Prioritising and Mapping Barriers to Achieve Equitable Surgical Care in South Africa : A Multi-disciplinary Stakeholder Workshop

Funding This work was supported by The Academy of Medical Sciences Global Challenges Research Fund Networking Grant [grant number: GCRFNGR4\1036].Peer reviewedPublisher PD

Effectiveness of a training intervention in increasing the use of misoprostol in postabortion care in Malawi : A quasi-experimental study

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Predictors of maternal serum concentrations for selected persistent organic pollutants (POPs) in pregnant women and associations with birth outcomes : a cross-sectional study from southern Malawi

DATA AVAILABILITY STATEMENT : Data will be made available upon reasonable request from the corresponding author.SUPPLEMENTARY MATERIAL : TABLE S1: Method detection limits (MDL) concentrations (wet weight pg/mL) for all POPs analysed at the laboratory; TABLE S2: Socio-demographic characteristics of recruited women and their neonates.Please read abstract in article.The study was funded by Norwegian University of Science and Technology (NTNU), and Northern Norway Regional Health Authority (Helse Nord).Norwegian University of Science and Technology (NTNU), and Northern Norway Regional Health Authority (Helse Nord).http://www.mdpi.com/journal/ijerphSchool of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-beingSDG-15:Life on lan

Experiences of using misoprostol in the management of incomplete abortions : a voice of healthcare workers in central Malawi

Complications after abortion are a major cause of maternal death. Incomplete abortions are common and require treatment with surgical or medical uterine evacuation. Even though misoprostol is a cheaper and safer option, it is rarely used in Malawi. To improve services, an intervention was performed to increase the use of misoprostol in post-abortion care. This study explored healthcare providers’ perceptions and experiences with misoprostol in the Malawian setting and their role in achieving effective implementation of the drug. A descriptive phenomenological study was conducted in three hospitals in central Malawi. Focus group discussions were conducted with healthcare workers in centres where the training intervention was offered. Participants were purposefully sampled, and thematic analysis was done. Most of the healthcare workers were positive about the use of misoprostol, knew how to use it and were confident in doing so. The staff preferred misoprostol to surgical treatment because it was perceived safe, effective, easy to use, cost-effective, had few complications, decreased hospital congestion, reduced workload, and saved time. Additionally, misoprostol was administered by nurses/midwives, and not just physicians, thus enhancing task-shifting. The results showed acceptability of misoprostol in post-abortion care among healthcare workers in central Malawi, and further implementation of the drug is recommended.Helse Nord and The Liaison Committee for education, research, and innovation in Central Norway through the Norwegian University of Science and Technology (NTNU) and Malawi University of Science and Technology (MUST).https://www.mdpi.com/journal/ijerphSchool of Health Systems and Public Health (SHSPH

Serum concentrations of selected poly- and perfluoroalkyl substances (PFASs) in pregnant women and associations with Birth outcomes. A cross-sectional study from southern Malawi

DATA AVAILABILITY STATEMENT: Data will be made available upon reasonable request to the corresponding author.Pervasive exposure to per-and polyfluoroalkyl substances (PFASs) shows associations with adverse pregnancy outcomes. The aim of the present study was to examine the determinants of different serum PFAS concentrations in late pregnancy and their relationship with birth outcomes in southern Malawi. The sample included 605 pregnant women with a mean age of 24.8 years and their offspring from three districts in the southern region of Malawi. Six PFAS were measured in serum from third-trimester women. The serum PFAS concentrations were assessed with head circumference, birth length, birth weight, gestational age and ponderal index. Participants living in urban areas had significantly higher serum levels of PFOA, PFNA and SumPFOS, while SumPFHxS concentrations were higher in women from rural settings. High PFOA, PFNA and SumPFHxS concentrations were generally inversely associated with head circumference. Birth length was negatively associated with PFOA and PFNA while SumPFHxS was negatively associated with birth weight. SumPFOS was inversely associated with gestational age. Urban area of residence was the strongest predictor for high PFAS concentrations in the maternal serum and was generally associated with adverse birth outcomes. The results highlight the need to investigate SumPFHxS further as it follows a pattern that is different to similar compounds and cohorts.Norwegian University of Science and Technology (NTNU) and Northern Norway Regional Health Authority (Helse Nord).http://www.mdpi.com/journal/ijerphSchool of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Iodine status in Norwegian preschool children and associations with dietary iodine sources: the FINS-KIDS study

Iodine is an essential trace element necessary for thyroid hormone synthesis. Iodine deficiency is a continuing public health problem despite international efforts to eliminate it. Studies on iodine status in preschoolers are scarce. Thus, the aims of the current study were to determine the iodine status and to investigate possible associations between urinary iodine concentration (UIC) and estimated 24 h iodine extraction (UIE) and iodine-rich foods.publishedVersio

Cardiovascular disease risk profile and management among people 40 years of age and above in Bo, Sierra Leone : a cross-sectional study

Introduction: Access to care for cardiovascular disease risk factors (CVDRFs) in low- and middle-income countries is limited. We aimed to describe the need and access to care for people with CVDRF and the preparedness of the health system to treat these in Bo, Sierra Leone. Methods: Data from a 2018 household survey conducted in Bo, Sierra Leone, was analysed. Demographic, anthropometric and clinical data on CVDRF (hypertension, diabetes mellitus or dyslipidaemia) from randomly sampled individuals 40 years of age and above were collected. Future risk of CVD was calculated using the World Health Organisation–International Society of Hypertension (WHO-ISH) calculator with high risk defined as >20% risk over 10 years. Requirement for treatment was based on WHO package of essential non-communicable (PEN) disease guidelines (which use a risk-based approach) or requiring treatment for individual CVDRF; whether participants were on treatment was used to determine whether care needs were met. Multivariable regression was used to test associations between individual characteristics and outcomes. Data from the most recent WHO Service Availability and Readiness Assessment (SARA) were used to create a score reflecting health system preparedness to treat CVDRF, and compared to that for HIV. Results: 2071 individual participants were included. Most participants (n = 1715 [94.0%]) had low CVD risk; 423 (20.6%) and 431 (52.3%) required treatment based upon WHO PEN guidelines or individual CVDRF, respectively. Sixty-eight (15.8%) had met-need for treatment determined by WHO guidelines, whilst 84 (19.3%) for individual CVDRF. Living in urban areas, having education, being older, single/widowed/divorced, or wealthy were independently associated with met need. Overall facility readiness scores for CVD/CVDRF care for all facilities in Bo district was 16.8%, compared to 41% for HIV. Conclusion: The number of people who require treatment for CVDRF in Sierra Leone is substantially lower based on WHO guidelines compared to CVDRF. CVDRF care needs are not met equitably, and facility readiness to provide care is low

Prevalence and socio-demographic associations of diet and physical activity risk-factors for cardiovascular disease in Bo, Sierra Leone

Background Little is known about modifiable dietary and physical activity risk factors for cardiovascular diseases (CVDs) in Sierra Leone. This information is critical to the development of health improvement interventions to reduce the prevalence of these diseases. This cross-sectional study investigated the prevalence and socio-demographic correlates of dietary and physical activity risk behaviours amongst adults in Bo District, Sierra Leone. Methods Adults aged 40+ were recruited from 10 urban and 30 rural sub-districts in Bo. We examined risk factors including: ≤150 min of moderate or vigorous-intensity physical activity (MVPA) weekly, physical inactivity for ≥3 h daily, ≤5 daily portions of fruit and vegetables, and salt consumption (during cooking, at the table, and in salty snacks). We used logistic regression to investigate the relationship between these outcomes and participants’ socio-demographic characteristics. Results 1978 eligible participants (39.1% urban, 55.6% female) were included in the study. The prevalence of behavioural risk factors was 83.6% for ≤5 daily portions of fruit and vegetables; 41.4 and 91.6% for adding salt at the table or during cooking, respectively and 31.1% for eating salty snacks; 26.1% for MVPA ≤150 min weekly, and 45.6% for being physically inactive ≥3 h daily. Most MVPA was accrued at work (nearly 24 h weekly). Multivariable analysis showed that urban individuals were more likely than rural individuals to consume ≤5 daily portions of fruit and vegetables (Odds Ratio (OR) 1.09, 95% Confidence Interval (1.04–1.15)), add salt at the Table (OR 1.88 (1.82–1.94)), eat salty snacks (OR 2.00 (1.94–2.07)), and do MVPA ≤150 min weekly (OR 1.16 (1.12–1.21)). Male individuals were more likely to add salt at the Table (OR 1.23 (1.20–1.27)) or consume salty snacks (OR 1.35 (1.31–1.40)) than female individuals but were less likely to report the other behavioural risk-factors examined. Generally, people in lower wealth quintiles had lower odds of each risk factor than those in the higher wealth quintiles. Conclusion Dietary risk factors for CVD are highly prevalent, particularly among urban residents, of Bo District, Sierra Leone. Our findings highlight that forthcoming policies in Sierra Leone need to consider modifiable risk factors for CVD in the context of urbanisation

The epidemiology of multimorbidity in conditions of extreme poverty: a population-based study of older adults in rural Burkina Faso

Introduction Multimorbidity is a health issue of increasing importance worldwide, and is likely to become particularly problematic in low-income countries (LICs) as they undergo economic, demographic and epidemiological transitions. Knowledge of the burden and consequences of multimorbidity in LICs is needed to inform appropriate interventions. Methods A cross-sectional household survey collected data on morbidities and frailty, disability, quality of life and physical performance on individuals aged over 40 years of age living in the Nouna Health and Demographic Surveillance System area in northwestern Burkina Faso. We defined multimorbidity as the occurrence of two or more conditions, and evaluated the prevalence of and whether this was concordant (conditions in the same morbidity domain of communicable, non-communicable diseases (NCDs) or mental health (MH)) or discordant (conditions in different morbidity domains) multimorbidity. Finally, we fitted multivariable regression models to determine associated factors and consequences of multimorbidity. Results Multimorbidity was present in 22.8 (95% CI, 21.4 to 24.2) of the study population; it was more common in females, those who are older, single, more educated, and wealthier. We found a similar prevalence of discordant 11.1 (95% CI, 10.1 to 12.2) and concordant multimorbidity 11.7 (95% CI, 10.6 to 12.8). After controlling for age, sex, marital status, education, and wealth, an increasing number of conditions was strongly associated with frailty, disability, low quality of life, and poor physical performance. We found no difference in the association between concordant and discordant multimorbidity and outcomes, however people who were multimorbid with NCDs alone had better outcomes than those with multimorbidity with NCDs and MH disorders or MH multimorbidity alone. Conclusions Multimorbidity is prevalent in this poor, rural population and is associated with markers of decreased physical performance and quality of life. Preventative and management interventions are needed to ensure that health systems can deal with increasing multimorbidity and its downstream consequences.Support for the CRSN Heidelberg Aging Study and for TB was provided by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award to Till Bärnighausen, funded by the German Federal Ministry of Education and Research. CFP is supported by the ANU Futures Scheme. Professor Witham acknowledges support from the NIHR Newcastle Biomedical Research Centre. MJS receives research support from the National Institutes of Health (R01 HL141053 and R01 AG 059504 and P30AI060354). GH is supported by a fellowship copyright. on May 13, 2020 at Australian National University. Protected by http://gh.bmj.com/BMJ Glob Health: first published as 10.1136/bmjgh-2019-002096 on 29 March 2020. Downloaded from Odland ML, et al. BMJ Global Health 2020;5:e002096. doi:10.1136/bmjgh-2019-00209613BMJ Global Health from the Wellcome Trust and Royal Society 210479/Z/18/Z. JMG was supported by Grant Number T32 AI007433 from the National Institute of Allergy and Infectious Disease