Using vital registration data to track mortality in Zimbabwe's metropolitan populations: 2000-2012

The vital registration system in Zimbabwe is incomplete and mortality estimates produced from these data might not give a true representation of mortality in the population. However, it may be assumed that vital registration data for urban areas is more complete than for the country as a whole. This research was, therefore, conducted in an attempt to answer the question of whether vital registration data can be used to track the mortality of Zimbabwe's metropolitan populations. To answer this question, direct and indirect estimates from census and Demographic and Health Survey (DHS) data were used to decide on the viability of using these vital registration data to estimate mortality. Estimates of under-five mortality between 2001 and 2011 from vital registration data ranged from around 50 to 80 deaths per thousand for Harare while Bulawayo's estimates were generally between 55 and 105 deaths per thousand in the same period. Bulawayo's vital registration data appeared to produce reasonable estimates of under-five mortality, while Harare's vital registration data underestimated both infant and under-five mortality when compared to the other supporting estimates from the alternative data sources

Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers

Abstract Background Service providers' attitudes toward interventions are essential for adopting and implementing novel interventions into healthcare settings, but evidence of evaluations in the HIV context is still limited. This study is part of the CombinADO cluster randomized trial (ClinicalTrials.gov NCT04930367), which is investigating the effectiveness of a multi-component intervention package (CombinADO strategy) aimed at improving HIV outcomes among adolescents and young adults living with HIV (AYAHIV) in Mozambique. In this paper we present findings on key stakeholder attitudes toward adopting study interventions into local health services. Methods Between September and December 2021, we conducted a cross-sectional survey with a purposive sample of 59 key stakeholders providing and overseeing HIV care among AYAHIV in 12 health facilities participating in the CombinADO trial, who completed a 9-item scale on attitudes towards adopting the trial intervention packages in health facilities. Data were collected in the pre-implementation phase of the study and included individual stakeholder and facility-level characteristics. We used generalized linear regression to examine the associations of stakeholder attitude scores with stakeholder and facility-level characteristics. Results Overall, service-providing stakeholders within this setting reported positive attitudes regarding adopting intervention packages across study clinic sites; the overall mean total attitude score was 35.0 ([SD] = 2.59, Range = [30–41]). The study package assessed (control or intervention condition) and the number of healthcare workers delivering ART care in participating clinics were the only significant explanatory variables to predict higher attitude scores among stakeholders (β = 1.57, 95% CI = 0.34–2.80, p = 0.01 and β = 1.57, 95% CI = 0.06–3.08, p = 0.04 respectively). Conclusions This study found positive attitudes toward adopting the multi-component CombinADO study interventions among HIV care providers for AYAHIV in Nampula, Mozambique. Our findings suggest that adequate training and human resource availability may be important in promoting the adoption of novel multi-component interventions in healthcare services by influencing healthcare provider attitudes

Overall patient-level and eye-level meta-analysis of the accuracy of AI in detecting RDR compared with trained HGs.

Overall patient-level and eye-level meta-analysis of the accuracy of AI in detecting RDR compared with trained HGs.</p

Coupled forest plots showing the subgroups in the DR classification criteria.

ICDR, International Clinical Diabetic Retinopathy; NHS DES, National Health Service Diabetic Eye Screening.</p

Coupled forest plot of included studies for eye-level analysis.

Coupled forest plot of included studies for eye-level analysis.</p

Coupled forest plot of studies with ≥3 human graders as the ground truth on reference standard.

Coupled forest plot of studies with ≥3 human graders as the ground truth on reference standard.</p

Coupled forest plot of included studies for patient-level analysis.

Coupled forest plot of included studies for patient-level analysis.</p

Subgroup analyses for the accuracy of AI in detecting RDR compared with trained HGs on patient-level analysis.

Subgroup analyses for the accuracy of AI in detecting RDR compared with trained HGs on patient-level analysis.</p

HSROC plot of sensitivity vs specificity of AI for detecting RDR on eye-level analysis.

HSROC plot of sensitivity vs specificity of AI for detecting RDR on eye-level analysis.</p