Health education to promote knowledge about sickle cell disease and newborn screening in pregnant women: a community-based pilot study using the healthy beginning initiative.

BACKGROUND: Pregnancy presents a critical period for any maternal and child health intervention that may impact the health of the newborn. With low antenatal care attendance by pregnant women in health facilities in Nigeria, community-based programs could enable increased reach for health education about sickle cell disease (SCD) and newborn screening (NBS) among pregnant women. This pilot study aimed to assess the effect of education on the knowledge about SCD and NBS among pregnant women using the Healthy Beginning Initiative, a community-based framework. METHODS: A pre-post study design was used to evaluate knowledge of SCD and NBS in a convenience sample of 89 consenting pregnant women from three communities. Participants were given surveys prior to and following completion of a health education session. McNemar's test was used to compare the proportion of participants with correct responses. The level of significance was taken as p < 0.05. RESULTS: Compared to pre-test values, post-test values showed that participants understood that SCD is hereditary (93.3% vs. 69.7%), both parents must have at least one gene for someone to have SCD (98.9% vs. 77.5) and blood test is the right way to know if one has SCD (98.8% vs. 78.7%). Also, a large proportion of participants (post-test ~ 89.9%; compared to pre-test ~ 23.6%) understood that the chance of conceiving a child with SCD was 25% for a couple with the sickle cell trait (SCT). Knowledge of the possibility of diagnosing SCD shortly after birth was highly increased in the post test phase of the study when compared to the pre-test phase (93.3% vs. 43.9%, respectively). Concerning the overall knowledge scores, those with high level of knowledge significantly increase from 12.6% pretest to 87.4% posttest (p = 0.015). CONCLUSION: The health education intervention was associated with significant improvement on almost all measures of SCD knowledge. Focused health education for pregnant women using community structures can improve knowledge of SCD and NBS.

Immune response to hepatitis B vaccine among children under 5 years in Africa: a meta-analysis.

BACKGROUND: Hepatitis B virus (HBV) infection in Africa is mostly acquired before the age of 5 years through vertical or horizontal routes. While all the countries in the World Health Organization African region have introduced HBV vaccination into their national immunization programs, the rate of protective immune response to HBV vaccine among children in Africa has not been systematically synthesized. In this study, we estimated the HBV vaccine seroprotection rate (defined as anti-HBs titer ≥ 10 IU/L) and the associated factors among under-five children who completed a primary series of HBV vaccination in Africa. METHODS: We systematically searched PubMed, Web Science, and Scopus databases from inception to May 2022 for potentially eligible studies. The pooled seroprotection rate was estimated using a random-effects model with Freeman-Tukey double arcsine transformation and the associated factors were examined using odds ratio estimated by the DerSimonian and Laird method. RESULTS: From the 1063 records identified, 29 studies with a total sample size of 9167 under-five children were included in the meta-analysis. The pooled seroprotection rate was 89.23% (95% CI 85.68-92.33%, I2 = 95.96%, p < 0.001). In the subgroup analyses, there was a significant difference in the rate by the assay method, vaccine dose, and vaccine combination. HIV-positive children had lower odds of achieving seroprotection when compared with HIV-negative children (OR = 0.22, 95%CI 0.12-0.40). CONCLUSIONS: The majority of under-five children in Africa achieved seroprotection after completing three or four doses of HBV vaccine. However, the rate was lower among children living with HIV. This calls for interventions to timely identify and address nonresponse to HBV vaccine, particularly among immunosuppressed children.

Comparative effectiveness of implementation strategies for Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services (ACCESS study): protocol for a cluster randomized hybrid type III trial in Nigeria.

BACKGROUND: Despite the increased risk of cervical cancer (CC) among women living with HIV (WLHIV), CC screening and treatment (CCST) rates remain low in Africa. The integration of CCST services into established HIV programs in Africa can improve CC prevention and control. However, the paucity of evidence on effective implementation strategies (IS) has limited the success of integration in many countries. In this study, we seek to identify effective IS to enhance the integration of CCST services into existing HIV programs in Nigeria. METHODS: Our proposed study has formative and experimental activities across the four phases of the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework. Through an implementation mapping conducted with stakeholders in the exploration phase, we identified a core package of IS (Core) and an enhanced package of IS (Core+) mostly selected from the Expert Recommendations for Implementing Change. In the preparation phase, we refined and tailored the Core and Core+ IS with the implementation resource teams for local appropriateness. In the implementation phase, we will conduct a cluster-randomized hybrid type III trial to assess the comparative effectiveness of Core versus Core+. HIV comprehensive treatment sites (k = 12) will be matched by region and randomized to Core or Core+ in the ratio of 1:1 stratified by region. In the sustainment phase, we will assess the sustainment of CCST at each site. The study outcomes will be assessed using RE-AIM: reach (screening rate), adoption (uptake of IS by study sites), IS fidelity (degree to which the IS occurred according to protocol), clinical intervention fidelity (delivery of CC screening, onsite treatment, and referral according to protocol), clinical effectiveness (posttreatment screen negative), and sustainment (continued integrated CCST service delivery). Additionally, we will descriptively explore potential mechanisms, including organizational readiness, implementation climate, CCST self-efficacy, and implementation intentions. DISCUSSION: The assessment of IS to increase CCST rates is consistent with the global plan of eliminating CC as a public health threat by 2030. Our study will identify a set of evidence-based IS for low-income settings to integrate evidence-based CCST interventions into routine HIV care in order to improve the health and life expectancy of WLHIV. TRIAL REGISTRATION: Prospectively registered on November 7, 2023, at ClinicalTrials.gov no. NCT06128304. https://classic. CLINICALTRIALS: gov/ct2/show/study/NCT06128304.

Ethics and Effectiveness of US COVID-19 Vaccine Mandates and Vaccination Passports: A Review.

BACKGROUND: The highest-income countries procured 50 times as many COVID-19 vaccines as low-income countries, a global health inequity that resulted in only 4.6% of the poorest 5th of the world receiving a COVID-19 vaccine. High-income countries are considering vaccine mandates and passports to contain the spread of COVID-19. This study is a curated discourse aimed at examining how vaccine mandates and passports may impact global vaccine equity from an ethics perspective. STUDY DESIGN: Narrative review adapted for a debate. METHODS: In November 2021, we conducted a review of studies examining global vaccine mandates for an upper-level global health course at Northeastern University, Boston, United States (U.S.). In total, 19 upper-level students, one research assistant, and one instructor participated in the data collection, analysis, and discussion. RESULTS: The review showed vaccine mandates are ethical and effective if autonomy-centered alternatives like soft mandates are first exhausted. Unwarranted stringent public health measures degrade public trust. In the U.S. alone, COVID-19-related deaths hovered above 300 000 before COVID-19 vaccination began in mid-December 2020. Since then, the number of COVID-19 deaths more than doubled, despite the wide availability of the vaccine. For many low- and middle-income countries (LMICs) vaccines are not available or easily accessible. Global collaboration to facilitate vaccine availability in LMICs should be a priority. CONCLUSIONS: It is essential to get as many people as possible vaccinated to return to some normality. However, vaccine mandates and passports need to be used only sparingly, especially when other options have been exhausted.

Health care Providers' Perceptions About Overweight and Obesity Among People Living With Human Immunodeficiency Virus in Nigeria.

HIV infection was associated with significant weight loss before the advent of potent antiretroviral therapy (ART). Weight gain while on treatment was seen as a clinical indicator of treatment success. Perceptions of health care providers (HCPs) about obesity among people living with (PLHIV) were examined. We conducted 16 key informant interviews with HCPs in two states in southeastern Nigeria, which were then coded thematically. The respondents included seven physicians, four nurses, three adherence counselors, and two pharmacists. The analysis revealed three key themes: HCPs do not see excess weight gain as a problem; there are several challenges in managing obesity among PLHIV; and comorbidities play a role in the management of obesity among PLHIV. We conclude that obesity among PLHIV is an important clinical issue that HCPs need to address with the commencement of ART.

Changes in body mass index among people living with HIV who are new on highly active antiretroviral therapy: a systematic review and meta-analysis.

In the era of highly active antiretroviral therapy (HAART), obesity is increasingly being reported among people living with HIV (PLHIV). In this study, we reviewed published literature on body mass index (BMI) changes among treatment-naïve adult PLHIV who started HAART and remained on treatment for at least six months. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline, four databases were searched, and results of included studies were synthesized to describe the BMI trend among PLHIV on treatment. The search generated 4948 studies, of which 30 were included in the qualitative synthesis and 18 were eligible for the meta-analysis. All the studies showed an increase in group BMI. HAART was associated with increase in BMI (pooled effect size [ES] = 1.58 kg/m2; 95% CI: 1.36, 1.81). The heterogeneity among the 18 studies was high (I2 = 85%; p < .01). Subgroup analyses showed pooled ES of 1.54 kg/m2 (95% CI: 1.21, 1.87) and 1.63 kg/m2 (95% CI: 1.34, 1.91) for studies with follow-up ≤1 year and >1 year, respectively. We conclude that the greatest gain in BMI is in the initial 6-12 months on treatment, with minor gains in the second and subsequent years of treatment.

Understanding the multidimensional trajectory of psychosocial maternal risk factors causing preterm birth: A systematic review.

OBJECTIVES: Among all known risk factors of preterm birth, psychosocial factors form an intricate collection, which includes a multidimensional spectrum of interrelated mediating mechanisms. The understanding of these interconnected mechanisms is vital for designing targeted interventions to reduce preterm births. The objective of this systematic review was to investigate potential psychosocial maternal factors and their interactions to cause preterm birth. METHODS: PubMed, CINAHL, Scopus, Medline, and Cochrane Database of Systematic Reviews were searched for U.S.-based English language studies published between 1989 and 2019. Titles, abstracts, and full-texts were screened to determine eligibility for inclusion. Data were extracted from eligible studies using a customized data collection form. The National Institutes of Health assessment tool was utilized for quality assessment. RESULTS: Among the 76 full texts that were reviewed, 9 records met the eligibility criteria, and were included in the final review. The included publications addressed psychosocial factors including racial disparity, lifetime racism, neighborhood disadvantage, lack of partner support, childhood maltreatment and life-course variations, including homelessness and marital status. Antenatal stress was identified as a common mechanism through which psychosocial mediators may act to cause preterm birth. CONCLUSIONS: This review highlights the need for controlling potential risk factors of maternal stress by improving prenatal care, providing proper housing, and establishing conducive social environments for pregnant women. The review also suggests the importance of maternal psychological counselling and extensive maternal health monitoring among minority groups during the pregnancy period.

HIV testing among men in Nigeria: a comparative analysis between young people and adults.

HIV testing among men is critical to ending the HIV epidemic in sub-Saharan Africa. Using the Multiple Indicator Cluster Survey, 2016/2017, we examined the uptake and determinants of HIV testing among sexually active men in Nigeria. A total of 1254 young people (15-24 years) and 7866 adults (25-49 years) were included in the analysis. We conducted binary logistic regression analyses to estimate the odds ratio (OR) and adjusted OR for testing for HIV in the last 12 months preceding the survey. Approximately 18.7% of men had tested for HIV (young people [17%] vs. adult [19%], p=0.125). The overall adjusted model showed that the likelihood of HIV testing was significantly higher among those with at least primary education, currently married, who used condom at last sexual intercourse, who drank alcohol one month preceding the survey, with no discriminatory attitudes towards people living with HIV (PLHIV), exposed to media, in the rich and richest quintiles, and in the North Central Zone. Education, geopolitical zone, and discriminatory attitudes towards PLHIV were the significant factors common to both age groups. Our results suggest that HIV testing among sexually active men in Nigeria is low, and the determinants vary between young people and adults.

Towards the elimination of mother-to-child transmission of HIV in Nigeria: a health system perspective of the achievements and challenges.

Despite its scaled-up response for prevention of mother-to-child transmission of HIV (PMTCT), Nigeria still contributes the greatest number of infants infected with HIV worldwide. Drawing on our knowledge, and review of policy documents and research papers, we explored the achievements and challenges in the elimination of mother-to-child transmission of HIV in Nigeria using the WHO's health systems framework. We found that Nigeria has increased the number of PMTCT sites, decentralized and integrated PMTCT care for expanded service delivery, adopted task-shifting to address the shortage of skilled healthcare providers, explored alternative sources of domestic funding to bridge the funding gap and harmonized the health management information system to improve data quality. Some of the challenges we identified included: difficulty in identifying HIV-infected pregnant women because of low uptake of antenatal care; interrupted supplies of medical commodities; knowledge gaps among healthcare workers; and lack of a national unique identifying system to enhance data quality. While there have been some achievements in the PMTCT program, gaps still exist in the different blocks of the health system. Elimination of mother-to-child transmission of HIV in Nigeria will require the implementation of feasible, culturally acceptable and sustainable interventions to address the health system-related challenges.

Health Benefits from Upgrading Public Buses for Cleaner Air: A Case Study of Clark County, Nevada and the United States.

Public transit buses, which move more than 5 billion passengers annually in the United States (U.S.), can contribute substantially to the environmental health burden through emitted air pollutants. As a leader in transforming to cleaner bus fleets, the Regional Transport Commission of Southern Nevada (RTC) has been transitioning from diesel to compressed natural gas (CNG) transit buses since 1999. By 2017, ~75% of RTC's buses operating in Clark County, Nevada were CNG-powered. This study assesses the health benefits of the venture using the US Environmental Protection Agency's (EPA) Co-Benefits Risk Assessment (COBRA) model, considering the emission and exposure changes from the 2017 baseline for two hypothetical scenarios: (1) no transition (CC_D) and (2) complete transition (CC_N). The CC_D scenario shows realized health benefits, mostly due to avoided mortality, of $0.79⁻8.21 million per year for 2017 alone, while CC_N suggests an additional $0.88⁻2.24 million annually that could be achieved by completing the transition. The wide range of estimates partly reflects uncertainties in determining diesel bus emissions under business-as-usual. These health benefits were not limited locally, with ~70% going to other counties. Two national-scale scenarios, US_D and US_N, were also constructed to explore the health impact of transitioning from diesel to CNG buses across the U.S. As of 2017, with CNG powering only ~20% of transit bus mileages nationwide, there could be massive unrealized health benefits of $0.98⁻2.48 billion per year including 114⁻258 avoided premature deaths and >5000 avoided respiratory and cardiovascular illnesses. Taking into account the health benefits, economic costs, and the inter-state nature of air pollution, expanding federal assistances to accelerate a nationwide transition to cleaner bus fleets is highly recommended.

The use of social marketing campaigns to increase HIV testing uptake: a systematic review.

Social marketing campaigns have been increasingly used in HIV prevention efforts to address barriers to HIV testing. The purpose of this review is to evaluate the social marketing campaigns in the past ten years (2008-2017) that have targeted HIV testing or intent to test as an outcome, and synthesize the results to determine which campaigns work or do not work. The search was conducted using PubMed, Scopus, PsycINFO, EMBASE, and ABI/Inform. The quality assessment tool for quantitative studies developed by the Effective Public Health Practice Project was used to assess study quality. The search generated 373 articles, of which 13 articles met the inclusion criteria. These articles were from 13 distinct campaigns carried out in 9 countries, twelve of which were in high income countries. Sixty-nine percent (n = 9) of the campaigns targeted MSM, gay men, or MSMW, 23% (n = 3) targeted the general population, while 8% (n = 1) focused on African-American women. The study designs for evaluating the campaigns were predominantly cross-sectional, with 4 of the articles combining two or three study designs to evaluate their campaign. Overall, 38% (n = 5) of the campaigns had an increase in HIV testing outcomes, 23% (n = 3) reported no change in HIV testing outcomes, and the remaining 38% (n = 5) of the studies reported mixed outcomes. The results of the quality rating showed that 69% (n = 9) of the papers had weak global ratings, while 31% (n = 4) had moderate rating. None of the articles had a strong rating. This review displayed that social marketing campaigns intended to increase HIV testing uptake were effective in some context. Social marketing practitioners will need to come up with a standardized way of communicating the results of campaign exposure and impact so as to enhance comparison among the multitude of campaigns.