International Journal of MCH and AIDS最新文献

{"title":"Integrating Heat-Stable Carbetocin and Tranexamic Acid for Prevention and Management of Postpartum Hemorrhage in Sub-Saharan Africa: A Five-Country Pilot Implementation Study.","authors":"Sara Rushwan, Fatu Forna, Ferid Abbas Abubeker, Tesfaye Tufa, Tieba Millogo, Miriam Nakalembe, Kwame Adu-Bonsaffoh, Francis L Moses, Lester Chinery, Gilda Piaggio, Metin Gülmezoglu","doi":"10.25259/IJMA_34_2024","DOIUrl":"10.25259/IJMA_34_2024","url":null,"abstract":"<p><strong>Background and objective: </strong>Globally, postpartum hemorrhage (PPH) remains the most common direct cause of maternal mortality. This study evaluated the feasibility and acceptability of introducing heat-stable carbetocin (HSC) for PPH prevention and tranexamic acid (TXA) for PPH treatment in five Sub-Saharan African countries following recent World Health Organization (WHO) recommendations. This study also assessed healthcare providers' (HCPs') favorability toward using these medicines.</p><p><strong>Methods: </strong>We conducted a mixed methods pilot implementation study in selected facilities across Burkina Faso, Ethiopia, Ghana, Sierra Leone, and Uganda between May and December 2022. We compared baseline data obtained from patient registers with data collected during implementation on the safe and appropriate use of HSC and TXA using descriptive statistics. HCP responses were analyzed qualitatively using a thematic analysis.</p><p><strong>Results: </strong>Following training, HSC was administered prophylactically in 11,329 (92.4%) of 12,262 deliveries in all study facilities which received a uteorotonic for PPH prevention during implementation and was used safely and appropriately. TXA administration for PPH treatment was done safely, appropriately, and within the WHO-recommended time. No adverse events were reported throughout the study. HCPs overall showed high confidence in, and favorability toward, using both medicines.</p><p><strong>Conclusion and global health implications: </strong>Our study demonstrated that HSC and TXA can be safely and appropriately implemented in primary and tertiary facilities, and their introduction is feasible and acceptable from the perspective of HCPs. A holistic approach to training and regular supportive supervision is needed to ensure the continued safe use of these new and lesser-utilized PPH medicines. Dedicated training is required to improve the documentation of patient charts on PPH care. Introducing these medicines holds promise for improving PPH care in low- and middle-income countries, including by addressing suboptimal efficacy due to cold chain system challenges.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 Suppl 1","pages":"S15-S27"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583826/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Hemorrhage in Humanitarian Settings: Heat-Stable Carbetocin and Tranexamic Acid Implementation Study in South Sudan.","authors":"Nguyen Toan Tran, Awatta Walter Ochan, Jemelia Sake, Okpwoku Sukere, Willibald Zeck, Armando Seuc, Catrin Schulte-Hillen","doi":"10.25259/IJMA_8_2023","DOIUrl":"10.25259/IJMA_8_2023","url":null,"abstract":"<p><strong>Background and objective: </strong>Postpartum hemorrhage (PPH) remains a significant concern in crisis-affected contexts, where the implementation of heat-stable carbetocin (HSC) and tranexamic acid (TXA) for PPH prevention and treatment lacks evidence. This study aims to evaluate the effects of a capacity-strengthening package on the use of uterotonics for PPH prevention and detection, and the use of TXA for PPH treatment in basic maternity facilities in South Sudan.</p><p><strong>Methods: </strong>In this implementation study, the six chosen facilities followed a stepwise sequence of PPH management: T1 (routine care), a transition period for package design; T2 (package without HSC and TXA); T3 (package and HSC); and T4 (package with HSC and TXA). The intervention comprised refresher training, an online provider community, PPH readiness kits, alarm bells, and displayed algorithms. The main outcomes were trends in prophylactic uterotonic use, including HSC, visual diagnosis of bleeding, and oxytocin and TXA use for PPH treatment. Analyses were adjusted for cluster effect and baseline characteristics. The study was registered in the Pan-African Clinical Trials Registry (PACTR202302476608339).</p><p><strong>Results: </strong>From February 1, 2022, to February 17, 2023, 3142 women were recruited. Nearly all women received prophylactic uterotonics across all four phases, with a significant increase after T3 (T4-T1: 100%-98%; 95% CI: 4.4-0.4). Oxytocin alone was the most used in T1 (98%) and T2 (94%) and HSC alone in T3 (87%) and T4 (82%) (T4-T1: 95% CI: 75.5-83.3). PPH diagnosis tripled from 1.2% of all births to 3.6% (T2-T1: 95% CI: 0.4-5.2) and stayed roughly at 3% in T3 and T4. For treatment, universal oxytocin use in T1 and T2 decreased in T3 upon HSC initiation (T3-T2: 27%-100%; 95% CI: 95.5-49.9), whereas TXA use increased in T4 (T4-T1: 95%-0%; 95% CI: 54.6-99.0).</p><p><strong>Conclusion and global health implications: </strong>An intervention package to improve the quality of PPH prevention and treatment can effectively increase HSC and TXA use in crisis settings. It could be scaled up in similar contexts with ongoing supervision to mitigate confusion between the existing and new medications, such as the reduced use of oxytocin for PPH treatment. Sustaining cold chain investments remain vital to ensure oxytocin quality.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 Suppl 1","pages":"S55-S63"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Tale of Two Medicines: The Need for Ownership, End-to-End Planning and Execution for Development and Introduction of Maternal Health Medicines.","authors":"Metin Gülmezoglu, Lester Chinery, Sara Rushwan, Anne Ammerdorffer","doi":"10.25259/IJMA_21_2024","DOIUrl":"10.25259/IJMA_21_2024","url":null,"abstract":"<p><p>Postpartum hemorrhage (PPH) persists as the leading direct cause of maternal mortality in low- and middle-income countries (LMICs) and is a major global health challenge. Following favorable evidence from pivotal efficacy clinical trials, the World Health Organization (WHO) recommends the use of heat-stable carbetocin to prevent PPH as a viable substitute in settings where maintaining a cold chain for thermosensitive uterotonics is compromised, and tranexamic acid as an adjunct therapy for PPH treatment. However, the implementation of these drugs has been hindered by several challenges, such as decentralized and disorganized procurement, poor quality assurance, inadequate supply chain management, and limited access in many LMICs. While including maternal health drugs in the essential medicines list and adopting updated global recommendations are necessary steps forward, they are not enough to guarantee access unless there is end-to-end (E2E) thinking, planning, and execution for essential maternal health commodities. We describe distinct access challenges between the two drugs, both having compelling safety and efficacy data and normative recommendations around the same time; one patent protected and owned by a pharmaceutical company and another with multiple generic manufacturers. We highlight the need for coordinated action to facilitate access to evidence-based maternal health commodities.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 Suppl 1","pages":"S9-S14"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum Hemorrhage in Humanitarian Settings: Heat-Stable Carbetocin and Tranexamic Acid Implementation Study in Uganda.","authors":"Nguyen Toan Tran, Kidza Mugerwa, Sarah Muwanguzi, Richard Mwesigwa, Damien Wasswa, Willibald Zeck, Armando Seuc, Catrin Schulte-Hillen","doi":"10.25259/IJMA_9_2023","DOIUrl":"10.25259/IJMA_9_2023","url":null,"abstract":"<p><strong>Background and objective: </strong>Postpartum hemorrhage (PPH) remains a major concern in crisis-affected settings. There is a lack of strategies for implementing heat-stable carbetocin (HSC) and tranexamic acid (TXA) in humanitarian settings. This study aims to investigate the impact of a capacity-strengthening package on the utilization of uterotonics for PPH prevention, PPH detection, and utilization of TXA for PPH treatment in basic obstetric care clinics in humanitarian settings in Uganda.</p><p><strong>Methods: </strong>A multi-stepped implementation research study was conducted, wherein six select facilities utilized an intervention package encompassing provider training, an online community of practice, and wall-displayed PPH algorithms. Facilities were conveniently assigned to the same study sequence: T1 (routine care), a transition period for training; T2 (package without HSC and TXA); T3 (package with HSC); and T4 (package with HSC and TXA). The primary outcomes assessed trends in prophylactic uterotonic use (including HSC), visual diagnosis of hemorrhage, and HSC and TXA use for hemorrhage treatment. Analysis followed an intention-to-treat approach, adjusting for cluster effect and baseline characteristics. Pan-African Clinical Trials Registry: PACTR202302476608339.</p><p><strong>Results: </strong>From April 10, 2022, to April 4, 2023, 2299 women were recruited (T1: 643, T2: 570, T3: 580, T4: 506). Over 99% of all women received prophylactic uterotonics across the four phases, with oxytocin alone primarily used in T1 (93%) and T2 (92%) and HSC alone in T3 (74%) and T4 (54%) (T4-T1 95% CI: 47.8-61.0). Hemorrhage diagnosis ranged from 1% to 4%. For hemorrhage treatment, universal oxytocin use in T1 and T2 decreased in T3 and T4 after HSC introduction (T4-T1: 33%-100%; 95% CI: -100.0 to -30.9), and TXA use increased in T4 (T4-T1: 33%-0%; 95% CI: -2.4 to 69.1).</p><p><strong>Conclusion and global health implications: </strong>An intervention package to reinforce providers' capacity to prevent and treat PPH can result in substantial HSC utilization and a moderate TXA adoption in cold-chain-challenged humanitarian settings. It could be scaled up with continuous capacity development and supportive supervision to mitigate confusion between existing and new medications, such as the decreased use of oxytocin for PPH treatment. Maintaining investments in cold-chain strengthening remains critical to ensure the quality of oxytocin.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 Suppl 1","pages":"S46-S54"},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immunization Status, Immunization Coverage, and Factors Associated with Immunization Service Utilization Among HIV-Exposed and HIV-Infected Children in India.","authors":"Mousumi Datta, Shamima Yasmin, Rahul Biswas","doi":"10.25259/IJMA_18_2024","DOIUrl":"https://doi.org/10.25259/IJMA_18_2024","url":null,"abstract":"<p><strong>Background and objective: </strong>HIV-infected and HIV-exposed children are known to have a lower immunization coverage. However, the current immunization coverage for this group of children in India is unknown. The present study assessed the immunization status, service-utilization issues, and factors associated with immunization status among them.</p><p><strong>Methods: </strong>A descriptive, cross-sectional, and multisite study was conducted in four districts (Nadia, Murshidabad, South and North 24 Parganas) of West Bengal, a state in the Eastern part of India. Children aged between 12 and 59 months were included in the study. A sample size of 131 was calculated using Cochrane's formula. Onsite data was collected using an interviewer-administered predesigned, pre-tested, face-validated, semi-structured schedule. Immunization status was the outcome variable. The unadjusted association of the outcome variable with other variables was tested by the Chi-square test and the adjusted association was tested by regression analysis.</p><p><strong>Results: </strong>The mean age of the children was 35.5 months (±15.7) and 50.4% were male. There were 18 (13.7%) HIV-infected children. Eighty-four percent of children were adequately immunized, but when considered along with the birth dose of the Hepatitis-B (Hep-B) vaccine, this reduced to 58.8%. Murshidabad district had the lowest proportion of fully immunized children (50%), while South 24 Parganas district had the lowest proportion of completely immunized children (60%). More than 95% of vaccinations were done in government facilities. Service utilization issues identified were lack of awareness of vaccine due dates and facing stigma from providers. Immunization status was associated with experience of stigma, mode and place of delivery by Chi-square test, it was only associated with stigma by regression analysis.</p><p><strong>Conclusion and global health implications: </strong>Relatively lower immunization coverage among children born of HIV-infected women can be attributed to parents' unawareness about vaccination due dates and facing stigma while accessing service. Measures like documenting vaccine due dates and training healthcare providers on non-discriminatory, respectful care may improve vaccination coverage.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e021"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544473/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Manifestations of HIV Infection and Dental Health Needs of Children with HIV Attending HIV Treatment Clinics in Western Cameroon.","authors":"Ashu Michael Agbor, Karpal Singh Sohal, Nguitewou Loith Nguimfack, Elvis Tarkang, Enow O'rock George, Sudeshni Naidoo","doi":"10.25259/IJMA_7_2024","DOIUrl":"https://doi.org/10.25259/IJMA_7_2024","url":null,"abstract":"<p><strong>Background and objective: </strong>Highly active antiretroviral therapy (HAART) has reduced morbidity related to HIV infection, but HIV infection remains a public health in the era of HAART. The aim of this study was to investigate the oral manifestations of children living with HIV in the city of Bafoussam, Cameroon.</p><p><strong>Methods: </strong>A cross-sectional study was carried out between February and April 2022 on children living with HIV/AIDS. A pretested questionnaire and data capture sheet were used to collect participants' data after an interview and clinical examination.</p><p><strong>Results: </strong>We recruited 163 children, including 89 (54.6%) boys and 74 (45.4%) girls aged 1-18 years. All participants presented with HIV-1 serology, 143 (88%) at WHO stage 1, all were on HAART, 62 (38%) had been on treatment for six years, 144 (89%) had a viral load of less than 1000 copies/ml, none of the children had an infection opportunistic and only 31.3% were taking cotrimoxazole as prophylaxis, 3 (1.8%) had dermatosis and 20 (12.3%) adenopathies. A third 49 (30%) had mucosal pathologies, 30 (19%) gingivitis, 15 (9%) candidiasis oral, and 40 (24.5%) caries pathology. There was a statistically significant association between viral load and caries pathology. Oral hygiene was poor and 151 (92.6%) of the children had never consulted a dental surgeon.</p><p><strong>Conclusion and global health implications: </strong>This study reveals that irrespective of compliance with HAART, some oral pathology related to HIV still persists. Therefore, early initiation to HAART and improvement of oral hygiene can further reduce these pathologies.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e022"},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recommendations for Integrating Traditional Birth Attendants to Improve Maternal Health Outcomes in Low- and Middle-Income Countries.","authors":"Jaleah D Rutledge, Alexis Kiyanda, Christina Jean-Louis, Elizabeth Raskin, Joanne Gaillard, Morgan Maxwell, Tynetta Smith, Trace Kershaw, Jasmine Abrams","doi":"10.25259/IJMA_16_2024","DOIUrl":"https://doi.org/10.25259/IJMA_16_2024","url":null,"abstract":"<p><p>Adverse maternal health outcomes and high rates of maternal mortality continue to disproportionately affect low- and middle-income countries (LMICs). With limited access to health facility care, many women in LMICs rely on traditional birth attendants (TBAs) to meet their maternal health needs. While some studies consider the use of TBAs to be problematic, others suggest the integration of TBAs into maternal healthcare to improve health outcomes. The aim of this study is to utilize extant research to provide recommendations for optimizing the role of TBAs in maternal healthcare in Haiti, a LMIC. Each recommendation builds upon previous global health research, programmatic work, and a series of research studies conducted in Haiti to better understand and improve maternal healthcare in low-resource settings. Recommendations for integrating TBAs in maternal health include: (1) Integrate TBAs throughout prenatal, perinatal, and postpartum care to provide culturally relevant physical and emotional support to mothers; (2) Build capacity among TBAs to identify high-risk situations and link patients to care; (3) create TBA-led efforts to improve coordination and care; (4) Establish a collaborative pipeline from TBAs to facility-based care; and (5) create inclusive facility environments for TBAs to help reduce medical mistrust among patients. TBAs occupy an important role in the maternal health of women in LMICs and have the potential to contribute toward improved maternal health outcomes. The recommendations provided herein can be used to aid practitioners and researchers in reducing maternal morbidity and mortality globally.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e019"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Precancer Treatment Outcomes in Cameroon.","authors":"Joseph F Nkfusai, Simon M Manga, Kathleen Nulah, Calvin Ngalla, Florence Manjuh, Claude Ngwayu Nkfusai, Tendongfor Nicholas, Halle Ekane Edie Gregory","doi":"10.25259/IJMA_8_2024","DOIUrl":"https://doi.org/10.25259/IJMA_8_2024","url":null,"abstract":"<p><strong>Background and objective: </strong>The ablative and excision treatment procedures are effective, accessible, and affordable in resource-constrained settings, but the rollout and posttreatment follow-up are not remarkable. The outcomes of treatment procedures among women treated for precancerous lesions of the cervix have not been adequately studied in Cameroon. This study assessed the outcome of ablative and excisional treatment procedures.</p><p><strong>Methods: </strong>This was a cross-sectional study that assessed the clinical outcome of 170 women treated for cervical precancers using ablative and excisional procedures in 2019 and 2020. Demographic and clinical data (treatment and posttreatment follow-up) were abstracted from the program registry. The data was analyzed to assess the clinical outcomes of cervical precancer treatment. The association between each independent variable and the dependent variable was examined in a simple logistic regression. All variables with p < 0.2 in the bivariate logistic regression model were subjected to a multivariable logistic model to get rid of cofounders and obtained adjustable odds ratios. The data was summarized using odds ratios, with <i>p</i>-value < 0.05 considered significant. All statistical analyses were performed using STATA version 17.</p><p><strong>Results: </strong>The cervical precancer treatment effectiveness of 93.55% was disaggregated into 94.37% and 88.23% for ablative and excisional procedures, respectively, with less severe adverse clinical effects. Despite the high awareness of women on the importance and timing of posttreatment follow-up, its uptake was 54.71%. Most of the women who got pregnant after the procedures delivered live and healthy babies. Women who were HIV positive were 89% (0.89 times) [aOR = 0.11, 95%CI (0.01 0.85), p = 0.034] less likely to have effective treatment for cervical precancer when compared to HIV-negative women. Those with low-grade lesions were eight times [aOR = 8.39, 95%CI (1.10 64.06), p = 0.04] more likely to have effective treatment for cervical precancer treatment compared to those with high-grade lesions.</p><p><strong>Conclusion and global health implications: </strong>Ablative and excisional treatment procedures for cervical precancer were effective with limited adverse effects in Cameroon. Women living with HIV and those with large lesions experienced lower treatment effectiveness. Most of the women who got pregnant after the procedures delivered live and healthy babies. Posttreatment follow-up which is highly recommended because of recurrent/persistent lesions was barely above average.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e020"},"PeriodicalIF":0.0,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544494/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geospatial Analysis of Parental Healthcare-Seeking Behavior in the Vicinity of Multispecialty Hospital in India.","authors":"Anjali Pal, Sunil Kumar Panigrahi, Pragyan Paramita Parija, Sagarika Majumdar","doi":"10.25259/IJMA_628","DOIUrl":"10.25259/IJMA_628","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;The healthcare-seeking behavior of vulnerable groups, such as children under five, depends on a multitude of factors, including the caregiver's decision making. Approximately 60% of Indians seek care from private hospitals. Recent health policy in India has favored the establishment of multispecialty hospitals. However, it remains unclear to what extent this policy has changed the number of Indians seeking healthcare from these government-established multispecialty hospitals. The study aims to assess the health-seeking behavior of parents of children under five in the vicinity of a public multispecialty tertiary care hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was a community-based cross-sectional survey with geospatial mapping conducted among the parents of children under five using a semi-structured questionnaire in Epi-collect mobile app. The study site was an urban slum in a catchment area [within five kilometers (km)] of a multispecialty tertiary care public hospital in the central Indian state of Chhattisgarh. The study was conducted for one year duration from February 2019 to January 2020. A questionnaire was administered to the parents of the children under five (N = 353) after their household confirmation from the nearby Anganwadi center, the community level service providing center under the Integrated Child Development Scheme by the Ministry of Women and Child Development (WCD). The questionnaire included sections for demographic characteristics, the illness pattern among their children, health-seeking decision-making, and more. Descriptive analysis was presented with numbers and percentages. Univariate analysis was used to assess the association between sociodemographic variables and health-seeking characteristics. Statistical significance was considered at p value less than 0.05. We used geospatial mapping using coordinates collected and compiled using the Microsoft Excel version 2021 and analyzed using QGIS (Quantum Geographic Information System) software.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the parents interviewed patients (N = 353), maternal literacy rates were over 85%. Approximately 54% of the families were below poverty line. Among 95.2% of the families, mothers were part of decision-making regarding their children's health-seeking. Over 92% of the families opted for consultation in a nearby private hospital or dispensary. Geospatial mapping of private hospitals was a favored place for healthcare-seeking by mothers, irrespective of their socioeconomic status or education rather than multispecialty hospital.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion and global health implications: &lt;/strong&gt;The majority of the parents in the vicinity of public multispecialty hospitals seek care from private clinics for ailments for children under five. The establishment of public multispecialty tertiary care hospitals, which are mandated for tertiary level of care and research, cannot replace primary-level health","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e014"},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Exposure Prophylaxis and HIV Prevention Among Key Populations in Nigeria.","authors":"Olaniyi Felix Sanni, Paul Umoh, Abiye Kalaiwo, Roger Abang, Agboola Oguntonade, Paul Amechi, Godwin Emmanuel","doi":"10.25259/IJMA_6_2023","DOIUrl":"10.25259/IJMA_6_2023","url":null,"abstract":"<p><strong>Background and objective: </strong>The discovery of innovative pharmacological preventative measures in Human Immunodeficiency Virus transmission has boosted optimism in the successful control of HIV/AIDS with the objective of eradication and the end of the epidemic. Hence, assessing the effect of pre-exposure prophylaxis (PrEP) on HIV prevention among key populations (KPs) is imperative in advancing the conversation on ending HIV/AIDs.</p><p><strong>Methods: </strong>This was a cross-sectional study using data from <b>KPs</b> (female sex workers (FSWs), men who have sex with men (MSM), and people who inject drugs (PWIDs) enrolled in Heartland Alliance Ltd/GTE One Stop Shops (OSS) between May 2019 and April 2023 in the six selected Nigerian states (Lagos, Bayelsa, Cross River, Akwa Ibom, Jigawa, and Niger). Data were cleaned in a spreadsheet and analyzed using IBM-SPSS version 28.0. Descriptive statistics, including frequency and percentage calculations, were conducted to analyze the dataset. Additionally, cross-tabulation analysis was performed, with a significance level set at 0.05, to explore relationships between variables.</p><p><strong>Results: </strong>The study population comprised 13,580 participants, with 56.1% female. In all, 43.9% were aged 18-35 and 97.3% were single. Among the three KPs examined, FSW was the largest subgroup (50.8%), followed by MSM (28.1%) and PWID (21.1%). Most participants had been on PrEP for 0-3 months (87.8%), and PrEP was initiated for 81.6% due to high-risk sexual behaviors and 9.9% for serodiscordant relationship reasons. Most of them were enrolled in community healthcare settings (97.0%). The results showed that 99.9% remained HIV negative, while only two (0.01%) were seroconverted while on PrEP. The HIV-positive cases did not complete one-month PreP treatment, comprising an FSW and a PWID. Recent HIV contact or poor compliance with PrEP medication are two possible causes of seroconversion.</p><p><strong>Conclusion and global health implications: </strong>The findings underscore the significance of integrating PrEP into a comprehensive HIV prevention approach, including newer molecules that will improve adherence and the necessity of ongoing monitoring and support for PrEP users. With these insights, there can be an advocacy for promoting PrEP among the KPs as a vital component of Nigeria's HIV prevention strategy.</p>","PeriodicalId":30480,"journal":{"name":"International Journal of MCH and AIDS","volume":"13 ","pages":"e013"},"PeriodicalIF":0.0,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11380895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}