31 research outputs found
New Antenatal Model in Africa and India (NAMAI) study: implementation research to improve antenatal care using WHO recommendations
Background: In 2020, an estimated 287 000 women died globally from pregnancyârelated causes and 2 million babies were stillborn. Many of these outcomes can be prevented by quality healthcare during pregnancy and childbirth. Within the continuum of maternal health, antenatal care (ANC) is a key moment in terms of contact with the health system, yet it remains an underutilized platform. This paper describes the protocol for a study conducted in collaboration with Ministries of Health and country research partners that aims to employ implementation science to systematically introduce and test the applicability of the adapted WHO ANC package in selected sites across four countries. Methods: Study design is a mixed methods stepped-wedge cluster randomized implementation trial with a nested cohort component (in India and Burkina Faso). The intervention is composed of two layers: (i) the country- (or state)-specific ANC package, including evidence-based interventions to improve maternal and newborn health outcomes, and (ii) the co-interventions (or implementation strategies) to help delivery and uptake of the adapted ANC package. Using COM-B model, co-interventions support behaviour change among health workers and pregnant women by (1) training health workers on the adapted ANC package and ultrasound (except in India), (2) providing supplies, (3) conducting mentoring and supervision and (4) implementing community mobilization strategies. In Rwanda and Zambia, a fifth strategy includes a digital health intervention. Qualitative data will be gathered from health workers, women and their families, to gauge acceptability of the adapted ANC package and its components, as well as experience of care. The implementation of the adapted ANC package of interventions, and their related costs, will be documented to understand to what extent the co-interventions were performed as intended, allowing for iteration. Discussion: Results from this study aim to build the global evidence base on how to implement quality ANC across different settings and inform pathways to scale, which will ultimately lead to stronger health systems with better maternal and perinatal outcomes. On the basis of the study results, governments will be able to adopt and plan for national scale-up, aiming to improve ANC nationally. This evidence will inform global guidance. Trial registration number: ISRCTN, ISRCTN16610902. Registered 27 May 2022. https://www.isrctn.com/ISRCTN16610902
Fine-Needle Aspiration Cytology In The Management Of Thyroid Nodules: A Preliminary Retrospective Review Of 53 Cases At King Faisal Hospital
Introduction: This is a retrospective review of 50 thyroid nodules
investigated by fine-needle aspiration cytology (FNAC). On clinical
grounds alone, it is not easy to differentiate between benign and
malignant lesions. The use of FNAC in the preliminary investigation of
cases assisted in the clinical management of these nodules in ruling
out malignancy and in helping to avoid unnecessary open biopsies and
surgery. Its cost-effectiveness and rapidity of results and attendant
relief of anxiety to the patient make it acceptable to both physician
and patient. Materials and Methods: 53 thyroid nodules were evaluated
clinically and sampled by FNA using 23G and 25G needles and 10 ml
syringes. Ethanol fixed and air-dried methanol âfixed smears were
prepared for Papanicolaou and Diff-Quik staining, respectively. Stained
preparations were evaluated on the light microscope. Results:
Cytodiagnoses included 24 nodular goitres, 19 colloid goitres, 5 cystic
lesions, 1 hyperplastic lesion, 1 thyroidifis, and 1 fungal infection.
Conclusions: FNAC was useful in ruling out malignancy and avoiding
unnecessary surgery. Benign thyroid nodules were more frequent than
thyroid carcinoma. Thyroid nodules were more frequent in female
patients than male patients with a ratio of 6:1. Further studies are
required to unravel any related aetiologic factors, if any.,Introduction: Il sâagit dâune revue rĂ©trospective de
53 nodules thyroïdiens investigués par cytologie aprÚs
aspiration Ă lâaiguille fine (CAAF). Il est parfois
difficile de faire la différence entre les lésions
bĂ©nignes et malignes sur base clinique seulement. Lâusage de
la CAAF comme moyen dâĂ©tude de ces cas a Ă©tĂ© utile
dans la prise en charge clinique de ces nodules, en Ă©liminant la
malignité et en évitant des biopsies à ciel ouvert et
une chirurgie inutile. Son trĂšs bon rapport
coût-efficacité, la rapidité des résultats et donc
lâabsence de lâanxiĂ©tĂ© en attendant ceux-ci font
que cette méthode est bien acceptée aussi bien par le
médecin que par le patient. Matériels et Méthodes: 53
nodules thyroïdiens ont été évalués
cliniquement et aspirés en utilisant une aiguille 23G et 25G ainsi
quâune seringue de 10ml. Des frottis humides fixĂ©s Ă
lâĂ©thanol et des frottis secs fixĂ©s au mĂ©thanol
ont été préparés puis colorés par la
méthode de Papanicolaou et au Diff-Quik. Les lames colorées
ont été analysées au microscope optique. Résultats:
Les rĂ©sultats de lâanalyse cytologique comprenaient 24
goitres nodulaires, 19 goßtres colloïdes, 5 lésions
kystiques, 2 cas suspects de malignité, une hyperplasie, une
thyroĂŻdite et une infection mycosique. Conclusion: La CAAF a
été utile en éliminant la malignité et en
évitant une chirurgie inutile. Les nodules thyroidiens bénins
ont été plus fréquents que les carcinomes thyroidiens.
Ces nodules thyroidiens intéressaient plus souvent les femmes que
les hommes avec une ratio de 6:1. Des études ultérieures sont
nécessaires à la recherche de tout facteur étiologique
sâil en existe
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Care-seeking patterns among families that experienced under-five child mortality in rural Rwanda
Background: Over half of under-five deaths occur in sub-Saharan Africa and appropriate, timely, quality care is critical for saving childrenâs lives. This study describes the context surrounding childrenâs deaths from the time the illness was first noticed, through the care-seeking patterns leading up to the childâs death, and identifies factors associated with care-seeking for these children in rural Rwanda. Methods: Secondary analysis of a verbal and social autopsy study of caregivers who reported the death of a child between March 2013 to February 2014 that occurred after discharge from the childâs birth facility in southern Kayonza and Kirehe districts in Rwanda. Bivariate analyses using Fisherâs exact tests were conducted to identify child, caregiver, and household factors associated with care-seeking from the formal health system (i.e., community health worker or health facility). Factors significant at α = 0.10 significance level were considered for backwards stepwise multivariate logistic regression, stopping when remaining factors were significantly associated with care-seeking at α = 0.05 significance level. Results: Among the 516 eligible deaths among children under-five, 22.7% (n = 117) did not seek care from the health system. For those who did, the most common first point of contact was community health workers (45.8%). In multivariate logistic regression, higher maternal education (OR = 3.36, 95% CI: 1.89, 5.98), having diarrhea (OR = 4.21, 95%CI: 1.95, 9.07) or fever (OR = 2.03, 95%CI: 1.11, 3.72), full household insurance coverage (3.48, 95%CI: 1.79, 6.76), and longer duration of illness (OR = 22.19, 95%CI: 8.88, 55.48) were significantly associated with formal care-seeking. Conclusion: Interventions such as community health workers and insurance promote access to care, however a gap remains as many children had no contact with the health system prior to death and those who sought formal care still died. Further efforts are needed to respond to urgent cases in communities and further understand remaining barriers to accessing appropriate, quality care
Human papillomavirus genotypes in cervical and other HPV-related anogenital cancer in Rwanda, according to HIV status
The study aim was to describe human papillomavirus (HPV)-attributable cancer burden in Rwanda, according to anogenital cancer site, HPV type, age and HIV status. Tissue specimens of cervical, vulvar, vaginal, penile and anal cancer diagnosed in 2012-2018 were retrieved from three cancer referral hospitals and tested for high-risk (HR) HPV DNA. Cervical cancer represented the majority of cases (598 of 738), of which 96.0% were HR-HPV positive. HPV-attributable fractions in other cancer sites varied from 53.1% in 81 penile, through 76.7% in 30 vulvar, 83.3% in 24 vaginal, up to 100% in 5 anal cases. HPV16 was the predominant HR-HPV type in cervical cancer (55.0%), followed by HPV18 (16.6%) and HPV45 (13.4%). HPV16 also predominated in other cancer sites (60-80% of HR-HPV-attributable fraction). For cervical cancer, type-specific prevalence varied significantly by histology (higher alpha-9 type prevalence in 509 squamous cell carcinoma vs. higher alpha-7 type prevalence in 80 adenocarcinoma), but not between 501 HIV-negative and 97 HIV-positive cases. With respect to types targeted, and/or cross-protected, by HPV vaccines, HPV16/18 accounted for 73%, HPV31/33/45/52/58 for an additional 22% and other HR-HPV types for 5%, of HPV-attributable cancer burden, with no significant difference by HIV status nor age. These data highlight the preventive potential of the ongoing national HPV vaccination program in Rwanda, and in sub-Saharan Africa as a whole. Importantly for this region, the impact of HIV on the distribution of causal HPV types was relatively minor, confirming type-specific relevance of HPV vaccines, irrespective of HIV status
Causes of death and predictors of childhood mortality in Rwanda: a matched case-control study using verbal social autopsy
Abstract Background Rwanda has dramatically reduced child mortality, but the causes and sociodemographic drivers for mortality are poorly understood. Methods We conducted a matched case-control study of all children who died before 5âyears of age in eastern Rwanda between 1st March 2013 and 28th February 2014 to identify causes and risk factors for death. We identified deaths at the facility level and via a community health worker reporting system. We used verbal social autopsy to interview caregivers of deceased children and controls matched by area and age. We used InterVA4 to determine probable causes of death and cause-specific mortality fractions, and utilized conditional logistic regression to identify clinical, family, and household risk factors for death. Results We identified 618 deaths including 174 (28.2%) in neonates and 444 (71.8%) in non-neonates. The most commonly identified causes of death were pneumonia, birth asphyxia, and meningitis among neonates and malaria, acute respiratory infections, and HIV/AIDS-related death among non-neonates. Among neonates, 54 (31.0%) deaths occurred at home and for non-neonates 242 (54.5%) deaths occurred at home. Factors associated with neonatal death included home birth (aOR: 2.0; 95% CI: 1.4â2.8), multiple gestation (aOR: 2.1; 95% CI: 1.3â3.5), both parents deceased (aOR: 4.7; 95% CI: 1.5â15.3), mothers non-use of family planning (aOR: 0.8; 95% CI: 0.6â1.0), lack of accompanying person (aOR: 1.6; 95% CI: 1.1â2.1), and a caregiver who assessed the medical services they received as moderate to poor (aOR: 1.5; 95% CI: 1.2â1.9). Factors associated with non-neonatal deaths included multiple gestation (aOR: 2.8; 95% CI: 1.7â4.8), lack of adequate vaccinations (aOR: 1.7; 95% CI: 1.2â2.3), household size (aOR: 1.2; 95% CI: 1.0â1.4), maternal education levels (aOR: 1.9; 95% CI: 1.2â3.1), mothers non-use of family planning (aOR: 1.6; 95% CI: 1.4â1.8), and lack of household electricity (aOR: 1.4; 95% CI: 1.0â1.8). Conclusion In the context of rapidly declining childhood mortality in Rwanda and increased access to health care, we found a large proportion of remaining deaths occur at home, with home deliveries still representing a significant risk factor for neonatal death. The major causes of death at a population level remain largely avoidable communicable diseases. Household characteristics associated with death included well-established socioeconomic and care-seeking risk factors
Descriptive characteristics of the child, caregivers, and household.
<p>Descriptive characteristics of the child, caregivers, and household.</p
Group antenatal care versus standard antenatal care and effect on mean gestational age at birth in Rwanda: protocol for a cluster randomized controlled trial
Formal and informal care seeking prior to the childâs death.
<p>Formal and informal care seeking prior to the childâs death.</p
Multivariate logistic regression of care-seeking predictors.
<p>Multivariate logistic regression of care-seeking predictors.</p
Bivariate associations between care-seeking and child, caregiver, and household characteristics.
<p>Bivariate associations between care-seeking and child, caregiver, and household characteristics.</p