Treatment Coverage Research Articles

Prevalence of malaria-helminth co-infections among children living in a setting of high coverage of standard interventions for malaria and helminths: Two population-based studies in Senegal.

Concurrent infections of Plasmodium falciparum with Soil Transmitted Helminths (STH) and Schistosoma spp are still a major public health problem among children living in Sub-Saharan Africa. We conducted two prospective studies among children living in urban and rural settings of Senegal, where control programmes for malaria, STH and schistosomiasis have been sustained, to determine the prevalence of malaria-helminth co-infection. We enrolled 910 children aged 1-14 years from Saraya and Diourbel districts of Senegal in June and November 2021, respectively. We collected finger-prick blood samples from the children for malaria parasite detection using microscopy and PCR methods. Stool samples were also collected and Kato-Katz and PCR methods were used to detect STH and S. mansoni; and Merthiolate-iodine-formalin (MIF) test for other intestinal protozoans. Urine samples were analyzed using a filtration test, Point of Care Circulating Cathodic Antigens (POC-CCA) and PCR methods for detection of S. haematobium. Statistical analyses were performed to compare the continuous and categorical variables across the two study sites and age groups, as well as using the adjusted Odds ratios (aOR) to explore risk factors for malaria-helminth co-infections. The overall prevalence of polyparasitism with P. falciparum, STH, S. haematobium and S. mansoni among children in the two study sites was 2.2% (20/910) while prevalence of P. falciparum-S. haematobium co-infection was 1.1% (10/910); P. falciparum-S. mansoni 0.7% (6/910) and P. falciparum with any intestinal protozoan 2.4% (22/910). Co-infection was slightly higher among 5-14 year old children (17/629, 2.7%; 95% CI: 1.43-3.97) than 1-4 years (3/281, 1.1%; 95% CI: -0.12-2.32) and, in boys (13/567, 2.3%; 95% CI: 1.27-3.96) than girls (7/343, 2.1%; 95% CI: 0.52-3.48). Children aged 5-14 years (aOR = 3.37; 95% CI: 0.82-13.77, p = 0.09), who were boys (aOR = 1.44; 95% CI: 0.48-4.36, p = 0.51) and lived in Saraya (aOR = 1.27; 95% CI: 0.24-6.69, p = 0.77) had a higher risk of malaria-helminth co-infection than other age group, in girls and those who lived in Diourbel. Living in houses with spaces between the walls and roofs as well as frequent contacts with water during swimming were statistically significant risk factors for malaria-helminth co-infection. The prevalence of malaria-helminth co-infection is low in two districts in Senegal, possibly due to sustained implementation of effective control measures for malaria and NTDs. These findings could help to develop and implement strategies that would lead to elimination of malaria and helminths in the study areas.

Persistent Malnutrition among Children under five in Pastoral Communities of Aweil Centre, South Sudan

Malnutrition is one of the leading causes of morbidity and mortality among children globally, and has been linked to 60% of the 10.9M deaths annually of under-fives. High prevalence of infectious diseases contributes to malnutrition and vice versa making the situation even worse. In WHO’s African region, the median stunting prevalence is 31.3%.
 The worst scenarios are seen in the war tone countries; for example Aweil Center of South Sudan has consistently high malnutrition rates despite running nutrition projects by UN agencies, government and other partners with relative stability. Results from Survey carried out in 2013 indicated poverty levels at 76%, severe acute malnutrition (SAM) prevalence rate of 6.3% (95% CI, 4.5-8.9), Global acute malnutrition (GAM) rate of 22.4% (95% CI, 17.8-27.7) with under five mortality rate of 152 deaths/ 1,000 live births.
 A cross-sectional study with two-stage cluster sampling method done to determine the associated factors of malnutrition among children 6-59 months in Aweil Center County. The results showed high burden of infectious diseases like fever, diarrhea, eye, skin and respiratory tract infections at 94.5% with p-value 0.00022 (95%C.I, 0.1667-0.291). Very low household dietary diversity score of only 24 % (125out of 513 families). There was low coverage of primary health care interventions; e.g. Vitamin A, LLITN and measles vaccinations at 53%, 52.8% and 55% respectively. Accessibility to CBDs for iCCM associated with better nutrition status of children p-value 0.032 and OR 0.62 (95% CI 0.41-0.94). Poor feeding methods, family planning practices; and poor access roads to markets impact on nutrition status of children.
 Multifaceted approach is needed to root out the persistent malnutrition from Aweil Center: Shift from food aid to support of food production, scale up of primary health care and iCCM interventions to include IPT for malnourished children and community awareness on feeding practices and family planning

Stigma toward psychosis in urban Chile: Engaging "what matters most" to resist stigma through recovery-oriented services.

Stigma jeopardizes recovery and successful implementation of mental health services (MHS) globally. Despite cultural variation in how stigma manifests, few studies have examined how culture fundamentally impacts the concept of "personhood" in Latin America. Chile has expanded MHS, providing universal coverage for evaluation and treatment of first episode psychosis (FEP). We applied the "what matters most" (WMM) framework of stigma to identify culturally salient factors that shape or protect against stigma in urban Chile, identifying potential implications for MHS and recovery. In-depth interviews (n = 48) were conducted with MHS users with psychotic disorders (n = 18), their family members (n = 15), and community members (n = 15), from two urban regions in Chile. Interviews were coded and analyzed to identify WMM, how WMM shapes stigma, and how MHS can influence achieving WMM. Traditional values emphasizing physical/social appearance, gender roles, family, and social connectedness are highly valued. Socioeconomic transitions have engendered capitalistic variations on traditional values, with increasing emphasis on professional careers for men and women, individualism, and independence. Psychotic disorders interfere with fulfillment of both traditional and capitalist values, thereby reinforcing stigma. However, MHS are seen as partially effective in enabling fulfillment of some goals, including employment, appearance, and independence, while often remaining insufficient in enabling capacity to achieve marriage and having a family. MHS that facilitate recovery by engaging users in services, such as pharmacotherapy, education/vocational rehabilitation, and family-centered care aligned with cultural values can mitigate stigma and facilitate recovery by enabling users to fulfill WMM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Managers' and providers' perspectives on barriers and facilitators for the implementation of differentiated service delivery models for HIV treatment in Mozambique: a qualitative study.

In 2018, Mozambique's Ministry of Health launched a guideline for a nationwide implementation of eight differentiated service delivery models to optimize HIV service delivery and achieve universal coverage of HIV care and treatment. The models were (1) Fast-track, (2) Three-month Antiretrovirals Dispensing, (3) Community Antiretroviral Therapy Groups, (4) Adherence Clubs, (5) Family-approach, and three one-stop shop models for (6) Tuberculosis, (7) Maternal and Child Health, and (8) Adolescent-friendly Health Services. This study identified drivers of implementation success and failure across these differentiated service delivery models. Twenty in-depth individual interviews were conducted with managers and providers from the Ministry of Health and implementing partners from all levels of the health system between July and September 2021. National-level participants were based in the capital city of Maputo, and participants at provincial, district and health facility levels were from Sofala province, a purposively selected setting. The Consolidated Framework for Implementation Research (CFIR) guided data collection and thematic analysis. Deductively selected constructs were assessed while allowing for additional themes to emerge inductively. The CFIR constructs of Relative Advantage, Complexity, Patient Needs and Resources, and Reflecting and Evaluating were identified as drivers of implementation, whereas Available Resources and Access to Knowledge and Information were identified as barriers. Fast-track and Three-month Antiretrovirals Dispensing models were deemed easier to implement and more effective in reducing workload. Adherence Clubs and Community Antiretroviral Therapy Groups were believed to be less preferred by clients in urban settings. COVID-19 (an inductive theme) improved acceptance and uptake of individual differentiated service delivery models that reduced client visits, but it temporarily interrupted the implementation of group models. This study described important determinants to be addressed or leveraged for the successful implementation of differentiated service delivery models in Mozambique. The models were considered advantageous overall for the health system and clients when compared with the standard of care. However, successful implementation requires resources and ongoing training for frontline providers. COVID-19 expedited individual models by loosening the inclusion criteria; this experience can be leveraged to optimize the design and implementation of differentiated service delivery models in Mozambique and other countries.

Protocol and statistical analysis plan for the Antibiotic Choice On ReNal outcomes (ACORN) randomised clinical trial

IntroductionAntibiotics are time-critical in the management of sepsis. When infectious organisms are unknown, patients are treated with empiric antibiotics to include coverage for gram-negative organisms, such as antipseudomonal cephalosporins and...

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 10. Summary, cost effectiveness, and policy implications

BackgroundThis is the final of 10 papers that describe the implementation of the Expanded Census-Based, Impact-Oriented Approach (CBIO+) by Curamericas/Guatemala in the Cuchumatanes mountains of the Department of Huehuetenango and its effectiveness in improving the health and well-being of women and children in a population of 98,000 in three municipalities. The CBIO+ Approach consists of three components: the CBIO (Census-Based, Impact-Oriented) Approach, the Care Group Approach, and the Community Birthing Center Approach.MethodsEach of the preceding papers was summarized. An assessment was made regarding the degree to which the initial implementation research hypotheses were confirmed. The total field cost per capita for operation of the Project was calculated. An assessment of the cost-effectiveness of the Project was made based on the estimated impact of the Project, the number of lives saved, and the number of disability-adjusted life years averted.ResultsThe Project attained a number of notable achievements in terms of expanding the coverage of key maternal and child health interventions, improving the nutritional status of children, reducing the mortality of children and mothers, providing quality care for mothers at the Community Birthing Centers (Casas Maternas Rurales) that integrate traditional midwives (comadronas) into the care of women during childbirth at the birthing centers, as well as empowering women and building social capital in the communities. CBIO+ is an effective and affordable approach that is particularly notable for its capacity to engage communities in the process of improving the health of mothers and children. Overall, there is strong and consistent evidence in support of the research hypotheses. The findings did produce evidence of declines in under-5 and maternal mortality, but they were not as robust as had been hoped.ConclusionCBIO+ is an approach that has been effective in engaging communities in the process of improving the health of their mothers and children and in reducing health inequities in this marginalized, difficult-to-reach population of Indigenous Maya people. The CBIO+ Approach is cost-effective and merits further development and broader application in Guatemala and beyond.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 3. Expansion of population coverage of key interventions

BackgroundThis is the third in a series of 10 articles describing the Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, and its effectiveness in improving the health and well-being of 15,327 children younger than 5 years of age and 32,330 women of reproductive age in the Department of Huehuetenango in180 communities that make up the municipalities of San Sebastian Coatán, Santa Eulalia, and San Miguel Acatán. The Project combined the Census-Based, Impact-Oriented (CBIO) Approach with the Care Group Approach and the Community Birthing Center (Casa Materna Rural) Approach. This combined approach we refer to as CBIO+. The Project trained women volunteers every two weeks (in Care Groups) to provide health education to neighboring households. Messages focused on the promotion of maternal and newborn health, nutrition, prevention and treatment of acute respiratory infection and diarrhea in children, and immunizations.MethodsHousehold knowledge, practice and coverage (KPC) surveys were executed at baseline in January 2011 and at endline in June 2015 to measure changes in levels of knowledge of danger signs, key household practices (such as Essential Newborn Care and handwashing), and health service utilization (such as antenatal care and care seeking for a child with signs of pneumonia) in two separate Project Areas (Area A with 41 months and Area B with 20 months of full intervention implementation).ResultsFor the 24 indicators of the interventions under the Project’s control, statistically significant improvements were observed for 21 in Area A and 19 in Area B. However, for some of the interventions that required support from the government's Extension of Coverage Program (immunization, family planning, and vitamin A administration) no improvements were noted because of the cessation of the program by the government after Project implementation began. In both Areas A and B one-half of the indicators improved by at least two-fold.ConclusionThis community-based Project has been effective in quickly achieving marked improvements in indicators for interventions that are important for the health of mothers and children. These achievements are notable in view of the challenging context in which the Project was implemented.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ approach of Curamericas: 2. Study site, design, and methods

BackgroundThe Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, included implementation research designed to assess the effectiveness of an approach referred to as CBIO+ , composed of: (1) the Census-Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. This is the second paper in a supplement of 10 articles describing the implementation research and its findings. Paper 1 describes CBIO+ , the Project Area, and how the Project was implemented.ObjectiveThis paper describes the implementation research design and details of how it was carried out.MethodsWe reviewed the original implementation research protocol and the methods used for all data collection related to this Project. The protocol and methods used for the implementation research related to this Project were all standard approaches to the monitoring and evaluation of child survival projects as developed by the United States Agency for International Development Child Survival and Health Grants Program (CSHGP) and the CORE Group. They underwent independent peer review supervised by the CSHGP before the implementation research began.ResultsThe study area was divided into two sets of communities with a total population of 98,000 people. Project interventions were implemented in Area A from 2011 until the end of the project in 2015 (44 months) and in Area B from late 2013 until 2015 (20 months). Thus, Area B served as a quasi-comparison area during the first two years of Project implementation. The overarching study question was whether the CBIO+ Approach improved the health and well-being of children and mothers. The outcome indicators included (1) changes in population coverage of evidence-based interventions, (2) changes in childhood nutritional status, (3) changes in the mortality of children and mothers, (4) quality of care provided at Community Birthing Centers, (5) the impact of the Project on women’s empowerment and social capital, (6) stakeholder assessment of the effectiveness of the CBIO+ Approach, and (7) the potential of wider adoption of the CBIO+ Approach.ConclusionThe implementation research protocol guided the assessment of the effectiveness of the CBIO+ Approach in improving the health and well-being of children, mothers, and their communities.

Accelerating the prevention, control and elimination of communicable diseases through integration and optimization of the support from Gavi and Global Fund: A vision for the Eastern Mediterranean Region

Over the years, the Eastern Mediterranean Region (EMR) has faced a funding gap with respect to malaria, tuberculosis (TB), HIV, and vaccine-preventable diseases programmes. In the early 2000s, Gavi, the Vaccine Alliance (Gavi) and the Global Fund against AIDS, TB and Malaria (GFATM) became important financial contributors to these programmes. In 2000-2015, funding support from these two global health initiatives allowed progress. However, from 2015, coverage of interventions plateaued, and the region is now behind on the related Sustainable Development Goal (SDG) targets.

Effective Coverage in Health Systems: Evolution of a Concept.

The manner in which high-impact, life-saving health interventions reach populations in need is a critical dimension of health system performance. Intervention coverage has been a standard metric for such performance. To better understand and address the decay of intervention effectiveness in real-world health systems, the more complex measure of "effective coverage" is required, which includes the health gain the health system could potentially deliver. We have carried out a narrative review to trace the origins, timeline, and evolution of the concept of effective coverage metrics to illuminate potential improvements in coherence, terminology, application, and visualizations, based on which a combination of approaches appears to have the most influence on policy and practice. We found that the World Health Organization first proposed the concept over 45 years ago. It became increasingly popular with the further development of theoretical underpinnings, and after the introduction of quantification and visualization tools. The approach has been applied in low- and middle-income countries, mainly for HIV/AIDS, TB, malaria, child health interventions, and more recently for non-communicable diseases, particularly diabetes and hypertension. Nevertheless, despite decades of application of effective coverage concepts, there is considerable variability in the terminology used and the choices of effectiveness decay steps included in the measures. Results frequently illustrate a profound loss of service effectiveness due to health system factors. However, policy and practice rarely address these factors, and instead favour narrowly targeted technical interventions.

Acceptability of PrEP among MSM and transgender communities-Qualitative findings from two metropolitan cities in India.

Global evidence suggests that Pre-Exposure Prophylaxis (PrEP) plays a pivotal role in reducing new HIV-infections among key populations (KP). However, the acceptability of PrEP differs across different geographical and cultural settings and among different KP typologies. Men who have sex with men (MSM) and transgender (TG) communities in India have around 15-17 times higher prevalence of human immunodeficiency virus (HIV) than the general population. The low rates of consistent condom use and poor coverage of HIV testing and treatment among the MSM and transgender communities highlight the need for alternative HIV prevention options. We used data from 20 in-depth interviews and 24 focused group discussions involving 143 MSM and 97 transgender individuals from the two metropolitan cities (Bengaluru and Delhi) in India to qualitatively explore their acceptability of PrEP as a HIV prevention tool. We coded data in NVivo and conducted extensive thematic content analysis. Awareness and use of PrEP were minimal among the MSM and transgender communities in both cities. However, on being provided with information on PrEP, both MSM and transgender communities expressed willingness to use PrEP as an additional HIV-prevention tool, to complement inability to consistently use condoms. PrEP was also perceived as a tool that could enhance the uptake of HIV-testing and counseling services. PrEP awareness, availability, accessibility and affordability were identified as determining factors that could influence its acceptability. Challenges such as stigma and discrimination, interrupted supply of drugs and non-community-friendly drug dispensing sites were identified barriers to continuing PrEP. Using qualitative data from two Indian settings, this study provides community perspectives and recommendations to stakeholders and policymakers for introduction of PrEP into programs as a prevention tool among MSM and transgender communities in India.

Causes Of Vision Impairment Among Adult Patients in Kerbala, Iraq

Background: Currently, there are at least 2.2 billion people worldwide with visual impairment, of whom at least 1 billion have preventable or untreated vision loss. The world faces major challenges in ophthalmology. This includes inequalities in the coverage and quality of prevention, treatment and rehabilitation services. shortage of qualified ophthalmologists; poor integration of eye care services into the health care system, among other problems; Therefore, we conduct this study.
 Aim: To identify the causes of visual impairment in Kerbala province, Iraq with view to address the treatment and challenges may face during the action.
 Methods: The study was a cross-sectional , 200 patients who attended the ophthalmology outpatient clinic in AL- Hussien Teaching hospital, Kerbala province, Iraq were enrolled, aged 20 and above. Data was collected by interviewing the patients and filling out the questionnaire from July 2019 until June 2020. In addition, we observed visual acuity measurement (VA), intraocular pressure (IOP), and ophthalmological examination of the patients
 Results: The main leading cause was a refractive error with 99 individual (51.3%) followed by cataract 26 (13.5% ). Refractive errors and cataract together were 24 (12.4%), allergy 14 (7.3), infection 12 (6.2%), age-related macular degeneration 12 (6.23%) and lastly glaucoma was only 6 (3.1%).
 According to the age group, 34 (17.6%) were between (17-39), followed by 102 (52.8%) between (40-59) and 57 (29.5%) between (60-89). In all these three groups RE was also the main diagnosis, 24 (70.6%) , 7 (55.9%) and 18 (31.6%) respectively. According to the smoking habit, 159 (82.4%) were nonsmoker, 14 (7.3%) were ex-smokers, 5 (2.6%) were light smokers (reported consumption of ≤5 cigarettes per day), moderate smokers (1 day for smoking 8 (4.1%) reported consuming 11 to 19 cigarettes per day ) , heavy smokers (reported smoking more than 20 cigarettes per day) 7 (3.6%) ز
 As regards systemic disease, we found that 80 (41.5%) of patients have hypertension and 63 (32.6%) were diabetics.
 Conclusions: We found that refractive errors were the most common cause of reduced visual acuity followed by cataracts. Cataracts are the most frequent cause of visual impairment in older people.

How Zambia reduced inequalities in under-five mortality rates over the last two decades: a mixed-methods study

BackgroundZambia experienced a major decline in under-five mortality rates (U5MR), with one of the fastest declines in socio-economic disparities in sub-Saharan Africa in the last two decades. We aimed to understand the extent to which, and how, Zambia has reduced socio-economic inequalities in U5MR since 2000.MethodsUsing nationally-representative data from Zambia Demographic Health Surveys (2001/2, 2007, 2013/14 and 2018), we examined trends and levels of inequalities in under-five mortality, intervention coverage, household water and sanitation, and fertility. This analysis was integrated with an in-depth review of key policy and program documents relevant to improving child survival in Zambia between 1990 and 2020.ResultsThe under-five mortality rate (U5MR) declined from 168 to 64 deaths per 1000 live births between 2001/2 and 2018 ZDHS rounds, particularly in the post-neonatal period. There were major reductions in U5MR inequalities between wealth, education and urban–rural residence groups. Yet reduced gaps between wealth groups in estimated absolute income or education levels did not simultaneously occur. Inequalities reduced markedly for coverage of reproductive, maternal, newborn and child health (RMNCH), malaria and human immunodeficiency virus interventions, but less so for water or sanitation and fertility levels.Several policy and health systems drivers were identified for reducing RMNCH inequalities: policy commitment to equity in RMNCH; financing with a focus on disadvantaged groups; multisectoral partnerships and horizontal programming; expansion of infrastructure and human resources for health; and involvement of community stakeholders and service providers.ConclusionZambia’s major progress in reducing inequalities in child survival between the poorest and richest people appeared to be notably driven by government policies and programs that centrally valued equity, despite ongoing gaps in absolute income and education levels. Future work should focus on sustaining these gains, while targeting families that have been left behind to achieve the sustainable development goal targets.

Health Literacy: Intervention and Outcome in Child Healthcare in Bangladesh

Bangladesh made significant improvements in child healthcare and achieved its Millennium Development Goal (MDG) 4 (to reduce child mortality). In 2010, the United Nations recognized Bangladesh for its exceptional progress towards MDG 4 to reduce child and maternal mortality in the face of many socioeconomic challenges. We are also committed to achieve our Sustainable Development Goal (SDG) by 2030. Health education department of Government of Bangladesh prioritized several essential health interventions over the past decades. There were focuses on expanding immunization, tackling diarrhoea and pneumonia, vitamin A campaign, prevention of blindness, iodine deficiency, and improving adolescent health. These programmes and strategies were scaled-up nationwide. The government along with its stakeholders promoted widespread availability and affordability of those health literacy interventions with an emphasis on community-based approaches. As a result, inequities in coverage of specific interventions declined; this may explain the improvements seen amongst even the most disadvantaged populations of the country. Media campaigns played a great role, which were undertaken in Bangladesh for decades and involved a nationally broadcast television supported by radio, television, newspaper, and billboard advertisements and local promotion activities. We expect that ongoing public private partnerships (PPPs) in which the government contracts NGOs and the private sector will enable us greater success and coverage of health information and literacy services throughout the country.
 CBMJ 2023 January: Vol. 12 No. 01 P: 124-128

Challenges and strategies for the uptake of mass drug administration among pastoralist communities in South Sudan

Preventive chemotherapy through mass drug administration (MDA) to control and eliminate neglected tropical diseases (NTDs) requires the active participation of communities living with NTDs, or at risk of NTD infections. Despite considerable progress by national control and elimination programs, achieving consistent and sustainable treatment campaigns that reach pastoralist communities remains challenging, which in turn delays the achievement of global disease elimination goals. The challenges of accessing pastoralist communities for treatment also hinder the achievement of the UN’s Sustainable Development Goals’ (SDGs) pledge to “leave no one behind“. Elimination targets cannot be achieved if significant proportions of endemic populations, such as pastoralists, are missed out during treatment campaigns. In South Sudan, close to 70% of the population is categorized as pastoralist, with previous data on MDA showing low access to and acceptance of MDA among the pastoralist community, as well as inconsistent treatment coverage. To address this challenge, a cross-sectional study design was conducted in five counties, with 239 pastoralist community respondents participating in in-depth interviews (IDIs), key informant interviews (KIIs), and focus group discussions (FGDs). Our findings show that, in the pastoralist community, high mobility, lay perceptions about the causes of NTDs and methods of treating them, limited awareness of MDA, and suboptimal health-seeking behaviors are the major factors that limit accessibility and participation. Our results suggest that improved uptake of MDA in these communities may be achieved by timing treatment campaigns to take account of pastoralists’ seasonal migration patterns, by involving pastoralist leaders in planning and social mobilization activities, by engaging community members as community drug distributors (CDDs), by using participatory behavior change approaches to design NTD interventions, and by addressing negative perceptions around the medicines involved, including those related to drug expiry and drugs causing impotence or other side effects. The results from this study could enable national programs to address the challenges of implementing treatment campaigns through the enhanced involvement and representation of pastoralist communities.

Narrowband ultraviolet B phototherapy in pediatric vitiligo: A retrospective study

To the Editor: Narrowband UV-B phototherapy (nbUV-B) is a first-line treatment for vitiligo management. 1 Mohammad T.F. Al-Jamal M. Hamzavi I.H. et al. The vitiligo working group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo. J Am Acad Dermatol. 2017; 76: 879-888 Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar Previous small studies have suggested that children can acquire repigmentation comparable to that of adults. 2 Magdaleno-Tapial J. Ortiz-Salvador J.M. Valenzuela-Oñate C. Marí-Cornejo P. Esteve-Martínez A. Pérez-Ferriols A. Comparison of phototherapy in pediatric and adult patients. Actas Dermosifiliogr. 2020; 111: 41-46 Crossref PubMed Scopus (3) Google Scholar Nevertheless, concerns regarding safety, practicality, and insurance coverage arise. 3 Blundell A. Sachar M. Gabel C.K. Bercovitch L.G. The scope of health insurance coverage of vitiligo treatments in the United States: implications for health care outcomes and disparities in children of color. Pediatr Dermatol. 2021; 38: 79-85 Crossref PubMed Scopus (2) Google Scholar To assess the prevalence, efficacy, and safety of nbUV-B, we conducted a retrospective chart review of pediatric patients with vitiligo seen by our department from January 1, 2009 to December 31, 2020. In 324 identified patients, 50% were male, median age at first visit was 8.7 years (SD, 4.3 years), and median follow-up was 20 months (IQR, 8-39 months). Clinical management included nbUV-B in 126 patients (38.9%) for a mean duration of 18 months (SD 13, Table I). The youngest patient that received nbUV-B treatment was aged 3 years, and 58 (46%) patients used home nbUV-B, which is typically an out-of-pocket cost. Table IManagement of Pediatric Vitiligo Treatment n % None 28 8.6 Topical calcineurin inhibitor 284 88 Topical steroid 188 58 Oral steroid 47 15 Outdoor sun exposure 21 6.5 Topical JAK inhibitor 9 2.8 Oral JAK inhibitor 2 0.62 Topical calcipotriene 6 1.9 MKTP 13 4.0 Excimer 32 9.9 Other 14 4.3 nbUV-B phototherapy (including home) 126 39 Phototherapy characteristics Home phototherapy 58 46 Occurrence of sunburn 33 29 Occurrence of blistering 4 3.5 Occurrence of scarring 0 0 Reported skin cancer 0 0 Duration of phototherapy (n = 108), mos ∗ Twice or 3 times a week. 18 † Mean. 13 ‡ SD. JAK, Janus kinase; MKTP, melanocyte-keratinocyte transplant procedure; nbUV-B, narrowband UVB. ∗ Twice or 3 times a week. † Mean. ‡ SD. Open table in a new tab JAK, Janus kinase; MKTP, melanocyte-keratinocyte transplant procedure; nbUV-B, narrowband UVB.

Methods for Assessing Spillover in Network-Based Studies of HIV/AIDS Prevention among People Who Use Drugs.

Human Immunodeficiency Virus (HIV) interventions among people who use drugs (PWUD) often have spillover, also known as interference or dissemination, which occurs when one participant's exposure affects another participant's outcome. PWUD are often members of networks defined by social, sexual, and drug-use partnerships and their receipt of interventions can affect other members in their network. For example, HIV interventions with possible spillover include educational training about HIV risk reduction, pre-exposure prophylaxis, or treatment as prevention. In turn, intervention effects frequently depend on the network structure, and intervention coverage levels and spillover can occur even if not measured in a study, possibly resulting in an underestimation of intervention effects. Recent methodological approaches were developed to assess spillover in the context of network-based studies. This tutorial provides an overview of different study designs for network-based studies and related methodological approaches for assessing spillover in each design. We also provide an overview of other important methodological issues in network studies, including causal influence in networks and missing data. Finally, we highlight applications of different designs and methods from studies of PWUD and conclude with an illustrative example from the Transmission Reduction Intervention Project (TRIP) in Athens, Greece.

Setting a research agenda to advance maternal, newborn, and child health in Ethiopia: An adapted CHNRI prioritization exercise.

Critical to the improvement of maternal, newborn, and child health (MNCH) in Ethiopia - where 14 000 mothers die from pregnancy-, childbirth-, or postpartum-related complications each year - is high-quality research and its effective translation into policy and practice. While Ethiopia has rapidly expanded the number of institutions that train and conduct MNCH research, the absence of a shared research agenda inhibits a coordinated approach to inform critical MNCH policy needs. The HaSET Maternal and Child Health Research Program (MCHRP) conducted a mixed methods formative assessment and prioritization exercise to guide investments in future MNCH research in Ethiopia. We adapted the Child Health and Nutrition Research Initiative (CHNRI) method, soliciting 56 priority research questions via key informant interviews. Through an online survey, experts scored these on their ability to generate new, actionable evidence that could inform more effective and equitable MNCH programs in Ethiopia. At a workshop in Addis Ababa, experts scored the questions by answerability and ethics, usefulness, disease burden reduction, and impact on equity. Research priority scores were calculated for both the online survey and workshop scoring and averaged to attain a ranked priority list. We validated and contextualized the results by conducting consensus-building discussions with MNCH experts and two community workshops. In total, approximately 100 participants were involved. Average research priority scores ranged from 58.4 to 83.7 out of 100.0. The top identified research priorities speak to critical needs in the Ethiopian context: to improve population coverage of proven interventions like integrated community case management (ICCM), family integrated newborn care, and kangaroo mother care (KMC); to better understand the determinants of outcomes like home deliveries, immunization drop-out, and antenatal and postpartum care-seeking; and to strengthen health system and workforce capabilities. This exercise expanded on the CHNRI methodology by comparing prioritization across different audiences, formats, and criteria. Agreement between both scoring rounds and consensus-building discussions was strong, demonstrating the reliability of the CHNRI method. By sharing this research priority list broadly among researchers, practitioners, and donors, we aim to improve coordinated MNCH evidence generation and translation into policy in Ethiopia.

Sponsorship bias in oncology cost effectiveness analysis

ObjectivesCost effectiveness analysis (CEA) has been increasingly used to inform cancer treatment coverage policy making worldwide. The primary objective of this study was to assess the association between industry sponsorship and CEA results in oncology. Study Design and SettingAll CEAs in oncology used incremental cost per quality-adjusted life year (QALY) as health effect identified from the Tufts CEA Registry since 1976 was analyzed. Descriptive analyses were performed to present and compare the characteristics of CEA funded by industry and non-industry. Robust logistic regression was performed to assess the relationship between the industry sponsorship and cost effective conclusion over a wide range of threshold values. ResultsA total of 1537 CEAs in oncology published from 1976 to 2021 were included. There were 387 (25.2%) with the industry sponsorship. CEAs sponsored by the industry were more likely to report ICERs below $50,000/QALY (adjusted odds ratio (OR), 1.91, 95% confidence interval (CI), 1.45-2.51, P < 0.001), $100,000/QALY (2.74, 1.98-3.79, P < 0.001), and $150,000/QALY (3.53, 2.37-5.27, P < 0.001) than studies without industry sponsorship. ConclusionsOur study suggests that there has been a significant sponsorship bias in CEAs in oncology. This bias could have a profound implication on drug pricing and coverage policy making.

A Post-Lockdown Assessment of Albendazole Treatment Coverage in Mass Drug Administration Campaigns Implemented Before and During COVID-19 Pandemic in Ekiti, Southwest Nigeria.

Objective: This study assessed the coverage of albendazole (ALB) in mass drug administration (MDA) programs implemented before (2019) and during the (2020 and 2021) COVID-19 pandemic in Ekiti State, Nigeria. Methods: Standardized questionnaires were administered to 1,127 children across three peri-urban communities to ascertain if they received and swallowed ALB across the years. Reasons, why ALB was not received, were documented and analyzed in SPSS. 20.0. Results: In 2019, the medicine reach was between 42.2%-57.8%, however, during the pandemic, the reach significantly reduced to 12.3%-18.6%, and increased to 28.5%-35.2% in 2021 (p < 0.000). About 19.6%-27.2% of the participants have missed 1 MDA, while 26.9%-37.8% and 22.4%-32.8% have missed 2 and 3 MDAs, respectively. The majority who did not receive ALB (60.8%-75%) claimed drug distributors never came, while about 14.9%-20.3% mentioned they did not hear about MDA. However, individual compliance towards swallowing was above 94% across the study years (p < 0.00). Conclusion: These results highlight the need to explore the perceptions of those who have consistently missed MDAs, and also understand the health-system-related issues including those imposed by the pandemic affecting MDA.