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  1 / 9349 MEDLINE  
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PMID:27776000
Autor:Oyeyemi AL; Conway TL; Adedoyin RA; Akinroye KK; Aryeetey R; Assah F; Cain KL; Gavand KA; Kasoma SS; Kolbe-Alexander TL; Lambert EV; Larouche R; Moss SJ; Ocansey R; Onywera VO; Prista A; Tremblay MS; Sallis JF
Endereço:1Department of Physiotherapy, University of Maiduguri, Maiduguri, NIGERIA; 2Physical Activity, Sport and Recreation, Faculty of Health Sciences, North-West University, Potchefstroom, SOUTH AFRICA; 3Department of Family Medicine and Public Health, University of California, San Diego, CA; 4Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, NIGERIA; 5Nigerian Heart Foundation, Lagos, NIGERIA; 6School of Public Health, University of Ghana, Legon Accra, GHANA; 7Faculty of Medicine and Biomedical Sciences, Department of Public Health, University of Yaoundé I, Yaoundé, CAMEROON; 8Department of Biochemistry and Sports Science, School of Biosciences, Makerere University, Kampala, UGANDA; 9Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, AUSTRALIA; 10Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, SOUTH AFRICA; 11Children's Hospital of Eastern Ontario Research Institute, Ottawa, CANADA; 12Active Living and Wellness Alliance Group, Nungua, GHANA; 13Department of Recreation Management and Exercise Science, Kenyatta University, Nairobi, KENYA; 14Physical Activity and Health Research Group, CIDAF-FEFF, Universidade Pedagogica, Maputo, MOZAMBIQUE; and 15Department of Pediatrics, University of Ottawa, Ottawa, CANADA.
Título:Construct Validity of the Neighborhood Environment Walkability Scale for Africa.
Fonte:Med Sci Sports Exerc; 49(3):482-491, 2017 Mar.
ISSN:1530-0315
País de publicação:United States
Idioma:eng
Resumo:PURPOSE: The development of valid measures of built environments relevant for physical activity is an important step toward controlling the global epidemic of physical inactivity-related noncommunicable diseases and deaths. This study assessed the construct validity of a self-report neighborhood environment walkability scale adapted for Africa (NEWS-Africa), by examining relationships with self-reported walking for transportation and recreation using pooled data from six sub-Saharan African countries. METHODS: NEWS was systematically adapted to assess urban, periurban, and rural environments in sub-Saharan Africa. Adults (n = 469, 18-85 yr, 49.7% women) from Cameroon, Ghana, Mozambique, Nigeria, South Africa, and Uganda were purposively recruited from neighborhoods varying in walkability and socioeconomic status, with some from villages. Participants completed the 76-item (13 subscales) NEWS-Africa by structured interview and reported weekly minutes of walking for transport and recreation using items from the International Physical Activity Questionnaire. RESULTS: The overall "walkability" index had a positive relationship with both walking for transportation (η = 0.020, P = 0.005) and recreation (η = 0.013, P = 0.028) in the pooled analyses. The mixed-use access and stranger danger scales were positively related with transport walking (η = 0.020, P = 0.006 and η = 0.021, P = 0.040, respectively). Proximity of recreational facilities (η = 0.016, P = 0.015), road/path connectivity (η = 0.025, P = 0.002), path infrastructure (η = 0.021, P = 0.005), and overall places for walking and cycling (η = 0.012, P = 0.029) scales were positively related to recreational walking. Country-specific results were mostly nonsignificant except for South Africa and Uganda. CONCLUSIONS: Of 14 NEWS-Africa scales, 7 were significantly related to walking behavior in pooled analyses, providing partial support for the construct validity of NEWS-Africa. However, effect sizes appeared to be lower than those from other continents. Further study with larger and more diverse samples is needed to determine whether the instrument performs well in each country.
Tipo de publicação: JOURNAL ARTICLE; VALIDATION STUDIES


  2 / 9349 MEDLINE  
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PMID:29360841
Autor:Uthman RT; Sutton AJ; Jackson LJ; Uthman OA
Endereço:Health Economics Unit, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
Título:Does directly administered antiretroviral therapy represent good value for money in sub-Saharan Africa? A cost-utility and value of information analysis.
Fonte:PLoS One; 13(1):e0191465, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Successful antiretroviral therapy (ART) relies on the optimal level of ART adherence to achieve reliable viral suppression, avert HIV drug resistance, and prevent avoidable deaths. It has been shown that there are various groups of people living with HIV at high-risk of non-adherence to ART in sub-Saharan Africa. The objective of this study was to examine the cost effectiveness and value-of-information of directly administered antiretroviral therapy (DAART) versus self-administered ART among people living with HIV, at high risk of non-adherence to ART in sub-Saharan Africa. METHODS AND FINDINGS: A Markov model was developed that describes the transition between HIV stages based on the CD4 count, along with direct costs, quality of life and the mortality rate associated with DAART in comparison with self-administered ART. Data used in the model were derived from the published literature. A health system perspective was employed using a life-time time horizon. Probabilistic sensitivity analysis was performed to determine the impact of parameter uncertainty. Value of information analysis was also conducted. The expected cost of self-administered ART and DAART were $5,200 and $15,500 and the expected QALYs gained were 8.52 and 9.75 respectively, giving an incremental cost effectiveness ratio of $8,400 per QALY gained. The analysis demonstrated that the annual cost DAART needs to be priced below $200 per patient to be cost-effective. The probability that DAART was cost-effective was 1% for a willingness to pay threshold of $5,096 for sub-Saharan Africa. The value of information associated with the cost of DAART and its effectiveness was substantial. CONCLUSIONS: From the perspective of the health care payer in sub-Saharan Africa, DAART cannot be regarded as cost-effective based on current information. The value of information analysis showed that further research will be worthwhile and potentially cost-effective in resolving the uncertainty about whether or not to adopt DAART.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Nome de substância:0 (Anti-HIV Agents)


  3 / 9349 MEDLINE  
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PMID:28464937
Autor:Greenwood B; Dicko A; Sagara I; Zongo I; Tinto H; Cairns M; Kuepfer I; Milligan P; Ouedraogo JB; Doumbo O; Chandramohan D
Endereço:Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK. brian.greenwood@lshtm.ac.uk.
Título:Seasonal vaccination against malaria: a potential use for an imperfect malaria vaccine.
Fonte:Malar J; 16(1):182, 2017 05 02.
ISSN:1475-2875
País de publicação:England
Idioma:eng
Resumo:In many parts of the African Sahel and sub-Sahel, where malaria remains a major cause of mortality and morbidity, transmission of the infection is highly seasonal. Seasonal malaria chemoprevention (SMC), which involves administration of a full course of malaria treatment to young children at monthly intervals during the high transmission season, is proving to be an effective malaria control measure in these areas. However, SMC does not provide complete protection and it is demanding to deliver for both families and healthcare givers. Furthermore, there is a risk of the emergence in the future of resistance to the drugs, sulfadoxine-pyrimethamine and amodiaquine, that are currently being used for SMC. Substantial progress has been made in the development of malaria vaccines during the past decade and one malaria vaccine, RTS,S/AS01, has received a positive opinion from the European Medicines Authority and will soon be deployed in large-scale, pilot implementation projects in sub-Saharan Africa. A characteristic feature of this vaccine, and potentially of some of the other malaria vaccines under development, is that they provide a high level of efficacy during the period immediately after vaccination, but that this wanes rapidly, perhaps because it is difficult to develop effective immunological memory to malaria antigens in subjects exposed previously to malaria infection. A potentially effective way of using malaria vaccines with high initial efficacy but which provide only a short period of protection could be annual, mass vaccination campaigns shortly before each malaria transmission season in areas where malaria transmission is confined largely to a few months of the year.
Tipo de publicação: JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
Nome de substância:0 (Malaria Vaccines); 0 (RTS,S-AS01 vaccine); 0 (Vaccines, Synthetic)


  4 / 9349 MEDLINE  
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PMID:29385135
Autor:Sabde Y; Chaturvedi S; Randive B; Sidney K; Salazar M; De Costa A; Diwan V
Endereço:Department of Community Medicine, R.D. Gardi Medical College, Ujjain, India.
Título:Bypassing health facilities for childbirth in the context of the JSY cash transfer program to promote institutional birth: A cross-sectional study from Madhya Pradesh, India.
Fonte:PLoS One; 13(1):e0189364, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:Bypassing health facilities for childbirth can be costly both for women and health systems. There have been some reports on this from Sub-Saharan African and from Nepal but none from India. India has implemented the Janani Suraksha Yojana (JSY), a large national conditional cash transfer program which has successfully increased the number of institutional births in India. This paper aims to study the extent of bypassing the nearest health facility offering intrapartum care in three districts of Madhya Pradesh, India, and to identify individual and facility determinants of bypassing in the context of the JSY program. Our results provide information to support the optimal utilization of facilities at different levels of the healthcare system for childbirth. Data was collected from 96 facilities (74 public) and 720 rural mothers who delivered at these facilities were interviewed. Multilevel logistic regression was used to analyze the data. Facility obstetric care functionality was assessed by the number of emergency obstetric care (EmOC) signal functions performed in the last three months. Thirty eighth percent of the mothers bypassed the nearest public facility for their current delivery. Primiparity, higher education, arriving by hired transport and a longer distance from home to the nearest facility increased the odds of bypassing a public facility for childbirth. The variance partition coefficient showed that 37% of the variation in bypassing the nearest public facility can be attributed to difference between facilities. The number of basic emergency obstetric care signal functions (AOR = 0.59, 95% CI 0.37-0.93), and the availability of free transportation at the nearest facility (AOR = 0.11, 95% CI 0.03-0.31) were protective factors against bypassing. The variation between facilities (MOR = 3.85) was more important than an individual's characteristics to explain bypassing in MP. This multilevel study indicates that in this setting, a focus on increasing the level of emergency obstetric care functionality in public obstetric care facilities will allow more optimal utilization of facilities for childbirth under the JSY program thereby leading to better outcomes for mothers.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T


  5 / 9349 MEDLINE  
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PMID:28455205
Autor:Borrow R; Caugant DA; Ceyhan M; Christensen H; Dinleyici EC; Findlow J; Glennie L; Von Gottberg A; Kechrid A; Vázquez Moreno J; Razki A; Smith V; Taha MK; Tali-Maamar H; Zerouali K; Global Meningococcal Initiative (GMI)
Endereço:Vaccine Evaluation Unit, Public Health England, Manchester Royal Infirmary, Manchester, M13 9WZ, UK. Electronic address: Ray.Borrow@phe.gov.uk.
Título:Meningococcal disease in the Middle East and Africa: Findings and updates from the Global Meningococcal Initiative.
Fonte:J Infect; 75(1):1-11, 2017 Jul.
ISSN:1532-2742
País de publicação:England
Idioma:eng
Resumo:The Global Meningococcal Initiative (GMI) has recently considered current issues in Middle Eastern and African countries, and produced two recommendations: (i) that vaccination of attendees should be considered for some types of mass-gathering events, as some countries mandate for the Hajj, and (ii) vaccination of people with human immunodeficiency virus should be used routinely, because of increased meningococcal disease (MD) risk. Differences exist between Middle Eastern and African countries regarding case and syndrome definitions, surveillance, and epidemiologic data gaps. Sentinel surveillance provides an overview of trends and prevalence of different capsular groups supporting vaccine selection and planning, whereas cost-effectiveness decisions require comprehensive disease burden data, ideally counting every case. Surveillance data showed importance of serogroup B MD in North Africa and serogroup W expansion in Turkey and South Africa. Success of MenAfriVac in the African "meningitis belt" was reviewed; the GMI believes similar benefits may follow development of a low-cost meningococcal pentavalent vaccine, currently in phase 1 clinical trial, by 2022. The importance of carriage and herd protection for controlling invasive MD and the importance of advocacy and awareness campaigns were also highlighted.
Tipo de publicação: JOURNAL ARTICLE; REVIEW
Nome de substância:0 (MenAfriVac); 0 (Meningococcal Vaccines)


  6 / 9349 MEDLINE  
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PMID:29351277
Autor:Hammami P; Lancelot R; Domenech J; Lesnoff M
Endereço:UMR 117 Animals, Health, Territories, Risks and Ecosystems (ASTRE), Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), Campus international de Baillarguet, 34398 Montpellier, France.
Título:Ex-ante assessment of different vaccination-based control schedules against the peste des petits ruminants virus in sub-Saharan Africa.
Fonte:PLoS One; 13(1):e0190296, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: Peste des petits ruminants (PPR) is a highly contagious and widespread viral infection of small ruminants (goats and sheep), causing heavy economic losses in many developing countries. Therefore, its progressive control and global eradication by 2030 was defined as a priority by international organizations addressing animal health. The control phase of the global strategy is based on mass vaccination of small ruminant populations in endemic regions or countries. It is estimated that a 70% post-vaccination immunity rate (PVIR) is needed in a given epidemiological unit to prevent PPR virus spread. However, implementing mass vaccination is difficult and costly in smallholder farming systems with scattered livestock and limited facilities. Regarding this, controlling PPR is a special challenge in sub-Saharan Africa. In this study, we focused on this region to assess the effect of several variables of PVIR in two contrasted smallholder farming systems. METHODS: Using a seasonal matrix population model of PVIR, we estimated its decay in goats reared in sub-humid areas, and sheep reared in semi-arid areas, over a 4-year vaccination program. Assuming immunologically naive and PPR-free epidemiological unit, we assessed the ability of different vaccination scenarios to reach the 70% PVIR throughout the program. The tested scenarios differed in i) their overall schedule, ii) their delivery month and iii) their vaccination coverage. RESULTS: In sheep reared in semi-arid areas, the vaccination month did affect the PVIR decay though it did not in goats in humid regions. In both cases, our study highlighted i) the importance of targeting the whole eligible population at least during the two first years of the vaccination program and ii) the importance of reaching a vaccination coverage as high as 80% of this population. This study confirmed the relevance of the vaccination schedules recommended by international organizations.
Tipo de publicação: JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Nome de substância:0 (Viral Vaccines)


  7 / 9349 MEDLINE  
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PMID:29296160
Autor:Vouking MZ; Tadenfok CN; Ekani JME
Endereço:Center for the Development of Best Practices in Health, Yaoundé Central Hospital, Henri-Dunant Avenue, Messa, Yaoundé, Cameroon.
Título:Strategies to increase immunization coverage of tetanus vaccine among women in Sub Saharan Africa: a systematic review.
Fonte:Pan Afr Med J; 27(Suppl 3):25, 2017.
ISSN:1937-8688
País de publicação:Uganda
Idioma:eng
Resumo:World Health Organization (WHO) estimated in 2013 that 49,000 deaths all over the world were caused by neonatal tetanus. Only as recently as the year 2000, neonatal tetanus was a public health problem in 59 countries, but since then it has been eliminated in 36 of the countries concerned. The objective of this piece of work, therefore, was to investigate which strategies intended to increase demand for vaccination are effective in increasing anti-tetanus vaccination coverage of women in Sub Saharan Africa. We searched the following electronic databases from January 1989 to July 2016: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Our search strategy yielded 191 records and after assessment for eligibility, 6 papers met the criteria for inclusion. In Ivory Coast, after reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96% of cases, respectively. In Kenya, the main factors contributing to having sufficiently immunized part of the population against tetanus are lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Particularly in Ethiopia, compared with other member countries, the size of the unimmunized population, reporting quality, fragileness of the health system, resource limitation, and others deserve further concerted attention. In Nigeria, the prevalence of missed opportunities was 66%. The factors responsible for missed opportunities were; poor history taking, lack of knowledge of the current immunization schedule, dependence on physician referral for immunization and inefficient immunization records keeping system. In Nigeria, socio-logistic variables found to be important in Expanded Programme on Immunization implementations included scheduling, health staff attitude, intersectoral collaboration, and health education. Lack of community participation was also found to be a crucial constraining factor. There are many challenges to increase immunization coverage of tetanus vaccine for women. So far very few interventions addressing these challenges have been evaluated scientifically. Community mobilization interventions to change or impact beliefs and attitudes of women are absolutely needed. Additionally, improving accessibility, affordability, availability and accommodation of vaccination service venues will make them more attractive.
Tipo de publicação: JOURNAL ARTICLE; REVIEW
Nome de substância:0 (Tetanus Toxoid)


  8 / 9349 MEDLINE  
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PMID:29293611
Autor:Revill P; Walker S; Cambiano V; Phillips A; Sculpher MJ
Endereço:Centre for Health Economics, University of York, York, United Kingdom.
Título:Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.
Fonte:PLoS One; 13(1):e0190283, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:BACKGROUND: The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. KEY ISSUES FOR ECONOMIC EVALUATION: The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. IMPLICATIONS: The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.
Tipo de publicação: JOURNAL ARTICLE
Nome de substância:0 (Anti-HIV Agents)


  9 / 9349 MEDLINE  
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PMID:29297544
Autor:Dzudie A; Dzekem BS; Kengne AP
Endereço:Department of Medicine, University of Cape Town, Cape Town, South Africa; Douala General Hospital and Clinical Research Education Networking and Consultancy, Douala, Cameroon; Faculty of Health Sciences, University of Buea, Buea, Cameroon. Email: aitdzudie@yahoo.com.
Título:NT-pro BNP and plasma-soluble ST2 as promising biomarkers for hypertension, hypertensive heart disease and heart failure in sub-Saharan Africa.
Fonte:Cardiovasc J Afr; 28(6):406-407, 2017 Nov/Dec.
ISSN:1680-0745
País de publicação:South Africa
Idioma:eng
Tipo de publicação: LETTER; COMMENT
Nome de substância:0 (Biomarkers); 0 (Peptide Fragments); 114471-18-0 (Natriuretic Peptide, Brain)


  10 / 9349 MEDLINE  
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PMID:29342157
Autor:Merdad L; Ali MM
Endereço:Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia.
Título:Timing of maternal death: Levels, trends, and ecological correlates using sibling data from 34 sub-Saharan African countries.
Fonte:PLoS One; 13(1):e0189416, 2018.
ISSN:1932-6203
País de publicação:United States
Idioma:eng
Resumo:Millennium Development Goal 5 has not been universally achieved, particularly in sub-Saharan Africa. Understanding whether maternal deaths occur during pregnancy, childbirth, or puerperium is important to effectively plan maternal health programs and allocate resources. Our main research objectives are to (1) describe the proportions and rates of mortality for the antepartum, intrapartum, and postpartum periods; (2) document how these trends vary by sub-region; and (3) investigate ecological correlations between these rates and maternal care interventions. We used data from the Demographic and Health Survey program, which comprises 84 surveys from 34 sub-Saharan African countries conducted between 1990 and 2014. We calculated age-standardized maternal mortality rates and time-specific maternal mortality rates and proportions, and we assessed correlations with maternal care coverage. We found high levels of maternal mortality in all three periods. Time-specific maternal mortality rates varied by country and region, with some showing an orderly decline in all three periods and others exhibiting alarming increases in antepartum and postpartum mortality. Ecological analysis showed that antenatal care coverage was significantly associated with low antepartum mortality, whereas the presence of a skilled attendant at childbirth was significantly associated with low postpartum mortality. In sub-Saharan Africa, maternal deaths occur at high rates in all three risk periods, and vary substantially by country and region. The provision of maternal care is a predictor of time-specific maternal mortality. These results confirm the need for country-specific interventions during the continuum of care to achieve the global commitment to eliminating preventable maternal mortality.
Tipo de publicação: JOURNAL ARTICLE



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