; P = 0.04). Indoor peak biting rates were observed between 02 a.m. to 04 a.m. in non-improved houses and from 02 a.m. to 06 a.m. in improved houses. CONCLUSION Housing improvement contributed to reducing indoor residual anopheline density and malaria transmission. This highlights the need for policy specialists to further evaluate and promote aspects of house design as a complementary control tool that could reduce indoor human-vector contact and malaria transmission in similar epidemiological settings.
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Affiliation(s)
- Rachel L Nguela
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon.
- Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
| | - Jude D Bigoga
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Tedjou N Armel
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Tallah Esther
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon
| | - Dongmo Line
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon
| | - Njeambosay A Boris
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
| | - Tchouine Frederic
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon
| | - Riksum Kazi
- Architecture for Health in Vulnerable Environments (ARCHIVE Global), New York, USA
| | - Peter Williams
- Architecture for Health in Vulnerable Environments (ARCHIVE Global), New York, USA
| | - Wilfred F Mbacham
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon
- Department of Biochemistry, Faculty of Science, University of Yaoundé I, Yaoundé, Cameroon
| | - Rose G F Leke
- Malaria Consortium-Cameroon Coalition Against Malaria (MC-CCAM), Bastos, PO Box 4256, Yaoundé, Cameroon.
- National Reference Unit for Vector Control, The Biotechnology Centre, University of Yaoundé I, Yaoundé, Cameroon.
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Hein S, Bick J, Issa G, Aoude L, Maalouf C, Awar A, Nourallah S, Zonderman AL, Householder S, Katsovich L, Khoshnood K, Moore C, Salah R, Britto PR, Leckman JF, Ponguta LA. Maternal perceptions of father involvement among refugee and disadvantaged families in Beirut, Lebanon. PLoS One 2020; 15:e0229670. [PMID: 32134961 PMCID: PMC7058288 DOI: 10.1371/journal.pone.0229670] [Citation(s) in RCA: 4] [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: 08/30/2019] [Accepted: 02/12/2020] [Indexed: 11/19/2022] Open
Abstract
The role of fathers in (co-)parenting their children among refugee and disadvantaged families in low and middle-income countries (LMICs) remains poorly understood. This study sought to examine the associations among mothers' perceptions of their husband's involvement (hereafter referred to as paternal involvement), and her perceptions of her own well-being and a number of other variables, as well as observed mother-child interactions in families living in refugee and disadvantaged communities in Beirut, Lebanon. We analyzed baseline data from 104 mother-child dyads (mean age of children = 4.34 years; range = 2.05 to 7.93 years of age) who participated in a randomized controlled trial aimed at evaluating the impact of the Mother-Child Education Program in Beirut. In addition to the mother's perception of paternal involvement and the videotaped mother-child interactions, data were collected concerning the mother's well-being and her level of social support, as well as her level of stress as a parent and the way her children were disciplined in the family. Mother-child pairs were videotaped while completing a puzzle together and dyadic interactions were coded. Path analysis showed that paternal involvement was significantly associated with a higher level of maternal well-being and lower distress levels. In addition, higher levels of maternal distress were associated with higher levels of harsh discipline and parenting stress. Correlation analysis showed that higher perceptions of paternal involvement were associated with more positive affect displayed by the child, more positive regard for the child, and better mother-child synchrony during the dyadic interactions. Limitations include the cross-sectional design and the modest sample size, which hinder causal inferences and generalizability of the findings. These preliminary findings suggest that higher levels of paternal involvement may have an impact on markers of maternal mental health and positive mother-child interactions in families living in disadvantaged communities or humanitarian settings. Paternal involvement should be considered when designing and implementing parenting programs in LMICs.
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Affiliation(s)
- Sascha Hein
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Johanna Bick
- Department of Psychology, University of Houston, Houston, Texas, United States of America
| | | | - Lara Aoude
- Arab Resource Collective, Beirut, Lebanon
| | | | - Abir Awar
- Arab Resource Collective, Beirut, Lebanon
| | | | - Anna L. Zonderman
- UChicago Medicine, The University of Chicago, Chicago, Illinois, United States of America
| | - Sarah Householder
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Liliya Katsovich
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Kaveh Khoshnood
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Christina Moore
- Department of Psychology, University of Delaware, Newark, Delaware, United States of America
| | - Rima Salah
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
| | - Pia R. Britto
- UNICEF, New York, New York, United States of America
| | - James F. Leckman
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
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Jo Y, LeFevre AE, Healy K, Singh N, Alland K, Mehra S, Ali H, Shaikh S, Haque R, Christian P, Labrique AB. Costs and cost-effectiveness analyses of mCARE strategies for promoting care seeking of maternal and newborn health services in rural Bangladesh. PLoS One 2019; 14:e0223004. [PMID: 31574133 PMCID: PMC6773420 DOI: 10.1371/journal.pone.0223004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 05/20/2019] [Accepted: 09/11/2019] [Indexed: 11/19/2022] Open
Abstract
Objective We examined the incremental cost-effectiveness between two mHealth programs, implemented from 2011 to 2015 in rural Bangladesh: (1) Comprehensive mCARE package as an intervention group and (2) Basic mCARE package as a control group. Methods Both programs included a core package of census enumeration and pregnancy surveillance provided by an established cadre of digitally enabled community health workers (CHWs). In the comprehensive mCARE package, short message service (SMS) and home visit reminders were additionally sent to pregnant women (n = 610) and CHWs (n = 70) to promote the pregnant women’s care-seeking of essential maternal and newborn care services. Economic costs were assessed from a program perspective inclusive of development, start-up, and implementation phases. Effects were calculated as disability adjusted life years (DALYs) and the number of newborn deaths averted. For comparative purposes, we normalized our evaluation to estimate total costs and total newborn deaths averted per 1 million people in a community for both groups. Uncertainty was assessed using probabilistic sensitivity analyses with Monte Carlo simulation. Results The addition of SMS and home visit reminders based on a mobile phone-facilitated pregnancy surveillance system was highly cost effective at a cost per DALY averted of $31 (95% uncertainty range: $19–81). The comprehensive mCARE program had at least 88% probability of being highly cost-effective as compared to the basic mCARE program based on the threshold of Bangladesh’s GDP per capita. Conclusion mHealth strategies such as SMS and home visit reminders on a well-established pregnancy surveillance system may improve service utilization and program cost-effectiveness in low-resource settings.
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Affiliation(s)
- Youngji Jo
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- * E-mail:
| | - Amnesty E. LeFevre
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Katherine Healy
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Neelu Singh
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kelsey Alland
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Sucheta Mehra
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hasmot Ali
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | | | - Rezawanul Haque
- JiVitA Program, Johns Hopkins University, Gaibandha, Bangladesh
| | - Parul Christian
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Alain B. Labrique
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Schwartz K, Cappella E, Aber JL, Scott MA, Wolf S, Behrman JR. Early Childhood Teachers' Lives in Context: Implications for Professional Development in Under-Resourced Areas. Am J Community Psychol 2019; 63:270-285. [PMID: 31034641 DOI: 10.1002/ajcp.12325] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study explores the personal, professional, and contextual conditions faced by early childhood education (ECE) teachers in under-resourced settings and how these relate to teacher responsiveness to professional development (PD): namely, teacher attrition (a sign of PD failure when occurring shortly after PD), take-up of offered PD, adherence to PD training/materials, and quality of implementation. We use data from six disadvantaged districts in the Greater Accra Region of Ghana and PD focused on implementation of a national, play-based curriculum. Descriptive statistics indicate that ECE teachers (n = 302) face a multitude of barriers to high quality teaching across the bioecological model. Multilevel mixed effects models find that teachers with low job satisfaction are more likely to leave the school within the academic year. Teachers with moderate to severe depression are less likely to attend PD trainings. Senior teachers and those with poverty risks are less likely to adhere to PD material. Teachers with many time demand barriers are more likely to adhere to material. They also implement the content at higher observed quality as do teachers with bachelor's degrees and early childhood development (ECD) training. Take-up of PD also predicts quality of implementation. Practice and research implications are discussed.
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Affiliation(s)
- Kate Schwartz
- Global TIES for Children, New York University, New York, NY, USA
| | - Elise Cappella
- Department of Applied Psychology, New York University, New York, NY, USA
| | - J Lawrence Aber
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Marc A Scott
- Department of Applied Statistics, New York University, New York, NY, USA
| | - Sharon Wolf
- Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA
| | - Jere R Behrman
- Economics Department, University of Pennsylvania, Philadelphia, PA, USA
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Awah PK, Boock AU, Mou F, Koin JT, Anye EM, Noumen D, Nichter M. Developing a Buruli ulcer community of practice in Bankim, Cameroon: A model for Buruli ulcer outreach in Africa. PLoS Negl Trop Dis 2018; 12:e0006238. [PMID: 29584724 PMCID: PMC5889189 DOI: 10.1371/journal.pntd.0006238] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 09/14/2017] [Revised: 04/06/2018] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
Background In the Cameroon, previous efforts to identify Buruli ulcer (BU) through the mobilization of community health workers (CHWs) yielded poor results. In this paper, we describe the successful creation of a BU community of practice (BUCOP) in Bankim, Cameroon composed of hospital staff, former patients, CHWs, and traditional healers. Methods and principle findings All seven stages of a well-defined formative research process were conducted during three phases of research carried out by a team of social scientists working closely with Bankim hospital staff. Phase one ethnographic research generated interventions tested in a phase two proof of concept study followed by a three- year pilot project. In phase three the pilot project was evaluated. An outcome evaluation documented a significant rise in BU detection, especially category I cases, and a shift in case referral. Trained CHW and traditional healers initially referred most suspected cases of BU to Bankim hospital. Over time, household members exposed to an innovative and culturally sensitive outreach education program referred the greatest number of suspected cases. Laboratory confirmation of suspected BU cases referred by community stakeholders was above 30%. An impact and process evaluation found that sustained collaboration between health staff, CHWs, and traditional healers had been achieved. CHWs came to play a more active role in organizing BU outreach activities, which increased their social status. Traditional healers found they gained more from collaboration than they lost from referral. Conclusion/ Significance Setting up lines of communication, and promoting collaboration and trust between community stakeholders and health staff is essential to the control of neglected tropical diseases. It is also essential to health system strengthening and emerging disease preparedness. The BUCOP model described in this paper holds great promise for bringing communities together to solve pressing health problems in a culturally sensitive manner. Buruli ulcer (BU) is a neglected tropical disease primarily found in West Africa largely effecting the rural poor. BU has a known cause and cure, but an unknown route of transmission and a poorly understood incubation period. If not treated early and in a timely manner, BU often progresses to an advanced state requiring surgery and prolonged wound care. In the Cameroon, previous efforts to mobilize community health workers and educate community members to identify cases of BU yielded poor results. In this paper, we describe steps undertaken to create a successful BU community of practice (BUCOP) composed of community stakeholders working in concert with clinic staff. The success of the BUCOP was measured in terms of numbers of suspected BU cases referred and confirmed, a decline in treatment drop out, and sustained collaboration among stakeholders both during and following the pilot project. Pilot project success is attributed to an innovative and culturally sensitive approach to BU outreach education, increased levels of patient assistance, and mutual respect among BUCOP members for what each stakeholder contributed to BU detection, treatment, psychosocial support, and spiritual protection.
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Affiliation(s)
- Paschal Kum Awah
- Department of Anthropology, Faculty of Art, Letters and Social Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | | | - Ferdinand Mou
- Monitoring & Evaluation Unit FAIRMED, Yaoundé, Cameroon
| | - Joseph Tohnain Koin
- Department of Anthropology, Faculty of Art, Letters and Social Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Evaristus Mbah Anye
- Department of Anthropology, Faculty of Art, Letters and Social Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Djeunga Noumen
- Bankim Health District, Ministry of Health, Adamaoua Region, Cameroon
| | - Mark Nichter
- School of Anthropology, University of Arizona, Tucson, United States of America
- * E-mail:
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24
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Mationg MLS, Gordon CA, Tallo VL, Olveda RM, Alday PP, Reñosa MDC, Bieri FA, Williams GM, Clements ACA, Steinmann P, Halton K, Li Y, McManus DP, Gray DJ. Status of soil-transmitted helminth infections in schoolchildren in Laguna Province, the Philippines: Determined by parasitological and molecular diagnostic techniques. PLoS Negl Trop Dis 2017; 11:e0006022. [PMID: 29108026 PMCID: PMC5703569 DOI: 10.1371/journal.pntd.0006022] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 05/01/2017] [Revised: 11/27/2017] [Accepted: 10/07/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Soil-transmitted helminths (STH) are the most common parasitic infections in impoverished communities, particularly among children. Current STH control is through school-based mass drug administration (MDA), which in the Philippines is done twice annually. As expected, MDA has decreased the intensity and prevalence of STH over time. As a result, the common Kato Katz (KK) thick smear method of detecting STH is less effective because it lacks sensitivity in low intensity infections, making it difficult to measure the impact of deworming programs. METHODOLOGY/PRINCIPAL FINDINGS A cross-sectional study was carried out over a four-week period from October 27, 2014 until November 20, 2014 in Laguna province, the Philippines. Stool samples were collected from 263 schoolchildren, to determine the prevalence of STH and compare diagnostic accuracy of multiplex quantitative polymerase chain reaction (qPCR) with the KK. A large discrepancy in the prevalence between the two techniques was noted for the detection of at least one type of STH infection (33.8% by KK vs. 78.3% by qPCR), Ascaris lumbricoides (20.5% by KK vs. 60.8% by qPCR) and Trichuris trichiura (23.6% by KK vs. 38.8% by qPCR). Considering the combined results of both methods, the prevalence of at least one type of helminth infection, A. lumbricoides, and T. trichiura were 83.3%, 67.7%, and 53.6%, respectively. Sensitivity of the qPCR for detecting at least one type of STH infection, A. lumbricoides, and T. trichiura were 94.1%, 89.9%, and 72.3% respectively; whereas KK sensitivity was 40.6%, 30.3%, and 44.0%, respectively. The qPCR method also detected infections with Ancylostoma spp. (4.6%), Necator americanus (2.3%), and Strongyloides stercoralis (0.8%) that were missed by KK. CONCLUSION/SIGNIFICANCE qPCR may provide new and important diagnostic information to improve assessment of the effectiveness and impact of integrated control strategies particularly in areas where large-scale STH control has led to low prevalence and/or intensity of infection.
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Affiliation(s)
- Mary Lorraine S. Mationg
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Catherine A. Gordon
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Veronica L. Tallo
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Remigio M. Olveda
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Portia P. Alday
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Mark Donald C. Reñosa
- Department of Epidemiology and Biostatistics, Research Institute for Tropical Medicine, Manila, Philippines
| | - Franziska A. Bieri
- Research School of Population Health, The Australian National University, Canberra, Australia
| | - Gail M. Williams
- Discipline of Epidemiology and Biostatistics, School of Public Health, University of Queensland, Brisbane, Australia
| | - Archie C. A. Clements
- Research School of Population Health, The Australian National University, Canberra, Australia
| | - Peter Steinmann
- Swiss Tropical and Public Health Institute, Basel Switzerland
- University of Basel, Basel Switzerland
| | - Kate Halton
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Yuesheng Li
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- Hunan Institute of Parasitic Diseases, World Health Organization Collaborating Centre for Research and Control on Schistosomiasis in Lake Region, Yueyang, People’s Republic of China
| | - Donald P. McManus
- Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, Brisbane, Australia
- * E-mail: (DJG); (DPM)
| | - Darren J. Gray
- Research School of Population Health, The Australian National University, Canberra, Australia
- * E-mail: (DJG); (DPM)
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Essé C, Koffi VA, Kouamé A, Dongo K, Yapi RB, Moro HM, Kouakou CA, Palmeirim MS, Bonfoh B, N’Goran EK, Utzinger J, Raso G. "Koko et les lunettes magiques": An educational entertainment tool to prevent parasitic worms and diarrheal diseases in Côte d'Ivoire. PLoS Negl Trop Dis 2017; 11:e0005839. [PMID: 28934198 PMCID: PMC5630154 DOI: 10.1371/journal.pntd.0005839] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 10/06/2017] [Accepted: 07/31/2017] [Indexed: 11/26/2022] Open
Abstract
Background Integrated control programs, emphasizing preventive chemotherapy along with health education, can reduce the incidence of soil-transmitted helminthiasis and schistosomiasis. The aim of this study was to develop an educational animated cartoon to improve school children’s awareness regarding soil-transmitted helminthiasis, diarrheal diseases, and related hygiene practices in Côte d’Ivoire. The key messages included in the cartoon were identified through prior formative research to specifically address local knowledge gaps. Methodology In a first step, preliminary research was conducted to assess the knowledge, attitudes, practices, and beliefs of school-aged children regarding parasitic worm infections and hygiene, to identify key health messages to be included in an animated cartoon. Second, an animated cartoon was produced, which included the drafting of the script and story board, and the production of the cartoon’s initial version. Finally, the animated cartoon was pilot tested in eight selected schools and further fine-tuned. Principal findings According to the questionnaire results, children believed that the consumption of sweet food, eating without washing their hands, sitting on the floor, and eating spoiled food were the main causes of parasitic worm infections. Abdominal pain, diarrhea, lack of appetite, failure to grow, and general fatigue were mentioned as symptoms of parasitic worm infections. Most of the children knew that they should go to the hospital for treatment if they experienced symptoms of parasitic worm diseases. The animated cartoon titled “Koko et les lunettes magiques” was produced by Afrika Toon, in collaboration with a scientific team composed of epidemiologists, civil engineers, and social scientists, and the local school children and teachers. Pilot testing of the animated cartoon revealed that, in the short term, children grasped and kept key messages. Most of the children who were shown the cartoon reported to like it. Acceptance of the animated cartoon was high among children and teachers alike. The messaging was tailored to improve knowledge and practices for prevention of helminthiases and diarrheal diseases through prior identification of knowledge gaps. Integration of such education tools into the school curriculum, along with deworming campaigns, might improve sustainability of control and elimination efforts against helminthiases and diarrheal diseases. Soil-transmitted helminthiases, schistosomiasis, and diarrhea remain important public health issues in sub-Saharan Africa. Health educational animated cartoons can help raise awareness and improve hygiene practices, and thus contribute to the control and elimination of these diseases. For the development of an educational animated cartoon, we first evaluated the knowledge, attitudes, practices, and beliefs of school-aged children in Côte d’Ivoire regarding soil-transmitted helminthiases, diarrhea, and schistosomiasis in order to identify setting-specific health messages for our animated cartoon. We found that children believed that the consumption of sweet food, eating without washing their hands, sitting on the floor, and eating spoiled food were the main causes of parasitic worm infections. As a next step, the alpha version of the animated cartoon was produced and given the title: “Koko et les lunettes magiques”. The animated cartoon was pre-tested in eight schools and further developed. Our study found that children could retain most of the information provided by the animated cartoon. It is suggested that such a tool, integrated into the school curriculum, together with deworming campaigns in Côte d’Ivoire, might improve the sustainability of control and elimination efforts against soil-transmitted helminthiases, diarrhea, and schistosomiasis.
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Affiliation(s)
- Clémence Essé
- Unité de Formation et de Recherche des Sciences de l’Homme et de la Société, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Véronique A. Koffi
- Unité de Formation et de Recherche des Sciences de l’Homme et de la Société, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Kouassi Dongo
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Richard B. Yapi
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Honorine M. Moro
- Unité de Formation et de Recherche des Sciences de l’Homme et de la Société, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Christiane A. Kouakou
- Unité de Formation et de Recherche des Sciences de l’Homme et de la Société, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Marta S. Palmeirim
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Bassirou Bonfoh
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
| | - Eliézer K. N’Goran
- Département Recherche et Développement, Centre Suisse de Recherches Scientifiques en Côte d’Ivoire, Abidjan, Côte d’Ivoire
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d’Ivoire
| | - Jürg Utzinger
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Giovanna Raso
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
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Lechenne M, Mindekem R, Madjadinan S, Oussiguéré A, Moto DD, Naissengar K, Zinsstag J. The Importance of a Participatory and Integrated One Health Approach for Rabies Control: The Case of N'Djaména, Chad. Trop Med Infect Dis 2017; 2:E43. [PMID: 30270900 PMCID: PMC6082095 DOI: 10.3390/tropicalmed2030043] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/27/2017] [Accepted: 08/03/2017] [Indexed: 02/06/2023] Open
Abstract
This study compares data on animal rabies cases from the Chadian national rabies laboratory, hosted at the Insitut de Recherche en Elevage pour le Developpement (IRED), with bite case reporting from health facilities. The data collection accompanied a mass dog vaccination intervention over two years in N'Djaména, Chad. This allowed for a comparison of the dynamics of the incidence of animal rabies cases, human bite exposure incidence and post-exposure prophylaxis (PEP) demand during a dog rabies elimination attempt. Following the mass vaccination, the monthly animal rabies incidence dropped from 1.1/10,000 dogs, as observed prior to the campaign in 2012, to 0.061/10,000 dogs in 2014. However, the PEP demand was found to be largely unaffected. The suspicion of the rabies exposure as reported by health personnel in most cases did not reflect the status of the biting animal but rather the severity of the bite wound, resulting in inappropriate PEP recommendations. In addition, the levels of reporting dead or killed animals to the rabies laboratory was found to be very low. These results reveal a profound lack of communication between health facilities and veterinary structures and the absence of an integrated bite case management (IBCM) approach. Improved communication between human health and veterinary workers is imperative to prevent human rabies deaths through the appropriate use of PEP and to further translate success in animal rabies control into cost savings for the public health sector through a lower PEP demand. Improved training of health and veterinary personnel and the sensitisation of the public are needed to achieve good IBCM practice, to increase the rate of diagnostic testing, to provide adequate and timely PEP, and to reduce the wastage of scarce vaccine resources.
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Affiliation(s)
- Monique Lechenne
- Swiss Tropical and Public Health Institute, P.O.Box, Socinstrasse 57, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4051 Basel, Switzerland.
| | - Rolande Mindekem
- Centre de Support en Santé International, BP: 972, Moursal, N'Djaména, Chad.
| | - Séraphin Madjadinan
- Centre de Support en Santé International, BP: 972, Moursal, N'Djaména, Chad.
| | - Assandi Oussiguéré
- Institut de Recherché en Elevage pour le Développement, BP: 433, Farcha, N'Djaména, Chad.
| | | | - Kemdongarti Naissengar
- Institut de Recherché en Elevage pour le Développement, BP: 433, Farcha, N'Djaména, Chad.
| | - Jakob Zinsstag
- Swiss Tropical and Public Health Institute, P.O.Box, Socinstrasse 57, CH-4002 Basel, Switzerland.
- University of Basel, Petersplatz 1, CH-4051 Basel, Switzerland.
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27
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Jaleta TG, Zhou S, Bemm FM, Schär F, Khieu V, Muth S, Odermatt P, Lok JB, Streit A. Different but overlapping populations of Strongyloides stercoralis in dogs and humans-Dogs as a possible source for zoonotic strongyloidiasis. PLoS Negl Trop Dis 2017; 11:e0005752. [PMID: 28793306 PMCID: PMC5565190 DOI: 10.1371/journal.pntd.0005752] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [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: 04/02/2017] [Revised: 08/21/2017] [Accepted: 06/26/2017] [Indexed: 01/10/2023] Open
Abstract
Strongyloidiasis is a much-neglected soil born helminthiasis caused by the nematode Strongyloides stercoralis. Human derived S. stercoralis can be maintained in dogs in the laboratory and this parasite has been reported to also occur in dogs in the wild. Some authors have considered strongyloidiasis a zoonotic disease while others have argued that the two hosts carry host specialized populations of S. stercoralis and that dogs play a minor role, if any, as a reservoir for zoonotic S. stercoralis infections of humans. We isolated S. stercoralis from humans and their dogs in rural villages in northern Cambodia, a region with a high incidence of strongyloidiasis, and compared the worms derived from these two host species using nuclear and mitochondrial DNA sequence polymorphisms. We found that in dogs there exist two populations of S. stercoralis, which are clearly separated from each other genetically based on the nuclear 18S rDNA, the mitochondrial cox1 locus and whole genome sequence. One population, to which the majority of the worms belong, appears to be restricted to dogs. The other population is indistinguishable from the population of S. stercoralis isolated from humans. Consistent with earlier studies, we found multiple sequence variants of the hypervariable region I of the 18 S rDNA in S. stercoralis from humans. However, comparison of mitochondrial sequences and whole genome analysis suggest that these different 18S variants do not represent multiple genetically isolated subpopulations among the worms isolated from humans. We also investigated the mode of reproduction of the free-living generations of laboratory and wild isolates of S. stercoralis. Contrary to earlier literature on S. stercoralis but similar to other species of Strongyloides, we found clear evidence of sexual reproduction. Overall, our results show that dogs carry two populations, possibly different species of Strongyloides. One population appears to be dog specific but the other one is shared with humans. This argues for the strong potential of dogs as reservoirs for zoonotic transmission of S. stercoralis to humans and suggests that in order to reduce the exposure of humans to infective S. stercoralis larvae, dogs should be treated for the infection along with their owners.
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MESH Headings
- Animals
- Cambodia/epidemiology
- Cluster Analysis
- DNA, Helminth/chemistry
- DNA, Helminth/genetics
- DNA, Mitochondrial/chemistry
- DNA, Mitochondrial/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Disease Reservoirs
- Dog Diseases/epidemiology
- Dog Diseases/parasitology
- Dog Diseases/transmission
- Dogs
- Electron Transport Complex IV/genetics
- Genotype
- Humans
- Molecular Epidemiology
- Phylogeny
- Polymorphism, Genetic
- RNA, Ribosomal, 18S/genetics
- Rural Population
- Sequence Analysis, DNA
- Strongyloides stercoralis/classification
- Strongyloides stercoralis/genetics
- Strongyloides stercoralis/isolation & purification
- Strongyloidiasis/epidemiology
- Strongyloidiasis/parasitology
- Strongyloidiasis/transmission
- Strongyloidiasis/veterinary
- Zoonoses/epidemiology
- Zoonoses/parasitology
- Zoonoses/transmission
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Affiliation(s)
- Tegegn G. Jaleta
- Department of Evolutionary Biology, Max-Planck-Institute for Developmental Biology, Tübingen, Germany
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Siyu Zhou
- Department of Evolutionary Biology, Max-Planck-Institute for Developmental Biology, Tübingen, Germany
| | - Felix M. Bemm
- Department of Molecular Biology, Max-Planck-Institute for Developmental Biology, Tübingen, Germany
| | - Fabian Schär
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Sinuon Muth
- National Center for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - James B. Lok
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Adrian Streit
- Department of Evolutionary Biology, Max-Planck-Institute for Developmental Biology, Tübingen, Germany
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Carreño JM, Perez-Shibayama C, Gil-Cruz C, Lopez-Macias C, Vernazza P, Ludewig B, Albrich WC. Evolution of Salmonella Typhi outer membrane protein-specific T and B cell responses in humans following oral Ty21a vaccination: A randomized clinical trial. PLoS One 2017; 12:e0178669. [PMID: 28570603 PMCID: PMC5453566 DOI: 10.1371/journal.pone.0178669] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 02/23/2017] [Accepted: 05/17/2017] [Indexed: 11/23/2022] Open
Abstract
Vaccination against complex pathogens such as typhoidal and non-typhoidal Salmonella requires the concerted action of different immune effector mechanisms. Outer membrane proteins (Omps) of Salmonella Typhi are potent immunogens, which elicit long-lasting and protective immunity. Here, we followed the evolution of S. Typhi OmpC and F-specific T and B cell responses in healthy volunteers after vaccination with the vaccine strain Ty21a. To follow humoral and cellular immune responses, pre- and post-vaccination samples (PBMC, serum and stool) collected from 15 vaccinated and 5 non-vaccinated individuals. Immunoglobulin levels were assessed in peripheral blood by enzyme-linked immunosorbent assay. B cell and T cell activation were analyzed by flow cytometry. We observed a significant increase of circulating antibody-secreting cells and maximal Omp-specific serum IgG titers at day 25 post vaccination, while IgA titers in stool peaked at day 60. Likewise, Omp-specific CD4+ T cells in peripheral blood showed the highest expansion at day 60 post vaccination, concomitant with a significant increase in IFN-γ and TNFα production. These results indicate that S. Typhi Omp-specific B cell responses and polyfunctional CD4+ T cell responses evolve over a period of at least two months after application of the live attenuated vaccine. Moreover, these findings underscore the potential of S. Typhi Omps as subunit vaccine components. Trial registration:ISRCTN18360696
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Affiliation(s)
- Juan Manuel Carreño
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Cristina Gil-Cruz
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Constantino Lopez-Macias
- Medical Research Unit on Immunochemistry (UIMIQ), Specialties Hospital, National Medical Centre “Siglo XXI”, Mexican Social Security Institute (IMSS), Mexico City, Mexico
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Burkhard Ludewig
- Institute of Immunobiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- * E-mail:
| | - Werner C. Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Pray IW, Ayvar V, Gamboa R, Muro C, Moyano LM, Benavides V, Flecker RH, Garcia HH, O’Neal SE. Spatial relationship between Taenia solium tapeworm carriers and necropsy cyst burden in pigs. PLoS Negl Trop Dis 2017; 11:e0005536. [PMID: 28406898 PMCID: PMC5404875 DOI: 10.1371/journal.pntd.0005536] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 10/26/2016] [Revised: 04/25/2017] [Accepted: 03/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Taenia solium, a parasite that affects humans and pigs, is the leading cause of preventable epilepsy in the developing world. Geographic hotspots of pigs testing positive for serologic markers of T. solium exposure have been observed surrounding the locations of human tapeworm carriers. This clustered pattern of seropositivity in endemic areas formed the basis for geographically targeted control interventions, which have been effective at reducing transmission. In this study, we further explore the spatial relationship between human tapeworm carriers and infected pigs using necroscopic examination as a quantitative gold-standard diagnostic to detect viable T. solium cyst infection in pigs. METHODOLOGY/PRINCIPAL FINDINGS We performed necroscopic examinations on pigs from 7 villages in northern Peru to determine the number of viable T. solium cysts in each pig. Participating humans in the study villages were tested for T. solium tapeworm infection (i.e., taeniasis) with an ELISA coproantigen assay, and the distances from each pig to its nearest human tapeworm carrier were calculated. We assessed the relationship between proximity to a tapeworm carrier and the prevalence of light, moderate, and heavy cyst burden in pigs. The prevalence of pig infection was greatest within 50 meters of a tapeworm carrier and decreased monotonically as distance increased. Pigs living less than 50 meters from a human tapeworm carrier were 4.6 times more likely to be infected with at least one cyst than more distant pigs. Heavier cyst burdens, however, were not more strongly associated with proximity to tapeworm carriers than light cyst burdens. CONCLUSION/SIGNIFICANCE Our study shows that human tapeworm carriers and pigs with viable T. solium cyst infection are geographically correlated in endemic areas. This finding supports control strategies that treat humans and pigs based on their proximity to other infected individuals. We did not, however, find sufficient evidence that heavier cyst burdens in pigs would serve as improved targets for geographically focused control interventions.
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Affiliation(s)
- Ian W. Pray
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
- * E-mail:
| | - Viterbo Ayvar
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Ricardo Gamboa
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Claudio Muro
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Luz M. Moyano
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Victor Benavides
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
| | - Robert H. Flecker
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
| | - Hector H. Garcia
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
- School of Sciences, Department of Microbiology, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Seth E. O’Neal
- School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, United States of America
- Center for Global Health Tumbes, Universidad Peruana Cayetano Heredia, Tumbes, Peru
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30
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Forrer A, Khieu V, Schindler C, Schär F, Marti H, Char MC, Muth S, Odermatt P. Ivermectin Treatment and Sanitation Effectively Reduce Strongyloides stercoralis Infection Risk in Rural Communities in Cambodia. PLoS Negl Trop Dis 2016; 10:e0004909. [PMID: 27548286 PMCID: PMC4993485 DOI: 10.1371/journal.pntd.0004909] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 03/21/2016] [Accepted: 07/17/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Strongyloides stercoralis is the only soil-transmitted helminth with the ability to replicate within its host, leading to long-lasting and potentially fatal infections. It is ubiquitous and its worldwide prevalence has recently been estimated to be at least half that of hookworm. Information on the epidemiology of S. stercoralis remains scarce and modalities for its large-scale control are yet to be determined. METHODOLOGY/PRINCIPAL FINDINGS A community-based two-year cohort study was conducted among the general population in a rural province in North Cambodia. At each survey, participants infected with S. stercoralis were treated with a single oral dose of ivermectin (200μg/kg BW). Diagnosis was performed using a combination of the Baermann method and Koga agar plate culture on two stool samples. The cohort included participants from eight villages who were either positive or negative for S. stercoralis at baseline. Mixed logistic regression models were employed to assess risk factors for S. stercoralis infection at baseline and re-infection at follow-up. A total of 3,096 participants were examined at baseline, revealing a S. stercoralis prevalence of 33.1%. Of these participants, 1,269 were followed-up over two years. Re-infection and infection rates among positive and negative participants at baseline were 14.4% and 9.6% at the first and 11.0% and 11.5% at the second follow-up, respectively. At follow-up, all age groups were at similar risk of acquiring an infection, while infection risk significantly decreased with increasing village sanitation coverage. CONCLUSIONS/SIGNIFICANCE Chemotherapy-based control of S. stercoralis is feasible and highly beneficial, particularly in combination with improved sanitation. The impact of community-based ivermectin treatment on S. stercoralis was high, with over 85% of villagers remaining negative one year after treatment. The integration of S. stercoralis into existing STH control programs should be considered without further delay.
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Affiliation(s)
- Armelle Forrer
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Virak Khieu
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Fabian Schär
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Hanspeter Marti
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Meng Chuor Char
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Sinuon Muth
- National Centre for Parasitology, Entomology and Malaria Control, Ministry of Health, Phnom Penh, Cambodia
| | - Peter Odermatt
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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31
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Alba S, Bakker MI, Hatta M, Scheelbeek PFD, Dwiyanti R, Usman R, Sultan AR, Sabir M, Tandirogang N, Amir M, Yasir Y, Pastoor R, van Beers S, Smits HL. Risk Factors of Typhoid Infection in the Indonesian Archipelago. PLoS One 2016; 11:e0155286. [PMID: 27281311 PMCID: PMC4900629 DOI: 10.1371/journal.pone.0155286] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [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: 10/23/2015] [Accepted: 04/01/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knowledge of risk factors and their relative importance in different settings is essential to develop effective health education material for the prevention of typhoid. In this study, we examine the effect of household level and individual behavioural risk factors on the risk of typhoid in three Indonesian islands (Sulawesi, Kalimantan and Papua) in the Eastern Indonesian archipelago encompassing rural, peri-urban and urban areas. METHODS We enrolled 933 patients above 10 years of age in a health facility-based case-control study between June 2010 and June 2011. Individuals suspected of typhoid were tested using the typhoid IgM lateral flow assay for the serodiagnosis of typhoid fever followed by blood culture testing. Cases and controls were defined post-recruitment: cases were individuals with a culture or serology positive result (n = 449); controls were individuals negative to both serology and culture, with or without a diagnosis other than typhoid (n = 484). Logistic regression was used to examine the effect of household level and individual level behavioural risk factors and we calculated the population attributable fraction (PAF) of removing each risk significant independent behavioural risk factor. RESULTS Washing hands at critical moments of the day and washing hands with soap were strong independent protective factors for typhoid (OR = 0.38 95% CI 0.25 to 0.58 for each unit increase in hand washing frequency score with values between 0 = Never and 3 = Always; OR = 3.16 95% CI = 2.09 to 4.79 comparing washing hands with soap sometimes/never vs. often). These effects were independent of levels of access to water and sanitation. Up to two thirds of cases could be prevented by compliance to these practices (hand washing PAF = 66.8 95% CI 61.4 to 71.5; use of soap PAF = 61.9 95%CI 56.7 to 66.5). Eating food out in food stalls or restaurant was an important risk factor (OR = 6.9 95%CI 4.41 to 10.8 for every unit increase in frequency score). CONCLUSIONS Major gains could potentially be achieved in reducing the incidence of typhoid by ensuring adherence to adequate hand-washing practices alone. This confirms that there is a pivotal role for 'software' related interventions to encourage behavior change and create demand for goods and services, alongside development of water and sanitation infrastructure.
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Affiliation(s)
- Sandra Alba
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
- * E-mail:
| | - Mirjam I. Bakker
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Mochammad Hatta
- Department of Medical Microbiology, Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, South-Sulawesi, Indonesia
| | | | - Ressy Dwiyanti
- Department of Medical Microbiology, Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, South-Sulawesi, Indonesia
| | - Romi Usman
- Department of Medical Microbiology, Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, South-Sulawesi, Indonesia
| | - Andi R. Sultan
- Department of Medical Microbiology, Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, South-Sulawesi, Indonesia
| | - Muhammad Sabir
- Department of Medical Microbiology, Molecular Biology and Immunology Laboratory, Faculty of Medicine, Hasanuddin University, Makassar, South-Sulawesi, Indonesia
| | - Nataniel Tandirogang
- Department Microbiology, Faculty of Medicine, Mulawarman University, Samarinda, East-Kalimantan, Indonesia
| | - Masyhudi Amir
- Department Microbiology, Faculty of Medicine, Mulawarman University, Samarinda, East-Kalimantan, Indonesia
| | - Yadi Yasir
- Department Microbiology, Faculty of Medicine, Mulawarman University, Samarinda, East-Kalimantan, Indonesia
| | - Rob Pastoor
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Stella van Beers
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
| | - Henk L. Smits
- KIT Biomedical Research, Royal Tropical Institute (KIT), Amsterdam, The Netherlands
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Sharma SK, Kuch U, Höde P, Bruhse L, Pandey DP, Ghimire A, Chappuis F, Alirol E. Use of Molecular Diagnostic Tools for the Identification of Species Responsible for Snakebite in Nepal: A Pilot Study. PLoS Negl Trop Dis 2016; 10:e0004620. [PMID: 27105074 PMCID: PMC4841570 DOI: 10.1371/journal.pntd.0004620] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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: 02/11/2015] [Accepted: 03/15/2016] [Indexed: 11/19/2022] Open
Abstract
Snakebite is an important medical emergency in rural Nepal. Correct identification of the biting species is crucial for clinicians to choose appropriate treatment and anticipate complications. This is particularly important for neurotoxic envenoming which, depending on the snake species involved, may not respond to available antivenoms. Adequate species identification tools are lacking. This study used a combination of morphological and molecular approaches (PCR-aided DNA sequencing from swabs of bite sites) to determine the contribution of venomous and non-venomous species to the snakebite burden in southern Nepal. Out of 749 patients admitted with a history of snakebite to one of three study centres, the biting species could be identified in 194 (25.9%). Out of these, 87 had been bitten by a venomous snake, most commonly the Indian spectacled cobra (Naja naja; n = 42) and the common krait (Bungarus caeruleus; n = 22). When both morphological identification and PCR/sequencing results were available, a 100% agreement was noted. The probability of a positive PCR result was significantly lower among patients who had used inadequate "first aid" measures (e.g. tourniquets or local application of remedies). This study is the first to report the use of forensic genetics methods for snake species identification in a prospective clinical study. If high diagnostic accuracy is confirmed in larger cohorts, this method will be a very useful reference diagnostic tool for epidemiological investigations and clinical studies.
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Affiliation(s)
| | - Ulrich Kuch
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Patrick Höde
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Laura Bruhse
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany
| | - Deb P. Pandey
- Senckenberg Biodiversity and Climate Research Centre (BiK-F), Frankfurt am Main, Germany
- Senckenberg Forschungsinstitut, Frankfurt am Main, Germany
| | - Anup Ghimire
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Emilie Alirol
- Division of Tropical and Humanitarian Medicine, University Hospitals of Geneva, Geneva, Switzerland
- Médecins Sans Frontières UK, London, United Kingdom
- * E-mail:
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