Corneal pannus, Herbert's pits and conjunctival inflammation in older children in Papua New Guinea.

PURPOSE: The prevalence of trachomatous inflammation-follicular (TF) in Papua New Guinea (PNG) suggests antibiotic mass drug administration (MDA) is needed to eliminate trachoma as a public health problem but the burden of trichiasis is low. As a result, WHO issued bespoke recommendations for the region. If ≥ 20% of 10-14-year-olds have both any conjunctival scarring (C1 or C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. Equally, if ≥ 5% of that group have both moderate/severe conjunctival scarring (C2 or C3) and corneal pannus and/or Herbert's pits, MDA should be continued. METHODS: We identified 14 villages where > 20% of 1-9-year-olds had TF during baseline mapping undertaken 4 years and 1 month previously. Every child aged 10-14 years in those villages was eligible to be examined for clinical signs of corneal pannus, Herbert's pits and conjunctival scarring. A grading system that built on existing WHO grading systems was used. RESULTS: Of 1,293 resident children, 1,181 (91%) were examined. Of 1,178 with complete examination data, only one (0.08%) individual had concurrent scarring and limbal signs. CONCLUSIONS: The WHO-predefined criteria for continuation of MDA were not met. Ongoing behavioural and environmental improvement aspects of the SAFE strategy may contribute to integrated NTD control. Surveillance methods should be strengthened to enable PNG health authorities to identify future changes in disease prevalence

Habits, hassle, and health: how do blood donors respond to a temporary deferral due to low haemoglobin?

This thesis explored the impact on whole blood donors of a six month deferral from giving blood due to a low haemoglobin (Hb) concentration. The aims were two-fold: first, to quantify the effect of a temporary deferral on donation patterns once eligible to return, and second, to identify the processes contributing to the effect. The mixed methods design utilised four distinct research phases: statistical analysis of donation patterns over a three year period, surveys of whole blood donors three and twelve months after deferral, and semi-structured interviews with 25 blood donors in the weeks immediately following deferral. Deferral for a low Hb increased the likelihood of non-return in both new and repeat donors, and, amongst those who did return, delayed first return, reduced donation frequency and increased the likelihood of drop-out in later years. Qualitative interviews suggested that, predominantly, individuals give blood because it represents an easy and convenient way to help others, and provides additional rewards, such as enhancing positive self-concepts and a free health check. Returning promptly after deferral appears to be related to three aspects of a person and his/her context: an individual’s other obligations, especially parenting; the extent to which donation is considered personally rewarding; and whether donation arrangements were facilitated by a range of supports prior to deferral. Over three quarters of surveyed deferred donors seek further advice and investigations from their medical practitioner and nearly half of those are encouraged to change their donation patterns. With the exception of having a low haemoglobin level confirmed at follow-up testing, experiences seeking further investigations were not associated with either intentions or return. Triangulation of findings suggests that deferral disrupts the habit of regular donation, and that this disruption makes donors more vulnerable to changes to their personal circumstances or collection practices. Deferral may also increase the perceived inconvenience of the activity, decrease self-perceptions of competence and good health, and diminish the “blood donor” identity. Practical implications of these findings are recommendations that may increase retention of deferred donors, including encouraging donors to return promptly once eligible, enhancing the convenience of blood donation, and improving aspects of the deferral event.Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 201

A qualitative study on gender barriers to eye care access in Cambodia

Abstract Background The Fred Hollows Foundation (FHF) Cambodia recently partnered with the Ministry of Women’s Affairs (MoWA) and National Program for Eye Health (NPEH, part of the Ministry of Health) to establish the Gender Equality in Eye Health Project. As part of this project, a qualitative study was carried out to identify barriers affecting women’s access to eye health in Cambodia. Methods A cross-sectional qualitative study was conducted in four provinces in both urban and rural locations between May and June 2015. Purposive sampling was used to identify respondents from a range of age groups, geographical locations, and experiences to explore different perceptions regarding access barriers to eye health care. Thirteen women experiencing eye problems (age range 45–84 years; mean age 63 years) and 25 eye health professionals took part in in-depth interviews. Eleven focus groups discussions were held with 69 participants (50 women, 19 married men) to capture the views and experiences of both younger and older women, as well as household decision makers’ perspectives. Results Gender-based differences in decision-making, access and control over resources and women’s social status all contributed to impeding women’s access to eye health services. Women relied predominantly on informal sources of information about health, and these channels might be utilised to address barriers to information and access. Disparities in perceived costs of eye health treatment were evident between eye healthcare providers and users: costs were not perceived as a barrier by service providers due to health financing support for poor patients, however, many users were not aware of the availability of the scheme. Conclusion Demand-side and supply-side elements interact to reduce women’s ability to seek eye treatment

Urban health symposium : taking action for healthy cities in Bangladesh - full report

The Urban Health Symposium in Dhaka (2013) provided a platform for international, national and regional policy makers, practitioners, engineers and academics to exchange ideas and explore avenues to improve the state of urban health in Bangladesh. Health challenges include historically critical areas, such as infectious disease control and environmental health and nutrition, as well as “newer” problems, such as Non-Communicable Diseases (NCDs). The Symposium’s ‘call to action’ builds on Bangladesh’s advantages and begins to chip away at the challenges. Priority actions require different levels of collaboration between vertical ministries for which institutional structures and mechanisms do not yet exist

A national survey integrating clinical, laboratory, and WASH data to determine the typology of trachoma in Nauru.

BACKGROUND: The epidemiology of trachoma in several Pacific Islands differs from other endemic settings, in that there is a high prevalence of clinical signs of trachoma, particularly trachomatous inflammation-follicular (TF), but few cases of trichiasis and limited evidence of ocular chlamydial infection. This so-called "Pacific enigma" has led to uncertainty regarding the appropriate public health response. In 2019 alongside Nauru's national trachoma population survey, we performed bacteriological and serological assessments of children to better understand the typology of trachoma and to determine whether there is a need for trachoma interventions. METHODS: We used two-stage cluster sampling, examining residents aged ≥1 year and collecting household-level water, sanitation, and hygiene (WASH) variables. Children aged 1-9 years provided conjunctival swabs and finger-prick dried blood spots to investigate the presence of Chlamydia trachomatis nucleic acid and anti-Pgp3 antibodies, respectively. PRINCIPAL FINDINGS: In 818 participants aged 1-9 years, the age-adjusted TF prevalence was 21.8% (95% CI 15.2-26.2%); ocular C. trachomatis prevalence was 34.5% (95% CI 30.6-38.9), and anti-Pgp3 antibody prevalence was 32.1% (95% CI 28.4%-36.3%). The age- and gender-adjusted prevalence of trichiasis in ≥15-year-olds was 0.3% (95% CI 0.00-0.85), but no individual with trichiasis had trachomatous scarring (TS). Multivariable analysis showed an association between age and both TF (OR per year of age 1.3 [95% CI 1.2-1.4]) and anti-Pgp3 positivity (OR 1.2 [95% CI 1.2-1.3]). There were high rates of access to water and sanitation and no WASH variable was associated with the presence of TF. CONCLUSIONS: TF, nucleic acid, and age-specific antibody prevalence collectively indicate that high levels of C. trachomatis transmission among children present a high risk of ocular damage due to trachoma. The absence of trichiasis with trachomatous scarring suggest a relatively recent increase in transmission intensity