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1.
PLoS One ; 16(11): e0259849, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34780512

RESUMO

BACKGROUND: Insecticidal mosquito vector control products are vital components of malaria control programmes. Test facilities are key in assessing the effectiveness of vector control products against local mosquito populations, in environments where they will be used. Data from these test facilities must be of a high quality to be accepted by regulatory authorities, including the WHO Prequalification Team for vector control products. In 2013-4, seven insecticide testing facilities across sub-Saharan Africa, with technical and financial support from Innovative Vector Control Consortium (IVCC), began development and implementation of quality management system compliant with the principles of Good Laboratory Practice (GLP) to improve data quality and reliability. METHODS AND PRINCIPLE FINDINGS: We conducted semi-structured interviews, emails, and video-call interviews with individuals at five test facilities engaged in the IVCC-supported programme and working towards or having achieved GLP. We used framework analysis to identify and describe factors affeting progress towards GLP. We found that eight factors were instrumental in progress, and that test facilities had varying levels of control over these factors. They had high control over the training programme, project planning, and senior leadership support; medium control over infrastructure development, staff structure, and procurement; and low control over funding the availability and accessibility of relevant expertise. Collaboration with IVCC and other partners was key to overcoming the challenges associated with low and medium control factors. CONCLUSION: For partnership and consortia models of research capacity strengthening, test facilities can use their own internal resources to address identified high-control factors. Project plans should allow additional time for interaction with external agencies to address medium-control factors, and partners with access to expertise and funding should concentrate their efforts on supporting institutions to address low-control factors. In practice, this includes planning for financial sustainability at the outset, and acting to strengthen national and regional training capacity.

2.
Res Social Adm Pharm ; 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34362688

RESUMO

As several low- and middle-income countries roll out their COVID-19 vaccination programmes, COVID-19 vaccines hesitancy could threaten the success of such programmes. But pharmacists can play a leading role in addressing COVID-19 vaccine hesitancy by using a critical mobile phone-based technology. This technology, known as caller tunes or ringback tones, is flourishing in low- and middle-income countries such as those in Africa and Asia where it is used to promote popular songs and religious messages. With this technology, callers to mobile phones hear a message or a song instead of the typical ringing sound. There is a need for pharmacists associations to collaborate with the creative arts industry and telecommunication companies to have caller tunes on COVID-19 vaccines. As pharmacists and others download COVID-19 vaccine caller tunes onto their mobile phones, their callers will hear COVID-19 vaccines messages or songs. This could help combat disinformation and hesitancy, and promote widespread vaccination as availability increases.

3.
BMC Public Health ; 21(1): 1480, 2021 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-34325680

RESUMO

BACKGROUND: Severe anaemia (haemoglobin < 6 g/dL) is a leading cause of recurrent hospitalisation in African children. We investigated predictors of readmission in children hospitalised with severe anaemia in the TRACT trial (ISRCTN84086586) in order to identify potential future interventions. METHODS: Secondary analyses of the trial examined 3894 children from Uganda and Malawi surviving a hospital episode of severe anaemia. Predictors of all-cause readmission within 180 days of discharge were identified using multivariable regression with death as a competing risk. Groups of children with similar characteristics were identified using hierarchical clustering. RESULTS: Of the 3894 survivors 682 (18%) were readmitted; 403 (10%) had ≥2 re-admissions over 180 days. Three main causes of readmission were identified: severe anaemia (n = 456), malaria (n = 252) and haemoglobinuria/dark urine syndrome (n = 165). Overall, factors increasing risk of readmission included HIV-infection (hazard ratio 2.48 (95% CI 1.63-3.78), p < 0.001); ≥2 hospital admissions in the preceding 12 months (1.44(1.19-1.74), p < 0.001); history of transfusion (1.48(1.13-1.93), p = 0.005); and missing ≥1 trial medication dose (proxy for care quality) (1.43 (1.21-1.69), p < 0.001). Children with uncomplicated severe anaemia (Hb 4-6 g/dL and no severity features), who never received a transfusion (per trial protocol) during the initial admission had a substantially lower risk of readmission (0.67(0.47-0.96), p = 0.04). Malaria (among children with no prior history of transfusion) (0.60(0.47-0.76), p < 0.001); younger-age (1.07 (1.03-1.10) per 1 year younger, p < 0.001) and known sickle cell disease (0.62(0.46-0.82), p = 0.001) also decreased risk of readmission. For anaemia re-admissions, gross splenomegaly and enlarged spleen increased risk by 1.73(1.23-2.44) and 1.46(1.18-1.82) respectively compared to no splenomegaly. Clustering identified four groups of children with readmission rates from 14 to 20%. The cluster with the highest readmission rate was characterised by very low haemoglobin (mean 3.6 g/dL). Sickle Cell Disease (SCD) predominated in two clusters associated with chronic repeated admissions or severe, acute presentations in largely undiagnosed SCD. The final cluster had high rates of malaria (78%), severity signs and very low platelet count, consistent with acute severe malaria. CONCLUSIONS: Younger age, HIV infection and history of previous hospital admissions predicted increased risk of readmission. However, no obvious clinical factors for intervention were identified. As missing medication doses was highly predictive, attention to care related factors may be important. TRIAL REGISTRATION: ISRCTN ISRCTN84086586 .


Assuntos
Anemia , Infecções por HIV , Anemia/epidemiologia , Anemia/terapia , Criança , Humanos , Incidência , Malaui/epidemiologia , Readmissão do Paciente , Uganda/epidemiologia
4.
Br J Haematol ; 193(5): 894-901, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33993492

RESUMO

Owing to the rapid turnaround time in the assessment of haemoglobin level by point-of-care tests (POC Hb), these have grown in popularity and scope in large parts of the world. However, whilst POC testing for malaria and HIV remains has been integrated into patient management in Africa, the use of POC haemoglobin testing remains neglected by health services. The main users of transfusions (paediatric, maternity and trauma services) present largely as emergencies. Ward-based POC Hb could result in more rapid and accurate diagnosis of anaemia, contributing to saving of lives and at the same time reduce unnecessary transfusions which deplete the limited supplies of donated blood in Africa. Severe anaemia requiring transfusion is a major cause of paediatric admission in Africa. At a dissemination meeting to discuss the results of a large phase III paediatric transfusion trial and steps to implementation of the findings participants strongly recommended that one of the most pressing actions required was to prioritise the use of POC haemoglobin testing. This would facilitate implementation of the new transfusion algorithm, developed at the meeting, which refines patient management including blood transfusions. We present the rationale for the strongly recommended prioritisation of POC Hb, using paediatric transfusion as an exemplar.


Assuntos
Algoritmos , Anemia , Transfusão de Sangue , Hemoglobinas/metabolismo , Testes Imediatos , Anemia/sangue , Anemia/diagnóstico , Anemia/terapia , Criança , Pré-Escolar , Ensaios Clínicos Fase III como Assunto , Feminino , Humanos , Lactente , Malaui , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Uganda
5.
Br J Haematol ; 193(6): 1247-1259, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33955552

RESUMO

The phase III Transfusion and Treatment of severe anaemia in African Children Trial (TRACT) found that conservative management of uncomplicated severe anaemia [haemoglobin (Hb) 40-60 g/l] was safe, and that transfusion volume (20 vs. 30 ml/kg whole blood equivalent) for children with severe anaemia (Hb <60 g/l) had strong but opposing effects on mortality, depending on fever status (>37·5°C). In 2020 a stakeholder meeting of paediatric and blood transfusion groups from Africa reviewed the results and additional analyses. Among all 3196 children receiving an initial transfusion there was no evidence that nutritional status, presence of shock, malaria parasite burden or sickle cell disease status influenced outcomes or modified the interaction with fever status on volume required. Fever status at the time of ordering blood was a reliable determinant of volume required for optimal outcome. Elevated heart and respiratory rates normalised irrespective of transfusion volume and without diuretics. By consensus, a transfusion management algorithm was developed, incorporating three additional measurements of Hb post-admission, alongside clinical monitoring. The proposed algorithm should help clinicians safely implement findings from TRACT. Further research should assess its implementation in routine clinical practice.


Assuntos
Algoritmos , Anemia Falciforme/terapia , Transfusão de Sangue , Consenso , Malária/terapia , África/epidemiologia , Anemia Falciforme/epidemiologia , Criança , Pré-Escolar , Humanos , Malária/epidemiologia , Masculino , Índice de Gravidade de Doença
7.
BMJ Glob Health ; 6(3)2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33789870

RESUMO

This practice note presents four conceptual tools intended to support the design, selection and evaluation of research capacity strengthening (RCS) programmes in low-income and middle-income country settings. The tools may be used by a wide range of RCS stakeholders, including funders, implementing parties and programme evaluators, to guide decision-making in lieu of largely as yet unavailable empirical evidence. The first conceptual tool guides decision-making regarding RCS intervention design, focusing specifically on the combination and integration of potential intervention activities. The second conceptual tool provides a framework for assessing the implementation challenges of potential RCS interventions in terms of: (1) the overall cost of implementing the proposed intervention in a given context; (2) the length of time required to complete full implementation of the proposed intervention in a given context and (3) the level of control the implementing partners would have over the proposed intervention in a given context. The third conceptual tool provides a means to consider the anticipated impact of potential RCS interventions in order to inform selection decisions (ie, which out of a number of potential RCS intervention options may be most impactful in a given setting given the intervention design and implementation challenges). The fourth and final tool is designed to support the evaluation of a collective RCS effort, whether that be multiple RCS interventions delivered within the context of a single or continuous programme or multiple RCS programmes delivered in a common setting.

9.
PLoS One ; 16(2): e0246267, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33529189

RESUMO

INTRODUCTION: Moderate to severe acute malnutrition (SAM/MAM) and severe anaemia are important and associated co-morbidities in children aged less than five years. Independently, these two morbidities are responsible for high risk of in-hospital and post-discharge deaths and hospital readmissions. The primary objective of this study is to investigate the risk of death among severely anaemic children with moderate to severe acute malnutrition compared to children with severe anaemia alone. METHODS: This was a retrospective analysis of data collected from a large prospective study that was investigating severe anaemia in children aged less than 5 years old. The study was conducted at Queen Elizabeth Central Hospital in Blantyre and Chikhwawa district hospital in southern Malawi. Children aged less than five years old; with severe anaemia were screened and enrolled. Each child was followed up for eighteen months at one, three, six, twelve and eighteen months after enrolment. Data were analysed using STATA 15. RESULTS: Between July 2002 and July 2004, 382 severely anaemic children were enrolled in the main study. A total of 52 children were excluded due to missing anthropometric data. Out of the 330 included, 53 children were moderately to severely malnourished and 277 were not. At the end of the 18-month follow period, 28.3% of children with MAM/SAM died compared to 13% of children without MAM/SAM (RR 2.1, CI 0.9-4.2, p = 0.03). Similarly, children with moderate to severe malnutrition reported a significantly higher number of malaria infection cases (33.9%) compared to children with severe anaemia alone (27.9%, p = 0.02). However, the number of hospitalizations and recurrence of severe anaemia was similar and not statistically significant between the two groups (RR 0.8 (0.4-1.4), p = 0.6 and RR 1.1 (0.3-2.8), p = 0.8). CONCLUSION: Among children with severe anaemia, those who also had moderate to severe malnutrition had a twofold higher risk of dying compared to those who did not. It is therefore crucial to investigate acute malnutrition among severely anaemic children, as this might be treatable factor associated with high mortality.


Assuntos
Anemia/epidemiologia , Anemia/mortalidade , Transtornos da Nutrição Infantil/mortalidade , Assistência ao Convalescente , Transtornos da Nutrição Infantil/complicações , Transtornos da Nutrição Infantil/epidemiologia , Pré-Escolar , Estudos de Coortes , Comorbidade , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Malaui/epidemiologia , Masculino , Desnutrição/epidemiologia , Desnutrição/mortalidade , Alta do Paciente , Recidiva , Estudos Retrospectivos , Desnutrição Aguda Grave/epidemiologia
10.
Br J Haematol ; 193(1): 26-42, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33161568

RESUMO

The majority of the global population of sickle cell disease (SCD) patients resides in Africa. Individuals with this condition are at great risk of serious infections and early mortality secondary to splenic dysfunction without preventative measures. This review investigated the spectrum of splenic complications encountered in SCD among populations in Africa. We systematically searched several databases for all articles published through March 3, 2020. We included 55 studies from 14 African countries. This review reveals the difference in frequency of splenic complications in SCD in Africa when compared with their counterparts in the United State and Europe. While several studies (n = 45) described splenomegaly with a prevalence of 12% to 73% among children, and 4% to 50% among adults with HbSS, the reported prevalence for acute splenic sequestration crisis (n = 6 studies) and hypersplenism (n = 4 studies) was <10% and <5% respectively. A total of 30 surgical splenectomy was reported across eight studies. Only two (3.7%) studies provided data on spleen function. A conflicting pattern was observed amongst studies that evaluated the relationship between splenomegaly and the presence of bacterial and malaria infections. This review reveals the paucity of studies describing the role of SCD-induced splenic dysfunction in morbidity and infection related mortality in Africa.


Assuntos
Anemia Falciforme/complicações , Hemoglobina Falciforme/análise , Esplenopatias/etiologia , Esplenomegalia/epidemiologia , Adolescente , Adulto , África/epidemiologia , Anemia Falciforme/epidemiologia , Infecções Bacterianas/complicações , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Hiperesplenismo/epidemiologia , Hiperesplenismo/cirurgia , Malária/complicações , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Esplenectomia/métodos , Esplenectomia/estatística & dados numéricos , Esplenopatias/epidemiologia , Esplenopatias/patologia , Esplenopatias/cirurgia , Ruptura Esplênica/epidemiologia , Ruptura Esplênica/etiologia , Ruptura Esplênica/cirurgia , Esplenomegalia/complicações , Esplenomegalia/diagnóstico , Esplenomegalia/cirurgia
11.
Vox Sang ; 116(3): 324-335, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33161604

RESUMO

OBJECTIVE: This study seeks to identify factors that are predictive of intention to return to donate blood among first-time blood donors. METHODS: A cross-sectional survey of 505 first-time blood donors, selected from blood donation sessions across three regions in Ghana. Data were obtained on their intention to donate blood in the next four months, factors that would influence this decision. Logistic regression models were used to test factors that were predictive of intention to return. RESULTS: First-time donors were young with 87·4% below 35 years of age, male (72·5%), single (73·3%), Christian (93·7%), employed (58·8%), with at least a basic education (98%). Factors that positively predicted intention to return included: motivational incentives (OR = 1·67, 95%CI: 1·01-2·78; P = 0·045); ease of access to the donation site (OR = 2·65, 95%CI: 1·48-4·73; P = 0·001); SMS and email reminders (OR = 2·84, 95%CI: 1·60-5·06; P < 0·001); and television, radio or newspaper advertisements (OR = 2·97, 95%CI: 1·66-5·31; P < 0·001). Factors that negatively predicted intention included preferential access to transfusions (i.e. 'blood credits') (OR = 0·43, 95%CI: 0·23-0·83; P = 0·012); getting to know test results (OR = 0·40, 95%CI: 0·20-0·80; P = 0·010); and not knowing and/or trusting what happens to the blood after donating (OR = 0·50, 95%CI: 0·28-0·88; P = 0·016). CONCLUSION: Motivational incentives, convenient access to donation sessions, reminders and mass media advertisements appear to positively influence intention to return to donate. Conversely not knowing what happens to the blood after donation negatively influenced intention to return. Interventions to promote repeat blood donation should consider the identified factors.


Assuntos
Doadores de Sangue/psicologia , Motivação , Adolescente , Adulto , Doadores de Sangue/estatística & dados numéricos , Estudos Transversais , Feminino , Gana , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Gates Open Res ; 4: 59, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32789289

RESUMO

Background: With increasing insecticide resistance in malaria-endemic countries there is an urgent need for safe and effective novel vector control products. To improve the capacity of facilities that test insecticides in sub-Saharan Africa, a programme is supporting seven facilities towards Good Laboratory Practice (GLP) certification, the globally recognized standard for quality management system (QMS) for the conduct of non-clinical and environmental studies. The World Health Organization (WHO) GLP Handbook provides guidance on a stepwise approach to implement a GLP compliant QMS. This study assesses auditor GLP checklists and timings outlined in the WHO GLP Handbook in the real-life context of a Tanzanian insecticide-testing facility, evaluating their implementation in this context. Methods and Principle Findings: We conducted document review and semi-structured interviews with staff at all levels of the test facility to explore factors that influenced progress towards GLP certification. We found that while auditor GLP checklists underemphasised computer systems, they were otherwise broadly applicable. Factors that delayed time to completion of GLP certification included the need for extensive infrastructure improvements, the availability of regional expertise related to GLP, the capacity of national and regional external systems and services to meet GLP compliance requirements, and training development required for Standard Operating Procedure implementation. Conclusion: The standards required for full GLP compliance are rigorous, with an expected completion timeline to implementation of 24 months. This study shows that in low and middle-income countries this timeline may be unrealistic due to challenges related to infrastructure development and lack of regional capacity and expertise. We recommend a comprehensive gap analysis when starting a project, including these areas which are beyond those recommended by the WHO GLP Handbook. These challenges can be successfully overcome and the experience in Tanzania provides key lessons for other facilities seeking GLP certification or the development of similar QMS.

14.
PLoS One ; 15(6): e0233274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32492040

RESUMO

BACKGROUND: Hemorrhage is a leading cause of death after trauma and childbirth. In response to severe hemorrhage, bleeding patients often receive transfusions of red blood cells, plasma, platelets, or other blood components. We examined risk factors for transfusion in acute severe bleeding in two trials of over 20,000 patients to better understand factors associated with transfusion likelihood. STUDY DESIGN AND METHODS: We conducted a cohort analysis of data from the CRASH-2 and WOMAN trials, two multinational trials that recruited patients with traumatic and postpartum hemorrhage, respectively. For each trial, we examined the effect of 10 factors on blood transfusion likelihood. Univariate and multivariate Poisson regressions were used to analyze the relationship between risk factors and blood transfusion. RESULTS: Of the 20,207 traumatic hemorrhage patients, 10,232 (51%) received blood components. Of the 20,060 women with postpartum hemorrhage, 10,958 (55%) received blood components. For patients who suffered from traumatic hemorrhage, those greater than three hours from injury to hospitalization were more likely to be transfused (ARR 1.37; 95% CI, 1.20-1.56). Postpartum hemorrhage patients had an increased likelihood of transfusion if they gave birth outside the hospital (ARR 1.30; 95% CI 1.22-1.39), gave birth more than three hours before hospitalization (ARR 1.09; 95% CI 1.01-1.17), had a Caesarean section (ARR 1.16; 95% CI 1.08-1.25), and if they had any identifiable causes of hemorrhage other than uterine atony. CONCLUSION: Several risk factors are associated with an increased likelihood of transfusion in traumatic and postpartum hemorrhage patients. Altering modifiable factors, by reducing time from injury or childbirth to hospitalization, for example, might be able to reduce transfusions and their complications. TRIAL REGISTRATION: CRASH-2 is registered as ISRCTN86750102, ClinicalTrials.gov NCT00375258 and South African Clinical Trial Register DOH-27-0607-1919. WOMAN is registered as ISRCTN76912190, ClinicalTrials.gov NCT00872469, PACTR201007000192283, and EudraCT number 2008-008441-38.


Assuntos
Transfusão de Sangue , Hemorragia/terapia , Hemorragia Pós-Parto/terapia , Ferimentos e Lesões/terapia , Adulto , Antifibrinolíticos/uso terapêutico , Transfusão de Sangue/estatística & dados numéricos , Estudos de Coortes , Método Duplo-Cego , Feminino , Hemorragia/etiologia , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Gravidez , Fatores de Risco , Ácido Tranexâmico/uso terapêutico , Ferimentos e Lesões/complicações , Adulto Jovem
15.
F1000Res ; 9: 517, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32595961

RESUMO

Background: Development partners and research councils are increasingly investing in research capacity strengthening initiatives in low- and middle-income countries to support sustainable research systems. However, there are few reported evaluations of research capacity strengthening initiatives and no agreed evaluation metrics. Methods: To advance progress towards a standardised set of outcome and impact indicators, this paper presents a structured review of research capacity strengthening indicators described in the published and grey literature. Results: We identified a total of 668 indicators of which 40% measured output, 59.5% outcome and 0.5% impact. Only 1% of outcome and impact indicators met all four quality criteria applied. A majority (63%) of reported outcome indicators clustered in four focal areas, including: research management and support (97/400), the attainment and application of new research skills and knowledge (62/400), research collaboration (53/400), and knowledge transfer (39/400). Conclusions: Whilst this review identified few examples of quality research capacity strengthening indicators, it has identified priority focal areas in which outcome and impact indicators could be developed as well as a small set of 'candidate' indicators that could form the basis of development efforts.


Assuntos
Bibliometria , Pesquisa Biomédica/tendências , Literatura Cinzenta
16.
BMJ Glob Health ; 5(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32354784

RESUMO

INTRODUCTION: Global health research involves disciplines within and beyond the health sciences. A cross-disciplinary collaborative research approach enables an interchange of knowledge and experience and stimulates innovative responses to complex health challenges. However, there is little robust evidence to guide the design and implementation of cross-disciplinary research in global health, hampering effective collective action. This review synthesised evidence on practical actions for fostering cross-disciplinary research to provide guidance on the design and implementation of research in global health. METHODS: We searched five electronic databases using key words. The search included original research and research notes articles in English. We used a framework adapted from the socio-ecological model and thematic synthesis for data analysis. RESULTS: Thirty-six original research and 27 research notes articles were included in the review. These were predominantly from high-income countries and indicated that practical actions on fostering cross-disciplinary research are closely linked to leadership and teamwork which should be planned and implemented at research team and institutional levels. The publications also indicated that individual qualities such as being receptive to new ideas and funders' power and influence have practical implications for conducting cross-disciplinary research. Practical actions that individuals, research team leaders, academic institutions and funders can undertake to foster cross-disciplinary research were identified. CONCLUSION: Our review found evidence from high-income countries, not low-and-middle-income countries, about practices that can improve cross-disciplinary research in global health. Critical knowledge gaps exist around how leadership and teamwork processes can better integrate expertise from different disciplines to make cross-disciplinary research more effective.


Assuntos
Saúde Global , Liderança , Humanos , Universidades
17.
BMC Health Serv Res ; 20(1): 444, 2020 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-32429903

RESUMO

BACKGROUND: Anaemia and malaria are both major contributors to maternal and child mortality, and morbidity, with some of the worst outcomes occurring in sub-Saharan Africa. Point of care tests (POCT), if used appropriately, provide a simple, inexpensive form of diagnostic testing, as a reliable alternative when laboratory tests are not readily available. In such resource limited settings, clinical staff tend to rely on symptom-based diagnosis and presumptive treatment. This study uses qualitative methods to identify the current practice of POCT use for malaria and anaemia, to explore the enablers and barriers to effective implementation of these POCT, and to determine how relationships between each of the stakeholder groups may impact on POCT use. METHODS: Staff (clinical and laboratory) and patients (pregnant women) at three antenatal care facilities within the Ashanti Region of Ghana participated in interviews and focus group discussions (FGDs). An initial coding framework was developed based on the pre-defined objectives of the study. Thematic analysis was used to identify subthemes and categories within each of the key themes. RESULTS: At the time data were collected all three facilities used malaria POCT either as an adjunct to microscopy, or as their only form of malaria testing. Although all three facilities were familiar with haemoglobin colour scale (HCS), none of the facilities used them routinely. Clinical staff perceived symptom-based diagnosis was a quick way to diagnosis because access to POCT during consultations was unreliable, but recognized disadvantages associated with symptom-based diagnosis. Perceived advantages of malaria and anaemia POCT were user-friendliness, improved diagnosis and opportunity for patient engagement, as well as lower cost implication for patients. Perceived disadvantages included likelihood of missed diagnosis of mild anaemia, as well as likelihood of human error leading to in accurate diagnosis which could impact on patient trust. Poor communication and lack of trust between staff groups was also identified as a barrier to effective uptake of POCT. CONCLUSIONS: Consistent supply of POCT as well as staff training and staff and patient engagement, are fundamental to successful uptake of POCT for effective malaria and anaemia management.


Assuntos
Anemia/diagnóstico , Malária/diagnóstico , Testes Imediatos , Cuidado Pré-Natal , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Testes Diagnósticos de Rotina , Feminino , Grupos Focais , Gana , Hemoglobinas , Humanos , Sistemas Automatizados de Assistência Junto ao Leito , Gravidez , Gestantes , Pesquisa Qualitativa , Adulto Jovem
18.
PLoS One ; 15(2): e0218694, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32107492

RESUMO

INTRODUCTION: Iron deficiency is a treatable cause of severe anaemia in low-and-middle-income-countries (LMIC). Diagnosing it remains challenging as peripheral blood markers poorly reflect bone-marrow iron deficiency (BM-ID), especially in the context of HIV-infection. METHODS: Severely anaemic (haemoglobin ≤70g/l) HIV-infected adults were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. BM-ID was evaluated. Accuracy of blood markers (including hepcidin, mean corpuscular volume, mean cellular haemoglobin concentration, serum iron, serum ferritin, soluble transferrin receptor (sTfR), sTfR index, sTfR-ratio) to detect BM-ID was evaluated by ROC area under the curve (AUCROC). RESULTS: Seventy-three patients were enrolled and 35 (48.0%) had BM-ID. Although hepcidin and MCV performed best (AUCROC of 0.593 and 0.545 respectively) all markers performed poorly in identifying BM-ID (ROC<0.6). The AUCROC of hepcidin in males was 0.767 (sensitivity 80%, specificity 78%) and in women 0.490 (sensitivity 60%, specificity 61%). CONCLUSION: BM-ID deficiency was common in severely anaemic HIV-infected patients. It is an important and potential treatable contributor to severe anaemia but lack of definitive biomarkers makes it difficult to accurately assess iron status in these patients. Further investigation of the potential of hepcidin is needed, including exploration of the differences in hepcidin results between males and females.


Assuntos
Anemia Ferropriva/diagnóstico , Infecções por HIV/complicações , Hepcidinas/sangue , Adulto , Anemia Ferropriva/sangue , Anemia Ferropriva/complicações , Biomarcadores/sangue , Células da Medula Óssea/metabolismo , Feminino , Ferritinas/sangue , Humanos , Ferro/sangue , Malaui , Masculino , Receptores da Transferrina/sangue , Sensibilidade e Especificidade
19.
Vox Sang ; 115(3): 221-232, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32026497

RESUMO

BACKGROUND AND OBJECTIVES: Children and pregnant women use 75% of the blood supply in sub-Saharan Africa (SSA) but face widespread blood shortages. To increase safe blood supply, Africa-specific evidence and strengthened capacity for transfusion research are needed. Our study analysed seven years of SSA transfusion publications, compared researched topics against priorities and enumerated SSA transfusion research collaborations. MATERIALS AND METHODS: Data on research topic, journal type, authors' institutions and country were extracted from transfusion-related SSA articles published between 2008 and 14 and used to construct a quantitative, graphic visualization of collaborations. Research topics were compared to those identified as priorities for SSA blood services in 2008 and 2015. RESULTS: Of the 2176, 267 articles (average 38/year) met criteria for analysis. They involved 1245 authors, 673 institutions, 59 countries (35 SSA) and 1375 collaborations. About 41% were on transfusion-transmitted infections. About 34% were published in specialist transfusion journals. Only 7% involved exclusively collaborations within SSA. Two of the top fifteen institutions by publication quantity were from outside SSA. CONCLUSION: Despite a general paucity of SSA-relevant transfusion research, Francophone SSA was well-represented. Published research topics are not well matched to SSA research priorities; research on supply, distribution, financing and systems is particularly neglected. The study provides a baseline against which to track any refocusing of research activity to better meet SSA's needs. Transfusion research hubs within and beyond SSA have been identified as a springboard network for expanding SSA transfusion research capacity.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Reação Transfusional/epidemiologia , Adulto , África ao Sul do Saara/epidemiologia , Criança , Feminino , Humanos , Masculino , Gravidez
20.
PLoS One ; 15(2): e0218695, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32097440

RESUMO

BACKGROUND: Severe anaemia is a major cause of morbidity and mortality in HIV-infected adults living in resource-limited countries. Comprehensive data on the aetiology are lacking but are needed to improve outcomes. METHODS: HIV-infected adults with severe (haemoglobin ≤70g/l) or very severe anaemia (haemoglobin ≤ 50 g/l) were recruited at Queen Elizabeth Central Hospital, Blantyre, Malawi. Fifteen potential causes and associations with anaemia severity and mortality were explored. RESULTS: 199 patients were enrolled: 42.2% had very severe anaemia and 45.7% were on ART. More than two potential causes for anaemia were present in 94% of the patients including iron deficiency (55.3%), underweight (BMI<20: 49.7%), TB infection (41.2%) and unsuppressed HIV infection (viral load >1000 copies/ml) (73.9%). EBV/CMV co-infection (16.5%) was associated with very severe anaemia (OR 2.8 95% CI 1.1-6.9). Overall mortality was high (53%; 100/199) with a median time to death of 17.5 days (IQR 6-55) days. Death was associated with folate deficiency (HR 2.2; 95% CI 1.2-3.8) and end stage renal disease (HR 3.2; 95% CI 1.6-6.2). CONCLUSION: Mortality among severely anaemic HIV-infected adults is strikingly high. Clinicians should be aware of the urgent need for a multifactorial approach including starting or optimising HIV treatment, considering TB treatment, nutritional support and optimising renal management.


Assuntos
Anemia Ferropriva/etiologia , Infecções por HIV/complicações , Infecções por Herpesviridae/complicações , Desnutrição/complicações , Mortalidade , Tuberculose/complicações , Adulto , Anemia Ferropriva/complicações , Anemia Ferropriva/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por Herpesviridae/epidemiologia , Humanos , Masculino , Desnutrição/epidemiologia , Pessoa de Meia-Idade , Tuberculose/epidemiologia
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