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- Rodrigues, Amabelia, et al.
(author)
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Revaccination with Bacillus Calmette-Guerin (BCG) vaccine does not reduce morbidity from malaria in African children
- 2007
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In: Tropical Medicine & International Health. - : Wiley. - 1365-3156 .- 1360-2276. ; 12:2, s. 224-229
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Journal article (peer-reviewed)abstract
- BACKGROUND: Studies in West Africa and elsewhere have suggested that Bacillus Calmette-Guerin (BCG) vaccine given at birth is beneficial for child survival. It is possible that this effect is mediated partly through an effect on malaria, a hypothesis supported by animal studies. We investigated whether revaccination with BCG at 19 months of age reduced morbidity from malaria. METHOD: In the capital of Guinea-Bissau, between January and November 2003, children who had previously received BCG vaccination and who did not have a strong reaction to tuberculin were individually randomised to either receive revaccination with BCG at the age of 19 months or to be a control. Episodes of malaria were recorded during the 2003 malaria transmission season through passive case detection at health centres in the study area and at the national hospital. Cross-sectional surveys were carried out at the beginning and at the end of the rainy season. RESULTS: Incidence rates of first episodes of malaria associated with any level of parasitaemia were 0.16 episodes per child-year among 713 revaccinated children and 0.12 among 720 control children [incidence rate ratio (IRR) = 1.37; 95% confidence intervals (CI): 0.84-2.25]. Results were similar when the diagnosis of malaria was based on the presence of parasitaemia >5000 parasites/microl (IRR = 1.30; 95% CI: 0.61-2.77). The incidence of all-cause hospitalisation was higher among BCG-revaccinated children than among controls (IRR = 2.13; 95% CI: 1.10-4.13). There were no significant differences in the prevalence of parasitaemia between the two groups of children at cross-sectional surveys. CONCLUSION: We found no evidence that BCG revaccination reduces morbidity from malaria.
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- Baker, T
(author)
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Critical care in low-income countries
- 2009
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In: Tropical medicine & international health : TM & IH. - : Wiley. - 1365-3156 .- 1360-2276. ; 14:2, s. 143-148
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Journal article (peer-reviewed)
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- Filippi, Véronique, et al.
(author)
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Effects of severe obstetric complications on women's health and infant mortality in Benin
- 2010
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In: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 15:6, s. 733-742
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Journal article (peer-reviewed)abstract
- Women in developing countries face a high risk of severe complications during pregnancy and delivery. These can lead to adverse consequences for their own health and that of their offspring. Resources are needed to ensure that pregnant women receive adequate care before, during and after discharge from hospital. Near-miss women with a perinatal death appear a particularly high-risk group.
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- Lemma, Hailemariam, et al.
(author)
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Deploying artemether-lumefantrine with rapid testing in Ethiopian communities : impact on malaria morbidity, mortality and healthcare resources
- 2010
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In: Tropical medicine & international health. - Oxford, England : Blackwell Science. - 1360-2276 .- 1365-3156. ; 15:2, s. 241-250
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Journal article (peer-reviewed)abstract
- Objective: To assess the impact and feasibility of artemether-lumefantrine deployment at community level, combined with phased introduction of rapid diagnostic tests (RDTs), on malaria transmission, morbidity, and mortality and health service use in a remote area of Ethiopia.Methods: Two-year pilot study in two districts: artemether-lumefantrine was prescribed after parasitological confirmation of malaria in health facilities in both districts. In the intervention district, artemether-lumefantrine was also made available through 33 community health workers (CHWs); of these, 50% were equipped with RDTs in the second year.Results: At health facilities; 54 774 patients in the intervention and 100 535 patients in the control district were treated for malaria. In the intervention district, 75 654 patients were treated for malaria by community health workers. Use of RDTs in Year 2 excluded non-Plasmodium falciparumin 89.7% of suspected cases. During the peak of malaria transmission in 2005, the crude parasite prevalence was 7.4% (95% CI: 6.1-8.9%) in the intervention district and 20.8% (95% CI: 18.7-23.0%) in the control district. Multivariate modelling indicated no significant difference in risk of all-cause mortality between the intervention and the control districts [adjusted incidence rate ratio (aIRR) 1.03, 95%CI 0.87-1.21, P = 0.751], but risk of malaria-specific mortality was lower in the intervention district (aIRR 0.60, 95%CI 0.40-0.90, P = 0.013).Conclusions: Artemether-lumefantrine deployment through a community-based service in a remote rural population reduced malaria transmission, lowered the malaria case burden for health facilities and reduced malaria morbidity and mortality during a 2-year period which included a major malaria epidemic.
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- Pain, Adam
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Review: The impact of HIV on agricultural livelihoods in southern Uganda and the challenges of attribution
- 2011
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In: Tropical Medicine and International Health. - : Wiley. - 1360-2276 .- 1365-3156. ; 16, s. 324-333
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Research review (peer-reviewed)abstract
- Changes in agriculture and rural livelihoods in Africa are often attributed to the HIV epidemic. While acknowledging that the epidemic has devastated many families and communities because of excess morbidity and mortality, this review explores other causes of change in agriculture practices and production in southern Uganda. Over the past 20 years labour shortages, because of labour migration and changing aspirations (as well as HIV), crop and livestock pests and diseases, declining soil fertility, changes in commodity markets and a growing off-farm sector have contributed to the changes seen in rural southern Uganda. Policy interventions outside agriculture and health have also had an impact on households. The HIV epidemic has not happened in isolation. The perceived impacts of the epidemic cannot be addressed in isolation from these other drivers of change.
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- Tensou, Biruk, et al.
(author)
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Evaluating the InterVA model for determining AIDS mortality from verbal autopsies in the adult population of Addis Ababa.
- 2010
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In: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 15:5, s. 547-553
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To evaluate the performance of a verbal autopsy (VA) expert algorithm (the InterVA model) for diagnosing AIDS mortality against a reference standard from hospital records that include HIV serostatus information in Addis Ababa, Ethiopia. METHODS: Verbal autopsies were conducted for 193 individuals who visited a hospital under surveillance during terminal illness. Decedent admission diagnosis and HIV serostatus information are used to construct two reference standards (AIDS vs. other causes of death and TB/AIDS vs. other causes). The InterVA model is used to interpret the VA interviews; and the sensitivity, specificity and cause-specific mortality fractions are calculated as indicators of the diagnostic accuracy of the InterVA model. RESULTS: The sensitivity and specificity of the InterVA model for diagnosing AIDS are 0.82 (95% CI: 0.74-0.89) and 0.76 (95% CI: 0.64-0.86), respectively. The sensitivity and specificity for TB/AIDS are 0.91 (95% CI: 0.85-0.96) and 0.78 (95% CI: 0.63-0.89), respectively. The AIDS-specific mortality fraction estimated by the model is 61.7% (95% CI: 54-69%), which is close to 64.7% (95% CI: 57-72%) in the reference standard. The TB/AIDS mortality fraction estimated by the model is 73.6% (95% CI: 67-80%), compared to 74.1% (95% CI: 68-81%) in the reference standard. CONCLUSION: The InterVA model is an easy to use and cheap alternative to physician review for assessing AIDS mortality in populations without vital registration and medical certification of causes of death. The model seems to perform better when TB and AIDS are combined, but the sample is too small to statistically confirm that.
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- Waiswa, Peter, et al.
(author)
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Using the three delays model to understand why newborn babies die in eastern Uganda
- 2010
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In: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 15:8, s. 964-972
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Journal article (peer-reviewed)abstract
- OBJECTIVES To investigate causes of and contributors to newborn deaths in eastern Uganda using a three delays audit approach. METHODS Data collected on 64 neonatal deaths from a demographic surveillance site were coded for causes of deaths using a hierarchical model and analysed using a modified three delays model to determine contributing delays. A survey was conducted in 16 health facilities to determine capacity for newborn care. RESULTS Of the newborn babies, 33% died in a hospital/health centre, 13% in a private clinic and 54% died away from a health facility. 47% of the deaths occurred on the day of birth and 78% in the first week. Major contributing delays to newborn death were caretaker delay in problem recognition or in deciding to seek care (50%, 32/64); delay to receive quality care at a health facility (30%; 19/64); and transport delay (20%; 13/64). The median time to seeking care outside the home was 3 days from onset of illness (IQR 1-6). The leading causes of death were sepsis or pneumonia (31%), birth asphyxia (30%) and preterm birth (25%). Health facilities did not have capacity for newborn care, and health workers had correct knowledge on only 31% of the survey questions related to newborn care. CONCLUSIONS Household and health facility-related delays were the major contributors to newborn deaths, and efforts to improve newborn survival need to address both concurrently. Understanding why newborn babies die can be improved by using the three delays model, originally developed for understanding maternal death.
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| 39. |
- Padmawati, Retna Siwi, et al.
(author)
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Smoking among diabetes patients in Yogyakarta, Indonesia : cessation efforts are urgently needed.
- 2009
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In: Tropical medicine & international health : TM & IH. - : Wiley. - 1365-3156 .- 1360-2276. ; 14:4, s. 412-9
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To document the prevalence of tobacco use among male diabetes patients in a clinic based population of Yogyakarta Province, Indonesia; to examine patient's perceptions of smoking as a risk factor for diabetes complications; and to investigate whether patients had received cessation messages from their doctors. METHOD: Twelve in-depth interviews and five focus groups (n = 21) with diabetic patients in 2004-2005, followed by a cross-sectional survey of 778 male diabetic patients in diabetes clinics in 2006-2007. RESULTS: 65% of male diabetes patients smoked before being diagnosed, and 32% smoked in the last 30 days. Most patients incorrectly perceived low level smoking safe for diabetics (mean of 3.6 cigarettes). The median range of cigarettes smoked per day was in excess of this 'safe' amount (4-10 cigarettes). Most respondents did not associate smoking with diabetes and its complications. Only 35% of all patients recalled being asked whether they smoked by their doctors, and there were no differences between smokers and non-smokers. Quit messages received by patients were seen as general health advice and not diabetes specific. CONCLUSIONS: Many diabetic patients continue to smoke despite the hazard of smoking on diabetes complications and mortality. Smoking cessation is not commonly encouraged by health-care providers in Indonesia, and is not a routine part of diabetes counselling despite the risk of smoking to those with diabetes. Project Quit Tobacco International is currently developing cessation services for patients with diabetes and encouraging medical and nursing schools to incorporate disease specific tobacco education in its curriculum and skill based classes in tobacco cessation counselling.
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| 49. |
- Fottrell, Edward, et al.
(author)
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Mortality measurement in transition : proof of principle for standardised multi-country comparisons
- 2010
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In: Tropical medicine & international health. - : Wiley. - 1360-2276 .- 1365-3156. ; 15:10, s. 1256-1265
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Journal article (peer-reviewed)abstract
- Given the standardised method of VA interpretation, the observed differences in mortality cannot be because of local differences in assigning cause of death. Standardised, fit-for-purpose methods are needed to measure population health and changes in mortality patterns so that appropriate health policy and programmes can be designed, implemented and evaluated over time and place. The InterVA approach overcomes several longstanding limitations of existing methods and represents a valuable tool for health planners and researchers in resource-poor settings.
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