bluuebunny/crossref_metadata_2025 huggingface dataset:
PO 8609 PREVALENCE AND RISK FACTORS FOR GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD) DEFICIENCY IN TWOP. VIVAXMALARIA-ENDEMIC AREAS IN SUDAN
Authors: Hamid Muzamil Mahdi Abdel , Albsheer Musab , Muneer Mohamed , Altinae Lina , Lover Andrew A
Published: April 2019

Background

Plasmodium vivaxmalaria is a major health problem in Sudan and the parasite has become widely distributed in the recent years. The WHO recommends the use of primaquine as radical cure for liver dormant stage, the hypnozoite. However, prior its use, a test for Glucose-6-phosphate Dehydrogenase (G6PD) should be performed. The objective of the current study was to determine prevalence and risk factors for G6PD deficiency in twoP. vivaxmalaria-endemic areas in Sudan.

Methods

A cross-sectional study recruiting 557 subjects from two malaria-endemic areas in Sudan was conducted. Demographic data and blood samples were collected. G6PD activity was measured by spectrometry using SPINREACT enzymatic-UV kit.

Results

The measured G6PD activities for both sites ranged from 0.6 to 37.7 U/g Hb, with a median value of 12.8 U/g Hb. There was a significant difference in enzyme activity by study site (p<0.001), but not by sex (p=0.91). Overall, across the two study sites, 22 (3.9%) is G6PDd (<30%). Prevalence of G6PDd (<30%) in Khartoum is 1.8% (4/230) compared to 4.8% (16/327) in New Hafla. In univariate analysis predictors of G6PDd were study site (odds ratio of G6PD activity <3.8, Khartoum relative to New Halfa=0.22 (95% CI: 0.08 to 0.66), p=0.006), and recent antibiotic use (OR=2.45 (95% CI: 1.1 to 5.5), p=0.027). In multivariate analysis, the only factor that was significant was the individual’s weight in kilograms, with an OR of 0.97 (95% CI 0.95 to 0.99, p=0.014).

Conclusion

G6PD deficiency is less prevalent among Sudanese population and this indicates that the use of primaquine for radical cure ofP. vivaxmalaria is safe.
OC 8474 ASSESSMENT OF ETHICS REVIEW FRAMEWORKS FOR HEALTH RESEARCH IN EAST AFRICA FOR PURPOSES OF HARMONISATION
Authors: Kibiki Gibson S , Twungubumwe Novat , Kombe Francis , IJsselmuiden Carel , Bahati Prince N , Kamali Anatoli , Ngirabega Jean De Dieu
Published: April 2019

Background

Capacity in health research ethics review is key in Africa, given the increase in research activities, complexity, and use of advanced technologies. Harmonising ethics review frameworks can address challenges attributable to these complexities. Establishing an effective harmonised framework that is optimum or protection of the research subjects requires assessment of review capacity.

The East African Health Research Commission commissioned a study to assess the capacity of Review Ethics Committees (RECs) in the East African Community (EAC) countries, as a step towards strengthening and harmonising the regions’ capacity and review frameworks.

Methods

A desktop review of documentation (national and institutional guidelines, policies and SOPs) was conducted in five EAC countries. Semi-structured questionnaires were used to collect data from key informants. Qualitative interviews were used to collect views on stakeholders’ perception of benefits, opportunities and challenges of harmonisation.

Results

Sixty-nine (69) accredited RECs were mapped. All countries had national ethics guidelines and National Research Regulatory Authorities, whose mandates varied across countries. 57% of RECs reviewed local and international research, 43% reviewed local studies only. On average, 91 protocols were reviewed annually across all RECs (range 15 to 200). Membership ranged from 6 to 22 members per REC, with age range of 29 to 75 years.

Annual budget allocation ranged from $3000 to $2.9 million financed through review fees (84%) or/and institutional budget (14%). 71% of RECs had education policy but 41%had members with training in ethics. Review turn-around time ranged from 14 to 90 days. All RECs supported harmonisation and attributed it to improved efficiency, quality and standardised costs.

Conclusion

Similarities and dissimilarities were noted in the EAC countries’ ethics review frameworks. Harmonisation should consider 1) harmonisation of policy frameworks and tools; 2) institutionalisation of regional joint review mechanisms, 3) standardisation of training and capacity strengthening, 4) Review of the REC operational and financing models.
OC 8494 DRIVING REDUCED AIDS-ASSOCIATED MENINGO-ENCEPHALITIS MORTALITY
Authors: Loyse Angela , Mfinanga Godfrey S , Kanyama Cecilia , Kounfack Charles , Lesikari Sokoine , Chawinga Chimwemwe , Stack Muirgen , Molloy Sile
Published: April 2019

Background

DREAMM is an implementation study aiming to reduce meningo-encephalitis related mortality. Delays in diagnosis and treatment through poor access to diagnostics and treatments are significant contributing factors to the ongoing high mortality of HIV-associated central nervous system (CNS) infections, causing up to 25% of all HIV-related deaths in sub-Saharan Africa.

Methods

A before-after design is being implemented across 3 sites in Africa; Lilongwe, Malawi, Dar Es Salaam, Tanzania and Yaoundé, Cameroon. The study is composed of 3 phases: Observation, Training and Implementation.

Results

The observation phase (audit of practice) happened between November 2016 – May 2017 in Malawi and Tanzania. Overall, 110 patients were included. Ten-week all-cause mortality was 64% (42/66) in Tanzania and 37% (13/35) in Malawi. Approximately 75% of patients were ART experienced. Across sites, 76.6% of patients presented with abnormal mental status, with a median baseline CD4 count of 50 cells/µL. Only 2/75 patients in Tanzania had a lumbar puncture ordered compared to 27/35 in Malawi. All patients in Tanzania received empirical Fluconazole monotherapy whereas almost 1/3 patients in Malawi (11/35) were treated with Amphotericin B which is not readily available in both countries.

The training phase (completed in November 2017 for Malawi and Tanzania) used the train-the-trainer approach. Interactive workshops on using rapid diagnostic tests (RDTs), performing basic microbiological techniques and safe administration of medicines were chosen as the most pertinent to reducing mortality. Patient and laboratory pathways were optimised afterwards by increasing the routine laboratory capacity, performing CSF analysis, providing infectious diseases mentorship for clinicians and procuring RDTs and reagents not locally available.

Implementation is underway in Malawi and Tanzania and the audit phase is scheduled for autumn in Cameroon. Upon completion, the project is expected to create a sustainable approach to reduce the high mortality of HIV-related meningo-encephalitis with the optimised patient and laboratory pathways embedded within routine care.
OC 8510 BIOTRANSFORMATION OF PRAZIQUANTEL FOR THE PHARMACOKINETIC OPTIMISATION OF PRAZIQUANTEL USE IN MASS DRUG ADMINISTRATION AND DEVELOPMENT OF NEW PAEDIATRIC FORMULATIONS
Authors: Thelingwani Roslyn S , Kapungu Nyasha , Li Xueqing , Kanji Comfort , Mutiti Chenai , Reinhard-Rupp Wilma J , Masimirembwa Collen
Published: April 2019

Background

Praziquantel (PZQ) is the only drug available for the treatment of all forms of schistosomiasis. New paediatric formulations for the active enantiomer R-PZQ and the racemate PZQ are currently under development. There is however limited drug metabolism and pharmacokinetic data on PZQ available to support these initiatives. Detailed knowledge of PZQ metabolism will enable the use of PBPK modelling to determine appropriate doses for the new formulations in paediatric patients and to predict risks for drug-drug interactions in mass drug administration.

Methods

Biotransformation studies on PZQ were conducted in human liver microsomes and recombinant Cytochrome P450s (CYPs). Structure elucidation was inferred from mass spectra. Enzyme kinetic studies to determine the Michaelis-Menten kinetics, Km and Vmax, of the formation of the main metabolites and analysis of clinical samples were determined by LC-MS/MS.

Results

CYP reaction phenotyping studies with HLM and r-CYPs indicate major involvement of CYP1A2, 2 C19, 2D6 and 3A4/5 in the metabolism of R- and S-PZQ. Biotransformation studies showed that PZQ is metabolised to cis-4-OH-PZQ mainly by CYP1A2 and CYP2C19. CYP3A4/5 metabolises PZQ to a mono-hydroxyl metabolite (X-OH-PZQ) whilst CYP2D6 metabolises PZQ to minor novel mono-hydroxyl metabolite (Y-OH-PZQ) both pending structural elucidation by nuclear magnetic resonance. R-PZQ was more rapidly cleared than S–PZQ with variable interindividual AUC and Cmax.

Discussion and conclusion

The differential role of CYP1A2 and CYP2C19 and of CYP3A4 and CYP3A5 in the formation the 4-OH-PZQ and the novel X-OH-PZQ respectively are intriguing findings as this has not been reported before in humans.In vitro, cis and not trans 4-OH-PZQ formation has been observed contraryin vivoreports in humans which indicate trans 4-OH-PZQ as the main metabolite. The data will enable us to understand the rapid clearance of PZQ and predict potential drug-drug-gene interactions which mayexplain the inter-individual variability of PZQ pharmacokinetics.
OC 8713 MAXIMISING RESEARCH IMPACT TO STRENGTHEN PUBLIC HEALTHCARE
Authors: Sabiiti Wilber , Ntinginya Nyanda E , Msoka Elizabeth Fb , Orina Fred , Mwebaza Ivan , Mwanyonga Simeon , Miheso Barbara , Sanga Erica , Liyoyo Aliphonce , Meme Helen , Mmbaga Blandina T , Chirnside Ewan , Joloba Moses , Amukoye Evans , Okwera Alphonse , Kibiki Gibson S , Gillespie Stephen H , Mwebaza Wilber , Msoka Nyanda E
Published: April 2019

Background

Billions of dollars are spent on research globally every year, yet little is translated to public use through policy and/or commercialisation. For the few research findings that make it to policy, evidence in most LMICs shows they hardly see the light of implementation. Our EDCTP-funded TWENDE consortium used implementation of tuberculosis (TB) molecular diagnostics as a model to investigate the barriers, and opportunities to unlock them in order to maximise uptake of health research innovations into policy and practice.

Methods

Mixed methods approach including surveys, audits, in-depth interviews and focus group discussions (FGDs), policymaker dialogues to unravel the bottlenecks and how to overcome them.

Results

1119 respondents representing from Uganda, Kenya and Tanzania participated in the study. 19% were district/county health officers, 12% healthcare audits, 58% one-on-one interviews and FGDs with healthcare practitioners, community leaders, TB patients and survivors, and care givers, and 11% policymaker workshops. Barriers: government poverty, family/individual poverty, incompatibility of technologies to existing infrastructure, low awareness and socio-cultural beliefs in the community were found. Stigma at community and healthcare levels was rife. Consequently, TB diagnostics were underimplemented and underutilised. Xpert MTB/RIF test was fully utilised in ∼10% of healthcare facilities (conducting 8 tests per day) whilst Line probe assay was implemented in less than 1% of the facilities.

Conclusion

Based on our findings, we believe overcoming the barriers presents the opportunity to maximise research impact of public healthcare. This could be achieved through sustained public and practitioners’ sensitisation to remove stigma to increase demand and utilisation of services; early interaction of researchers and policymakers to increase sense of ownership and acceptability of research innovations; early communication between developers and end-users to align the tools with the needs and existing infrastructure capacity; and increased affordability of innovations through socioeconomic empowerment programmes.
OC 8718 WHAT DID WE LEARN FROM PANACEA 1 CLINICAL TRIALS?
Authors: Ntinginya Nyanda E
Published: April 2019

Background

The Pan African Consortium for the Evaluation of Anti-Tuberculosis Antibiotics (PanACEA) was designed to build clinical tuberculosis (TB) trial capacity whilst conducting clinical trials on novel and existing agents to shorten and simplify TB treatment. One of the objectives was to conduct, mentor and monitor observational and clinical studies at sites in 6 Sub-Saharan TB-endemic countries (Gabon, Kenya, South Africa, Tanzania, Uganda and Zambia)

Methods

Learning through experience. All centres in the 6 countries self-assessed their requirements for capacity development in the following fields: a) clinical staff availability and experience; b) TB laboratory infrastructure and staff; c) safety laboratory infrastructure and staff; d) clinical site facilities and equipment; e) pharmacy facilities and staff; IT facilities; and f) overall training needs of site personnel.

Results

From March 2011 – June 2014, we conducted four epidemiological studies (characterising TB patient populations in preparation for future studies) and five phase II studies (GCP standard intervention trials).

By working together in epidemiological and clinical trials, the sites identified their needs for resources and training as well as developing capabilities to perform independent large-scale TB clinical trials beyond PanACEA-initiated trials. Through the ReMoxTB study, for example, laboratories were brought to an international standard for safety and mycobacterial expertise. Furthermore, through developing skill-sets related to EBA studies, sites have since then attracted other sponsors for further studies.

Sites could be mentored to perform GCP-compliant clinical TB trials that is built on sound physical infrastructure, training and strong on-site leadership.

Conclusion

The learning-by-doing approach meant that staff could be trained whilst acquiring new core competencies and revealing operational gaps. Our experience of conducting TB trials within an environment of mentoring, networking and training has provided a platform for establishing future sustainable research centres that has capacities to conduct highly regulated studies.
PO 7151 COMPARING TWO BED NET DELIVERY MODELS IN’RURAL DISTRICTS OF MOZAMBIQUE
Authors: Arroz Jorge
Published: April 2019

Background

The use of long-lasting insecticidal nets (LLINs) is associated with a reduction in malaria transmission. In 2015, a new delivery strategy (intervention) for universal coverage campaign was tested and compared with standard strategy (control). The objective is to compare two bed net delivery models in rural districts of Mozambique.

Methods

Two districts served as intervention, and two as control. The following study design was used: 1) before and after; and 2) cost-effectiveness analysis. Three core implementation strategies were tested: 1) use of coupons during household registration, 2) use of stickers to identify registered houses, and 3) a new LLINs allocation criterion. The main endpoints measured were: i) percentage of distributed LLINs; ii) LLINs ownership and use coverage; iii) percentage of households that achieved universal coverage; iv) incremental cost-effectiveness ratio (ICER); v) incremental net benefit (INB).

Results

Approximately 88% (302,648) of LLINs were distributed in intervention districts compared to 77% (219,613) in control districts [OR: 2.14 (95% CI: 2.11–2.16)]. Six months after the 2015 campaign, 98.8% of the 760 households surveyed in the intervention districts had at least one LLIN; 89.6% of the 787 households surveyed in the control districts had at least one LLIN [OR: 9.7, (95% CI: 5.25–22.76)]. Near 95% and 87% of respondents who had at least one LLIN, reported having slept under the LLIN the previous night in the intervention and control districts, respectively [OR: 3.2; (95% CI 2.12–4.69)]; 71% of the households surveyed achieved universal coverage in the intervention districts against 59.6% in the control districts [OR: 1.6; (95% CI: 1.33–2.03)]. ICER per distributed LLIN was US$ 0.68. INB was positive.

Conclusion

Intervention districts had greater LLINs availability, greater LLINs ownership and use coverage, and a better progression toward reaching universal coverage targets. The new strategy was more cost-effective than the previous strategy.
OC 8259 THE VALIDATE NETWORK: EXPLOITING SYNERGIES BETWEEN COMPLEX INTRACELLULAR NEGLECTED PATHOGENS TO EXPEDITE VACCINE R&D FOR TUBERCULOSIS, LEISHMANIASIS, LEPROSY AND MELIOIDOSIS
Authors: Vermaak Samantha , Fletcher Helen , McShane Helen
Published: April 2019

Background

The VALIDATE ‘VAccine deveLopment for complex Intracellular neglecteD pAThogEns’ Network is a Global Challenges Research Fund (GCRF) Network, funded by the UK MRC and BBSRC and led by the University of Oxford and the London School of Hygiene and Tropical Medicine. It aims to accelerate vaccine development for four intracellular pathogens,Mycobacterium tuberculosis,Leishmaniaspp,Mycobacterium lepraeandBurkholderia pseudomallei, by creating a network of scientists from around the world in an interactive community, sharing information, learning from synergies and differences, and forming new collaborations promoting cross-disciplinary, cross-pathogen, and cross-continent research.

Membership

Currently VALIDATE has 125 members from 66 institutes in 28 countries, including world leading scientists, post-doctoral researchers, postgraduate students, and interested lay members from academia, governmental agencies, industry, and non-profits.

Activities

VALIDATE has four activity streams: 1) providing funding to its members, including pump-priming grants for excellent research, training grants for early career researchers, and fellowships to transition post-doctoral researchers to independence, 2) a members’ data-sharing portal, to encourage real-time sharing of data, catalysing the application of insights from one field into another, with an in-house Research Data Analyst working on cross-pathogen applications, 3) providing CPD opportunities for our members, including workshops, seminars and a mentoring scheme, and 4) speeding the dissemination of useful and relevant information via a hub website (www.validate-network.org) and social media (@NetworkValidate) where our members can easily find information about new research, relevant funding calls, events, and training, mentoring and other opportunities. Interested parties can read about our funded work, while a searchable directory of members on our website and a free annual meeting facilitates the formation of new collaborations.

VALIDATE is free to join and has an inclusive membership. This network would be of interest to researchers at the EDCTP Forum working on vaccine development for tuberculosis, leishmaniasis, leprosy and melioidosis.
PO 8248 DETERMINANTS OF ACCEPTABILITY OF MALARIA RAPID DIAGNOSTIC TEST AMONG HEALTH WORKERS IN KINTAMPO NORTH MUNICIPALITY, GHANA
Authors: Anaba Michael , Ae-Ngebisi Kenneth , Agyei Seth Owusu , Ibisomi Latifat
Published: April 2019

Background

Ghana rolled out the policy in 2013 with the use of malaria rapid diagnostic test (mRDT) promoted to facilitate diagnosis. However, health workers who are at the centre of mRDT implementation still treat half of febrile patients with negative mRDT results with antimalarial drugs, suggesting limited or lack of acceptability of the innovation.

Methods

We conducted a cross-sectional study to examine determinants of mRDT among health workers in Kintampo North Municipality (KNM) in Ghana. Data were collected from 110 health workers in KNM involved in malaria management from February to April 2017. The survey tool was based on two frameworks – the Technology Acceptance Model (TAM) and Normalisation Process Theory (NPT). Acceptability was measured by ease of use, perceived usefulness and intention to use.

We hypothesised that acceptability was influenced by coherence, cognitive participation, collective action, reflexive monitoring and respondent characteristics. A composite acceptability score was computed from a 21-item questionnaire for each respondent. The respondents were divided into three groups of low, moderate and high acceptability for ordered logistic regression to examine the relationship between acceptability and its determinants.

Results

The median acceptability score was 84(Q1, Q3:68, 103). About 34% of health workers had low acceptability while 37% and 29% had moderate and high acceptability respectively. In the multivariable analysis, coherence (OR=1.23, 95%CI=1.11–1.37), cognitive participation (OR=1.35, 95%CI=1.10–1.66), health workers in rural health facilities (OR=6.99, 95%CI=1.82–26.84) and health workers with more than three years’ experience (OR=5.53, 95%CI=1.98–15.42) were more likely to have high mRDT acceptability.

Conclusion

Acceptability of mRDT was moderate among the majority. This can be improved by enhancing health workers’ coherence on the benefits of mRDT through policy building or dissemination of information, promoting health workers’ cognitive participation in the mRDT implementation process through recruitment of local ‘champions’ to promote ‘buy-in’ and providing incentives to health workers to embed and sustain the use of the health technology.
PO 8269 SELECTION OF SEVEN-MUTATION PFCRT-PFMDR1 GENOTYPE AFTER SCALING-UP SEASONAL MALARIA CHEMOPREVENTION WITH SULPHADOXINE-PYRIMETHAMINE AND AMODIAQUINE IN MALI
Authors: Maiga Hamma , Bamadio Amadou , Traore Aliou , Diallo Nouhoum , Diarra Modibo , Sagara Issaka , Niangaly Hamidou , Coumare Samba , Sangare Boubou , Traore Djibril , Vaillant Michel , Dicko Alassane , Doumbo Ogobara K , Djimde Abdoulaye
Published: April 2019

Background

WHO recommended seasonal malaria chemoprevention (SMC) in 2012 for Sahel countries in Africa with the aim to reduce malaria among children under 5 years old by using sulphadoxine-pyrimethamine and amodiaquine (SP+AQ). This strategy was scaled up in Mali from 2012. The use of millions of doses of SP+AQ could generate potentialPlasmodium falciparumresistance in mutant parasites. The aim of this study was to monitor the prevalence ofPfdhfr +Pfdhps+pfcrt +pfmdr1mutations in parasites infecting the target population.

Methods

Two cross-sectional surveys were conducted before (August 2012, n=662) and after (June 2014, n=670) a pilot implementation of SMC in the health district of Koutiala. Children aged 3–59 months received 3 and 4 rounds of curative doses of SP+AQ over two malaria seasons in 2012 and 2013, respectively. Genotypes ofP. falciparum Pfdhfrcodons 51, 59, 108 and 164;Pfdhpscodons 437 and 540,Pfcrtcodon 76 andPfmdr1codon 86 were analysed by PCR on DNA of parasites from SMC population blood samples (after and before) and non-SMC patients aged 7 years or above (November 2014, n=500).

Results

In the SMC population 191 and 85 children before and after SMC implementation, respectively, were included inthe molecular analysis. In the non-SMC patients, 220 weresuccessfully PCR analysed. In the SMC population, theprevalence of the six-mutationPfcrt[Pfdhfr-dhpsquintuple +Pfcrt-76T] genotype increased significantly after SMC implementation, from 0.0% to 7.1% (p=0.0008). The post-intervention prevalence of the six-mutationPfmdr1[Pfdhfr-dhpsquintuple +Pfmdr1–86Y] and the seven-mutationPfcrt +Pfmdr1[Pfdhfr-dhpsquintuple +Pfmdr1–86Y+Pfcrt-76T] genotypes were both 1.2% among the SMC population. No six-mutation and seven-mutation genotypes were observed among SMC population at baseline nor in the non-SMC patient population (p=0.30).

Conclusion

SMC increased the prevalence of the six-mutationPfcrtgenotype ofP. falciparumthat can lead to resistance in a population exposed to SMC with SP+AQ.
PO 8289 ASSOCIATION BETWEEN PLASMA LEVELS OF IL-27, IL-6 CYTOKINES ANDP. FALCIPARUMINFECTION IN PREGNANT WOMEN LIVING IN MBALMAYO, CAMEROON
Authors: Fogang Balotin , Djontu Jean C , Megnekou Rosette , Ayong Lawrence
Published: April 2019

Background

The appropriate balance between anti-inflammatory and pro-inflammatory cytokines is necessary for protection against pregnancy-associated malaria and poor pregnancy outcomes. This study therefore aims to investigate the relationship between plasma levels of some regulatory cytokines andP. falciparuminfection in Cameroonian women during pregnancy.

Methods

Peripheral blood was collected from 131 women during pregnancy and 27 non-pregnant women living in the Mbalmayo area between May and December 2014. Parasitaemia was determined by microscopy and haemoglobin level using a haematological counter. Plasma levels of IL-27 and IL-6 cytokines were measured using the Magnetic Luminex Screening Assay technique.

Results

Parasitaemia associated negatively with haemoglobin level (rs=–0.43; p<0.001). The plasma level of IL-6 was higher in pregnant women than in non-pregnant women (p=0.05). Regarding parasitaemia, plasma level of IL-27 was significantly higher in non-infected than in infected women (p=0.028) while that of IL-6 was significantly higher in infected women (p<0.0001). Moreover, parasitaemia correlated negatively with the plasma level of IL-27 (p=0.034) and positively with that of IL-6 (p<0.0001). In addition, level of IL-6 was significantly higher in anaemia-positive than in anaemia-negative women (p=0.028). On the other hand, level of IL-27 negatively associated with the parity (p=0.022) and gestation age (p=0.014).

Conclusion

These results show that in pregnant women,P. falciparummalaria infection is associated with high plasma level of IL-6 and low level of IL-27, suggesting that IL-27 could have a protective effect against pregnancy-associated malaria while IL-6 seem to be a potential biomarker of the disease.
OC 8360 GLOBAL HEALTH RESEARCH AND ITS ROLE IN IMPROVING HEALTH AND HEALTH EQUITY IN AFRICA
Authors: Munung Nchangwi Syntia , Vries Jantina De , Pratt Bridget F
Published: April 2019

Background

Health research has the potential to generate knowledge that may be used to improve health and health equity. This has led to calls for African governments to dedicate at least 2% of their national budgets to heath research, but such resource allocations have never been achieved. Rather, most of health research in Africa continues to be funded by high-income countries (HICs) and involves collaborative partnerships between researchers in high-income countries and those in Africa. These research partnerships have many benefits, but they also raise ethical issues related to justice and fairness in global health research.

Methods

The ‘Research for Health Justice Framework’ makes recommendations on how global health research partnerships may foster the ideals of justice through their selection of research populations and questions, research capacity strengthening, delivery of ancillary care and the provision of post-trial benefits. We applied these criteria to collaborative genomics research consortia in Africa (an example of global health research in Africa).

Results

The results show that the lack of national health research priorities in most African countries hinders the intention of global health actors to use global health research as a means of promoting global health equity. Furthermore, capacity building efforts need to be more coordinated and monitored. The responsibility for this lies with several actors.

Conclusion

The potential for global health research to improve the health capability of countries in Africa will require that attention is paid to research that improves the health of people in Africa and that global health research partnerships identify, first and foremost, what kind of capacity strengthening is required and who is responsible for this activity. African governments and research institutions can play a role to help global health research improve health and health equity in Africa, in ways that are sustainable.
PO 8296 REDUCING LOSS TO FOLLOW-UP OF CHILDREN EXPOSED TO HIV IN THE PROVINCES OF MANICA AND SOFALA, CENTER OF MOZAMBIQUE
Authors: Vieira Lúcia da Costa , Mahumane Arlete
Published: April 2019

Background

Early childhood diagnosis of HIV is a challenge in many developing countries, including Mozambique. Approximately 50% of exposed children and HIV-positive are lost to follow-up, i.e. during Postpartum Consultation (CPP), at-risk child consultation (CCR) or ART consultation in the country. The objective was to carry out an intervention to reduce the loss to follow-up of children exposed to and positive for HIV in Manica and Sofala provinces.

Methods

Intervention study in HIV-positive women and their children in CPP and CCR in six health facilities in 2016. Stepped-wedge design with 3 cohorts for 3 months of two health facilities randomly selected. Interventions included activist allocation, telephone calls to contact the mothers, guide the mothers with exposed child from CPP to CCR, active outreach to missed mothers, and initiation of ART in the CCR for 3 months. Data were collected from the health facilities and study books. Analysis was binomial logistic regression model with mixed effects.

Results

Of the aggregated data, PCR +was 7.7%, and proportion of HIV-positive women in CPP 17.4%. In the control group only 24% of the mothers had more than 2 visits with us, compared with 60% in the intervention group [OR=2.05 (95% CI: 1.60, 2.62)]. In the intervention group, more children were transferred to CCR 52% vs 32% in the control [OR=1.7 (CI: 1.3–2.41)], 65% of the mothers in intervention group reached at CCR vs 57% of the mothers in the control group [OR=1.69 CI: 1.27–2.41)] and returned to receive the PCR result of their child, 6.7% in the control vs 8.2% in intervention [OR=2.3 (CI: 1.36, 3.87)].

Conclusion

The intervention had a greater impact on the number of visits to CPP, the transfer of mothers from CPP to CCR, and the reception of PCR results in CCR by the companion.
PO 8302 IMPACT OF TWO ANNUAL ROUNDS OF MASS DRUG ADMINISTRATION WITH DIHYDROARTEMISININ-PIPERAQUINE ON MALARIA TRANSMISSION IN A PROSPECTIVE COHORT STUDY
Authors: Mwesigwa Julia , Achan Jane , Wathuo Miriam , Worwui Archibald , Mohammed Nuredin , Kanuteh Fatomatta , Geertruyden Jean-Pierre Van , D Alessandro Umberto
Published: April 2019

Background

Mass drug administration (MDA) may reduce malaria transmission in low-transmission areas and interrupt transmission. The impact of MDA with dihydroartemisinin-piperaquine (DP) on malaria infection and clinical malaria was determined in a prospective cohort study in The Gambia.

Methods

Single annual MDA rounds with DP were done in 2014 and 2015 in a prospective cohort among residents aged >6 months in twelve villages in The Gambia at the start of the transmission season in June. Monthly blood samples for microscopy and PCR were collected during the transmission season from July to December, post MDA and once before MDA during the dry season in April. The incidence of infection and clinical malaria post-MDA were compared to 2013 and mixed effects logistic regression models assessed the efficacy and risk of re-infection post MDA.

Results

Coverage of 3 DP doses was 68.22% in 2014 and 65.60% in 2015. Compliance to 3 doses was high, 83.11% in 2014 and 85.93% in 2015. Incidence of infection in 2014 (2014: IR=0.23 PPY, 2013: IR=1.12 PPY, p<0.01) and clinical malaria in 2014 (2014: IR=0.08 PPY, 2013: IR=0.39: IRR=0.22, p<0.01) and 2015 (2015: IR=0.19, 2013:IR=0.38, IRR=0.50, p<0.01) was significantly lower after MDA compared to 2013. The incidence of clinical malaria remained higher in eastern Gambia compared to the western region. Subjects that took 3 DP doses had lower odds of infection in 2014 at 28 days (OR=0.61, 95% CI: 0.38–0.99) and 42 days (2014: OR=0.52, 95% CI: 0.29–0.89)

Conclusion

A single annual MDA round with DP temporarily reduced malaria infection and clinical disease during the transmission season and subjects that took 3 doses had lower risk of infection. However, several MDA rounds covering the entire transmission season and some targeting the human reservoir during the dry season, are needed to achieve a more marked sustained reduction of transmission.
PO 8394 SOUTH-SOUTH AND NORTH-SOUTH CAPACITY STRENGTHENING WITHIN THE SCREENTB CONSORTIUM: WHAT HAVE WE LEARNT?
Authors: Dockrell Hazel , Schacht Claudia , Walzl Gerhard
Published: April 2019

Background

Most research consortia and multicentre trials include capacity strengthening as one of their objectives. Activities are included in annual reports but the overall success or otherwise of these is hard to evaluate.

Methods

The training and capacity building work package in the EDCTP2-funded ScreenTB Consortium includes support for the individual career development of young researchers. We have made mentoring the central activity, building on what we had learnt in the previous AE-TBC Consortium. We carried out formal training sessions and provided dedicated time-slots for meetings of mentee and mentor during annual meetings. We also introduced the concept of personal development plans through presentations and small group work.

Results

Formal timetabled presentations and mentoring sessions have helped make capacity strengthening work. Challenges and solutions have been identified in group sessions and will be presented. This has enabled us to evaluate what works well and what is more challenging, when including capacity strengthening activities within a consortium with 5 African and 3 European partners.

Conclusion

Dedicated time and commitment are required to make capacity strengthening work, but when it does, mentoring and personal development planning can provide both African and European researchers with an impartial opportunity to find solutions to their current challenges and to discuss their longer-term goals.
Impact of sleep disordered breathing on performance in judo players
Authors: Wada Hiroo , Nagata Kazumasa , Shirahama Ryutaro , Tajima Tomokazu , Kimura Manami , Ikeda Ai , Maruyama Koutatsu , Tamura Masahiro , Suzuki Keiji , Tanigawa Takeshi
Published: April 2019

Objective

Previous studies have suggested that young sports players may suffer from sleep disordered breathing (SDB). It was hypothesised that SDB in heavy-class judo players was far more prevalent than expected and that it could reduce judo performance, which could be improved by appropriate therapies. To address this, the present study estimated the percentage of heavy-class judo players with SDB and investigated the effect of SDB treatment on judo performance.

Methods

We enrolled 19 young judo players from a university judo team with body weight >100 kg and/or body mass index >30 kg/m2. Both excessive daytime sleepiness (EDS) and respiratory disturbance index (RDI) were evaluated using the Epworth Sleepiness Scale (ESS) and an overnight type 3 sleep monitor.

Results

The percentages of young heavyweight-class judo players with EDS (ESS ≥11) and those with SDB (RDI ≥5) were both 63%, which was unexpectedly high for the age class. Seven of the participants underwent continuous positive airway pressure therapy, which improved both RDI and ESS scores (p<0.05 for each) and subsequently the sleep quality and judo performance of the participants.

Conclusions

Our study indicates that young judo players might silently suffer from SDB, leading to poorer judo performance and to future cardiovascular diseases. Clinicians should be aware of the possible presence of SDB in young sports players and consider the application of diagnostic and therapeutic remedies.
Relation of injuries and psychological symptoms in amateur soccer players
Authors: Jansen Petra , Lehmann Jennifer , Fellner Birgit , Huppertz Gunnar , Loose Oliver , Achenbach Leonard , Krutsch Werner
Published: April 2019

Objectives

The first main goal of this study was to investigate the prevalence of depression and anxiety as well as self-compassion in a heterogeneous sample of male amateur soccer players. The second main goal of this study was the examination of the relationship between injuries and psychological factors in amateur soccer players.

Methods

Players were recruited from German amateur soccer clubs of the fourth to seventh league. 419 soccer players with the mean age of 22.88 years participated in the psychological and the injury assessment at the beginning of the season and at the end, 9 months later. For the psychological assessment, depression and anxiety rate as well as self-compassion was analysed. Furthermore, the frequencies of injuries were registered.

Results

The results showed that players of the highest amateur league, the fourth league in German soccer, showed significantly higher anxiety values than players from a lower league (p=0.013). There were no differences in depression values dependent on the league. Furthermore, players who suffered from an injury before the start of the season demonstrated higher anxiety values (p=0.027). This result was independent of the respective league.

Conclusion

The results of this study demonstrate that even in higher amateur soccer the anxiety level of the players varies between soccer players of different leagues. Because an injury before the start of the season influenced the anxiety level, a psychological treatment during injury should be considered.
Computed tomographic coronary angiography in risk stratification prior to non-cardiac surgery: a systematic review and meta-analysis
Authors: Koshy Anoop N , Ha Francis Jonathan , Gow Paul J , Han Hui-Chen , Amirul-Islam FM , Lim Han S , Teh Andrew W , Farouque Omar
Published: April 2019

Objectives

Utility of CT coronary angiography (CTA) and coronary artery calcium (CAC) scoring in risk stratification prior to non-cardiac surgery is unclear. Although current guidelines recommend stress testing in intermediate-high risk individuals, over one-third of perioperative major adverse cardiovascular events (MACE) occur in patients with a negative study. This systematic review and meta-analysis evaluates the value of CTA and CAC score in preoperative risk prognostication prior to non-cardiac surgery.

Methods

MEDLINE, PubMed and EMBASE databases were searched for articles published up to June 2018. Summary ORs for degree of coronary artery disease (CAD) and perioperative MACE were pooled using a random-effects model.

Results

Eleven studies were included. Two hundred and fifty-two (7.2%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (no CAD 2.0%; non-obstructive 4.1%; obstructive single-vessel 7.1%; obstructive multivessel 23.1%, p<0.001). Multivessel disease (MVD) demonstrated the greatest risk (OR 8.9, 95% CI 5.1 to 15.3, p<0.001). Increasing CAC score was associated with higher perioperative MACE (CAC score: ≥100 OR 5.1, ≥1000 OR 10.4, both p<0.01). In a cohort deemed high risk by established clinical indices, absence of MVD on CTA demonstrated a negative predictive value of 96% (95% CI 92.8 to 98.4) for predicting freedom from MACE.

Conclusions

Severity and extent of CAD on CTA conferred incremental risk for perioperative MACE in patients undergoing non-cardiac surgery. The ‘rule-out’ capability of CTA is comparable to other non-invasive imaging modalities and offers a viable alternative for risk stratification of patients undergoing non-cardiac surgery.

Trial registration number

CRD42018100883
A marginal structural model approach to analyse work-related injuries: an example using data from the health and retirement study
Authors: Baidwan Navneet Kaur , Gerberich Susan Goodwin , Kim Hyun , Ryan Andrew D , Church Timothy , Capistrant Beatrix Davoli
Published: April 2019

Background

Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries.

Methods

7212 working US adults aged ≥50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries.

Results

The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses.

Conclusions

MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.
Assessing veterinary students using in‐training evaluation scores: what is being assessed?
Authors: Norman Elizabeth Jane
Published: April 2019

In‐training evaluations are commonly used for assessing veterinary students during clinical training, but are criticised for being unable to discriminate dimensions of performance. This study investigated scores on an in‐training evaluation in use at one veterinary school to determine the dimensions being assessed and the influence of the dimensions on the overall score awarded. Common factor analysis and ordinal logistic regression were conducted on a retrospective sample of 3466 evaluations of 197 final year veterinary students. The findings suggested a higher‐order dimensional structure, with one overarching factor and two to four subfactors, consistent with the complex construct of competency that thSAS Institute e assessment was intended to assess. In the four ‐factor model, all dimensions were significantly related to overall grade, with the effects of the professional attitude factor and the knowledge factor dependent on the placement. The professional attitude factor had the strongest effect on overall grade (β=2.71, P=0.0004). There was a significant effect of placement on overall grade (P=0.021). Neither academic status of the supervisor nor grade point average had significant effects on the overall grade (P>0.49), and a student's overall grade did not significantly differ over time (P=1). The results suggest that the complexity of supervisor judgement is effectively represented in evaluation scores.
Canadian newcomer children’s bone health and vitamin D status
Authors: Lane Ginny , Nisbet Christine , Whiting Susan J. , Vatanparast Hassan
Published: April 2019

Adequate calcium intake and supply of vitamin D during childhood play important roles in ensuring adequate bone mass gain to achieve optimal peak bone mass. The Healthy Immigrant Children study employed a mixed-method cross-sectional study design to characterize the health and nutritional status of 300 immigrant and refugee children aged 3–13 years who had been in Canada for less than 5 years. This paper presents bone mineral content and vitamin D status data along with qualitative data that deepen the understanding of newcomer bone health status. A significantly higher percentage of refugee children (72.3%) had insufficient (<50 nmol/L) or deficient (<30 nmol/L) serum vitamin D compared with immigrants (53.2%). Vitamin D deficiency was most common among ethnic minority girls. Newcomer children with higher intakes of vitamin D, younger newcomer children, and those from western Europe or the United States had higher serum vitamin D levels. Immigrants had significantly higher mean total body bone mineral content compared with refugees. Total body fat, serum vitamin D, calcium intake, height, height by calcium intake, total body fat by calcium intake, and total body fat by height predicted total body bone mineral content levels. Vitamin D deficiency among newcomer children may be related to lack of knowledge regarding children’s vitamin D requirements in the Canadian environment, dietary habits established in country of origin, low income that limits healthy dietary choices, and lifestyle habits that limit exposure to sunlight. Results suggest a need to screen newcomer children and pregnant women for vitamin D deficiency and support early intervention.
Reproductive limitation mediates the response of white spruce (Picea glauca) to climate warming across the forest–tundra ecotone
Authors: Lantz Trevor C. , Moffat Nina D. , Fraser Robert H. , Walker Xanthe
Published: April 2019

Shifts in the extent of the boreal forest during past warm intervals and correlations between climate and the position of the forest–tundra ecotone suggest that recent temperature increases will facilitate forest expansion into tundra ecosystems. In this study, we used a unique set of high-resolution repeat photographs to characterize white spruce (Picea glauca (Moench) Voss) populations in 1980 and 2015 at 52 sites across the forest–tundra transition in the Northwest Territories, Canada. We also conducted field inventories at eight sites to examine mapping accuracy, construct age distributions, and assess cone production and seed viability. Our analysis shows that stand density in the forest–tundra has increased significantly since 1980 but that the density of spruce at sites in the tundra has not changed. Age distributions constructed from field sampling also indicate that recent recruitment has occurred in the forest–tundra but not at tundra sites. The nonlinear relationship between summer temperature and seed viability suggests that recent warming has facilitated recruitment in the northern Subarctic but that cold temperatures still limit recruitment at higher latitude tundra sites. Additional research to determine the extent of changes in forest density across the northern Subarctic should be conducted to determine if similar changes are occurring across this ecotone.
Field study of pile – prefabricated vertical drain (PVD) interaction in soft clay
Authors: Zhu Dongli , Indraratna Buddhima , Poulos Harry , Rujikiatkamjorn Cholachat
Published: April 2019

Piles and prefabricated vertical drains (PVDs) are two well-established inclusions used by geotechnical practitioners when dealing with soft compressible foundations. Induced movements in highly compressible soil can adversely influence the pile response by inducing additional movements and stresses in the piles. Especially, undesirable soil–pile interaction often leads to the development of excess pore-water pressure during pile installation and negative skin friction caused by the settlement of compressible soil surrounding the piles. Additional drainage by PVDs prior to the installation of a pile could reduce excess pore-water pressure, lateral soil movement, and negative skin friction on the pile. In this paper, full-scale field testing on two trial embankments built on soft soil is reported and the relative behaviour of these two embankments is compared and discussed. Soft soil underneath both embankments was consolidated before one pile was installed at the centre of each embankment. The pore-water pressure, lateral soil movement, surface settlement, and associated strain at the pile shaft were recorded. The pile capacity was tested immediately and 3 h after pile installation. The monitoring and testing results indicated that preconsolidation with PVDs before piling can effectively reduce the excess pore-water pressure, lateral soil movement, and downdrag on the pile.