Hypertension, its correlates and differences in access to healthcare services by gender among rural Zambian residents: a cross-sectional study

[Objectives] To examine the prevalence of hypertension and access to related healthcare services among rural residents of Mumbwa district in Zambia. [Design] Cross-sectional study with probability cluster sampling. [Setting] Rural Zambia. [Participants] We recruited 690 residents from Mumbwa district aged 25–64 years who had been living in the study area for ≥6 months and had adopted the lifestyle of the study area. Pregnant women and women who had given birth in the past 6 months were excluded. The data collection—questionnaire survey and anthropometric and biological measurements—was conducted between May and July 2016. [Results] In the overall sample, 39.7% and 33.5% of the men and women had hypertension (systolic blood pressure (BP)≥140 or diastolic BP ≥90 mm Hg), respectively. Among the participants without a previous diagnosis of hypertension, 30.3% presented with hypertension at the time of measurement. In the multivariable analysis, alcohol intake and urban residence in men, and older age group, higher education and body mass index ≥25 kg/m2 in women were significantly associated with hypertension. Among the 21.8% who never had their BP measured, 83.8% were men; among these men, older age (adjusted OR (AOR), 0.43; 95% CI 0.25 to 0.73) and HIV positive status (AOR, 0.37; 95% CI 0.14 to 0.97) were negatively associated, while current smoker status (AOR, 2.09; 95% CI 1.19 to 3.66) was positively associated with the lack of BP measurements. [Conclusion] We found that hypertension is prevalent in the target rural area. However, many were not aware of their hypertension status and many never had their BP measured, indicating a serious gap in cardiovascular disease prevention services in Zambia. There is an urgent need for health promotion and screening for hypertension, especially in the primary health services of rural Zambia. Issues related to healthcare accessibility in men require particular attention

Appraising the Potential of Using Satellite‐Based Rainfall Estimates for Evaluating Extreme Precipitation: A Case Study of August 2014 Event Across the West Rapti River Basin, Nepal

Heavy precipitation events are recurrently occurring in Nepal, affecting lives and properties every year, especially in the summer monsoon season (i.e., June-September). We investigated an extreme (heavy) precipitation event of August 2014 over the West Rapti River (WRR) Basin, Nepal. First, we forced a rainfall-runoff model with ground-based (gauge) hourly rainfall data of nine stations. Second, we validated against hourly water level at an outlet of the WRR Basin. This study then evaluated the performance of different satellite-based rainfall estimates (SREs) in capturing an extreme precipitation event. We considered the use of half-hourly data of Integrated Multi-satellite Retrievals for GPM (IMERG) (Early, Late, and Final versions), spatial resolution (10 km), and hourly data of Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks (PERSIANN), spatial resolution (25 km), and Precipitation Estimation from Remotely Sensed Information using Artificial Neural Networks-Cloud Classification System (PERSIANN-CCS), spatial resolution (4 km). Also, we used 3 h data of Tropical Multi-satellite Precipitation Analysis (TMPA) product real-time (3B42RT), spatial resolution (25 km). In general, we find that all selected SREs depicted a similar pattern of extreme precipitation as shown by the gauge data on a daily scale. However, we find these products could not replicate precisely on a sub-daily scale. Overall, IMERG and TMPA showed a better performance than PERSIANN and PERSIANN-CCS. Finally, we corrected poor-performed SREs with respect to gauge data and also filled data gaps of gauge rainfall using the information of good-performed SREs. Our study reveals that there is a great challenge in local flood simulation employing SREs at high-temporal resolution in Nepal

Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study.

BACKGROUND: Food insecurity is increasingly reported as an important barrier of patient adherence to antiretroviral therapy (ART) in both resource-poor and rich settings. However, unlike in resource rich-settings, very few quantitative studies to date have investigated the association of food insecurity with patient adherence to ART in Sub-Saharan Africa. The current study examines the association between food insecurity and adherence to ART among HIV-infected adults in the Democratic Republic of Congo (DRC). METHODS AND FINDINGS: This is a cross-sectional quantitative study of patients receiving ART at three private and one public health facilities in Kinshasa, DRC. Participants were consecutively recruited into the study between April and November 2012. Adherence was measured using a combined method coupling pharmacy refill and self-reported adherence. Food insecurity was the primary predictor, and was assessed using the Household Food Insecurity Access Scale (HFIAS). Of the 898 participants recruited into the study, 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32) and decreased (AOR, 0.31; CI, 0.11-0.83) odds of non-adherence to ART. CONCLUSION: Food insecurity is prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. Our findings highlight the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa

Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review

© 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.Objectives: Eighty-two percent of human immunodeficiency virus (HIV)–positive adolescents live in Sub-Saharan Africa (SSA). Despite the availability of antiretroviral therapy (ART), adherence levels are suboptimal, leading to poor outcomes. This systematic review investigated factors impacting ART adherence among adolescents in SSA, including religious beliefs and intimate relationships. Methods: A systematic review was conducted between June and August 2016 using eight electronic databases, including Cochrane and PubMed. Published, ongoing and unpublished research, conducted in SSA from 2004 to 2016, was identified and thematic analysis was used to summarise findings. Results: Eleven studies from eight SSA countries, published in English between 2011 and 2016, reported on factors impacting ART adherence among adolescents living with HIV (ALHIV). Forty-four barriers and 29 facilitators to adherence were identified, representing a complex web of factors. The main barriers were stigma, ART side-effects, lack of assistance and forgetfulness. Facilitators included caregiver support, peer support groups and knowledge of HIV status. Conclusions: Stigma reflects difficult relations between ALHIV and their HIV-negative peers and adults. Most interventions target only those with HIV, suggesting a policy shift towards the wider community could be beneficial. Recommendations include engaging religious leaders and schools to change negative societal attitudes. Limitations of the review include the urban settings and recruitment of predominantly vertically infected participants in most included studies. Therefore, the findings cannot be extrapolated to ALHIV residing in rural locations or horizontally infected ALHIV, highlighting the need for further research in those areas.Peer reviewedFinal Accepted Versio

Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis

Introduction: Adherence to HIV antiretroviral therapy (ART) is a critical determinant of HIV-1 RNA viral suppression and health outcomes. It is generally accepted that HIV-related stigma is correlated with factors that may undermine ART adherence, but its relationship with ART adherence itself is not well established. We therefore undertook this review to systematically assess the relationship between HIV-related stigma and ART adherence. Methods: We searched nine electronic databases for published and unpublished literature, with no language restrictions. First we screened the titles and abstracts for studies that potentially contained data on ART adherence. Then we reviewed the full text of these studies to identify articles that reported data on the relationship between ART adherence and either HIV-related stigma or serostatus disclosure. We used the method of meta-synthesis to summarize the findings from the qualitative studies. Results: Our search protocol yielded 14,854 initial records. After eliminating duplicates and screening the titles and abstracts, we retrieved the full text of 960 journal articles, dissertations and unpublished conference abstracts for review. We included 75 studies conducted among 26,715 HIV-positive persons living in 32 countries worldwide, with less representation of work from Eastern Europe and Central Asia. Among the 34 qualitative studies, our meta-synthesis identified five distinct third-order labels through an inductive process that we categorized as themes and organized in a conceptual model spanning intrapersonal, interpersonal and structural levels. HIV-related stigma undermined ART adherence by compromising general psychological processes, such as adaptive coping and social support. We also identified psychological processes specific to HIV-positive persons driven by predominant stigmatizing attitudes and which undermined adherence, such as internalized stigma and concealment. Adaptive coping and social support were critical determinants of participants’ ability to overcome the structural and economic barriers associated with poverty in order to successfully adhere to ART. Among the 41 quantitative studies, 24 of 33 cross-sectional studies (71%) reported a positive finding between HIV stigma and ART non-adherence, while 6 of 7 longitudinal studies (86%) reported a null finding (Pearson's χ 2=7.7; p=0.005). Conclusions: We found that HIV-related stigma compromised participants’ abilities to successfully adhere to ART. Interventions to reduce stigma should target multiple levels of influence (intrapersonal, interpersonal and structural) in order to have maximum effectiveness on improving ART adherence

コンゴ民主共和国において、患者の抗HIV治療アドヒアランスに関連する要因に関するミクストメソッド研究 : 食糧飢餓の意義について

京都大学0048新制・課程博士博士(医学)甲第18165号医博第3885号新制||医||1003(附属図書館)31023京都大学大学院医学研究科医学専攻(主査)教授 中山 健夫, 教授 髙折 晃史, 教授 中原 俊隆学位規則第4条第1項該当Doctor of Medical ScienceKyoto UniversityDFA

Correlates of HIV Testing Experience among Migrant Workers from Myanmar Residing in Thailand: A Secondary Data Analysis.

BACKGROUND:Thailand continues to attract an increasing number of migrant workers (MW) from neighboring countries including mainly Myanmar, Cambodia, and Laos; however, little is known about the extent to which MWs from these countries have access to HIV prevention, treatment, and care services. We used data from the baseline survey of the Prevention of HIV/AIDS among MWs in Thailand (PHAMIT-2) project to document the prevalence of, and factors associated with, HIV testing among MWs from Myanmar, the largest group of MWs in Thailand. METHODS AND FINDINGS:The baseline survey of PHAMIT-2 was conducted in 2010 among MWs from Myanmar, Cambodia, and Laos in 10 purposely-selected provinces of Thailand. Of the 1,034 participants who qualified for the analysis to identify correlates of HIV testing, only 5.3% reported ever having been tested for HIV. Factors associated with HIV testing included having a secondary or higher education level (AOR, 2.58; CI, 1.36-4.90; P = 0.004), being female (AOR, 1.96; CI, 1.05-3.66; P = 0.033), knowing someone who died of AIDS (AOR, 1.81; CI, 1.00-3.27; P = 0.048), working in the fishery sector (AOR, 2.51; CI, 1.28-4.92; P = 0.007), and not having a work permit (AOR, 3.71; CI, 1.36-10.13; P = 0.010). CONCLUSION:Our study, in addition to revealing significantly low HIV testing among MWs from Myanmar, identifies important barriers to HIV testing which could be addressed through interventions that promote migrants' culturally-sensitive and friendly service, for example by facilitating flow of information about places for HIV testing, availability of language assistance, and ensuring confidentiality of HIV testing

Stability and accuracy of the weakly compressible SPH with particle regularization techniques

This paper proposes and validates two new particle regularization techniques for the Smoothed Particle Hydrodynamics (SPH) numerical method to improve its stability and accuracy for free surface flow simulations. We introduce a general form of the Dynamic pair-wise Particle Collision (DPC) regularization technique that we recently proposed in the context of the Moving Particle Semi-implicit (MPS) method in [1]. The DPC coupled with the standard Particle Shifting (PS) technique has given rise to a hybrid approach that we propose to alleviate particle clustering issues in the free-surface and splashed regions. We validate the proposed techniques to four benchmark cases: (i) the oscillating droplet, (ii) the two-dimensional water dam-break, (iii) the two-dimensional water sloshing, and (iv) the three-dimensional water dam break against a rigid obstacle. We evaluate their impacts on the stability, accuracy and the conservation properties of the test cases. The qualitative and quantitative analysis of the results shows that despite its simplicity, the DPC technique is more effective in reducing the spatial disorder and capturing the impact events compared with the standard and the newly improved hybrid PS methods. Although the hybrid PS technique improves particle distribution at the free surface, it still suffers from the inconsistent implementation of the PS equation which unphysically increases the fluid volume and violates the conservation of potential energy in the long-term simulations. Overall, the conservative DPC algorithm proves to be a simple and efficient alternative regularization technique for simulating such highly dynamic free-surface flows.Comment: 51 Pages, 24 Figures, 1 Graphical Abstract, Accepted Manuscrip