Women’s Utilisation, Experiences and Satisfaction with Postnatal Follow-up Care: Systematic literature review

Postnatal follow-up care is reported to be the ‘underutilised’ aspect of the maternity care continuum. This review explores women’s utilisation of early and late postnatal follow-up and their experiences and satisfaction with it. Five online databases were searched for English or Arabic articles published between 2011 and 2021. Methodological quality of included studies was assessed using the Mixed Methods Appraisal Tool; the Andersen healthcare utilisation model was the framework for data analysis. A total of 19 articles met all inclusion criteria. Utilisation facilitators included complications, travel distance, knowledge of the importance for attending and being offered a telephonecall and home visit or clinic visit as options for follow-up. Impediments included lack of perceived need and notbeing provided with information about postnatal care. Comprehensive discussions with and examination by health providers were reported as positive experiences and influenced repeat utilisation. Dissatisfaction was associated with inconsistent information provided by health providers.Keywords: Postpartum Period; Postnatal Care; Women; Literature Review

Investigating Cognitive, Behavioural, and Environmental Barriers to HIV/AIDS’ Patients Adherence in Nigeria

Background Much of health care today involves helping patients manage conditions whose outcomes can be greatly influenced by lifestyle or behaviour change. HIV/AIDS is an imminent lifethreatening disease. HIV/AIDS patients’ adherence to health behaviours is related to their perceptions of the severity of a potential illness or the consequences of not preventing or treating the illness. Nonadherence involves patients taking medications incorrectly or not at all, forgetting or refusing to make essential behavioural changes for their care, and persisting in behaviours including high-risk sexual activity that jeopardize their health. Adoption of technology is slow in behavioural healthcare. This paper investigates the inherent individual and environmental barriers to HIV/AIDS’ patient adherence in an ongoing research on Women’s Health in Nigeria. Methods A mix of both qualitative and quantitative indicators are used to develop case studies of the inherent individual and environmental barriers to patient adherence. Focus groups discussions and semi-structured interviews. The study currently covers a clinic and a university teaching hospital each in case selected across rural and urban Ekiti, Lagos, Ogun, Ondo, and Oyo States of Nigeria. Results The primary causes of nonadherence are poor provider–patient communication, lack of understanding of the treatment and its importance, lack of trust and mutual caring in the therapeutic relationship, and provider behaviour that is controlling and paternalistic. Depressed patients with HIV have decreased adherence to antiretroviral therapy. Increased patient adherence to diagnostic and therapeutic plans leads to greater clinical efficiency and effectiveness. Conclusion The main drivers fuelling Nigeria’s HIV/AIDS epidemic include low risk perception, multiple concurrent sexual partners, informal transactional and intergenerational sex, lack of STI services, gender inequalities, stigma and discrimination, and inadequate health services. HIV/AIDS’ patients are required to take 95% or more of antiretroviral medications to control the disease. Keywords: adherence, behaviour, clinician-patient relationship, healthcare, HIV/AIDS, medicatio

Child health and mortality in resource-poor settings: a life-course and systemic approach

While there has been a staggering decline in global child mortality, sub-Saharan Africa (SSA) has consistently contributed the largest share. The 2020 global estimates on child mortality indicate SSA contributing 42%, 53% and 61% of neonatal, under-five, and 5-9 deaths, respectively. Moreover, the 1990-2020 child mortality data indicate an upward trend in SSA’s contribution in all age groups. The persistent high child mortality within the region could be attributed, amongst others, to inequities in health services’ access within countries. Additionally, there have been limited interventions that target children aged 5 years and beyond due to the limited research and data systems. As the focus of this paper-based thesis, Uganda as the study area shows the same issues within the SSA context. Therefore, it presents a novel opportunity to understand child health and mortality mechanisms among children aged 0-9 years. Guided by the concepts of interdependence, social interactions and health service delivery systems’ drawn from social and health systems and life-course perspectives, the thesis’ specific objectives are to: 1) determine the under-10 mortality age-specific estimates; 2) assess the epidemiological shift in the under-10 mortality risk factors and causes of death; 3) assess the role of Low Birth Weight (LBW) in mediating the new-born mortality risk factors and the role of institutional delivery in new-born mortality; 4) identify key community and household predictors of suspected pneumonia and diarrhoea, and 5) examine how multiple factors concurrently affect access to appropriate health care services. Using a decade (2005-2015) of event history data collected by Iganga-Mayuge Health and Demographic Surveillance Site (HDSS) in Eastern Uganda in Chapter 31, I found that the under-10 and 5-9 years of age mortality probabilities were 99 per 1000 live births and 11 per 1000 children aged 5-9 years, respectively. The new-born mortality and perinatal mortality were estimated at 22 and 31 per 1000 live births, respectively, with death within the first day of life (0-1 day) contributing the largest share (62%). I found that the magnitude of the association of the risk factors with under-10 mortality varied by age, with a stronger association observed among infants. The order of the top causes of mortality altered with age, with gastrointestinal infections and injuries emerging among 5-9 years old, but malaria and malnutrition remaining among the leading four mortality causes. Using Iganga-Mayuge HDSS data in Chapter 42, I found that institutional delivery had an insignificant inverse effect on new-born mortality. The LBW mediated multiple factors, including adolescence age, rural residence, multiple births and unmarried marital status. The novel machine learning technique applied on 2006-2016 Uganda DHS data in Chapter 53 helps us identify rural-urban differentials in the deterministic pattern of a child’s diarrhoea and acute respiratory infection (ARI). The study findings confirm the notion that ARI and diarrhoea risk factors overlap. These factors relate to the household’s structure and composition, which is characterised by poor hygiene and sanitation and poor household environments that make children more suspectable of developing these diseases; maternal socio-economic factors such as education, occupation, and fertility (birth order); individual risk factors such as child age, birth weight and nutritional status; and protective interventions (immunisation). Furthermore, the qualitative data analysis collected in Chapter 64 revealed how multiple factors concurrently affect access to obstetric and child health care services. Chapter 6 findings were used to develop a multisectoral and multidimensional implementation framework for obstetric and child health care services in resource-poor settings. Overall, the application of life course and systemic approach in the analysis and interpretation of the results provides an insight into the need for holistic interventions (social, structural, and health systems) throughout the stages of child development. Each paper brings new insights into the mechanisms and determinants of under-10 mortality in resource-poor settings. Together, the papers help us build a stronger life-course and health systems framework for child health and survival, contributing to the recent call for redesigning child health programs

Refugee, Migrant and Ethnic Minority Health

International migration, particularly to Europe, has increased in the last few decades, making research on aspects of this phenomenon, including numbers, challenges, and successes, particularly vital. This Special Issue highlights this necessary and relevant area of research. It presents 37 articles including studies on diverse topics relating to the health of refugees and migrants. Most articles (28) present studies focusing on European host countries. The focus on Europe is justified if we take into consideration the increased number of refugees and migrants who have come to Europe in recent years. However, there are also articles which present studies from countries in other continents. The topics discussed in the Issue include healthcare utilization, infectious diseases, mother and child health, mental health, and chronic diseases. Finding from the included articles indicate that further development of guidelines and policies at both local and international levels is needed. Priorities must be set by encouraging and funding in-depth research that aims to evaluate the impact of existing policies and interventions. Such research will help us formulate recommendations for the development of strategies and approaches that improve and strengthen the integration of migrants and refugees into the host countries

CHANGES IN ADHERENCE AND PROGRAM RETENTION AND ASSOCIATED FACTORS AMONG HIV-INFECTED WOMEN RECEIVING OPTION B+ FOR PREVENTING MOTHER-TO-CHILD TRANSMISSION OF HIV IN KAMPALA, UGANDA: A MIXED METHODS APPROACH

Background: Mother-to-child transmission of HIV continues to be the leading cause of pediatric HIV infections. Prevention of mother-to-child transmission (PMTCT) care and treatment strategies have been shown to drastically reduce rates of vertical transmission but attrition along the PMTCT cascade is a persisting issue. One barrier for PMTCT is inconsistent medication adherence and program retention. Option B+ is the current strategy recommended by the World Health Organization (WHO) for PMTCT and includes the provision of combination antiretroviral therapy (ART) to all pregnant and postpartum HIV-infected women, regardless of CD4 cell count or clinical stage, to be continued for life from the time of treatment initiation. Study goal and specific aims: The overall goal of this dissertation was to further the current understanding of medication adherence and program retention of HIV-infected pregnant and postpartum women receiving Option B+ for PMTCT and how medication adherence and program retention may change over time. A mixed methods approach was used to address this goal. Manuscript one aims to summarize the existing Option B+ adherence and program retention literature. Manuscript two aims to measure rates of medication adherence and clinic visit attendance in pregnancy and the postpartum period as well as the effects of various factors on these outcomes for a cohort of HIV-infected pregnant women presenting for care and initiating treatment at Mulago National Referral Hospital. Manuscript three aims to explore the changing experiences of HIV-infected pregnant women and mothers with the Option B+ program at Mulago National Referral Hospital from pregnancy through six weeks postpartum as well as the changes in potential barriers and facilitators to adherence and program retention that may occur over time. Methods: First, a systematic review of the current Option B+ adherence and program retention literature was performed by searching the PubMed, Embase, Global Health and Scopus databases for relevant peer-reviewed studies. Second, routinely collected PMTCT program data were used for a longitudinal analysis of adherence and clinic visit attendance from pregnancy through six months postpartum for a cohort of first-time initiators of Option B+ at Mulgo National Referral Hospital in 2014. Third, a series of longitudinal in-depth interviews during pregnancy and at six weeks postpartum were conducted with a subgroup of HIV-infected pregnant women participating in the “Friends for Life Circles” randomized controlled trial and assigned to receive the standard of care at Mulago National Referral Hospital. Results: The systematic review found that loss to follow-up (LTFU), patient self-report and pill counts were the most commonly used measures of program retention and medication adherence and that these outcomes varied greatly across studies and program implementation settings. The longitudinal data analysis found that a relatively low proportion of HIV-infected women were adherent in pregnancy and that the proportion of adherent women decreased at six months postpartum. A number of factors were found to predict adherence in pregnancy and six months postpartum, but only status disclosure was associated with sustained adherence at both time points. This study also found that postpartum clinic visit attendance remained consistent and that previous PMTCT experience, previous HIV diagnosis, time spent on ART during pregnancy and male partner counseling and testing in antenatal care were predictors of sustained clinic visit attendance at six weeks and six months postpartum. The in-depth interviews found medication adherence and clinic visit attendance to be consistently high among participants, but also identified a number of themes surrounding experiences with ART adherence and the Option B+ program in pregnancy and at six weeks postpartum. Effective messaging and counseling at the time of HIV testing and treatment initiation, support from health workers between clinic visits, HIV status disclosure during pregnancy and a desire for a healthy baby and a healthy life were the biggest motivators for good medication adherence and clinic visit attendance, while concerns with unwanted HIV status exposure, modifying daily routines to prioritize ART adherence and health, concerns with the Option B+ approach and health facility limitations came through as potential barriers to good adherence and clinic visit attendance. Conclusions: The results of this dissertation may be useful as PMTCT clinical care and research teams continue to strive toward the goal of eliminating vertical HIV transmission. First, this work confirms the limitations that exist with pill count adherence measures and should encourage continued efforts to improve and standardize adherence measurements in the future. Second, this work underscores the need for continued monitoring and evaluation of maternal medication adherence and program retention as well as interventions aimed at improving these outcomes. Focusing on strategies for improving ART adherence during pregnancy might be effective for improving and sustaining good adherence and program retention over time. More specifically, increasing effective status disclosure, supporting health workers to provide appropriate guidance during HIV testing and ART initiation as well as throughout pregnancy and addressing the specific needs of HIV-infected pregnant women who work outside the home or desire to work outside the home may be appropriate for improving adherence and program retention in pregnancy and the postpartum period

ABSTRACT BOOK 50th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union)

The International Journal of Tuberculosis and Lung Disease is an official journal of The Union. The Journal’s main aim is the continuing education of physicians and other health personnel, and the dissemination of the most up-to-date infor mation in the field of tuberculosis and lung health. It publishes original articles and commissioned reviews not only on the clinical and biological and epidemiological aspects, but also—and more importantly—on community aspects: fundamental research and the elaboration, implementation and assessment of field projects and action programmes for tuberculosis control and the promo tion of lung health. The Journal welcomes articles submitted on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research

From despair to hope studies in HIV and tuberculosis 1992-2011

Includes abstract. Includes bibliographical references

Development of a nanobody-based amperometric immunocapturing assay for sensitive and specific detection of Toxocara canis excretory-secretory antigen

Introduction Human Toxocariasis (HT) is a zoonosis that, despite of its wide distribution around the world, remains poorly diagnosed. The identification of specific IgG immunoglobulins against the Toxocara canis Excretory-Secretory antigen (TES), a mix of glycoproteins that the parasite releases during its migration to the target organs in infected patients, is currently the only laboratory tool to detect the disease. The main drawbacks of this test are the inability to distinguish past and active infections together with lack of specificity. These factors seriously hamper the diagnosis, follow-up and control of the disease. Aim To develop an amperometric immunocapturing diagnostic assay based on single domain immunoglobulins from camelids (nanobodies) for specific and sensitive detection of TES. Methods After immunization of an alpaca (Vicugna pacos) with TES, RNA from peripheral blood lymphocytes was used as template for cDNA amplification with oligo dT primers and library construction. Isolation and screening of TES-specific nanobodies were carried out by biopanning and the resulting nanobodies were expressed in Escherichia coli. Two-epitopes amperometric immunocapturing assay was designed using paramagnetic beads coated with streptavidin and bivalent nanobodies. Detection of the system was carried out with nanobodies chemically coupled to horseradish peroxidase. The reaction was measured by amperometry and the limit of detection (LOD) was compared to conventional sandwich ELISA. Results We obtained three nanobodies that specifically recognize TES with no-cross reactivity to antigens of Ascaris lumbricoides and A. suum. The LOD of the assay using PBST20 0.05% as diluent was 100 pg/ml, 10 times more sensitive than sandwich ELISA. Conclusion Sensitive and specific detection of TES for discrimination of active and past infections is one of the most difficult challenges of T. canis diagnosis. The main advantage of our system is the use of two different nanobodies that specifically recognize two different epitopes in TES with a highly sensitive and straightforward readout. Considering that the amounts of TES available for detection in clinical samples are in the range of picograms or a few nanograms maximum, the LOD found in our experiments suggests that the test is potentially useful for the detection of clinically relevant cases of HT