Mace K.E.,Center for Global Health |
Chalwe V.,University of Zambia |
Katalenich B.L.,United States Peace Corps |
Nambozi M.,Tropical Diseases Research Center |
And 7 more authors.
Malaria Journal | Year: 2015
Background: Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulphadoxine-pyrimethamine (SP) decreases placental parasitaemia, thus improving birth outcomes. Zambian policy recommends monthly SP-IPTp doses given presumptively during pregnancy at each antenatal examination, spaced one month apart after 16 weeks of gestation. The effectiveness of SP-IPTp was evaluated in Zambia where a recent study showed moderate prevalence of Plasmodium falciparum parasites with genetic mutations that confer SP resistance. Methods: HIV-negative women were enrolled at the time of delivery at two facilities in Mansa, Zambia, an area of high malaria transmission. Women were interviewed and SP exposure was determined by antenatal card documentation or self-reports. Using Poisson regression modelling, the effectiveness of SP-IPTp was evaluated for outcomes of parasitaemia (microscopic examination of maternal peripheral, cord, and placental blood films), maternal anaemia (Hb < 11 g/dl), placental infection (histopathology), and infant outcomes (low birth weight (LBW), preterm delivery, and small for gestational age) in women who took 0.4 doses of SP-IPTp. Results: Participants included 435 women, with a median age of 23 years (range 16.44). Thirty-four women took zero doses of SP-IPTp, while 115, 142 and 144 women took one, two, or. three doses, respectively. Multivariate Poisson regression models considering age, mosquito net usage, indoor residual spraying, urban home, gravidity, facility, wet season delivery, and marital status showed that among paucigravid women ≥ two doses of SP-ITPp compared to one or less doses was associated with a protective effect on LBW (prevalence ratio (PR) 0.33, 95% confidence interval (CI) 0.12.0.91) and any infection (PR 0.76, CI 0.58.0.99). Multivariate models considering SP-IPTp as a continuous variable showed a protective dose.response association with LBW (paucigravid women: PR 0.54, CI 0.33.0.90, multigravid women: PR 0.63, CI 0.41.0.97). Conclusions: In Mansa, Zambia, an area of moderate SP resistance, ≥ two doses of SP-IPTp were associated with a protective effect from malaria in pregnancy, especially among paucigravid women. Each dose of SP-IPTp contributed to a 46 and 37% decrease in the frequency of LBW among paucigravid and multigravid women, respectively. SP-IPTp remains a viable strategy in this context. © 2015 Mace et al.; licensee BioMed Central. Source
Baral S.,Center for Public Health and Human Rights |
Adams D.,United States Peace Corps |
Lebona J.,Matrix |
Kaibe B.,Matrix |
And 4 more authors.
Journal of the International AIDS Society | Year: 2011
Background: Evidence is increasing of high HIV risks among southern African men who have sex with men (MSM). This represents the first study of HIV risks and human rights contexts among MSM in Lesotho. Methods. Two hundred and fifty-two men who reported ever having anal sex with another man were accrued with snowball sampling and were administered a structured quantitative instrument in October and November 2009. Results: Of the participants, 96.4% (240/249) were ethnic Basotho with a mean age of 26.3 years (range 18-56), 49.6% (124/250) were currently employed, and 95.2% (238/250) had at least a secondary-level education. Self-reported HIV prevalence was 11.6% (22/190); 54.5% (128/235) reported being tested for HIV in the last year. HIV knowledge was low; only 3.7% (8/212) of MSM knew that receptive anal intercourse was the highest risk for HIV and that a water-based lubricant was most appropriate to use with condoms. Bivariate associations of wearing condoms during last intercourse with men include: having easy access to condoms (OR 3.1, 95% CI 1.2-8.5, p < 0.05); being older than 26 years (OR 2.3, 95% CI 1.3-4.2, p < 0.01); knowing that receptive anal intercourse is higher risk than insertive anal intercourse (OR 2.6, 95% CI 1.2-5.9, p < 0.05); wearing condoms with female sexual partners (OR 3.5, 95% 1.4-8.3, p < 0.01); using water-based lubricants (OR 2.8, 95% CI 1.4-5.5, p < 0.01); being less likely to report having been diagnosed with a sexually transmitted infecton (OR 0.21, 95% CI 0.06-0.76, p < 0.05); and being more likely to have been tested for HIV in the last year (OR 2.0, 95% CI 1.2-3.6, p > 0.05). Human rights abuses were common: 76.2% (170/223) reported at least one abuse, including rape (9.8%, 22/225), blackmail (21.3%, 47/221), fear of seeking healthcare (22.2%, 49/221), police discrimination (16.4%, 36/219), verbal or physical harassment (59.8%, 140/234), or having been beaten (18.9%, 43/228). Conclusions: MSM in Lesotho are at high risk for HIV infection and human rights abuses. Evidence-based and rights-affirming HIV prevention programmes supporting the needs of MSM should be developed and implemented. © 2011 Baral et al; licensee BioMed Central Ltd. Source
Stevens E.R.,United States Peace Corps |
Aldridge A.,United States Peace Corps |
Degbey Y.,Ministere de la Sante |
Pignandi A.,Secretariat Permanent du CCM |
And 3 more authors.
Malaria Journal | Year: 2013
Background: Malaria remains a substantial public health problem in Togo. An integrated child health campaign was conducted in Togo in October 2011. This campaign included a component of free distribution of 2,799,800 long-lasting, insecticide-treated nets (LLINs) to households throughout Togo. This distribution marked the first effort in Togo at universal LLIN coverage and was not targeted specifically to children under five years and pregnant women, but to all household members. This study reports the results of the LLIN distribution campaign in terms of bed net possession and utilization. Methods. A representative household survey was implemented during the rainy season nine months after the LLIN distribution component of the campaign. Some 6,015 households selected through two stages of probability proportion to size stratified random sampling were interviewed using a brief questionnaire that included a demographic section with questions on the number of household members and sleeping spaces, and a campaign participation section with questions used to evaluate non-LLIN aspects of the campaign. A net roster listed all nets and their characteristics, and a household roster listed all members and visitors with information about bed net use. The questions addressed different aspects of bed net and LLIN possession and utilization. Crude weighted frequencies, percentages, and t- tests of association were calculated using the Stata 12.0 Survey features. Results: Possession of at least one bed net and/or LLIN increased from 41.3% to 96.7% (P <0.001). Household possession of at least one campaign LLIN was 93.3%. Report LLIN among pregnant women was 77.5% and 79.3% for children under five. For the general population LLIN use was 68.3%. Conclusions: Due to the gap in LLIN possession and use and the significant number of individuals reporting a lack of nets as a reason for non-use, additional national LLIN distribution campaigns with a stronger educational component need to be implemented in order increase the use of available LLINs and to reach and maintain universal coverage of LLINs in Togo. The LLIN distribution campaign focusing on universal coverage of the general population in Togo was more successful at increasing LLIN possession and use of children under five years and pregnant women than other campaigns focusing only on these target groups. © 2013 Stevens et al.; licensee BioMed Central Ltd. Source
Hall J.S.,Smithsonian Tropical Research Institute |
Love B.E.,Smithsonian Tropical Research Institute |
Love B.E.,University of Alberta |
Garen E.J.,The New School |
And 9 more authors.
Forest Ecology and Management | Year: 2011
Interest in native species is growing across the tropics as reforestation of degraded lands becomes more widespread. In this study four tree species native to Panama - Cedrela odorata, Pachira quinata, Samanea saman, and Tabebuia rosea - were grown on rural farms at two dry tropical sites in Panama for up to five years. Survivorship and growth data at these "on-farm" trials are compared to data recorded from nearby experimental or "species selection" trial sites and evaluated in terms of soil fertility and management. Participant farmers were also asked about their interest in planting trees in general as well as their interest in 61 species grown in the species selection trial. Although, on-farm survivorship was variable and generally lower than that found on the species selection trial, one species (S. saman) experienced high and consistent survivorship. High survivorship combined with growth data from farms at both sites for this species suggests it would be a good candidate for extension projects working with rural farmers. Survivorship of other species appears more sensitive to farmer management and/or local site conditions. Generally lower growth on the Los Santos farms as compared to the species-selection trial is attributed to the lower soil fertility (plant available P) at the on-farm sites compared to the species selection trial. In contrast, only one species - P. quinata - had a growth variable found to be significantly lower between the on-farm and species selection trial sites in Rio Hato. C. odorata, P. quinata T. rosea can all be used in on-farm conditions with consideration to specific site and management conditions. By 2009, approximately 80% of the farmers planting trees still wished to participate in tree planting activities. All of the farmers no longer wishing to continue with the project expressed slow growth rates of trees as a principal reason. All but one of these farmers had growth rates for his/her trees markedly below those of the species selection trial nearby. Some farmers wishing to continue had very high mortality rates (>70% for all species), suggesting non-tangible benefits for participating in project activities. Other species that were not tested on-farm but grew well in the species-selection trials and were of interest to local farmers are discussed. As long as specific site and management conditions are carefully considered, data from species selection trials can be useful in informing tree planting projects with rural farmers; however, care should be taken to manage expectations. © 2010 Elsevier B.V. Source
Garen E.J.,Smithsonian Tropical Research Institute |
Saltonstall K.,Smithsonian Tropical Research Institute |
Ashton M.S.,The New School |
Slusser J.L.,United States Peace Corps |
And 2 more authors.
Forest Ecology and Management | Year: 2011
To examine the opportunities available for designing diverse tree planting and land restoration initiatives in agricultural landscapes that contain tropical dry forests, the tree planting and protecting practices of cattle ranchers and small-scale agriculturalists were examined in two study sites in rural Panama. Ninety-nine tree species were identified that they utilize, plant, or protect on their land, the majority of which are native to Panama. The farmers had diverse reasons for maintaining trees, including improving the environment, providing food and shade for cattle, and generating a source of wood for construction, furniture, and firewood. Most of the trees mentioned in the study provide multiple uses and values and the majority of farmers wanted to plant additional trees. Some differences in species preferences and motivations for planting and protecting trees were seen between sites, thereby suggesting that land restoration and tree planting projects should be site specific. Our data indicate that there are ample opportunities to increase native tree cover in our study sites and highlight the need to incorporate farmer input into project design, implementation, and evaluation as a necessary and continuous feature throughout projects. © 2010 Elsevier B.V. Source