Journal Article > ResearchFull Text
Glob Health Action. 25 April 2024; Volume 17 (Issue 1); 2331291.; DOI:10.1080/16549716.2024.2331291
Caleo G, Lokuge K, Kardamanidis K, Greig J, Belava J, et al.
Glob Health Action. 25 April 2024; Volume 17 (Issue 1); 2331291.; DOI:10.1080/16549716.2024.2331291
BACKGROUND
There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.
OBJECTIVES
The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.
METHODS
We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.
RESULTS
Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.
CONCLUSION
Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.
There is a lack of empirical data on design effects (DEFF) for mortality rate for highly clustered data such as with Ebola virus disease (EVD), along with a lack of documentation of methodological limitations and operational utility of mortality estimated from cluster-sampled studies when the DEFF is high.
OBJECTIVES
The objectives of this paper are to report EVD mortality rate and DEFF estimates, and discuss the methodological limitations of cluster surveys when data are highly clustered such as during an EVD outbreak.
METHODS
We analysed the outputs of two independent population-based surveys conducted at the end of the 2014-2016 EVD outbreak in Bo District, Sierra Leone, in urban and rural areas. In each area, 35 clusters of 14 households were selected with probability proportional to population size. We collected information on morbidity, mortality and changes in household composition during the recall period (May 2014 to April 2015). Rates were calculated for all-cause, all-age, under-5 and EVD-specific mortality, respectively, by areas and overall. Crude and adjusted mortality rates were estimated using Poisson regression, accounting for the surveys sample weights and the clustered design.
RESULTS
Overall 980 households and 6,522 individuals participated in both surveys. A total of 64 deaths were reported, of which 20 were attributed to EVD. The crude and EVD-specific mortality rates were 0.35/10,000 person-days (95%CI: 0.23-0.52) and 0.12/10,000 person-days (95%CI: 0.05-0.32), respectively. The DEFF for EVD mortality was 5.53, and for non-EVD mortality, it was 1.53. DEFF for EVD-specific mortality was 6.18 in the rural area and 0.58 in the urban area. DEFF for non-EVD-specific mortality was 1.87 in the rural area and 0.44 in the urban area.
CONCLUSION
Our findings demonstrate a high degree of clustering; this contributed to imprecise mortality estimates, which have limited utility when assessing the impact of disease. We provide DEFF estimates that can inform future cluster surveys and discuss design improvements to mitigate the limitations of surveys for highly clustered data.
Journal Article > ResearchFull Text
J. Affect. Disord.. 18 February 2023; Volume 12; 100503.; DOI:10.1016/j.jadr.2023.100503
Carter SE, Sadiq S, Calear AL, Housen TSS, Joshy G, et al.
J. Affect. Disord.. 18 February 2023; Volume 12; 100503.; DOI:10.1016/j.jadr.2023.100503
BACKGROUND
Complex humanitarian emergencies have a significant negative impact on the prevalence and severity of child mental health. The capacity of primary caregivers to provide care to their children is often adversely affected. There is a lack of evidence-based interventions to guide primary caregivers. This study assessed the feasibility and acceptability of implementing and evaluating a caregiver group counselling intervention, and provided an indication of its potential benefits.
METHODS
A single arm pilot study was conducted in Northern Iraq. Primary caregivers of a child aged 8-12 years with concern about their child's mental health attended the caregiver group intervention. Quantitative and qualitative outcome measures were completed by caregivers and children at pre-intervention, post-intervention, and 12-week follow-up.
RESULTS
The intervention was found to be feasible and acceptable to implement. Twelve participants were recruited, of which ten started the intervention and eight completed the intervention. All eight participants reported finding the intervention helpful. Evaluation of the intervention was found to be feasible and acceptable. Indicative results showed potential improvements across child and caregiver mental health.
LIMITATIONS
Limitations are that the small sample size limits the range of perspectives, lack of control group means observed changes could be due to factors other than the intervention, and potential bias exists due to self-completed fidelity monitoring and possible response bias.
CONCLUSIONS
The caregiver group intervention was feasible and acceptable to implement and evaluate in a humanitarian setting, and showed potential to positively impact child and caregiver mental health, warranting further research on its effectiveness.
Complex humanitarian emergencies have a significant negative impact on the prevalence and severity of child mental health. The capacity of primary caregivers to provide care to their children is often adversely affected. There is a lack of evidence-based interventions to guide primary caregivers. This study assessed the feasibility and acceptability of implementing and evaluating a caregiver group counselling intervention, and provided an indication of its potential benefits.
METHODS
A single arm pilot study was conducted in Northern Iraq. Primary caregivers of a child aged 8-12 years with concern about their child's mental health attended the caregiver group intervention. Quantitative and qualitative outcome measures were completed by caregivers and children at pre-intervention, post-intervention, and 12-week follow-up.
RESULTS
The intervention was found to be feasible and acceptable to implement. Twelve participants were recruited, of which ten started the intervention and eight completed the intervention. All eight participants reported finding the intervention helpful. Evaluation of the intervention was found to be feasible and acceptable. Indicative results showed potential improvements across child and caregiver mental health.
LIMITATIONS
Limitations are that the small sample size limits the range of perspectives, lack of control group means observed changes could be due to factors other than the intervention, and potential bias exists due to self-completed fidelity monitoring and possible response bias.
CONCLUSIONS
The caregiver group intervention was feasible and acceptable to implement and evaluate in a humanitarian setting, and showed potential to positively impact child and caregiver mental health, warranting further research on its effectiveness.
Conference Material > Slide Presentation
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/pyhg-f359
Conference Material > Abstract
Lavilla KM, Teal J, Schausberger B, Sankoh M, Conteh AB, et al.
MSF Scientific Days International 2022. 11 May 2022; DOI:10.57740/8sd6-2h56
INTRODUCTION
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.
MSF and the MoHS implemented a partnership model of free and accessible maternal and child healthcare at primary and hospital-level health facilities in Tonkolili District, Sierra Leone, in order to reduce barriers to care and improve health outcomes. We conducted a health-seeking behaviour (HSB) study in 2021 to evaluate impact and change since a previous HSB study conducted in 2016/17. We also compared MSF-supported primary health unit (PHU) catchment areas with MSF-unsupported PHU’s. In addition, we explored adolescent reproductive health, family planning, and female genital mutilation (FGM).
METHODS
Study design was mixed-methods, similar to that used in 2016/17, including a quantitative household survey, structured interviews with key informants, and qualitative in-depth interviews (IDI’s). We randomly selected 60 clusters; 30 in MSF-supported areas, and 30 in unsupported areas. IDI’s explored topics identified through the survey, and were conducted with purposively-sampled participants, and analyzed thematically.
ETHICS
This study was approved by the Sierra Leone Ethical and Scientific Review Committee and by the MSF Ethics Review Board
RESULTS
Between February and August 2021, 1,164 women and 1,177 carers (of 1,559 children aged under 5) participated in the survey; 59 structured interviews and 42 IDI’s were conducted. Compared to the 2016/17 study, access to healthcare improved, with the proportion of women delivering in a health facility increasing from 52.0% (95% confidence intervals (CI) 42-64) to 90.9% (95% CI 89.2-92.5), and the proportion of mothers reporting at least one barrier to accessing care decreasing from 90.0% (95% CI 80-95) to 45.9% (95% CI 43.0-48.8). Outcomes of care also improved over this period, with under-5 mortality decreasing from 1.55 per 10,0000/day (95% CI 1.30-1.86) to 0.25 per 10,000/day (95% CI 0.17-0.36).When comparing unsupported PHU’s versus supported areas in 2021, complications during labour or delivery were higher in unsupported areas (10.9%; 95% CI 8.6-13.6) vs 7.2% (95% CI 5.3-9.7), as was stillbirth (4.5%; 95% CI 3.1-6.5) vs 1.4% (95% CI 0.6-2.8). Under-5 mortality was 0.44 per 10,000/day (95% CI 2.4-7.2) in unsupported areas and 0.17 per 10,000/day (95% CI 0.8-2.9) in supported areas. 42.9% (95% CI 34.7-51.4) of adolescents in unsupported areas and 39.7% (95% CI 31.3- 48.7) in supported areas reported unmet need for contraception. More than 90% (96.6%, 95% CI 95.3-97.5) of women reported FGM. Qualitative data suggests that communities recognized the importance of delivering in a health facility with trained assistance. Nevertheless, health staff and community members felt the current fine system for home births was applied inflexibly in circumstances when distance, transport, or cost restricted or delayed access.
CONCLUSION
Since 2016/17, access to healthcare and outcomes have improved in all areas, but improvement has been greatest in areas where, in addition to hospital care, MSF supported MoHS PHU’s. This provides evidence for ongoing implementation and scale-up of comprehensive models of care. Progress made must not overshadow areas requiring further attention, such as care for adolescents, access to contraception, and the need to reduce stillbirths.
CONFLICTS OF INTEREST
None declared.
Protocol > Research Protocol
Elston JWT, Snag S, Kazungu DS, Jimissa A, Caleo GNC, et al.
1 July 2018
To describe health seeking behaviour during pregnancy, for childbirth and in children under the age of five years, and to identify barriers to accessing and receiving healthcare services at the time of the study and since the start of the Ebola outbreak in an urban and rural area of Tonkolili District.
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
PRIMARY OBJECTIVES
1. To estimate utilisation of health facilities by women for childbirth in Magburaka town and Yoni chiefdom since the start of the Ebola outbreak ;
2. To estimate utilisation of healthcare services by children aged <5 years in Magburaka town and Yoni chiefdom during their most recent febrile illness within the three month period preceding the day of the survey.
3. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare during pregnancy and for childbirth
4. To identify and describe factors influencing utilisation of health services and delays in seeking and receiving adequate healthcare for febrile illness in children aged <5 years
Protocol > Research Protocol
Verputten M, Siddiqui R, Gray NSB, Casimir CF, Finaldi P, et al.
1 July 2018
2 Research question and objectives
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
2.1 Research question
To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Port-au-Prince, Haiti
2.2 Primary objective
To understand how to improve utilization of SGBV services for the population in MSF catchment area Port-au-Prince, Haiti
2.3 Specific objectives
1. To understand community knowledge related to SGBV, including its causes, consequences, treatment and services
2. To understand attitudes towards SGBV
3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake
4. To understand which strategies/activities people consider would be effective in improving uptake of SGBV services
5. To understand which strategies/activities people consider would be effective in preventing SGBV
Protocol > Research Protocol
Shah T, Caleo GNC, Lokuge K
16 December 2015
1. To describe the source case for children
2. To describe the viral load at presentation
3. To document the intervals between symptom onset and presentation for those who die and those who survive
4. To describe early symptoms of Ebola virus disease
5. To assess the association between risk factors and death
2. To describe the viral load at presentation
3. To document the intervals between symptom onset and presentation for those who die and those who survive
4. To describe early symptoms of Ebola virus disease
5. To assess the association between risk factors and death
Journal Article > ResearchFull Text
BMC Public Health. 13 February 2018; Volume 18 (Issue 1); DOI:10.1186/s12889-018-5158-6
Caleo GNC, Duncombe J, Jephcott F, Lokuge K, Mills C, et al.
BMC Public Health. 13 February 2018; Volume 18 (Issue 1); DOI:10.1186/s12889-018-5158-6
Little is understood of Ebola virus disease (EVD) transmission dynamics and community compliance with control measures over time. Understanding these interactions is essential if interventions are to be effective in future outbreaks. We conducted a mixed-methods study to explore these factors in a rural village that experienced sustained EVD transmission in Kailahun District, Sierra Leone.
Journal Article > ResearchFull Text
PLOS One. 1 May 2017 (Issue 5)
Theocharopoulos G, Danis K, Greig J, Hoffmann A, De Valk H, et al.
PLOS One. 1 May 2017 (Issue 5)
Between August-December 2014, Ebola Virus Disease (EVD) patients from Tonkolili District were referred for care to two Médecins Sans Frontières (MSF) Ebola Management Centres (EMCs) outside the district (distant EMCs). In December 2014, MSF opened an EMC in Tonkolili District (district EMC). We examined the effect of opening a district-based EMC on time to admission and number of suspect cases dead on arrival (DOA), and identified factors associated with fatality in EVD patients, residents in Tonkolili District. Residents of Tonkolili district who presented between 12 September 2014 and 23 February 2015 to the district EMC and the two distant EMCs were identified from EMC line-lists. EVD cases were confirmed by a positive Ebola PCR test. We calculated time to admission since the onset of symptoms, case-fatality and adjusted Risk Ratios (aRR) using Binomial regression. Of 249 confirmed Ebola cases, 206 (83%) were admitted to the distant EMCs and 43 (17%) to the district EMC. Of them 110 (45%) have died. Confirmed cases dead on arrival (n = 10) were observed only in the distant EMCs. The median time from symptom onset to admission was 6 days (IQR 4,8) in distant EMCs and 3 days (IQR 2,7) in the district EMC (p<0.001). Cases were 2.0 (95%CI 1.4-2.9) times more likely to have delayed admission (>3 days after symptom onset) in the distant compared with the district EMC, but were less likely (aRR = 0.8; 95%CI 0.6-1.0) to have a high viral load (cycle threshold ≤22). A fatal outcome was associated with a high viral load (aRR 2.6; 95%CI 1.8-3.6) and vomiting at first presentation (aRR 1.4; 95%CI 1.0-2.0). The opening of a district EMC was associated with earlier admission of cases to appropriate care facilities, an essential component of reducing EVD transmission. High viral load and vomiting at admission predicted fatality. Healthcare providers should consider the location of EMCs to ensure equitable access during Ebola outbreaks.
Protocol > Research Protocol
Caleo GNC, Kardamanidis K, Broeder R, Belava J, Kremer R, et al.
1 July 2018
2. Objectives
2.1. Primary objectives
The Primary objective of the survey is to:
Estimate mortality in a sample of the population in the urban and rural area of Bo District from the approximate start of the Ebola outbreak in Sierra Leone (mid May 2014) until the day of the survey.
2.2. Secondary objectives
Estimate overall and cause-specific mortality (EVD and non-EVD) in children under the age of 5 years, and the population aged 5 years and older within the study area, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Bo district (19 September 2014) and the period during which it was receiving cases from the district (last confirmed case exited 26 January 2015);
Estimate overall and cause-specific mortality (EVD and non-EVD) in quarantined and non-quarantined households; and contact-traced and non-contact-traced households;
Describe health seeking behaviour in terms of whether health care was sought, where health care was sought and whether access to health care was possible.
2.1. Primary objectives
The Primary objective of the survey is to:
Estimate mortality in a sample of the population in the urban and rural area of Bo District from the approximate start of the Ebola outbreak in Sierra Leone (mid May 2014) until the day of the survey.
2.2. Secondary objectives
Estimate overall and cause-specific mortality (EVD and non-EVD) in children under the age of 5 years, and the population aged 5 years and older within the study area, with particular attention to the period prior to the MSF Ebola Management Centre (EMC) opening in Bo district (19 September 2014) and the period during which it was receiving cases from the district (last confirmed case exited 26 January 2015);
Estimate overall and cause-specific mortality (EVD and non-EVD) in quarantined and non-quarantined households; and contact-traced and non-contact-traced households;
Describe health seeking behaviour in terms of whether health care was sought, where health care was sought and whether access to health care was possible.