bluuebunny/crossref_metadata_2025_split huggingface dataset:
VARIATION IN NEONATAL MORTALITY AND ITS RELATION TO COUNTRY CHARACTERISTICS IN SUB-SAHARAN AFRICA
Authors: Kayode Gbenga , Grobbee Diederick , Amoakoh-Coleman Mary , Ansah Evelyn , Uthman Olalekan , Klipstein-Grobusch Kerstin 
Published: February 2017

BackgroundA substantial reduction in neonatal mortality is the main priority to reduce under-five mortality. A clear understanding of the variation in neonatal mortality and the underlying causes is important for targeted intervention. We aimed to explore variation in neonatal mortality and identify underlying causes of variation in neonatal mortality in sub-Saharan Africa.MethodsThis ecological study used publicly available data from the World Health Organization, United States Agency for International Development and World Bank. Variation in neonatal mortality across 49 sub-Saharan Africa countries was examined using control chart and explanatory spatial data analysis. Associations between country-level characteristics and neonatal mortality were examined using linear regression analysis.ResultsThe control chart showed that 28 (57%) countries exhibited special-cause variation, fourteen countries were below and above the 99.8% control-limits. The remaining 21 (43%) countries showed common-cause variation. No spatial clustering was observed for neonatal mortality (Global Moran's I statistic – 0.10; p=0.74). Linear regression analysis showed HIV/AIDS prevalence among the population of reproductive age to be positively associated with neonatal mortality (β 0.463; 95% CI 0.135 to 0.790; p-value <0.01). Declining socioeconomic deprivation (β –0.234; 95% CI: –0.424–– 0.044; p-value <0.05) and high quality of healthcare governance (β –1.327, 95% CI–2.073–– 0.580; p-value <0.01) were inversely associated with neonatal mortality.ConclusionThis study shows a wide variation in neonatal mortality in sub-Saharan Africa. A substantial part of this variation can be explained by differences in the quality of healthcare governance, prevalence of HIV and socioeconomic deprivation.
FUNCTIONAL COMMUNICATION IN MULTISITE, MULTILINGUAL CONSORTIUMS: EVALUATION OF THE COMMUNICATION TOOLS USED IN THE WANETAM NETWORK
Authors: Thorpe Marie , Batchilly Elizabeth , N'Guessan Jean-Pierre , Kanteh Dembo 
Published: February 2017

BackgroundEffective communication is a key challenge in managing multi-disciplinary teams (Bruce et al. 1995). This challenge is intensified when teams are dispersed in a multi-lingual consortium. Created in EDCTP's capacity building call, the ‘West African Network against TB, AIDS and Malaria’' (WANETAM/WANETAM Plus) network partnered 19 research institutions from 10 West African countries. WANETAM's objectives are i) Capacity building and technology transfer to prepare West African sites for the successful conduct of clinical trials, ii) Creation of a network for subregional scientific collaborations. Whilst WANETAM successfully integrated capacity-building training, it is important to evaluate the effectiveness of the consortium's communication methods. This evaluation aims to i) Evaluate information sharing across a trilingual network; ii) Identify key successes, gaps in communications, iii) Identify tools that enable effective communication in multisite consortiums.MethodsProject documentation was reviewed to understand communication methods. An adapted Organizational Communication Audit questionnaire measured how communication systems aided desired project outputs/outcomes (Greenbaum et al 1988). Questions specifically evaluated the effectiveness of Basecamp, IP phones and email. This questionnaire was sent to WANETAM sites to gauge user perspectives.ResultsBasecamp, the online collaboration project management software, enabled communications and document distribution in a single system. Despite efforts, usage was low. As predicted, technical difficulties with IP phones affected user acceptability. Email was the central communication method used to manage project milestones and deadlines. As the average person receives 121 emails daily over-reliance on email for primary communication poses challenges (Kane 2015).ConclusionsThe role of e-collaboration is crucial in multi-site consortiums. Despite low usage, cloud computing networks remove the need for infrastructure (IP phones), lower costs and allow for accessibility regardless of location. When employed correctly, it achieves efficient, effective communication to achieve desired consortium objectives.
NEW E-LEARNING TOOL FOR FEMALE GENITAL SCHISTOSOMIASIS: A SUPPLEMENT TO THE WHO POCKET ATLAS OF FGS
Authors: Søfteland Solrun , Sebitloane Motshedisi , Vwalika Bellington , Taylor Myra , Galappaththi-Arachchige Hashini , Holmen Sigve , Gundersen Svein Gunnar , Ndhlovu Patricia , Kjetland Eyrun Floerecke 
Published: February 2017

BackgroundSchistosomiasis affects 261 million people worldwide, most of them in Africa. Female genital schistosomiasis (FGS) may cause abnormal vaginal discharge, contact bleeding, genital tumours, infertility, ectopic pregnancies and increased susceptibility to HIV. Visualisation of lesions is the key to diagnosis but there is little knowledge about FGS among health professionals. In order to facilitate the use of the WHO pocket atlas for FSG, we present an e-learning module for medical students in endemic areas. The e-learning material is usable on smartphones, and in areas with low internet speed.MethodsTwo FGS atlases form the platform for the e-learning: The First Colposcopic Atlas of Schistosomiasis in the Lower Female Genital Tract (Norseth et al. 2014) and The WHO Pocket Atlas for FGS (WHO, 2015). Actors were recruited for demonstration of the examination techniques. Medical students were approached to explore their current e-learning platforms. Website creators of two existing e-learning modules were invited to collaborate. The project is part of a larger project that was granted permissions by the Biomedical Research Ethics Administration, University of KwaZulu-Natal (KZN), South Africa.ResultsA new e-learning tool is presented: all lesions, history taking and the examination techniques for identification of FGS are shown. There is a post-learning quiz for self-evaluation. Medical students in an endemic area were asked to give a qualitative evaluation on the learning outcome.ConclusionsThere is a need to raise the index of suspicion for FGS as a differential diagnosis among health care professionals. This e-learning may contribute to the dissemination of knowledge of FGS to all health care professionals who can access the internet when furthering knowledge in clinical practice. Furthermore, there is a need to disseminate knowledge to professionals who may not be using the internet.
RESEARCH ETHICS CAPACITY BUILDING FOR THE NEXT DECADE – ‘BEYOND TRAINING’ – RHINNO ETHICS AS MODEL TO IMPROVE AND ACCELERATE ETHICS REVIEW OF HEALTH RESEARCH
Authors: Kombe Francis , Toohey Jacintha , Ijsselmuiden Carel 
Published: February 2017

BackgroundWide social disparities and weak health care systems in Africa make timely development of essential medicines, vaccines, medical technologies in and for Africa a desperate need, given the burden of diseases facing the continent. We estimate that it takes, on average, 1.5 years to get research ethics clearance in many African institutions for complex research proposals needed to deal with disease and solutions. Such delay comes with potentially high human costs. The need for Research Ethics Committees (RECs) to promptly and competently review protocols is therefore critical. Competent and efficiently RECs can save human lives, reduce costs and ultimately contribute to scientific development.MethodsResearch for Health and Innovation Organiser (RHInnO Ethics) is both an information management system and an expert-decision support system for individual RECs that is currently installed in 29 RECs in 8 African countries. It enables online, better quality, efficient and standardised reviews that can reduce review time in complex, multicentre trials by 12 months or more.ResultsWhat progress has been achieved in the process of implementing RHInnO Ethics since its inception in 2013? While training courses (long and short) have been considered as the mainstay of research ethics capacity building for decades, the development of this software-as-a-service platform has led to a more substantial understanding of how we can both accelerate and enhance the quality of ethics review of health research. We present experiences of our end users on how RHInnO Ethics contributes in enhancing the quality and efficiency of ethics review process.ConclusionsHealth research ethics review needs to go beyond training. We also present new functionalities in RHInnOEthicsversion 2.0, including EthiCALL-(RECs connecting with other RECs worldwide), EthiXPERT (RECs updates on research ethics developments)as well as Invoicing, REC accreditation and pharmacovigilance functionalities that promise to revolutionise the research ethics review process in Africa and beyond.
EBOLA AND CLINICAL TRIAL ACTIVITY ON THE AFRICAN CONTINENT
Authors: Pienaar Elizabeth , Kredo Tamara 
Published: February 2017

BackgroundEbola virus disease (EVD) results in an often fatal acute, serious illness. There are no effective EVD treatments, however, there is ongoing research into potential interventions in affected African countries. Since 2005, in efforts to enhance transparency researchers must register trials on one of World Health Organization's clinical trials registries. WHO's International Clinical Trial Registry Platform (ICTRP) collates this data providing information about planned, ongoing or completed trials for researchers, funders and the public. This study mapped African EVD trial activity as found on WHO's ICTRP and identified available evidence from trial publications.MethodsWe conducted a cross-sectional analysis of EVD studies registered on ICTRP. Data extraction included trial location, intervention, participant age, and funders. We used registry identifiers to search PubMed for publications. Descriptive analysis was conducted in MS Excel™.ResultsICTRP was searched (20 June 2016) identifying 83 EVD studies. Of these 45 are Africa-based. Studies were registered from 2009–2016. Recruitment status indicates 6 completed, 2 withdrawn, 1 not started, 2 unknown status and 34 ongoing. Forty-one studies evaluate an intervention, 4 are observational. Interventions include vaccines (25), therapeutics (17), health services/care (1) and diagnostics (2). Children were included in 24 studies. Funding sources include local and international universities and governments, non-governmental organisations, and pharmaceutical industry. Of the 45 registered African studies, 11 records were found on PubMed, seven of which included results of EVD studies.ConclusionsMapping EVD clinical trial activity on ICTRP and searching for completed studies on PubMed can provide data on planned, ongoing or completed trials. The current research focus is on identifying safe and efficacious vaccines to prevent EVD including in children. The low number of trial reports indicates that evidence is not yet publicly accessible which may impact on evidence-informed policy development for the region.
THE UTILITY OF FINGERPRINT-BASED PARTICIPANT IDENTIFICATION AND CONSENTING IN CLINICAL TRIALS IN DEVELOPING COUNTRY SETTINGS
Authors: Okebe Joseph , Cham Pa Modou , Abubakar Ismaela , Dondeh Bai Lamin , D'Alessandro Umberto 
Published: February 2017

BackgroundInvolvement in clinical research requires evidence of informed participant consent, and in many low-income countries with high illiteracy rates, this is done by a fingerprint impression on paper. Due to poor quality of the impression, the individual is often untraceable and this reduces the quality of the process. The study assesses the potential usefulness of fingerprints for consenting and automated participant identification.MethodsAs part of a survey in villages in the North Bank West region of The Gambia, individuals of all ages were invited to provide a fingerprint scan to update the pre-trial census records. Using commercial software, scanned impressions were stored on encrypted templates and linked to a unique identifier. A scan is successful if any of the five fingers on the left hand is captured but documented as a failure if none of the five fingers on the left hand records an impression on the scanner. We determined the proportion of successful attempts, and the effect of age and gender on the successful scan using a logistic regression model.ResultsA total of 5204 persons were scanned with 74.7% successes for any finger; 70.3% (1550/2206) in males and 78.0% (2339/2998) in females and gender was strongly associated with success rate (Chi2 <0.001). The success rate in children <5 years was 70.6% (726/1029) but lowest in adult males ≥40 years; 29.7% (96/323). The odds of a successful scan were lower in males (adjusted OR 0.53; 95% CI: 0.46–0.61; p >0.001) and highest between ages 5–25 years (OR 8.32; 95% CI: 6.96–9.95; p<0.001) compared to adults ≥40 years.ConclusionsThe use of fingerprint-based identification is promising. However, recognition rates are lowest in adult males, perhaps due to occupational practice. Potential for improving sensitivity and application in data retrieval and documenting consent is being explored.
COMPARATIVE EVALUATION OF GENOTYPE MTBDRPLUS VERSION 2 AND GENE XPERT MTB/RIF ASSAYS TO DETECTMYCOBACTERIUM TUBERCULOSISAND RESISTANCE GENE PATTERNS IN GABON
Authors: Alabi Abraham , Foguim Francis , Sankarganesh Jeyaraj , Bruske Ellen , Mfoumbi Arnault , Mevyann Chester , Adegnika Ayola , Lell Bertrand , Kranzer Katharina , Kremsner Peter , Grobusch Martin 
Published: February 2017

BackgroundTuberculosis (TB) remains a major cause of morbidity and mortality in Africa. A major challenge of TB diagnosis is slow growth of its causative agent,Mycobacterium tuberculosiscomplex (MTBC). WHO has endorsed the application of molecular methods to rapidly diagnose TB and detect drug resistance mutations in MDR-TB. We hereby evaluate the efficacy of the GenXpert MTB/RIF and the GenoType MTBDRplus, using culture as gold standard.MethodsWe applied the GeneXpert MTB/RIF (Cepheid) and the Genotype MTBDRplus (Hain Life Sciences, Germany) to compare between molecular and standard traditional methods (smear microscopy and culture). In total, 246 consecutive sputa samples from suspected TB cases (individuals) in Lambarene and surrounding villages were analysed. The molecular methods confirm MTBC and detect resistant mutations in the rpoB, katG and inh genes corresponding to rifampicin (RIF) and isoniazid (INH), respectively.ResultsOf the 193 samples available for analysis, 51 were positive and 142 were negative by culture. The overall sensitivity of GeneXpert compared to culture was 86.3% and the specificity was 93.7%. The sensitivity and specificity of Genotype MTBDRplus compared to culture were 82.5% and 95.8%. Rifampicin-resistant strains determined by standard drug susceptibility testing (DST) were 100% identified by GeneXpert and 83.3% by Genotype MTBDRplus. All the rifampicin-resistant strains were also exhibiting the high level resistance against high-level isoniazid corresponding to katG genes. Genotype MTBDRplus identified two isolates carrying only mutations to low-level isoniazid resistance.ConclusionsThis comparative study has established a strong correlation between the GeneXpert and the MTBDRplus assays for the rapid diagnosis of multi-drug resistant TB (MDR-TB); as well as with drug susceptibility testing by standard culture method. Our findings further strengthen the WHO recommendation for the universal implementation of molecular tests in order to enhance the rapid diagnosis of TB and early initiation of treatment in confirmed cases.
IMPROVING EFFICIENCY AND QUALITY IN CLINICAL TRIALS IN SUB-SAHARAN AFRICA
Authors: Vischer Nerina , Pfeiffer Constanze , Burri Christian 
Published: February 2017

BackgroundConduct of clinical trials is significantly regulated and requires substantial infrastructure and human resource investments and efforts. Clinical research centres in sub-Saharan Africa face particular challenges from the increasing trial-related workload and administration, paired with capacity limitations. We investigated the challenges in clinical trial conduct in sub-Saharan Africa to optimising efficiency of processes while maintaining quality. Our working hypothesis was that existing regulations, not adapted to these particular situations, and their possibly overly strict interpretation were the main challenge.MethodsWe used an exploratory mixed methods design. Firstly, key informant interviews with questions about quality, guidelines, challenges, and inefficiencies in clinical trials were conducted with 60 clinical trial staff of different professional levels in two English- and two French-speaking African countries. Content analysis was performed to identify themes across settings and positions, respectively. Secondly, we developed an online survey to investigate trial protocol suitability based on the main interview themes and targeting trial staff working in sub-Saharan Africa.ResultsAccording to the interviewees, constraints to trial efficiency arose from two themes: ‘planning’ (mainly poor planning and missing context-adaptation), and ‘site organisation’ (mainly staff turnover and workload). The two themes are of particular relevance since they relate only to sponsors and sites and are therefore independent of external conditions (e.g. lengthy approval processes and population issues). Unexpectedly, the administrative burden resulting from the guidelines was not perceived as a difficulty; rather, researchers were grateful for having guidance in their daily work. The online survey corroborated that trial protocols need to be adapted to local contexts by early involvement of the sites and careful consideration of local capacity, systems and conditions.ConclusionsOur data suggest that careful site assessment, appropriate and coherent planning, clear task allocation and management capacity strengthening may increase trial efficiency. Involvement of study sites in protocol development was perceived to be beneficial.
FIELD PERFORMANCE OF POINT-OF-CARE TO DETERMINE HBSAG TEST FOR DIAGNOSIS OF ACTIVE HEPATITIS B VIRUS INFECTION IN ZAMBIA
Authors: Chisenga Caroline , Musukwa Kalo , Chilengi Roma , Zürcher Samuel , Munamunungu Virginia , Siyunda Alice , Mwandu Temwani , Bauer Sophie , Wandeler Gilles , Vinikoor Michael 
Published: February 2017

BackgroundIn Zambia, we evaluated the field performance of a rapid point-of-care test for hepatitis B surface antigen (HBsAg) which could support decentralisation and scale-up of care and treatment of chronic hepatitis B virus (HBV) infection in sub-Saharan Africa.MethodsAt two urban public health facilities in Zambia's capital Lusaka, we screened a cohort of HIV-infected adults for HBsAg per national guidelines. A subset was tested with both Determine HBsAg (Alere, USA), using finger prick in the clinic, and HBsAg serology (Access2Analyser, Beckman Coulter), using serum sent to a reference laboratory. If either test was reactive, we measured HBV viral load (VL) and determined HBV genotype with Sanger sequencing. We described patient demographic and clinical characteristics (including liver fibrosis biomarkers) and assessed the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of the Determine test. In secondary analyses, we assessed sensitivity among patients with replicating HBV (VL >20 IU/mL) and with high HBV VL (>20,000 IU/mL).ResultsAmong 412 participants with both HBsAg tests, median age was 34 years, 51% were women, and median CD4 was 208 cells/mm3. By serology, 66 (16%) were HBsAg-positive. HBV genotypes were A1 (n=21; 52.5%) and E (n=19; 47.5%) among successfully sequenced samples. Overall, the Determine test had 87.9% sensitivity (95% CI: 84.7–91.0%), 99.7% specificity, 98.3% PPV, and 97.7% NPV. The majority of patients (6/8) with false negative results had undetectable HBV VL and no evidence of significant liver fibrosis. Test sensitivity increased to 95.9% among the 51 with replicating HBV and to 100% among the 28 with high HBV VL.ConclusionsThe Determine HBsAg test accurately diagnosed HBsAg-emia in the majority of field-tested HIV patients, particularly those with higher HBV VL. False negatives tended to have inactive HBV infection further supporting the use of this low-cost test in public health settings in sub-Saharan Africa.
WATER SUPPLY AND SANITATION CONDITIONS IN RURAL SOUTHERN MOZAMBIQUE AND ITS ASSOCIATION WITH MORBIDITY AND MORTALITY INDICATORS, 2012–2015
Authors: Grau-Pujol Berta , Sacoor Charfudin , Nhabomba Augusto , Casellas Aina , Quintó Llorenç , Subirà Carme , Giné Ricard , Valentín Antònia , Muñoz Jose 
Published: February 2017

BackgroundWater, sanitation and hygiene (WASH) are major health determinants, responsible for an estimated world-wide disease burden of 5.7%. However, the debate about the effect of water quality, hygiene and sanitation in preventing diarrhoea is still ongoing. The aim of this study is to describe access to improved water supply and sanitation infrastructure, as defined by the Joint Monitoring Programme, in the Manhiça Health Research Centre (CISM) study area and evaluate its association with morbidity and mortality indicators.MethodsWe conducted a retrospective cohort study. All children under 15 living in the study area during the period 2012–2015 were included (N=61900). Children were followed up until they moved from the study area, turned 15 or until 2015. Water and sanitation household data were obtained from the CISM demographic surveillance system (DSS) in the Manhiça district, an area of around 2380 km2. Clinical data were obtained from CISM's round-the-clock morbidity surveillance system covering outpatient and hospital admissions at the Manhiça District Hospital (MDH) and rural health posts. A negative binomial regression model using Wald test was performed to assess the minimum community-based incidence rates (MCBIR) for every morbidity-mortality indicator.ResultsPreliminary data showed that 86% of the children lived at least once in a household with unimproved sanitation facilities, 27% with an unimproved water source. Spatial distribution of unimproved water and sanitation facilities showed to be clustered. Access to unimproved sanitation and water facilities was associated to higher rates of diarrhoea, a significant 30% of diarrhoea rate increase was observed for rivers, lakes and ponds as water sources. Other morbidity indicators (malnutrition, parasitaemia, anaemia) also showed a rate increase with the use of unimproved water and sanitation facilities.ConclusionsObtained results are useful to inform sector-related decision-making processes and ultimately improve access to safe drinking water and sanitation in rural southern Mozambique.