Afya Jamii: Evaluation of a Group Antenatal and Well-Child Care Program in Kenya

Objectives: Facility-based group antenatal care has been implemented with success in high-income countries (HICs), but there is no literature describing implementation in Sub-Saharan Africa. We assessed the feasibility of implementing antenatal and well-child group care in public health facilities in western Kenya. Methods: We conducted a retrospective analysis of uptake of health services from 5 group care and 9 comparison health facilities. We aimed to determine whether an antenatal and well-child group care model is feasible to implement within the public health system in Kenya. Results: Comparing group care and standard care health facilities, we found a statistically significant difference between the average monthly number of new Family Planning (FP) visits (41.5, 95% CI 36.1-46.9 and 32.3, 95% CI 29.2-35.5, p=0.004), the median monthly number of long-term FP visits (18, Interquartile Range (IQR) 11-29 and 11.5 IQR 4.5-26, p=0.001), and the median monthly number of newborns with low birth weight (0, IQR 0-1 and 1, IQR 0-3, p<0.001) at group and standard care health facilities, respectively. We found no difference in the primary outcome, the mean monthly number of the uptake of 4 or more ANC visits (28.7, 95% CI 25.8 to 31.6 and 25.9, 95% CI 24.0-27.8, p=0.104) or in the mean monthly number of facility deliveries (38.7, 95% CI 26.0-43.7 and 34.9, 95% CI 33.4-44.1, p=0.460) and OPV0 doses (35.1, 95% CI 29.7-40.6 and 36.8, 95% CI 32.7-41.0, p=0.616). Conclusion: Group antenatal care is a feasible health service delivery model in public health facilities in SSA. More research is needed to understand how facility-based group care can improve health outcomes for women and children in SSA.Master of Public Healt

The Impact of Health Workers' Strikes on Health Outcomes and Health Service Utilization in Low-and Middle-Income Countries: A Systematic Review

Background The impact of strikes by health workers in low- and middle-income countries (LMIC) is not well described. We systematically reviewed articles on the impact of health workers’ strikes on health outcomes or health service utilization in LMIC. Methods We searched PubMed, SCOPUS, Web of Science, and Google Scholar databases on May 27, 2019. To be included for review, articles met the following criteria: (1) reported on a strike that involved at least one cadre of health worker; (2) reported on a strike in a LMIC; (3) included at least one outcome related to patient or population health or health service utilization; and, (4) included a reference group or time period. There were no date or language restrictions. We modified the Newcastle-Ottawa Tool to appraise study quality. The review is registered with PROSPERO (CRD42019124989). Findings Among 5,123 articles, eleven articles met inclusion criteria. Studies examined 20 strikes in LMIC from 1991 to 2017 (average strike length of 32·9 days), with five studies from Kenya, two each from India and Nigeria, and one each from Malawi and South Africa. The majority of studies reported hospital admissions or inpatient mortality. Generally, health service utilization decreased during strike periods, but changes in patient mortality and other health outcomes varied. Study quality was heterogenous with most studies reporting from a single facility or medical department. Interpretation Compared to high-income settings, our study suggests a more complex picture of the effect of strikes by health workers on health and health service utilization outcomes in LMIC

European Multidisciplinary and Water-Column Observatory - European Research Infrastructure Consortium (EMSO ERIC): challenges and opportunities for strategic European marine sciences

EMSO (European Multidisciplinary Seafloor and water-column Observatory, www.emso-eu.org) is a large‐scale European Research Infrastructure I. It is a distributed infrastructure of strategically placed, deep‐sea seafloor and water column observatory nodes with the essential scientific objective of real‐time, longterm observation of environmental processes related to the interaction between the geosphere, biosphere, and hydrosphere. The geographic locations of the EMSO observatory nodes represent key sites in European waters, from the Arctic, through the Atlantic and Mediterranean, to the Black Sea (Figure 1), as defined through previous studies performed in FP6 and FP7 EC projects such as ESONET‐CA, ESONET‐NoE, EMSO-PP (Person et al., 2015)Peer Reviewe

Reducing maternal and child oral health disparities in Sub-Saharan Africa through a community-based strategy

Oral conditions disproportionately affect mothers and children in Sub-Saharan Africa, due to biological vulnerabilities, a scarcity of oral health workers, deficient preventive strategies, and gender-based barriers to care. The World Health Organization (WHO) recommends integrating oral health into broader health delivery models, to reduce these disparities. We propose integrating preventive oral healthcare into community-based programs to bridge these gaps. We examine integrating preventive oral healthcare into Western Kenya's Chamas for Change (Chamas) community-based program which aims to reduce maternal and child health disparities. Chamas incorporates women's health and microfinance programs best practices to produce a low-cost, community-driven, sustainable, and culturally acceptable health delivery platform. Our strategy is based on the Maternal and Child Oral Health Framework and uses the WHO Basic Package of Oral Care principles. This framework prioritizes community involvement, cultural sensitivity, regular screenings, and seamless integration into general health sessions. We discuss the strengths, weaknesses, opportunities, and threats to enriching Chamas with oral health promotion activities. It is crucial to assess the effectiveness, sustainability, and acceptability of the proposed strategy through implementation and evaluation. Future studies should investigate the long-term impact of integrated oral health models on community health and oral health disparity reduction in Africa

Modeling and characterization of the SPIDER half-wave plate

Spider is a balloon-borne array of six telescopes that will observe the Cosmic Microwave Background. The 2624 antenna-coupled bolometers in the instrument will make a polarization map of the CMB with approximately one-half degree resolution at 145 GHz. Polarization modulation is achieved via a cryogenic sapphire half-wave plate (HWP) skyward of the primary optic. We have measured millimeter-wave transmission spectra of the sapphire at room and cryogenic temperatures. The spectra are consistent with our physical optics model, and the data gives excellent measurements of the indices of A-cut sapphire. We have also taken preliminary spectra of the integrated HWP, optical system, and detectors in the prototype Spider receiver. We calculate the variation in response of the HWP between observing the CMB and foreground spectra, and estimate that it should not limit the Spider constraints on inflation

Pointing control for the SPIDER balloon-borne telescope

We present the technology and control methods developed for the pointing system of the SPIDER experiment. SPIDER is a balloon-borne polarimeter designed to detect the imprint of primordial gravitational waves in the polarization of the Cosmic Microwave Background radiation. We describe the two main components of the telescope's azimuth drive: the reaction wheel and the motorized pivot. A 13 kHz PI control loop runs on a digital signal processor, with feedback from fibre optic rate gyroscopes. This system can control azimuthal speed with < 0.02 deg/s RMS error. To control elevation, SPIDER uses stepper-motor-driven linear actuators to rotate the cryostat, which houses the optical instruments, relative to the outer frame. With the velocity in each axis controlled in this way, higher-level control loops on the onboard flight computers can implement the pointing and scanning observation modes required for the experiment. We have accomplished the non-trivial task of scanning a 5000 lb payload sinusoidally in azimuth at a peak acceleration of 0.8 deg/s$^2$, and a peak speed of 6 deg/s. We can do so while reliably achieving sub-arcminute pointing control accuracy.Comment: 20 pages, 12 figures, Presented at SPIE Ground-based and Airborne Telescopes V, June 23, 2014. To be published in Proceedings of SPIE Volume 914

Improving maternal, newborn and child health outcomes through a community-based women's health education program: a cluster randomised controlled trial in western Kenya

Introduction: Community-based women's health education groups may improve maternal, newborn and child health (MNCH); however, evidence from sub-Saharan Africa is lacking. Chamas for Change (Chamas) is a community health volunteer (CHV)-led, group-based health education programme for pregnant and postpartum women in western Kenya. We evaluated Chamas' effect on facility-based deliveries and other MNCH outcomes. Methods: We conducted a cluster randomised controlled trial involving 74 community health units in Trans Nzoia County. We included pregnant women who presented to health facilities for their first antenatal care visits by 32 weeks gestation. We randomised clusters 1:1 without stratification or matching; we masked data collectors, investigators and analysts to allocation. Intervention clusters were invited to bimonthly, group-based, CHV-led health lessons (Chamas); control clusters had monthly, individual CHV home visits (standard of care). The primary outcome was facility-based delivery at 12-month follow-up. We conducted an intention-to-treat approach with multilevel logistic regression models using individual-level data. Results: Between 27 November 2017 and 8 March 2018, we enrolled 1920 participants from 37 intervention and 37 control clusters. A total of 1550 (80.7%) participants completed the study with 822 (82.5%) and 728 (78.8%) in the intervention and control arms, respectively. Facility-based deliveries improved in the intervention arm (80.9% vs 73.0%; risk difference (RD) 7.4%, 95% CI 3.0 to 12.5, OR=1.58, 95% CI 0.97 to 2.55, p=0.057). Chamas participants also demonstrated higher rates of 48 hours postpartum visits (RD 15.3%, 95% CI 12.0 to 19.6), exclusive breastfeeding (RD 11.9%, 95% CI 7.2 to 16.9), contraceptive adoption (RD 7.2%, 95% CI 2.6 to 12.9) and infant immunisation completion (RD 15.6%, 95% CI 11.5 to 20.9). Conclusion: Chamas participation was associated with significantly improved MNCH outcomes compared with the standard of care. This trial contributes robust data from sub-Saharan Africa to support community-based, women's health education groups for MNCH in resource-limited settings.Trial registration numberNCT03187873

Microfinance, retention in care, and mortality among patients enrolled in HIV 2 Care in East Africa

Objective: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. Design and methods: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. Results: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01–1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28–1.09; P = 0.105). Conclusion: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings

Epidemiology of Gallbladder Disease: Cholelithiasis and Cancer

Diseases of the gallbladder are common and costly. The best epidemiological screening method to accurately determine point prevalence of gallstone disease is ultrasonography. Many risk factors for cholesterol gallstone formation are not modifiable such as ethnic background, increasing age, female gender and family history or genetics. Conversely, the modifiable risks for cholesterol gallstones are obesity, rapid weight loss and a sedentary lifestyle. The rising epidemic of obesity and the metabolic syndrome predicts an escalation of cholesterol gallstone frequency. Risk factors for biliary sludge include pregnancy, drugs like ceftiaxone, octreotide and thiazide diuretics, and total parenteral nutrition or fasting. Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones. Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity. Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians. Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps