risk factors associated with road traffic injuries in Mozambique: results of the 2016 INCOMAS study

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Do mothers pick up a phone? A cross-sectional study on delivery of MCH voice messages in Lagos, Nigeria

Background: Voice messages have been employed as an effective and efficient approach for increasing health service utilization and health promotion in low- and middleincome countries. However, unlike SMS, voice message services require their users to pick up a phone call at its delivery time. Furthermore, voice messages are difficult for the users to review their contents afterward. While recognizing that voice messages are more friendly to specific groups (eg, illiterate or less literate populations), there should be several challenges in successfully operationalizing its intervention program.Objective: This study is aimed to estimate the extent to which voice message service users pick up the phone calls of voice messages and complete listening up to or beyond the core part of voice messages.Methods: A voice message service program composed of 14 episodes on maternal, newborn, and child health was piloted in Lagos, Nigeria, from 2018 to 2019. A voice message call of each of 14 episodes was delivered to the mobile phones of the program participants per day for 14 consecutive days. A total of 513 participants in the voice message service chose one of five locally spoken languages as the language to be used for voice messages. Two multilevel logistic regression models were created to understand participants’ adherence to the voice message: (a) Model 1 for testing whether a voice message call is picked up; and (b) Model 2 for testing whether a voice message call having been picked up is listened to up to the core messaging part.Results: The greater the voice message episode number became, the smaller proportion of the participants picked up the phone calls of voice message (aOR: 0.98; 95% CI: 0.97–0.99; P =.01). Only 854 of 3765 voice message calls having been picked up by the participants (22.7%) were listened to up to their core message parts. It was found that picking up a phone call did not necessarily ensure listening up to the core message part. This indicates a discontinuity between these two actions. Conclusions: The participants were likely to stop picking up the phone as the episode number of voice messages progressed. In view of the discontinuity between picking up a phone call and listening up to the core message part, we should not assume that those picking up the phone would automatically complete listening to the entire or core voice message

Glutathione S-transferase pi localizes in mitochondria and protects against oxidative stress.

Glutathione S-transferases (GSTs) are multifunctional enzymes involved in the protection of cellular components against anti-cancer drugs or peroxidative stress. Previously we found that GST pi, an isoform of the GSTs, is transported into the nucleus. In the present study, we found that GST pi is present in mitochondria as well as in the cytosol and nucleus in mammalian cell lines. A construct comprising the 84 amino acid residues in the amino-terminal region of GST pi and green fluorescent protein was detected in the mitochondria. The mutation of arginine to alanine at positions 12, 14, 19, 71, and 75 in full-length GST pi completely abrogated the ability to distribute in the mitochondria, suggesting that arginine, a positively charged residue, is required for the mitochondrial transport of GST pi. Chemicals generating reactive oxygen species, such as rotenone and antimycin A, decreased cell viability and reduced mitochondrial membrane potential. The overexpression of GST pi diminished these changes. GST pi-targeting siRNA abolished the protective effect of GST pi on the mitochondria under oxidative stress. The findings indicate that the peptide signal is conducive to the mitochondrial localization of GST pi under steady-state conditions without alternative splicing or posttranslational modifications such as proteolysis, suggesting that GST pi protects mitochondria against oxidative stress

The neglected epidemic—Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

This study was supported by the Doris Duke Charitable Foundation’s African Health Initiative funded study "Strengthening Integrated Primary Health Care and Workforce Training in Sofala Province, Mozambique" (2009059) and by the Doris Duke Charitable Foundation's African Health Initiative funded study "Spreading IDEAs: the integrated district evidence to action program to improve maternal, newborn and child health" (2016106). which was awarded to KS, as Principal Investigator. The Doris Duke Charitable Foundation had no role in the design of the study, the collection, analysis, and interpretation of the data and in the writing of the manuscript.In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical “hotspots” of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the “Beira corridor” (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the “Beira corridor”, higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.Peer reviewe

Determinants of health facility utilization for childbirth in rural western Kenya: cross-sectional study

Background: Skilled attendance at delivery is recognized as one of the most important factors in preventing maternal death. However, more than 50% of births in Kenya still occur in non-institutional locations supported by family members and/or traditional birth attendants (TBAs). To improve this situation, a study of the determinants of facility delivery, including individual, family and community factors, was necessary to consider effective intervention in Kenya.Methods: This study was conducted to identify the factors which influence the place of delivery in rural western Kenya, and to recommend ways to improve women\u27s access to skilled attendants at delivery. A community-based cross-sectional survey was carried out from August to September 2011 in all 64 sub-locations which were covered by community health workers (CHWs). An interviewer-administered questionnaire on seventeen comprehensive variables was administered to 2,560 women who had children aged 12-24 months.Results: The response rate was 79% (n = 2,026). Of the respondents, 48% of births occurred in a health facility and 52% in a non-institutional location. The significant determinants of facility delivery examined using multivariate analysis were: maternal education level, maternal health knowledge, ANC visits, birth interval, economic status of household, number of household members, household sanitation practices and traveling time to nearest health facility.Conclusions: The results suggest that the involvement of TBAs to promote facility delivery is still one of the most important strategies. Strengthening CHWs\u27 performance by focusing on a limited number of topics and clear management guidance might also be an effective intervention. Stressing the importance of regular attendance at ANC (at least four times) would be effective in enhancing motivation for a facility delivery. Based on our findings, those actions to improve the facility delivery rate should focus more on pregnant women who have a low education level, poor health knowledge and short pregnancy spacing. In addition, women with low economic status, a large number of family members and a long distance to travel to a health facility should also be targeted by further interventions

Priority setting for achieving Universal Health Coverage in Nigeria: A Spatial and Temporal Analysis and Cost-Benefit Analysis

Thesis (Ph.D.)--University of Washington, 2023Universal Health Coverage (UHC) is an urgent global priority outlined in the Sustainable Development Goals (SDGs) to ensure the accessibility of health services for all people without causing financial hardship. If current progress continues to 2030, 37% to 61% of the global population will not be covered by essential health services.1 Therefore, we need to accelerate the increase of service coverage to achieve the UHC target by 2030. There are three specific aims of this dissertation; 1) To identify both individual and contextual factors that are consistently associated with utilization of nine essential maternal and child health services (i.e., ANC, facility-based delivery, modern contraceptive use, immunizations, and childhood illnesses), across survey years and household geolocations, using five national representative cross-sectional surveys in Nigeria; 2) To estimate grid-level coverage of selected essential MCH services in Nigeria using generalized additive models (GAMs) and Gradient Boosting (GB) 3) To estimate required costs and avoidable child deaths by increasing selected essential health service coverage in each community, and to identify the priority sub-national areas. This dissertation emphasizes the importance of multi-dimensional priority setting in achieving Universal Health Coverage in Nigeria. By identifying the factors influencing health service utilization, assessing regional disparities, estimating required costs, and quantifying potential impacts, policymakers can make evidence-based decisions to maximize the efficiency and effectiveness of healthcare interventions. The findings and recommendations of this research contribute to the broader global agenda of achieving UHC and improving health outcomes for all populations, particularly in low- and middle-income countries

Effectiveness of four interventions in improving community health workers\u27 performance in western Kenya: a quasi-experimental difference-in-differences study using a longitudinal data

BACKGROUND: Community health workers (CHWs) are up-front health workers delivering the most effective life-saving health services to communities. They are the key driver to achieve Universal Health Coverage. However, maintaining CHWs\u27 performance is one of the challenges in sustaining their effectiveness. This article assessed the effectiveness of the four interventions and their combinations on the CHWs\u27 performance in terms of health knowledge, job satisfaction, and household coverage. METHODS: We used the longitudinal survey data collected in western Kenya. Our study participants were the representative of all CHWs working in the four districts, Kenya. The four types of interventions were composed of a basic core intervention (i.e., refresher training with/without defaulter tracing) and three supplementary interventions (i.e., provision of a bicycle, frequent supportive supervision, and financial incentives). We performed the three fixed-effect models to assess the effectiveness of the four interventions and their combinations on the three performance indicators. RESULTS: Three single and combination interventions significantly increased CHWs\u27 health knowledge: refresher training only [Coef.: 48.43, 95% CI: 42.09-54.76, P \u3c 0.001]; refresher training plus defaulter-tracing [Coef.: 38.80, 95% CI: 32.71-44.90, P \u3c 0.001]; combination of refresher training plus defaulter-tracing and frequent supervision [Coef.: 17.02, 95% CI: 7.90-26.15, P \u3c 0.001]. Financial support was the only intervention that significantly increased job satisfaction among CHWs [Coef.: 4.97, 95% CI: 0.20-9.75, P = 0.041]. There was no single intervention that significantly increased household coverage. Yet, the combinations of the interventions significantly increased household coverage. CONCLUSIONS: There was no single intervention to improve all the aspects of CHWs\u27 performance. The refresher training significantly improved their health knowledge, while financial incentive enhanced the level of their job satisfaction. The combinations of regular refresher training and other intervention(s) are the recommended as the effective interventions in improving and further sustaining CHWs\u27 performance

Effects of the COVID-19 pandemic on essential health and nutrition service utilisations in Ghana: interrupted time-series analyses from 2016 to 2020

Objectives This study aimed to assess the national-level and subnational-level effects of the COVID-19 pandemic on essential health and nutrition service utilisation in Ghana.Design Interrupted time-series.Setting and participants This study used facility-level data of 7950 governmental and non-governmental health facilities in Ghana between January 2016 and November 2020.Outcome measures As the essential health and nutrition services, we selected antenatal care (ANC); institutional births, postnatal care (PNC); first and third pentavalent vaccination; measles vaccination; vitamin A supplementations (VAS); and general outpatient care. We performed segmented mixed effects linear models for each service with consideration for data clustering, seasonality and autocorrelation. Losses of patient visits for essential health and nutrition services due to the COVID-19 pandemic were estimated as outcome measures.Results In April 2020, as an immediate effect of the COVID-19 pandemic, the number of patients for all the services decreased except first pentavalent vaccine. While some services (ie, institutional birth, PNC, third pentavalent and measles vaccination) recovered by November 2020, ANC, VAS and outpatient services had not recovered to prepandemic levels. The total number of lost outpatient visits in Ghana was estimated to be 3 480 292 (95% CI: −3 510 820 to −3 449 676), followed by VAS (−180 419, 95% CI: −182 658 to −177 956) and ANC (−87 481, 95% CI: −93 644 to −81 063). The Greater Accra region was the most affected region by COVID-19, where four out of eight essential services were significantly disrupted.Conclusion COVID-19 pandemic disrupted the majority of essential healthcare services in Ghana, three of which had not recovered to prepandemic levels by November 2020. Millions of outpatient visits and essential ANC visits were lost. Furthermore, the immediate and long-term impacts of the COVID-19 pandemic on service utilisation varied by service type and region