Rajbhandari S.,Options Cambodia |
Hodgins S.,Nepal Family Health Program |
Sanghvi H.,JHPIEGO |
Pradhan Y.V.,Ministry of Health and Population
International Journal of Gynecology and Obstetrics | Year: 2010
Objective: To determine feasibility of community-based distribution of misoprostol for preventing postpartum hemorrhage (PPH) to pregnant woman through community volunteers working under government health services. Methods: Implemented in one district in Nepal. The primary measure of performance was uterotonic protection after childbirth, measured using pre- and postintervention surveys (28 clusters, each with 30 households). Maternal deaths were ascertained through systematic health facility and community-based surveillance; causes of death were assigned based on verbal autopsy. Results: Of 840 postintervention survey respondents, 73.2% received misoprostol. The standardized proportion of vaginal deliveries protected by a uterotonic rose from 11.6% to 74.2%. Those experiencing the largest gains were the poor, the illiterate, and those living in remote areas. Conclusion: Community-based distribution of misoprostol for PPH prevention can be successfully implemented under government health services in a low-resource, geographically challenging setting, resulting in much increased population-level protection against PPH, with particularly large gains among the disadvantaged. © 2009 International Federation of Gynecology and Obstetrics.
Kandeel A.M.,Ministry of Health and Population |
Talaat M.,Us Naval Medical Research Unit No 3 Namru 3 |
Afifi S.A.,Us Naval Medical Research Unit No 3 Namru 3 |
El-Sayed N.M.,Ministry of Health and Population |
And 3 more authors.
BMC Infectious Diseases | Year: 2012
Background: Identification of risk factors of acute hepatitis C virus (HCV) infection in Egypt is crucial to develop appropriate prevention strategies.Methods: We conducted a case-control study, June 2007-September 2008, to investigate risk factors for acute HCV infection in Egypt among 86 patients and 287 age and gender matched controls identified in two infectious disease hospitals in Cairo and Alexandria. Case-patients were defined as: any patient with symptoms of acute hepatitis; lab tested positive for HCV antibodies and negative for HBsAg, HBc IgM, HAV IgM; and 7-fold increase in the upper limit of transaminase levels. Controls were selected from patients' visitors with negative viral hepatitis markers. Subjects were interviewed about previous exposures within six months, including community-acquired and health-care associated practices.Results: Case-patients were more likely than controls to have received injection with a reused syringe (OR=23.1, CI 4.7-153), to have been in prison (OR=21.5, CI 2.5-479.6), to have received IV fluids in a hospital (OR=13.8, CI 5.3-37.2), to have been an IV drug user (OR=12.1, CI 4.6-33.1), to have had minimal surgical procedures (OR=9.7, CI 4.2-22.4), to have received IV fluid as an outpatient (OR=8, CI 4-16.2), or to have been admitted to hospital (OR=7.9, CI 4.2-15) within the last 6 months. Multivariate analysis indicated that unsafe health facility practices are the main risk factors associated with transmission of HCV infection in Egypt.Conclusion: In Egypt, focusing acute HCV prevention measures on health-care settings would have a beneficial impact. © 2012 Kandeel et al.; licensee BioMed Central Ltd.
Bar-Zeev N.,University of Malawi |
Bar-Zeev N.,University of Liverpool |
Kapanda L.,University of Malawi |
Tate J.E.,Centers for Disease Control and Prevention |
And 19 more authors.
The Lancet Infectious Diseases | Year: 2015
Background: Rotavirus is the main cause of severe acute gastroenteritis in children in Africa. Monovalent human rotavirus vaccine (RV1) was added into Malawi's infant immunisation schedule on Oct 29, 2012. We aimed to assess the impact and effectiveness of RV1 on rotavirus gastroenteritis in the 2 years after introduction. Methods: From Jan 1, 2012, to June 30, 2014, we recruited children younger than 5 years who were admitted into Queen Elizabeth Central Hospital, Blantyre, Malawi, with acute gastroenteritis. We assessed stool samples from these children for presence of rotavirus with use of ELISA and we genotyped rotaviruses with use of RT-PCR. We compared rotavirus detection rates in stool samples and incidence of hospital admittance for rotavirus in children from Jan 1 to June 30, in the year before vaccination (2012) with the same months in the 2 years after vaccination was introduced (2013 and 2014). In the case-control portion of our study, we recruited eligible rotavirus-positive children from the surveillance platform and calculated vaccine effectiveness (one minus the odds ratio of vaccination) by comparing infants with rotavirus gastroenteritis with infants who tested negative for rotavirus, and with community age-matched and neighbourhood-matched controls. Findings: We enrolled 1431 children, from whom we obtained 1417 stool samples (99%). We detected rotavirus in 79 of 157 infants (50%) before the vaccine, compared with 57 of 219 (40%) and 52 of 170 (31%) in successive calendar years after vaccine introduction (p=0·0002). In the first half of 2012, incidence of rotavirus hospital admission was 269 per 100 000 infants compared with 284 in the same months of 2013 (rise of 5·8%, 95% CI -23·1 to 45·4; p=0·73) and 153 in these months in 2014 (a reduction from the prevaccine period of 43·2%, 18·0-60·7; p=0·003). We recruited 118 vaccine-eligible rotavirus cases (median age 8·9 months; IQR 6·6-11·1), 317 rotavirus-test-negative controls (9·4 months; 6·9-11·9), and 380 community controls (8·8 months; 6·5-11·1). Vaccine effectiveness for two doses of RV1 in rotavirus-negative individuals was 64% (95% CI 24-83) and community controls was 63% (23-83). The point estimate of effectiveness was higher against genotype G1 than against G2 and G12. Interpretation: Routine use of RV1 reduced hospital admissions for several genotypes of rotavirus in children younger than 5 years, especially in infants younger than 1 year. Our data support introduction of rotavirus vaccination at the WHO recommended schedule, with continuing surveillance in high-mortality countries. Funding: Wellcome Trust, GlaxoSmithKline Biologicals. © 2015 Bar-Zeev, et al.
Barriers affecting utilization of family planning services among rural Egyptian women [Obstacles influant sur lutilisation des services de planification familiale par des femmes égyptiennes en milieu rural]
Eltomy E.M.,Ministry of Health and Population |
Saboula N.E.,Menoufia University |
Hussein A.A.,Menoufia University
Eastern Mediterranean Health Journal | Year: 2013
Access to family planning (FP), quality of care and exploring barriers to utilization of services are key factors in the adoption and continuation of contraception in Egypt. We conducted this study to explore the barriers affecting utilization of FP as well as the characteristics of women who discontinue using FP and nonusers of the FP services. A descriptive cross-sectional research design was used. A multistage random selection of 8 family health centres in Menufia Governorate, Egypt was done. We selected a purposive sample of 500 married, rural women of reproductive age who fulfilled the required criteria (109 non-users, 391 discontinued). Cognitive barriers were cited by more than 55% of the participants in both groups and cultural barriers by 40% of both groups. Barriers related to the method were cited by 35.8% of the women who had discontinued, and demographic barriers by 39.4% of the non-users.
Ibrahim J.M.,Ain Shams University |
Wegdan O.M.,Ministry of Health and Population
Journal of the Egyptian Public Health Association | Year: 2011
Background Many patients with end-stage renal disease undergoing dialysis therapy suffer from sleep disturbances. The aims of this study were to determine the prevalence of sleep disorders in patients with end-stage renal disease on maintenance dialysis and to determine the risk factors underlying these disorders. Patients and methods A total of 264 patients on maintenance dialysis were enrolled in the study. Demographic, renal, and dialysis data were recorded. Using Personal Professional Interviews, we assessed the presence of the following sleep disorders: insomnia, restless leg syndrome (RLS), and obstructive sleep apnea syndrome (OSAS). Moreover, to determine the prevalence of sleep disturbances and the possible effect of demographic or clinical data on sleep, we divided our population into two groups: with and without sleep disorders. Results The prevalence of sleep disorders was 61.4%. The survey revealed the presence of insomnia (57.6%), RLS (56.4%), and OSAS (21.2%). Insomnia, RLS, and OSAS were significantly associated with inadequate dialysis, hyperphosphatemia, and hypoalbuminemia. Insomnia and RLS were also significantly associated with anemia. Significant independent association was observed between insomnia and both RLS and OSAS as well as between RLS and OSAS. Conclusion The survey showed a high prevalence of sleep disruption in dialytic populations. Our data might help nephrologists to deal with patients with uremia with possible sleep disorders. © 2011 Egyptian Public Health Association.
Agency: European Commission | Branch: FP7 | Program: CP-FP-SICA | Phase: HEALTH.2010.1.2-4 | Award Amount: 3.89M | Year: 2010
The proposed project aims to identify novel biomarkers and provide new insight into the mechanisms of spontaneous clearance of hepatitis C virus (HCV) during the early stages of acute infection. Indeed hepatitis C is a major public health problem with high incidence in regions such as Egypt and other Mediterranean Partner Countries (MPCs). Our current application follows from an FP5 project entitled Promoting Healthy Societies: research in support of regional infectious disease surveillance, which permitted development of a cohort of patients with acute symptomatic HCV. Herein, we propose to build on this program for biochemical, immunologic and gene polymorphism assessment of patients with an enriched Consortium of European, Egyptian and Tunisian academic institutions and one European SME. Our multi-national, inter-disciplinary Consortium is in a strong position to establish an in-depth understanding of spontaneous viral clearance and provide needed information that will impact patient management and the design of candidate vaccines for HCV genotype 4. Specifically, we aim to use -omics or hypothesis-generating approaches to perform: (i) multi-analyte profiling of plasma analytes; (ii) characterization of HCV-specific cellular immune responses during the clearance phase; and (iii) assessment of genetic and epigenetic variations that predict viral clearance. Together, this will provide a framework for understanding the host response to acute HCV. In addition, we aim to establish a cooperative training program under the umbrella of the EU/MPC Research Collaboration Fighting Hepatitis in Egypt, which will enhance Clinical Epidemiology and Biomarker Discovery. Cross-Consortia collaborations with the EU funded HepaCute Project and Egyptian funded STDF will further enhance the impact of our proposed work.
Thapa S.,Nepal Public Health Foundation |
Sharma S.K.,Ipas Nepal |
Khatiwada N.,Ministry of Health and Population
Journal of Biosocial Science | Year: 2014
This paper assesses women's awareness of the liberalization of abortion law and their knowledge of a place for obtaining abortion services in Nepal. The data are from the 2011 Nepal Demographic and Health Survey. The results are compared with data from a similar survey conducted in 2006. Variations in the two measures among several population sub-groups are analysed by performing logistic regression. Among women aged 15-44, 38.7% (CI: 37.8, 39.6) were aware of the legal status of abortion and 59.8% (CI: 58.9, 60.7) knew of a place to have an abortion. The percentages of both measures varied considerably by various population sub-groups. Over a 5-year period, knowledge of the legality of abortion increased by 6.4 percentage points, and awareness of service delivery sites increased by 3.3 percentage points. The increases in both measures were, however, largely limited to higher wealth quintiles and those with higher educational attainment. The results suggest the need to intensify efforts to educate women in Nepal, particularly the most disadvantaged women, about abortion law, including the conditions under which abortion is permitted, and where to access safe abortion services. © 2013 Cambridge University Press.
Pries A.M.,Helen Keller International |
Huffman S.L.,Helen Keller International |
Adhikary I.,Helen Keller International |
Upreti S.R.,Ministry of Health and Population |
And 3 more authors.
Maternal and Child Nutrition | Year: 2016
Commercially produced complementary foods can help improve nutritional status of young children if they are appropriately fortified and of optimal nutrient composition. However, other commercially produced snack food products may be nutritionally detrimental, potentially increasing consumption of foods high in salt or sugar and displacing consumption of other more nutritious options. Helen Keller International, in collaboration with the Nepal government, implemented a study to assess mothers' utilization of commercial food products for child feeding and exposure to commercial promotions for these products. A cross-sectional survey was conducted among 309 mothers of children less than 24 months of age across 15 health facilities. Utilization of breastmilk substitutes was low, having been consumed by 6.2% of children 0-5 months of age and 7.5% of children 6-23 months of age. Approximately one-fourth (24.6%) of children 6-23 months age had consumed a commercially produced complementary food in the prior day. Twenty-eight percent of mothers reported observing a promotion for breastmilk substitutes, and 20.1% reported promotions for commercially produced complementary foods. Consumption of commercially produced snack food products was high at 74.1% of children 6-23 months. Promotions for these same commercially produced snack food products were highly prevalent in Kathmandu Valley, reported by 85.4% of mothers. In order to improve diets during the complementary feeding period, development of national standards for complementary food products is recommended. Nutritious snack options should be promoted for the complementary feeding period; consumption of commercially produced snack food products high in sugar and salt and low in nutrients should be discouraged. © 2016 John Wiley & Sons Ltd.
Ghimire M.,World Health Organization |
Pradhan Y.V.,Ministry of Health and Population |
Maskey M.K.,National Health Research Council
Bulletin of the World Health Organization | Year: 2010
Problem: Acute diarrhoeal diseases and acute respiratory infections (ARIs) are the most common causes of child mortality worldwide. Safe, effective and inexpensive solutions are available for prevention and control, but they do not reach needy communities. Approach:Interventions based on research were designed to train and engage community health volunteers (CHVs) to implement a community-based control programme in Nepal. With the advent of the Integrated Management of Childhood Illnesses (IMCI) strategy, this programme subsequently emerged as a community-based IMCI but retained its mainstream activities. We reviewed and analysed policy decisions and programme development, implementation and expansion. Local setting: Severe resource constraints and difficult terrain limit access to health-care facilities in many parts of Nepal. Relevant changes: In districts with interventions, more cases of acute diarrhoea and of ARIs (including pneumonia) were reported. The proportion of diarrhoea cases with dehydration and the proportion of ARI cases with pneumonia were significantly lower in districts with interventions. Case fatality rates due to acute diarrhoea and the proportion of severe pneumonia among ARI cases across the country showed a significant trend towards a decrease from 2004 to 2007. Nepal has succeeded in training many CHVs and is on course to meet the Millennium Development Goal for child mortality. Lessons learnt: The burden of acute diarrhoea and ARIs can be reduced by training and engaging CHVs to implement community-based case management and prevention strategies. Monitoring, supervision and logistical support are essential. Policy decisions based on evidence from national research contributed to the success of the programme.
Bruce M.C.,University of Glasgow |
MacHeso A.,Ministry of Health and Population |
MacHeso A.,Management science for Health Malawi Programme |
McConnachie A.,University of Glasgow |
And 2 more authors.
Malaria Journal | Year: 2011
Background: Described here is the first population genetic study of Plasmodium malariae, the causative agent of quartan malaria. Although not as deadly as Plasmodium falciparum, P. malariae is more common than previously thought, and is frequently in sympatry and co-infection with P. falciparum, making its study increasingly important. This study compares the population parameters of the two species in two districts of Malawi with different malaria transmission patterns - one seasonal, one perennial - to explore the effects of transmission on population structures. Methods. Six species-specific microsatellite markers were used to analyse 257 P. malariae samples and 257 P. falciparum samples matched for age, gender and village of residence. Allele sizes were scored to within 2 bp for each locus and haplotypes were constructed from dominant alleles in multiple infections. Analysis of multiplicity of infection (MOI), population differentiation, clustering of haplotypes and linkage disequilibrium was performed for both species. Regression analyses were used to determine association of MOI measurements with clinical malaria parameters. Results: Multiple-genotype infections within each species were common in both districts, accounting for 86.0% of P. falciparum and 73.2% of P. malariae infections and did not differ significantly with transmission setting. Mean MOI of P. falciparum was increased under perennial transmission compared with seasonal (3.14 vs 2.59, p = 0.008) and was greater in children compared with adults. In contrast, P. malariae mean MOI was similar between transmission settings (2.12 vs 2.11) and there was no difference between children and adults. Population differentiation showed no significant differences between villages or districts for either species. There was no evidence of geographical clustering of haplotypes. Linkage disequilibrium amongst loci was found only for P. falciparum samples from the seasonal transmission setting. Conclusions: The extent of similarity between P. falciparum and P. malariae population structure described by the high level of multiple infection, the lack of significant population differentiation or haplotype clustering and lack of linkage disequilibrium is surprising given the differences in the biological features of these species that suggest a reduced potential for out-crossing and transmission in P. malariae. The absence of a rise in P. malariae MOI with increased transmission or a reduction in MOI with age could be explained by differences in the duration of infection or degree of immunity compared to P. falciparum. © 2011 Bruce et al; licensee BioMed Central Ltd.