Journal Article > ResearchFull Text
Public Health Action. 25 April 2018; Volume 8 (Issue 1); DOI:10.5588/pha.17.0034
Mbokazi F, Coetzee M, Brooke B, Govere J, Reid A, et al.
Public Health Action. 25 April 2018; Volume 8 (Issue 1); DOI:10.5588/pha.17.0034
Background: The malaria vector Anopheles merus occurs in the Mpumalanga Province of South Africa. As its contribution to malaria transmission in South Africa has yet to be ascertained, an intensification of surveillance is necessary to provide baseline information on this species. The aim of this study was therefore to map An. merus breeding sites in the Ehlanzeni District of Mpumalanga Province and to assess qualitative trends in the distribution and relative abundance of this species over a 9-year period. Methods: The study was carried out during the period 2005-2014 in the four high-risk municipalities of Ehlanzeni District. Fifty-two breeding sites were chosen from all water bodies that produced anopheline mosquitoes. The study data were extracted from historical entomological records that are captured monthly. Results: Of the 15 058 Anopheles mosquitoes collected, 64% were An. merus. The abundance and distribution of An. merus increased throughout the four municipalities in Ehlanzeni District during the study period. Conclusion: The expanded distribution and increased abundance of An. merus in the Ehlanzeni District may contribute significantly to locally acquired malaria in Mpumalanga Province, likely necessitating the incorporation of additional vector control methods specifically directed against populations of this species.
Journal Article > ResearchFull Text
Trop Med Int Health. 19 May 2018; Volume 23 (Issue 7); 785-794.; DOI:10.1111/tmi.13078
Kuria N, Reid AJ, Owiti P, Tweya H, Kibet CK, et al.
Trop Med Int Health. 19 May 2018; Volume 23 (Issue 7); 785-794.; DOI:10.1111/tmi.13078
OBJECTIVE
To determine and compare, among three models of care, compliance with scheduled clinic appointments and adherence to antihypertensive medication of patients in an informal settlement of Kibera, Kenya.
METHODS
Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than 6 months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication.
RESULTS
A total of 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance with appointments of 63%. Compliance was high in the health facilities and walkway clinics, but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to antihypertensive medication than patients at the health facility (OR 1.97, 95% CI 1.25-3.10).
CONCLUSION
Walkway clinics outperformed health facilities and weekend clinics. The use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting.
To determine and compare, among three models of care, compliance with scheduled clinic appointments and adherence to antihypertensive medication of patients in an informal settlement of Kibera, Kenya.
METHODS
Routinely collected patient data were used from three health facilities, six walkway clinics and one weekend/church clinic. Patients were eligible if they had received hypertension care for more than 6 months. Compliance with clinic appointments and self-reported adherence to medication were determined from clinic records and compared using the chi-square test. Univariate and multivariate logistic regression models estimated the odds of overall adherence to medication.
RESULTS
A total of 785 patients received hypertension treatment eligible for analysis, of whom two-thirds were women. Between them, there were 5879 clinic visits with an overall compliance with appointments of 63%. Compliance was high in the health facilities and walkway clinics, but men were more likely to attend the weekend/church clinics. Self-reported adherence to medication by those complying with scheduled clinic visits was 94%. Patients in the walkway clinics were two times more likely to adhere to antihypertensive medication than patients at the health facility (OR 1.97, 95% CI 1.25-3.10).
CONCLUSION
Walkway clinics outperformed health facilities and weekend clinics. The use of multiple sites for the management of hypertensive patients led to good compliance with scheduled clinic visits and very good self-reported adherence to medication in a low-resource setting.
Journal Article > ReviewFull Text
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); S55-S57.
Gituma KS, Hussein S, Mwitari J, Kizito W, Edwards JK, et al.
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); S55-S57.
Journal Article > ResearchFull Text
Public Health Action. 21 March 2020; Volume 10 (Issue 1); DOI:10.5588/pha.19.0067
Moudachirou R, van Cutsem G, Chuy RI, Tweya H, Senkoro M, et al.
Public Health Action. 21 March 2020; Volume 10 (Issue 1); DOI:10.5588/pha.19.0067
Setting: In 2010, Médecins Sans Frontières set up decentralised community antiretroviral therapy (ART) refill centres ("poste de distribution communautaire", PODI) for the follow-up of stable human immunodeficiency virus (HIV) patients.
Objective: To assess retention in care and sustained viral suppression after transfer to three main PODI in Kinshasa, Democratic Republic of Congo (DRC) (PODI Barumbu/Central, PODI Binza Ozone/West and PODI Masina I/East).
Design: Retrospective cohort study using routine programme data for adult HIV patients transferred from Kabinda Hospital to PODIs between January 2015 and June 2017.
Results: A total of 337 patients were transferred to PODIs: 306 (91%) were on ART for at least 12 months; 118 (39%) had a routine "12-month" viral load (VL) done, 93% (n = 110) of whom had a suppressed VL <1000 copies/ml. Median time from enrolment into PODI to 12-month routine VL was 14.6 months (IQR 12.2-20.8). Kaplan-Meier estimates of retention in care at 6, 12 and 18 months after enrolment into PODIs were respectively 96%, 92% and 88%.
Conclusion: Retention in care and viral suppression among patients in PODI with VL results were better than patients in clinic care and national outcomes.
Objective: To assess retention in care and sustained viral suppression after transfer to three main PODI in Kinshasa, Democratic Republic of Congo (DRC) (PODI Barumbu/Central, PODI Binza Ozone/West and PODI Masina I/East).
Design: Retrospective cohort study using routine programme data for adult HIV patients transferred from Kabinda Hospital to PODIs between January 2015 and June 2017.
Results: A total of 337 patients were transferred to PODIs: 306 (91%) were on ART for at least 12 months; 118 (39%) had a routine "12-month" viral load (VL) done, 93% (n = 110) of whom had a suppressed VL <1000 copies/ml. Median time from enrolment into PODI to 12-month routine VL was 14.6 months (IQR 12.2-20.8). Kaplan-Meier estimates of retention in care at 6, 12 and 18 months after enrolment into PODIs were respectively 96%, 92% and 88%.
Conclusion: Retention in care and viral suppression among patients in PODI with VL results were better than patients in clinic care and national outcomes.
Journal Article > ResearchFull Text
Bull World Health Organ. 1 November 2007; Volume 85 (Issue 11); 851-857.; DOI:10.2471/blt.07.041434
Makombe SD, Jahn A, Tweya H, Chuka S, Yu JKL, et al.
Bull World Health Organ. 1 November 2007; Volume 85 (Issue 11); 851-857.; DOI:10.2471/blt.07.041434
OBJECTIVE
To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves.
METHODS
We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system.
FINDINGS
By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level.
CONCLUSION
A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.
To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves.
METHODS
We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system.
FINDINGS
By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level.
CONCLUSION
A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.
Journal Article > ResearchFull Text
AIDS. 10 September 2009; Volume 23 (Issue 14); 1867-74.; DOI:10.1097/QAD.0b013e32832e05b2
Keiser O, Tweya H, Boulle AM, Braitstein P, Schechter M, et al.
AIDS. 10 September 2009; Volume 23 (Issue 14); 1867-74.; DOI:10.1097/QAD.0b013e32832e05b2
BACKGROUND
In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia.
DESIGN AND METHODS
Multicohort study of 17 ART programmes. All sites monitored CD4 cell count and had access to second-line ART and 10 sites monitored viral load. We compared times to switching, CD4 cell counts at switching and obtained adjusted hazard ratios for switching (aHRs) with 95% confidence intervals (CIs) from random-effects Weibull models.
RESULTS
A total of 20 113 patients, including 6369 (31.7%) patients from 10 programmes with access to viral load monitoring, were analysed; 576 patients (2.9%) switched. Low CD4 cell counts at ART initiation were associated with switching in all programmes. Median time to switching was 16.3 months [interquartile range (IQR) 10.1-26.6] in programmes with viral load monitoring and 21.8 months (IQR 14.0-21.8) in programmes without viral load monitoring (P < 0.001). Median CD4 cell counts at switching were 161 cells/microl (IQR 77-265) in programmes with viral load monitoring and 102 cells/microl (44-181) in programmes without viral load monitoring (P < 0.001). Switching was more common in programmes with viral load monitoring during months 7-18 after starting ART (aHR 1.38; 95% CI 0.97-1.98), similar during months 19-30 (aHR 0.97; 95% CI 0.58-1.60) and less common during months 31-42 (aHR 0.29; 95% CI 0.11-0.79).
CONCLUSION
In resource-limited settings, switching to second-line regimens tends to occur earlier and at higher CD4 cell counts in ART programmes with viral load monitoring compared with programmes without viral load monitoring.
In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia.
DESIGN AND METHODS
Multicohort study of 17 ART programmes. All sites monitored CD4 cell count and had access to second-line ART and 10 sites monitored viral load. We compared times to switching, CD4 cell counts at switching and obtained adjusted hazard ratios for switching (aHRs) with 95% confidence intervals (CIs) from random-effects Weibull models.
RESULTS
A total of 20 113 patients, including 6369 (31.7%) patients from 10 programmes with access to viral load monitoring, were analysed; 576 patients (2.9%) switched. Low CD4 cell counts at ART initiation were associated with switching in all programmes. Median time to switching was 16.3 months [interquartile range (IQR) 10.1-26.6] in programmes with viral load monitoring and 21.8 months (IQR 14.0-21.8) in programmes without viral load monitoring (P < 0.001). Median CD4 cell counts at switching were 161 cells/microl (IQR 77-265) in programmes with viral load monitoring and 102 cells/microl (44-181) in programmes without viral load monitoring (P < 0.001). Switching was more common in programmes with viral load monitoring during months 7-18 after starting ART (aHR 1.38; 95% CI 0.97-1.98), similar during months 19-30 (aHR 0.97; 95% CI 0.58-1.60) and less common during months 31-42 (aHR 0.29; 95% CI 0.11-0.79).
CONCLUSION
In resource-limited settings, switching to second-line regimens tends to occur earlier and at higher CD4 cell counts in ART programmes with viral load monitoring compared with programmes without viral load monitoring.
Journal Article > ResearchFull Text
Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya
East Afr Med J. 1 October 2016
Mbuli CW, Waqo E, Owiti P, Tweya H, Kizito W, et al.
East Afr Med J. 1 October 2016
Journal Article > CommentaryFull Text
BMJ Glob Health. 8 February 2019; Volume 4 (Issue 1); e001334.; DOI:10.1136/bmjgh-2018-001334
Addisu A, Adriaensen W, Balew A, Asfaw M, Diro EGJ, et al.
BMJ Glob Health. 8 February 2019; Volume 4 (Issue 1); e001334.; DOI:10.1136/bmjgh-2018-001334
SUMMARY BOX
The international community has pledged through the Sustainable Development Goals to eliminate neglected tropical diseases by 2030.
Authors from 19 institutions around the world call for urgent reflection and a change in mind-set to garner support and hasten progress towards achieving this fast approaching target.
They advocate for an empowering approach that will propel political momentum, milestones and targets for accountability, new science in drug development and increased funding particularly from G20 countries.
The international community has pledged through the Sustainable Development Goals to eliminate neglected tropical diseases by 2030.
Authors from 19 institutions around the world call for urgent reflection and a change in mind-set to garner support and hasten progress towards achieving this fast approaching target.
They advocate for an empowering approach that will propel political momentum, milestones and targets for accountability, new science in drug development and increased funding particularly from G20 countries.
Journal Article > ResearchFull Text
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); Supplement.
Nganga M, Matendechero S, Kariuki L, Omondi W, Makworo N, et al.
East Afr Med J. 1 October 2016; Volume 93 (Issue 10); Supplement.
BACKGROUND
Soil-transmitted helminthiases cause a substantial yet under-appreciated public health burden. School age children harbour the heaviest burden. Infected children experience growth stunting and diminished physical fitness as well as impaired memory and cognition. These adverse health consequences impair educational performance, and reduce school attendance. Determination of the burden is central to designing and implementing appropriate interventions.
OBJECTIVE
To determine the burden of soil-transmitted helminthiases among primary school children in Migori County, Kenya.
DESIGN
Descriptive cross-sectional study.
SETTING
Primary schools in Migori County.
SUBJECTS
Children aged between seven and fourteen years.
RESULTS
Overall, 17% of the children were diagnosed with soil-transmitted helminthiases. Ascaris lumbricoides infections were the most common (9%) followed by hookworm (7%) and Trichuris trichiura infections (3%). Hookworm prevalence was highest in the older children while A. lumbricoides infections were highest in younger children. Further, more boys than girls harboured hookworm infections (p<0.001). Hookworm-A. lumbricoides, hookworm-T. trichiura and A. lumbricoides-T. trichiura coinfections were observed in 2, 3 and 7% of the children respectively. Two children (1%) were infected with all three helminth infections. Majority of the infection were of light intensity. In 12 (39%) of the 31 sampled schools, the prevalence of helminthiasis was above 20%.
CONCLUSION
Soil transmitted helminthiases is still prevalent in the study area. Our findings also strongly suggest that deworming alone will not eliminate these infections. This may suggest a need to take a more comprehensive approach that incorporates, among other activities, improvement in sanitation and intensification of public health campaigns.
Soil-transmitted helminthiases cause a substantial yet under-appreciated public health burden. School age children harbour the heaviest burden. Infected children experience growth stunting and diminished physical fitness as well as impaired memory and cognition. These adverse health consequences impair educational performance, and reduce school attendance. Determination of the burden is central to designing and implementing appropriate interventions.
OBJECTIVE
To determine the burden of soil-transmitted helminthiases among primary school children in Migori County, Kenya.
DESIGN
Descriptive cross-sectional study.
SETTING
Primary schools in Migori County.
SUBJECTS
Children aged between seven and fourteen years.
RESULTS
Overall, 17% of the children were diagnosed with soil-transmitted helminthiases. Ascaris lumbricoides infections were the most common (9%) followed by hookworm (7%) and Trichuris trichiura infections (3%). Hookworm prevalence was highest in the older children while A. lumbricoides infections were highest in younger children. Further, more boys than girls harboured hookworm infections (p<0.001). Hookworm-A. lumbricoides, hookworm-T. trichiura and A. lumbricoides-T. trichiura coinfections were observed in 2, 3 and 7% of the children respectively. Two children (1%) were infected with all three helminth infections. Majority of the infection were of light intensity. In 12 (39%) of the 31 sampled schools, the prevalence of helminthiasis was above 20%.
CONCLUSION
Soil transmitted helminthiases is still prevalent in the study area. Our findings also strongly suggest that deworming alone will not eliminate these infections. This may suggest a need to take a more comprehensive approach that incorporates, among other activities, improvement in sanitation and intensification of public health campaigns.
Journal Article > ResearchFull Text
East Afr Med J. 1 October 2016
Owiti P, Kosgei RJ, Ogutu O, Kizito W, Edwards JK, et al.
East Afr Med J. 1 October 2016