Determinants of health related quality of life (HRQoL) of adults in a public sector HAARTprogram in Botswana

ABSTRACT Introduction The advent of potent anti-retroviral agents for HIV treatment has resulted in marked decrease in deaths. Health workers now have to ensure that their patient’s physical, social, and psychological well-being is optimized. This study used a validated tool to measure Health Related Quality of Life concepts amongst HIV patients in a public treatment program. The main objective of this research was to establish factors that are associated with poor quality of life of these patients with the purpose of using this information as a basis for determining who would require individualized medical care and attention. Materials and methods The study is set at Bontleng Clinic in Gaborone, Botswana. The study questionnaire consisted of two parts: part one for collecting data on sociodemographic, illness and treatment related factors, and part two was the Medical Outcomes Study – Short Form tool used to obtain data on quality of life concepts. Two groups of participants were interviewed: ART-Naïve (n=90) and ARTExperienced (n=110). The study protocol had ethical approval from both the University of the Witwatersrand, Johannesburg and the Ministry of Health in Botswana. iv Results A smaller proportion of ART-experienced participants reported various disease symptoms as compared to those participants who were ART-naïve. Statistically significant differences were noted for: weight loss (25% vs 77%), diarrhoea (3% vs 11%), cough (19% vs 39%), and night sweats (24% vs 43%) for ART experienced and ART Naïve patients respectively. CD4 counts and HB levels were also significantly higher in patients on HAART. The overall QoL summary score was significantly higher (better) in the ART-experienced (mean score 53 out of 100) compared to the ART-naïve group (mean score 47 out of 100). Therefore being on ART favoured a higher QoL score. However, changes in the three laboratory indices of CD4 count, Hb level, and viral load had no statistical significant association with HRQoL scores. Multiple regression identified only five factors as being associated with better QoL scores. These factors were to do with the absence of the following disease symptoms: weight loss, diarrhoea, night sweats, and feet pains; as well as absence of recent hospitalisation. Discussion The study patients do respond well to HAART with significant improvements in all dimensions of QoL. This is in keeping with findings from other populations. In assessing these patients at the initiation of HAART, and at subsequent visits, one must take into account any history of recent hospital admission, history of weight loss, and most importantly presence/absence of various disease symptoms. Conclusions and recommendations Symptoms, regardless of the underlying cause: be it due to HIV disease itself or drug side effects; greatly impact patients’ quality of life. Efforts should be made to include the assessment of symptoms in the continuum of care of HIV patients. The introduction of newer potent anti-retroviral agents with fewer side effects should also favour the beneficial impact of HAART

Responding to cholera outbreaks in Somalia in 2017–2019

Background: Somalia reported repeated cholera outbreaks between 2017 and 2019. These outbreaks were attributed to multiple risk factors which made response challenging. Aims: To describe lessons from the preparedness and response to the cholera outbreaks in Somalia between 2017 and 2019. Methods: We reviewed outbreak response reports, surveillance records and preparedness plans for the cholera outbreaks in Somalia from January 2017 to December 2019 and other relevant literature. We present data on cholera-related response indicators including cholera cases and deaths and case fatality rates for the 3 years. Qualitative data were collected from 5 focus group discussions and 10 key informant interviews to identify the interventions, challenges and lessons learnt from the Somali experience. Results: In 2017, a total of 78 701 cholera cases and 1163 related deaths were reported (case fatality rate 1.48%), in 2018, 6448 cholera cases and 45 deaths were reported (case fatality rate 0.70%), while in 2019, some 3089 cases and 4 deaths were reported in Somalia (case fatality rate 0.13%). The protracted conflict, limited access to primary health care, and limited access to safe water and proper sanitation among displaced populations were identified as the main drivers of the repeated cholera outbreaks. Conclusions: Periodic assessment of response to and preparedness for potential epidemics is essential to identify and close gaps within the health systems. Somalia’s experience offers important lessons on preventing and controlling cholera outbreaks for countries experiencing complex humanitarian emergencies

Cholera prevention, control strategies, challenges and World Health Organization initiatives in the Eastern Mediterranean Region: A narrative review

The resurgence of cholera is presenting unusual challenges in the Eastern Mediterranean Region (EMR), where it is considered endemic in nine-member states. The risk of a cholera outbreak spreading to non-endemic countries remains high. We discuss the regional trends of cholera, regional burden, and challenges with a focus on World Health Organization (WHO) initiatives in the region that could be useful in preventing and controlling the disease in similar contexts. Despite significant progress in the control of cholera worldwide, the disease continues to be a major public health problem across the region, where it constitutes both an emerging and re-emerging threat. Recurring cholera outbreaks are an indication of deprived water and sanitation conditions as well as weak health systems, contributing to the transmission and spread of the cholera infection. We note that despite the challenges in eliminating cholera in the region, effective implementation of the proposed WHO EMR Strategic framework, among other measures, could sustain the region's cholera prevention, preparedness, and response needs

Reproductive health voucher program and facility based delivery in informal settlements in Nairobi: A longitudinal analysis

Introduction: In Kenya, the maternal mortality rate had ranged from 328 to 501 deaths per 100,000 live births over the last three decades. To reduce these rates, the government launched in 2006 a means-tested reproductive health output-based approach (OBA) voucher program that covers costs of antenatal care, a facility-based delivery (FBD) and a postnatal visit in prequalified healthcare facilities. This paper investigated whether women who bought the voucher for their index child and had a FBD were more likely to deliver a subsequent child in a facility compared to those who did not buy vouchers. Methods and Findings: We used population-based cohort data from two Nairobi slums where the voucher program was piloted. We selected mothers of at least two children born between 2006 and 2012 and divided the mothers into two groups: Index-OBA mothers bought the voucher for the index child (N = 352), and non-OBA mothers did not buy the voucher during the study period (N = 514). The most complete model indicated that the adjusted odds-ratio of FBD of subsequent child when the index child was born in a facility was 3.89 (p \u3c 0.05) and 4.73 (p \u3c 0.01) in Group 2. Discussion and Conclusion: The study indicated that the voucher program improved poor women access to FBD. Furthermore, the FBD of an index child appeared to have a persistent effect, as a subsequent child of the same mother was more likely to be born in a facility as well. While women who purchased the voucher have higher odds of delivering their subsequent child in a facility, those odds were smaller than those of the women who did not buy the voucher. However, women who did not buy the voucher were less likely to deliver in a good healthcare facility, negating their possible benefit of facility-based deliveries. Pathways to improve access to FBD to all near poor women are needed

Crude Odds Ratios for a facility based delivery (FBD) of the subsequent children by voucher purchase status.

<p>Standard error in parentheses*** p<0.01, ** p<0.05, * p<0.1</p

Odds ratio and (Standard deviation) of facility-based delivery (FBD) of the subsequent children.

<p>Standard error in parentheses*** p<0.01, ** p<0.05, * p<0.1</p

Emerging and Reemerging Diseases in the World Health Organization (WHO) Eastern Mediterranean Region—Progress, Challenges, and WHO Initiatives

The Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) continues to be a hotspot for emerging and reemerging infectious diseases and the need to prevent, detect, and respond to any infectious diseases that pose a threat to global health security remains a priority. Many risk factors contribute in the emergence and rapid spread of epidemic diseases in the Region including acute and protracted humanitarian emergencies, resulting in fragile health systems, increased population mobility, rapid urbanization, climate change, weak surveillance and limited laboratory diagnostic capacity, and increased human–animal interaction. In EMR, several infectious disease outbreaks were detected, investigated, and rapidly contained over the past 5 years including: yellow fever in Sudan, Middle East respiratory syndrome in Bahrain, Oman, Qatar, Saudi Arabia, United Arab Emirates, and Yemen, cholera in Iraq, avian influenza A (H5N1) infection in Egypt, and dengue fever in Yemen, Sudan, and Pakistan. Dengue fever remains an important public health concern, with at least eight countries in the region being endemic for the disease. The emergence of MERS-CoV in the region in 2012 and its continued transmission currently poses one of the greatest threats. In response to the growing frequency, duration, and scale of disease outbreaks, WHO has worked closely with member states in the areas of improving public health preparedness, surveillance systems, outbreak response, and addressing critical knowledge gaps. A Regional network for experts and technical institutions has been established to facilitate support for international outbreak response. Major challenges are faced as a result of protracted humanitarian crises in the region. Funding gaps, lack of integrated approaches, weak surveillance systems, and absence of comprehensive response plans are other areas of concern. Accelerated efforts are needed by Regional countries, with the continuous support of WHO, to build and maintain a resilient public health system for detection and response to all acute public health events

Descriptive statistics of main variables.

<p>*** p<0.01, ** p<0.05, * p<0.1 difference in the subgroups of mothers who bought the voucher for the index- OBA child and those who did not buy vouchers at all (Group 1: index-OBA versus Group 2:non-OBA) </p

Current and future distribution of Aedes aegypti and Aedes albopictus (Diptera: Culicidae) in WHO Eastern Mediterranean Region

Abstract Background Aedes-borne diseases as dengue, zika, chikungunya and yellow fever are an emerging problem worldwide, being transmitted by Aedes aegypti and Aedes albopictus. Lack of up to date information about the distribution of Aedes species hampers surveillance and control. Global databases have been compiled but these did not capture data in the WHO Eastern Mediterranean Region (EMR), and any models built using these datasets fail to identify highly suitable areas where one or both species may occur. The first objective of this study was therefore to update the existing Ae. aegypti (Linnaeus, 1762) and Ae. albopictus (Skuse, 1895) compendia and the second objective was to generate species distribution models targeted to the EMR. A final objective was to engage the WHO points of contacts within the region to provide feedback and hence validate all model outputs. Methods The Ae. aegypti and Ae. albopictus compendia provided by Kraemer et al. (Sci Data 2:150035, 2015; Dryad Digit Repos, 2015) were used as starting points. These datasets were extended with more recent species and disease data. In the next step, these sets were filtered using the Köppen–Geiger classification and the Mahalanobis distance. The occurrence data were supplemented with pseudo-absence data as input to Random Forests. The resulting suitability and maximum risk of establishment maps were combined into hard-classified maps per country for expert validation. Results The EMR datasets consisted of 1995 presence locations for Ae. aegypti and 2868 presence locations for Ae. albopictus. The resulting suitability maps indicated that there exist areas with high suitability and/or maximum risk of establishment for these disease vectors in contrast with previous model output. Precipitation and host availability, expressed as population density and night-time lights, were the most important variables for Ae. aegypti. Host availability was the most important predictor in case of Ae. albopictus. Internal validation was assessed geographically. External validation showed high agreement between the predicted maps and the experts’ extensive knowledge of the terrain. Conclusion Maps of distribution and maximum risk of establishment were created for Ae. aegypti and Ae. albopictus for the WHO EMR. These region-specific maps highlighted data gaps and these gaps will be filled using targeted monitoring and surveillance. This will increase the awareness and preparedness of the different countries for Aedes borne diseases