A comparison of vitamin D and cathelicidin (LL-37) levels between patients with active TB and their healthy contacts in a high HIV prevalence setting: a prospective descriptive study

BACKGROUND: Studies from Asia and Europe indicate an association between vitamin D deficiency and susceptibility to TB. We performed an observational case-control study to determine vitamin D and cathelicidin (LL-37) levels and their association with active TB in newly diagnosed and microbiologically confirmed adult TB patients in Zambia, a high HIV prevalence setting. METHODS: Both total vitamin D and LL-37 were measured using ELISA from serum and supernatant isolated from cultured whole blood that was stimulated with heat-killed Mycobacterium tuberculosis. Statistical analysis was performed using STATA statistical software version 12. RESULTS: The median vitamin D in TB patients and healthy contacts was 28.7 (19.88-38.64) and 40.8 (31.2-49.44) ng/ml, respectively (p<0.001). The median LL-37 in TB patients compared with healthy contacts was 1.87 (2.74-8.93) and 6.73 (5.6-9.58) ng/ml, respectively (p=0.0149). Vitamin D correlation with LL-37 in healthy contacts was R2=0.7 (95% CI 0.566 to 0.944), p<0.0001. Normal vitamin D significantly predicted a healthy status (OR 4.06, p=0.002). CONCLUSIONS: Significantly lower levels of vitamin D and LL-37 are seen in adults with newly diagnosed active TB. Longitudinal studies across various geographical regions are required to accurately define the roles of vitamin D and LL-37 in preventive and TB treatment outcomes

The early-stage comprehensive costs of routine PrEP implementation and scale-up in Zambia

Pre-exposure prophylaxis (PrEP) is an effective HIV prevention option, but cost-effectiveness is sensitive to implementation and program costs. Studies indicate that, in addition to direct delivery cost, PrEP provision requires substantial demand creation and client support to encourage PrEP initiation and persistence. We estimated the cost of providing PrEP in Zambia through different PrEP delivery models. Taking a guidelines-based approach for visits, labs and drugs, we estimated the annual cost of providing PrEP per client for five delivery models: one focused on key populations (men-who-have-sex-with-men (MSM) and female sex workers (FSW), one on adolescent girls and young women (AGYW), and three integrated programs (operated within HIV counselling and testing services at primary healthcare centres). Program start-up and support costs were based on program expenditure data and number of PrEP sites and clients in 2018. PrEP clinic visit costs were based on micro-costing at two PrEP delivery sites (2018 USD). Costs are presented in 2018 prices and inflated to 2021 prices. The annual cost/PrEP client varied by service delivery model, from $394 (AGYW) to$655 (integrated model). Cost differences were driven largely by client volume, which impacted the relative costs of program support and technical assistance assigned to each PrEP client. Direct service delivery costs ranged narrowly from $205-212/PrEP-client and were a key component in the cost of PrEP, representing 35–65% of total costs. The results show that, even when integrated into full service delivery models, accessing vulnerable, marginalised populations at substantial risk of HIV infection is likely to cost more than previously estimated due to the programmatic costs involved in community sensitization and client support. Improved data on individual client resource usage and outcomes is required to get a better understanding of the true resource utilization, expected outcomes and annual costs of different PrEP service delivery programs in Zambia

Initial implementation of PrEP in Zambia: health policy development and service delivery scale-up

INTRODUCTION: Daily pre-exposure prophylaxis (PrEP) for HIV prevention is highly effective, but not yet widely deployed in sub-Saharan Africa. We describe how Zambia developed PrEP health policy and then successfully implemented national PrEP service delivery. POLICY DEVELOPMENT: Zambia introduced PrEP as a key strategy for HIV prevention in 2016, and established a National PrEP Task Force to lead policy advocacy and development. The Task Force was composed of government representatives, regulatory agencies, international donors, implementation partners and civil society organisations. Following an implementation pilot, PrEP was rolled out nationally using risk-based criteria alongside a national HIV prevention campaign. NATIONAL SCALE-UP: In the first year of implementation, ending September 2018, 3626 persons initiated PrEP. By September 2019, the number of people starting PrEP increased by over sixfold to 23 327 persons at 728 sites across all ten Zambian provinces. In the first 2 years, 26 953 clients initiated PrEP in Zambia, of whom 31% were from key and priority populations. Continuation remains low at 25% and 11% at 6 and 12 months, respectively. LESSONS LEARNT: Risk-based criteria for PrEP ensures access to those most in need of HIV prevention. Healthcare worker training in PrEP service delivery and health needs of key and priority populations is crucial. PrEP expansion into primary healthcare clinics and community education is required to reach full potential. Additional work is needed to understand and address low PrEP continuation. Finally, a task force of key stakeholders can rapidly develop and implement health policy, which may serve as a model for countries seeking to implement PrEP

Informing prevention of stillbirth and preterm birth in Malawi:development of a minimum dataset for health facilities participating in the DIPLOMATIC collaboration

OBJECTIVE: The global research group, DIPLOMATIC (Using eviDence, Implementation science, and a clinical trial PLatform to Optimise MATernal and newborn health in low Income Countries), aims to reduce stillbirths and preterm births and optimise outcomes for babies born preterm. Minimum datasets for routine data collection in healthcare facilities participating in DIPLOMATIC (initially in Malawi) were designed to assist understanding of baseline maternal and neonatal care processes and outcomes, and facilitate evaluation of improvement interventions and pragmatic clinical trials. DESIGN: Published and grey literature was reviewed alongside extensive in-country consultation to define relevant clinical best practice guidance, and the existing local data and reporting infrastructure, to identify requirements for the minimum datasets. Data elements were subjected to iterative rounds of consultation with topic experts in Malawi and Scotland, the relevant Malawian professional bodies and the Ministry of Health in Malawi to ensure relevance, validity and feasibility. SETTING: Antenatal, maternity and specialist neonatal care in Malawi. RESULTS: The resulting three minimum datasets cover the maternal and neonatal healthcare journey for antenatal, maternity and specialist neonatal care, with provision for effective linkage of records for mother/baby pairs. They can facilitate consistent, precise recording of relevant outcomes (stillbirths, preterm births, neonatal deaths), risk factors and key care processes. CONCLUSIONS: Poor quality routine data on care processes and outcomes constrain healthcare system improvement. The datasets developed for implementation in DIPLOMATIC partner facilities reflect, and hence support delivery of, internationally agreed best practice for maternal and newborn care in low-income settings. Informed by extensive consultation, they are designed to integrate with existing local data infrastructure and reporting as well as meeting research data needs. This work provides a transferable example of strengthening data infrastructure to underpin a learning healthcare system approach in low-income settings.DIPLOMATIC is funded by the UK National Institute for Health Research

Examining Sport-for-development Using a Critical Occupational Approach to Research

Operating under the rubric of sport-for-development, nongovernmental organizations have mobilized sport activities as a tool for international development. Along with these initiatives, a scholarly analysis of the phenomenon has emerged. However, this body of research has not included analysis from a critical occupational perspective. This is a conspicuous shortcoming since, in the language of occupational science, sport-for-development initiatives are occupation-based programs. This study explored sport-for-development using a critical occupational approach to research I constructed, wherein the central site of knowledge production was occupations used in sport-for-development programs. Through five case studies with sport-for-development organizations in Lusaka, Zambia, I describe how staff and youth participants spoke about and understood the use of sport occupations in sport-for-development programs and the sport-for-development ideologies and practices in Zambia and how these shaped the participation of youth. Data generation included observing program activities, interviewing participants, and analyzing organization documents. The findings drew attention to the form, function, and meaning of the sport occupations used in sport-for-development, and illuminate that football, which is a heavily gendered and segregated sport, was constructed as the preferential activity for programs. This prioritization of football, in conjunction with a hierarchical, authoritative approach to decision making, and focus on the development of youths’ sports skills, led to athletic, non-disabled boys living in urban areas being the primary beneficiaries of the programs. I argue that the ideological beliefs that re/produced these understandings contributed to occupational injustices by (1) contributing to the practice of sport being used uncritically as an activity for all youth, (2) perpetuating what were considered acceptable activities for boys and girls in the local context to do, and (3) defining boys in opposition to girls, rural youth, poor youth, and youth with disabilities from both genders. Finally, I propose directions for institutionally-orientated actions to address occupational injustices and consideration of the wider uses and implications of a critical occupational approach within health and social research.Ph

Deporte para el desarrollo: ¿Un nivel del campo de juego?

In dem expandierenden Feld des Sport for Development werden mögliche Vorteile der Teilhabe von Jugendlichen breit diskutiert. Zugleich wurde festgestellt, dass einige Jugendliche infolge von z.B. körperlichen oder geistigen Einschränkungen, ihrer örtlichen Zugehörigkeit, der Nichtverfügung über ökonomische Mittel  oder ihrer Geschlechtszugehörigkeit nur sehr eingeschränkte Zugangsmöglichkeiten haben. Wir vermuteten, dass hier ideologische Ursachen eine Rolle spielen könnten bzw. versuchten herauszufinden, wie Sport-for-Development-Ideologien jugendliche Partizipationsmöglichkeiten beeinflussen könnten. Ausgehend von empirischem Material, das aus fünf Fallstudien stammt, die in Sport-for-Development-Organisationen in Lusaka (Sambia) durchgeführt wurden, konnten drei Themen identifiziert werden, die ideologische Glaubenssätze in diesen Kontexten betreffen: Der erste, Sport nützt allen, war wesentlich für eine Praxis, in der Sport unkritisch als jugendliche Aktivität angesehen wurde. Der zweite, Gute Kids tun es, unterstrich, was als akzeptiertes Verhalten von Jugendlichen in ihren spezifischen Kontexten galt. Der dritte schließlich, Sport ist ein Ausweg, privilegierte männliche Jugendliche, die Fußball spielten oder allgemeiner athletisch und körperlich nicht beeinträchtigt sind im Vergleich zu weiblichen Jugendliche, armen oder aus ländlichen Regionen stammenden Jugendlichen oder männlichen Jugendlichen mit körperlichen Einschränkungen. Gemeinsam haben diese Glaubenssätze sowohl zu Erfolgen (Sportkarrieren) als auch zu Beeinträchtigungen (Ungleichheit) geführt, die beide mit dem Phänomenon des Sport for Development verbunden sind.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1502120In the burgeoning field of sport-for-development, the benefits of participation for youths have been widely discussed. However, it has also been noted that some youth are excluded based on ability, location, economic means, and gender and are thus not participating. We considered that this might be an issue of ideologies. Thus, it was the purpose of this study to use a critical occupational approach to explore how sport-for-development ideologies in Zambia shape the participation of young people. Drawing on empirical data gathered from five case studies of sport-for-development organizations in Lusaka, Zambia, three themes were identified that describe ideological beliefs within the Zambian sport-for-development context. The first, sport benefits all, contributed to the practice of sport being used uncritically as an activity for all youth. The second, good people do, perpetuated what were considered acceptable activities that boys and girls could do in the local context. Finally, a belief that sport is the way out privileged boys who play football as well as athletic non-disabled boys in opposition to girls, poor youths, rural youths, and girls and boys with disabilities. Together these beliefs have contributed to successes (careers in sport) and shortcomings (occupational injustices) associated with the sport-for-development phenomenon.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs1502120En el floreciente campo del deporte para el desarrollo, se han discutido ampliamente los beneficios de la participación de los jóvenes. Sin embargo, se ha observado también que algunos jóvenes se excluyen a partir de la capacidad, ubicación, medios económicos y género y, por lo tanto, no participan. Consideramos que esto podría ser un problema de ideologías. Por lo tanto, el propósito de este estudio fue usar un enfoque crítico ocupacional para explorar las ideologías del deporte para el desarrollo perfilan la participación de los jóvenes en Zambia. Con base en datos empíricos recogidos de cinco estudios de caso de organizaciones de deporte para el desarrollo en Lusaka, Zambia, se identificaron tres temas que describen las creencias ideológicas en el contexto del deporte para el desarrollo zambiano. El primero, beneficios completos del deporte, contribuyó a la práctica del deporte, siendo utilizado acríticamente como una actividad para todos los jóvenes. El segundo, gente buena lo hace pero no lo hagas, perpetuó lo que consideraron actividades aceptables que muchachos y muchachas podrían hacer en el contexto local. Finalmente, la creencia de que el deporte es la salida privilegiada para muchachos que juegan fútbol así como para atletas sin discapacidades en oposición a las muchachas, jóvenes pobres, jóvenes rurales y muchachas y muchachos con discapacidades. En conjunto, estas creencias han contribuido a los éxitos (carreras en el deporte) y deficiencias (injusticias laborales) asociadas con el fenómeno del deporte para el desarrollo.URN: http://nbn-resolving.de/urn:nbn:de:0114-fqs150212

Towards a Critical Occupational Approach to Research

Critical approaches to research are becoming increasingly more prevalent but occupational science and critical approaches have not been explicitly combined into one approach despite the potential to enrich the understanding of the assumptions and ideologies underlying human activity. In this article we outline an approach to research that is mutually informed by occupational and critical social science perspectives. The critical occupational approach we describe can be used to explore the ways in which knowledge is produced through engagement in occupation, who controls knowledge production, the mechanisms of how occupations are taken up, and who stands to gain or lose. We discuss the implications and considerations for generating research purposes and methods and conducting analyses. We then illustrate the use of the approach through a case study. We conclude this article with consideration of the wider uses and implications of a critical occupational approach within health and social research

Sport-for-development: a level playing field?

In the burgeoning field of sport-for-development, the benefits of participation for youths have been widely discussed. However, it has also been noted that some youth are excluded based on ability, location, economic means, and gender and are thus not participating. We considered that this might be an issue of ideologies. Thus, it was the purpose of this study to use a critical occupational approach to explore how sport-for-development ideologies in Zambia shape the participation of young people. Drawing on empirical data gathered from five case studies of sport-for-development organizations in Lusaka, Zambia, three themes were identified that describe ideological beliefs within the Zambian sport-for-development context. The first, sport benefits all, contributed to the practice of sport being used uncritically as an activity for all youth. The second, good people do, perpetuated what were considered acceptable activities that boys and girls could do in the local context. Finally, a belief that sport is the way out privileged boys who play football as well as athletic non-disabled boys in opposition to girls, poor youths, rural youths, and girls and boys with disabilities. Together these beliefs have contributed to successes (careers in sport) and shortcomings (occupational injustices) associated with the sport-for-development phenomenon. (author's abstract)In dem expandierenden Feld des Sport for Development werden mögliche Vorteile der Teilhabe von Jugendlichen breit diskutiert. Zugleich wurde festgestellt, dass einige Jugendliche infolge von z.B. körperlichen oder geistigen Einschränkungen, ihrer örtlichen Zugehörigkeit, der Nichtverfügung über ökonomische Mittel oder ihrer Geschlechtszugehörigkeit nur sehr eingeschränkte Zugangsmöglichkeiten haben. Wir vermuteten, dass hier ideologische Ursachen eine Rolle spielen könnten bzw. versuchten herauszufinden, wie Sport-for-Development-Ideologien jugendliche Partizipationsmöglichkeiten beeinflussen könnten. Ausgehend von empirischem Material, das aus fünf Fallstudien stammt, die in Sport-for-Development-Organisationen in Lusaka (Sambia) durchgeführt wurden, konnten drei Themen identifiziert werden, die ideologische Glaubenssätze in diesen Kontexten betreffen: Der erste, Sport nützt allen, war wesentlich für eine Praxis, in der Sport unkritisch als jugendliche Aktivität angesehen wurde. Der zweite, Gute Kids tun es, unterstrich, was als akzeptiertes Verhalten von Jugendlichen in ihren spezifischen Kontexten galt. Der dritte schließlich, Sport ist ein Ausweg, privilegierte männliche Jugendliche, die Fußball spielten oder allgemeiner athletisch und körperlich nicht beeinträchtigt sind im Vergleich zu weiblichen Jugendliche, armen oder aus ländlichen Regionen stammenden Jugendlichen oder männlichen Jugendlichen mit körperlichen Einschränkungen. Gemeinsam haben diese Glaubenssätze sowohl zu Erfolgen (Sportkarrieren) als auch zu Beeinträchtigungen (Ungleichheit) geführt, die beide mit dem Phänomenon des Sport for Development verbunden sind. (Autorenreferat

Towards a Critical Occupational Approach to Research

Critical approaches to research are becoming increasingly more prevalent but occupational science and critical approaches have not been explicitly combined into one approach despite the potential to enrich the understanding of the assumptions and ideologies underlying human activity. In this article we outline an approach to research that is mutually informed by occupational and critical social science perspectives. The critical occupational approach we describe can be used to explore the ways in which knowledge is produced through engagement in occupation, who controls knowledge production, the mechanisms of how occupations are taken up, and who stands to gain or lose. We discuss the implications and considerations for generating research purposes and methods and conducting analyses. We then illustrate the use of the approach through a case study. We conclude this article with consideration of the wider uses and implications of a critical occupational approach within health and social research