27 research outputs found
Estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania: protocol for a mixed methods study [Protocol]
Introduction: Musculoskeletal (MSK) disorders are one of the major causes of disability globally. A 2010 Global Burden of Disease study reported that MSK diseases account for 20% of all Years Lived with Disability (YLDs) in Low- and Middle-Income countries. This study will use mixed methods to generate new findings on the prevalence, quality of life, economic and societal impact of musculoskeletal disorders (including arthritis) in the Hai district in Tanzania. Methods and analysis: In this mixed-methods study funded by the UK’s National Institute for Health Research (NIHR) Global Health Research Units and Groups (Award no: 17/63/35) we will conduct quantitative, community-based (urban, peri - urban and rural) and hospital based prospective surveys, supported by rapid ethnographic assessments (REAs), in-depth interviews, focus group discussions (FGDs) and clinical diagnostic screening to estimate the prevalence, economic and societal impact of arthritis. A retrospective medical records baseline review at the Kilimanjaro Christian Medical Centre (KCMC) will also be conducted to assess prevailing documentation and management of arthritis. Ethics and dissemination: Ethical approval has been obtained through Kilimanjaro Christian Medical University College (KCMUCo) Research Ethics and Review committee (CRERC) in Moshi, National Health Research Ethics Committee (NatHREC) of the National Institute for Medical research (NIMR) in Tanzania and the Medical Veterinary and Life Sciences (MVLS) Ethics committee at the University of Glasgow, UK (MVLS ethics project number:20018010). We will disseminate the findings in clinical, epidemiological, and economic peer reviewed journals. Other dissemination modalities include professional conferences, short reports, community leaflets, policy briefs and dissemination events to communities and various stakeholders including the Ministry of health in Tanzania
Estimating the prevalence, quality of life, economic and societal impact of arthritis in Tanzania: protocol for a mixed methods study [Protocol]
Introduction:
Musculoskeletal (MSK) disorders are one of the major causes of disability globally. A 2010 Global Burden of Disease study reported that MSK diseases account for 20% of all Years Lived with Disability (YLDs) in Low- and Middle-Income countries. This study will use mixed methods to generate new findings on the prevalence, quality of life, economic and societal impact of musculoskeletal disorders (including arthritis) in the Hai district in Tanzania.
Methods and analysis:
In this mixed-methods study funded by the UK’s National Institute for Health Research (NIHR) Global Health Research Units and Groups (Award no: 17/63/35) we will conduct quantitative, community-based (urban, peri - urban and rural) and hospital based prospective surveys, supported by rapid ethnographic assessments (REAs), in-depth interviews, focus group discussions (FGDs) and clinical diagnostic screening to estimate the prevalence, economic and societal impact of arthritis. A retrospective medical records baseline review at the Kilimanjaro Christian Medical Centre (KCMC) will also be conducted to assess prevailing documentation and management of arthritis.
Ethics and dissemination:
Ethical approval has been obtained through Kilimanjaro Christian Medical University College (KCMUCo) Research Ethics and Review committee (CRERC) in Moshi, National Health Research Ethics Committee (NatHREC) of the National Institute for Medical research (NIMR) in Tanzania and the Medical Veterinary and Life Sciences (MVLS) Ethics committee at the University of Glasgow, UK (MVLS ethics project number:20018010). We will disseminate the findings in clinical, epidemiological, and economic peer reviewed journals. Other dissemination modalities include professional conferences, short reports, community leaflets, policy briefs and dissemination events to communities and various stakeholders including the Ministry of health in Tanzania
Rituximab in Combination with Corticosteroids for the Treatment of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis: A NICE Single Technology Appraisal
As part of its single technology appraisal (STA) process, the National Institute for Health and Care Excellence (NICE) invited the manufacturer of rituximab (Roche Products) to submit evidence of the clinical and cost effectiveness of rituximab in combination with corticosteroids for treatment of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The School of Health and Related Research Technology Appraisal Group at the University of Sheffield was commissioned to act as the independent Evidence Review Group (ERG). The ERG produced a critical review of the evidence for the clinical and cost effectiveness of the technology, based upon the manufacturer’s submission to NICE. The evidence was derived mainly from a double-blind, phase III, placebo-controlled trial of rituximab in patients with new or relapsed ‘severe’ AAV, which compared a rituximab treatment regimen with an oral cyclophosphamide treatment regimen. Intravenous cyclophosphamide is also commonly used but was not included in the pivotal trial. The evidence showed that rituximab is noninferior to oral cyclophosphamide in terms of induction of remission in adults with AAV and de novo disease, and is superior to oral cyclophosphamide in terms of remission in adults who have relapsed once on cyclophosphamide. The ERG concluded that the results of the manufacturer’s economic evaluation could not be considered robust, because of errors and because the full range of relevant treatment sequences were not modelled. The ERG amended the manufacturer’s model and demonstrated that rituximab was likely to represent a cost-effective addition to the treatment sequence if given after cyclophosphamide treatment
Socializing One Health: an innovative strategy to investigate social and behavioral risks of emerging viral threats
In an effort to strengthen global capacity to prevent, detect, and control infectious diseases in animals and people, the United States Agency for International Development’s (USAID) Emerging Pandemic Threats (EPT) PREDICT project funded development of regional, national, and local One Health capacities for early disease detection, rapid response, disease control, and risk reduction. From the outset, the EPT approach was inclusive of social science research methods designed to understand the contexts and behaviors of communities living and working at human-animal-environment interfaces considered high-risk for virus emergence. Using qualitative and quantitative approaches, PREDICT behavioral research aimed to identify and assess a range of socio-cultural behaviors that could be influential in zoonotic disease emergence, amplification, and transmission. This broad approach to behavioral risk characterization enabled us to identify and characterize human activities that could be linked to the transmission dynamics of new and emerging viruses. This paper provides a discussion of implementation of a social science approach within a zoonotic surveillance framework. We conducted in-depth ethnographic interviews and focus groups to better understand the individual- and community-level knowledge, attitudes, and practices that potentially put participants at risk for zoonotic disease transmission from the animals they live and work with, across 6 interface domains. When we asked highly-exposed individuals (ie. bushmeat hunters, wildlife or guano farmers) about the risk they perceived in their occupational activities, most did not perceive it to be risky, whether because it was normalized by years (or generations) of doing such an activity, or due to lack of information about potential risks. Integrating the social sciences allows investigations of the specific human activities that are hypothesized to drive disease emergence, amplification, and transmission, in order to better substantiate behavioral disease drivers, along with the social dimensions of infection and transmission dynamics. Understanding these dynamics is critical to achieving health security--the protection from threats to health-- which requires investments in both collective and individual health security. Involving behavioral sciences into zoonotic disease surveillance allowed us to push toward fuller community integration and engagement and toward dialogue and implementation of recommendations for disease prevention and improved health security
The role of rodents and small carnivores in plague ende- micity in Tanzania
Belgian journal of zoology 2005; 135 (supplement): 119-125Between 1974 and 2003, blood samples were collected from wild and commensal rodents, and wild
and domestic small carnivores in selected villages of seven districts in Tanzania that have experienced human
plague outbreaks and seven districts that have not experienced any outbreak of the disease. The samples were tested
for antibodies against Yersinia pestis Fraction I antigen, using passive haemagglutination (PHA) or ELISA tests. Of
the 3354 rodents and 558 small carnivores from the plague infected districts, 122 (3.6 %) rodents (captured in
Mbulu and Lushoto districts) were plague positive ; 29 (5.2 %) small carnivores from Mbulu, Arumeru, Hai and
Lushoto districts were plague positive, 28 of these were domestic dogs (Canis familiaris). PCR tests showed that
17.5 % of 211 rodents tested from Lushoto contained Y. pestis DNA. In the non-infected districts, 1545 rodents and
171 domestic dogs were tested. 11 (0.7 %) of the rodents (captured in Monduli, Chunya and Masasi districts) were
plague-positive. In Masasi district, 10.4% (7/67) of the rodents and 43.6 % (17/39) of the dogs were positive for
anti-Y. pestis IgG. It was concluded that wild and commensal rodents as well as wild and domestic small carnivores
play a potential role as reservoirs and/or carriers of sylvatic plague in Tanzania, and that the disease exists in areas
where human plague outbreaks have not occurred before. In order to update the distribution of the disease it is pro-
posed that further epidemiological surveillance activities are established
The role of rodents and small carnivores in plague ende- micity in Tanzania
Belgian journal of zoology 2005; 135 (supplement): 119-125Between 1974 and 2003, blood samples were collected from wild and commensal rodents, and wild
and domestic small carnivores in selected villages of seven districts in Tanzania that have experienced human
plague outbreaks and seven districts that have not experienced any outbreak of the disease. The samples were tested
for antibodies against Yersinia pestis Fraction I antigen, using passive haemagglutination (PHA) or ELISA tests. Of
the 3354 rodents and 558 small carnivores from the plague infected districts, 122 (3.6 %) rodents (captured in
Mbulu and Lushoto districts) were plague positive ; 29 (5.2 %) small carnivores from Mbulu, Arumeru, Hai and
Lushoto districts were plague positive, 28 of these were domestic dogs (Canis familiaris). PCR tests showed that
17.5 % of 211 rodents tested from Lushoto contained Y. pestis DNA. In the non-infected districts, 1545 rodents and
171 domestic dogs were tested. 11 (0.7 %) of the rodents (captured in Monduli, Chunya and Masasi districts) were
plague-positive. In Masasi district, 10.4% (7/67) of the rodents and 43.6 % (17/39) of the dogs were positive for
anti-Y. pestis IgG. It was concluded that wild and commensal rodents as well as wild and domestic small carnivores
play a potential role as reservoirs and/or carriers of sylvatic plague in Tanzania, and that the disease exists in areas
where human plague outbreaks have not occurred before. In order to update the distribution of the disease it is pro-
posed that further epidemiological surveillance activities are established
Treatment outcomes and associated epidemiological characteristics among patients hospitalized with COVID-19 in critical care and isolation wards at a tertiary hospital in Kiambu County, Kenya
Background: COVID-19 was a novel infection whose outcomes were not well established to be associated with any factors during the start of the pandemic that it caused globally.
Objective: To establish epidemiological characteristics associated with mortality among patients hospitalized with covid-19 at a tertiary hospital in Kiambu County Kenya
Methods: This was a retrospective Analytical cross-sectional study done at Avenue Hospital Isolation and Intensive care wards. Polymerase chain reaction (PCR) positively identified Covid-19 adult patients who were admitted were recruited into the study. The mortality rate from COVID-19 infection and epidemiological characteristics associated with the mortalities among the COVID-19 hospitalized patients were the measures of outcomes being investigated.
Results: A total of 154 patients were recruited in the study. Almost two thirds of the patients had comorbidities (n=96; 62.3%). Out of 154 patients, 23.4% (n=36) died and 76.6% n= (118) were discharged alive. Kaplan Meier statistics revealed, the median survival time was 22 days (95% CI: 16.626 - 27.374) among patents who died. The epidemiological factor predicting death of a patient after adjusting for odds was increase in age (AOR: 1.138; 95% CI: 1.009 - 1.285; p-value- 0.036).
Conclusion and Recommendations: Majority of the patients admitted with COVID-19 were discharged alive compared to those with mortalities. The mortalities which occurred were associated with an increase in age among the patients. The study recommends healthcare professionals to prioritize older demographic patients diagnosed with COVID-19 during triage and routine care
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Wildlife, Livestock, and Companion Animals
Outbreaks of foodborne illness associated with the consumption of leafy green produce from California and across the United States have heightened the need to identify vertebrate sources of these microbial hazards. Concern has focused on wildlife species that have direct access to the produce production environment and irrigation water supplies. Recent fecal surveys of California wildlife, feral animals, and livestock and companion animals are allowing regulators to compare the food safety risks of such pathogens as E. coli O157:H7 and Salmonella from these various animal species. In order to make valid food safety risk comparisons between wildlife, livestock, and companion animals, a variety of methodological and epidemiological issues need to be addressed in order to avoid substantial biases. For example, the amount of feces tested per animal can vary up to a 1000-fold, substantially biasing the probability of testing positive for large fecal contributors (e.g., cattle) compared to smaller wildlife (e.g., deer mice). Many wildlife species intrude and forage as a group in fields of produce, which can lead to in-field defecation, substantially, elevating the risk of microbial contamination compared to many larger animal species that do not have direct access to produce fields due to fencing. This paper highlights the technical challenges of making valid quantitative comparisons of microbial food safety risks from wildlife compared to other domestic animals