scholarly journals Effectiveness and implementation of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: proposal for a cluster Randomized Controlled Trial SMS reminders and tailored feedback through evriMED and adherence to TB treatment

2019 ◽  
Author(s):  
I. Marion Sumari-de Boer ◽  
Francis M Pima ◽  
Kennedy M Ngowi ◽  
Geoffrey M Chelangwa ◽  
Linda Minja ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Care Facility ◽  
Health Care Facility ◽  
Cluster Randomized Trial ◽  
World Health ◽  
Tb Treatment ◽  
Sms Reminders ◽  
Cluster Randomized ◽  
Health Organization ◽  
Monitoring Technologies

Abstract Background: Adherence to Tuberculosis (TB) treatment is challenging because of many factors. The World Health Organization (WHO) has recommended the use of digital adherence monitoring technologies in its End-TB-strategy. However, there is paucity on its evidence in improving adherence. EvriMED is a real time medication monitoring (RTMM) device which was found feasible and acceptable in few studies in Asia. However, in Tanzania, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy and cost effectiveness which may have an implication for treatment outcomes. We propose a pragmatic cluster randomized trial, to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. Methods: We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented or a control arm, where standard practice Directly Observed Treatment (DOT) will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the ‘Stages­of-change’­model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action and evaluation to change behaviour for tailored feedback on adherence reports from the device. Discussion: If the intervention shows a significant effect on adherence and the devices are accepted, accurate and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes. Trial registration: PACTR201811755733759 at 8 November 2018 at https://pactr.samrc.ac.za/

scholarly journals Effectiveness and implementation of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: proposal for a cluster Randomized Controlled Trial SMS reminders and tailored feedback through evriMED and adherence to TB treatment

2019 ◽  
Author(s):  
I. Marion Sumari-de Boer ◽  
Francis M Pima ◽  
Kennedy M Ngowi ◽  
Geoffrey M Chelangwa ◽  
Benson Mtesha ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Care Facility ◽  
Health Care Facility ◽  
Cluster Randomized Trial ◽  
Tb Treatment ◽  
National Tuberculosis ◽  
Sms Reminders ◽  
Cluster Randomized ◽  
Monitoring Technologies ◽  
Adherence Monitoring

Abstract Background Adherence to TB treatment is challenging because of many factors. WHO has recommended the use of digital adherence monitoring technologies in its End-TB-strategy. However, there is paucity on its evidence in improving adherence. EvriMED a real time medication monitoring (RTMM) which was found feasible and acceptable in few studies in Asia. However, in Tanzania, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy and cost effectiveness which may have an implication for treatment outcomes. We propose a pragmatic cluster randomized trial, to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. Methods We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented or a control arm, where standard practice DOTs will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the ‘Stages­of-change’­model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action and evaluation to change behaviour for tailored feedback on adherence reports from the device. Discussion If the intervention shows a significant effect on adherence and the devices are accepted, accurate and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes.

scholarly journals Azithromycin Reduction to Reach Elimination of Trachoma (ARRET): study protocol for a cluster randomized trial of stopping mass azithromycin distribution for trachoma

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Abdou Amza ◽  
Boubacar Kadri ◽  
Beido Nassirou ◽  
Ahmed M. Arzika ◽  
Ariana Austin ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Controlled Trial ◽  
Clinical Signs ◽  
Cluster Randomized Trial ◽  
World Health ◽  
Baseline Assessment ◽  
Randomized Controlled ◽  
Registration Number ◽  
Cluster Randomized ◽  
Health Organization

Abstract Background The World Health Organization (WHO) recommends annual mass azithromycin distribution until districts drop below 5% prevalence of trachomatous inflammation—follicular (TF). Districts with very low TF prevalence may have little or no transmission of the ocular strains of Chlamydia trachomatis that cause trachoma, and additional rounds of mass azithromycin distribution may not be useful. Here, we describe the protocol for a randomized controlled trial designed to evaluate whether mass azithromycin distribution can be stopped prior to the current WHO guidelines. Methods The Azithromycin Reduction to Reach Elimination of Trachoma (ARRET) study is a 1:1 community randomized non-inferiority trial designed to evaluate whether mass azithromycin distribution can be stopped in districts with baseline prevalence of TF under 20%. Communities in Maradi, Niger are randomized after baseline assessment either to continued annual mass azithromycin distribution or stopping annual azithromycin distribution over a 3-year period. We will compare the prevalence of ocular C. trachomatis (primary outcome), TF and other clinical signs of trachoma, and serologic markers of trachoma after 3 years. We hypothesize that stopping annual azithromycin distribution will be non-inferior to continued annual azithromycin distributions for all markers of trachoma prevalence and transmission. Discussion The results of this trial are anticipated to provide potentially guideline-changing evidence for when mass azithromycin distributions can be stopped in low TF prevalence areas. Trial registration number This study is registered at clinicaltrials.gov (NCT04185402). Registered December 4, 2019; prospectively registered pre-results.

scholarly journals Current practices of waste management in teaching hospitals and presence of incinerators in densely populated areas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Salma Khalid ◽  
Najibul Haq ◽  
Zia-ul-Ain Sabiha ◽  
Abdul Latif ◽  
Muhammad Amjad Khan ◽  
...  
Keyword(s):  
Waste Management ◽  
Care Facility ◽  
Health Care Facility ◽  
Waste Incineration ◽  
World Health ◽  
Teaching Hospitals ◽  
Operational Parameters ◽  
Hospital Waste ◽  
Private And Public ◽  
Health Organization

Abstract Background Hospital waste management (HWM) practices are the core need to run a proper health care facility. This study encompasses the HWM practices in teaching hospitals of Peshawar, Pakistan and examine the enforcement of Pak HWM (2005) rules and risks through transmission of pathogens via blood fluids, air pollution during waste incineration and injuries occurring in conjunction with open burning and dumping. Methods A questionnaire based on World Health Organization (WHO) recommendations was used to survey the selected private and public teaching hospital (n = 16). Site visits and personnel observations were also included in the data. It was spatio-statistically analyzed using descriptive statistics, Krushkal-wallis and Fisher’s exact tests. Results The findings revealed that the lack of HWM practices in all surveyed hospitals (p > 0.05), besides statistical difference (p < 0.017) in waste generation/day. No proper segregation of waste from generation point to final disposal was practiced. However, the performance of private teaching hospitals (50%) was found better in terms of HWM personnel and practices. In surveyed hospitals, only nine hospitals (56.3%) were found with the incinerator facility while rest of the hospitals (43.7%) practiced open dumping. Moreover, operational parameters of the incinerators were not found satisfactory and located in densely populated areas and emitting hazardous gases. Conclusion Proper HWM practices are not being followed in the light of WHO guidelines. Hospital waste impose serious menace to healthcare workers and to nearby population. WHO issued documents for improving HWM practices but triggered no change in Pakistan. To improve the situation, insights in this context is need for enforcement of rules.

scholarly journals Epidemiology of preoperative hyperglycaemia among patients undergoing surgery at a tertiary health care facility of Eastern India

2019 ◽  
Vol 6 (7) ◽  
pp. 2838
Author(s):  
Souvik Banerjee ◽  
Rakesh Kumar ◽  
Debasis Basu
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Overweight And Obesity ◽  
World Health ◽  
Surgical Patients ◽  
Care Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Health Organization

Background: With about 425 million patients globally and 72.9 million patients in India, diabetes mellitus (DM) is one of the global health emergency of 21st century. Perioperative hyperglycaemia is reported in 20-40% of patients undergoing general surgery. A substantial body of literature demonstrates a clear association between perioperative hyperglycaemia and adverse clinical outcomes. This study aims to find out the frequency of preoperative hyperglycaemia and factors influencing it among patients undergoing surgery at a tertiary health care hospital of Eastern India.Methods: This Institution based, cross-sectional, observational study was conducted among study subjects who were operated at IQ City Medical College and Multispecialty Hospital, Durgapur, India during January-February 2019. Relevant medical records were reviewed to collect data regarding clinic-social data. Estimation of fasting plasma glucose (FPG) has been done as per World Health Organization (WHO) guidelines. Hyperglycaemia was defined and classified as per American Diabetes Association (ADA). Anthropometric measurements were taken as per standard WHO protocols.Results: A total 158 study subjects participated in study. The mean age and mean FPG of the study subjects was 42.63±12.95 years and 103.3±17.37 mg/dl respectively. As per the ADA criteria, 58.9% had normal FPG, 24.0% had impaired fasting glucose (IFG) and 17.1% had diabetes. Out of total 27 T2DM patients, 22 (13.9%) were known cases of T2DM and 5 (3.2%) were undiagnosed. The frequency of preoperative hyperglycaemia i.e. sums of IFG and diabetes was found to be 41.1%. Increasing age, male gender and overweight and obesity significantly influenced the occurrence of preoperative hyperglycaemia.Conclusions: The prevalence of preoperative hyperglycaemia among patients undergoing surgery is higher than the prevalence of hyperglycaemia among non surgical patients. Routine HbA1C should be done in all surgical patients to differentiate between chronic undiagnosed hyperglycaemia and stress hyperglycaemia.

scholarly journals Insecticide resistance characteristic of Anopheles vector species successfully controlled by deployment of pyrethroid and PBO long lasting insecticidal treated nets (LLINs) in Tanzania

2021 ◽  
Author(s):  
Johnson Matowo ◽  
David Weetman ◽  
Patricia Pignatell ◽  
Alexandra Wright ◽  
Jacques Charlwood ◽  
...  
Keyword(s):  
Insecticide Resistance ◽  
Pyrethroid Resistance ◽  
Cluster Randomized Trial ◽  
World Health ◽  
Malaria Vectors ◽  
Metabolizing Enzymes ◽  
Sub Saharan ◽  
Underlying Mechanisms ◽  
Cluster Randomized ◽  
Health Organization

Long lasting insecticidal nets (LLINs) are a proven tool to reduce malaria transmission, but in Africa efficacy is being reduced by pyrethroid resistance in the major vectors. A cluster randomized trial in Muleba district, Tanzania demonstrated that permethrin LLINs co-treated with piperonyl butoxide (PBO), a synergist that can block pyrethroid-metabolizing enzymes in the mosquito, had much greater efficacy than pyrethroid-only nets. Insecticide resistance profiles and underlying mechanisms were investigated in Anopheles gambiae and An. funestus from Muleba during the trial. Diagnostic dose bioassays using permethrin, together with intensity assays, suggest pyrethroid resistance that is both strong and very common, but not extreme. Transcriptomic analysis found multiple P450 genes over expressed including CYP6M2, CYP6Z3, CYP6P3, CYP6P4, CYP6AA1 and CYP9K1 in An. gambiae and CYP6N1, CYP6M7, CYP6M1 and CYP6Z3 in An. funestus. Indeed, very similar suites of P450 enzymes commonly associated with resistant populations elsewhere in Africa were detected as over expressed suggesting a convergence of mechanisms across Sub-Saharan African malaria vectors. The findings give insight into factors that may correlate with pyrethroid PBO LLIN success, broadly supporting model predictions, but revision to guidelines previously issued by the World Health Organization is warranted.

scholarly journals Comparison of 3 Days Amoxicillin Versus 5 Days Co-Trimoxazole for Treatment of Fast-breathing Pneumonia by Community Health Workers in Children Aged 2–59 Months in Pakistan: A Cluster-randomized Trial

2018 ◽  
Vol 69 (3) ◽  
pp. 397-404
Author(s):  
Salim Sadruddin ◽  
Ibad ul Haque Khan ◽  
Matthew P Fox ◽  
Abdul Bari ◽  
Attaullah Khan ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Health Workers ◽  
Cluster Randomized Trial ◽  
Risk Difference ◽  
Community Level ◽  
World Health ◽  
Serious Adverse Events ◽  
Oral Amoxicillin ◽  
Cluster Randomized ◽  
Health Organization

Abstract Background Globally, most deaths due to childhood pneumonia occur at the community level. Some countries are still using oral co-trimoxazole, despite a World Health Organization recommendation of oral amoxicillin for the treatment of fast-breathing pneumonia in children at the community level. Methods We conducted an unblinded, cluster-randomized, controlled-equivalency trial in Haripur District, Pakistan. Children 2–59 months of age with fast-breathing pneumonia were treated with oral amoxicillin suspension (50 mg/kg/day) for 3 days in 14 intervention clusters and oral co-trimoxazole suspension (8 mg trimethoprim/kg and 40 mg sulfamethoxazole/kg/day) for 5 days in 14 control clusters by lady health workers (LHW). The primary outcome was treatment failure by day 4 for intervention clusters and by day 6 for control clusters. The analysis was per protocol. Results Out of the 15 749 cases enrolled in the study, 9153 cases in intervention and 6509 cases in control clusters were included in the analysis. Treatment failure rates were 3.6% (326) in intervention clusters and 9.1% (592) in control clusters. After adjusting for clustering, the risk of treatment failure was lower in intervention clusters (risk difference [RD] -5.5%, 95% confidence interval [CI] -7.4–-3.7%) than in control clusters. Children with incomplete adherence had a small increase in treatment failure versus those with complete adherence (RD 2.9%, 95% CI 1.6–4.1%). No deaths or serious adverse events occurred. Conclusions A 3-day course of oral amoxicillin, administered by LHWs, is an effective and safe treatment for fast-breathing pneumonia in children 2–59 months of age. A shorter course of amoxicillin improves adherence to therapy, is low in cost, and puts less pressure on antimicrobial resistance. Clinical Trials Registration ISRCTN10618300.

scholarly journals Feasibility Study of the World Health Organization Health Care Facility-Based Antimicrobial Stewardship Toolkit for Low- and Middle-Income Countries

Antibiotics ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. 556
Author(s):  
Gina Maki ◽  
Ingrid Smith ◽  
Sarah Paulin ◽  
Linda Kaljee ◽  
Watipaso Kasambara ◽  
...  
Keyword(s):  
Health Care ◽  
World Health Organization ◽  
Feasibility Study ◽  
Care Facility ◽  
Health Care Facility ◽  
World Health ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World ◽  
Health Organization

Antimicrobial stewardship (AMS) has emerged as a systematic approach to optimize antimicrobial use and reduce antimicrobial resistance. To support the implementation of AMS programs, the World Health Organization developed a draft toolkit for health care facility AMS programs in low- and middle-income countries. A feasibility study was conducted in Bhutan, the Federated States of Micronesia, Malawi, and Nepal to obtain local input on toolkit content and implementation of AMS programs. This descriptive qualitative study included semi-structured interviews with national- and facility-level stakeholders. Respondents identified AMS as a priority and perceived the draft toolkit as a much-needed document to further AMS program implementation. Facilitators for implementing AMS included strong national and facility leadership and clinical staff engagement. Barriers included lack of human and financial resources, inadequate regulations for prescription antibiotic sales, and insufficient AMS training. Action items for AMS implementation included improved laboratory surveillance, establishment of a stepwise approach for implementation, and mechanisms for reporting and feedback. Recommendations to improve the AMS toolkit’s content included additional guidance on defining the responsibilities of the committees and how to prioritize AMS programming based on local context. The AMS toolkit was perceived to be an important asset as countries and health care facilities move forward to implement AMS programs.

Simplifying the World Health Organization Protocol: 3 Steps Versus 6 Steps for Performance of Hand Hygiene in a Cluster-randomized Trial

2018 ◽  
Vol 69 (4) ◽  
pp. 614-620 ◽  
Author(s):  
Sarah Tschudin-Sutter ◽  
Daniel Sepulcri ◽  
Marc Dangel ◽  
Anja Ulrich ◽  
Reno Frei ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Randomized Trial ◽  
World Health Organization ◽  
Cluster Randomized Trial ◽  
Interquartile Range ◽  
World Health ◽  
Bacterial Colony ◽  
Bacterial Counts ◽  
Cluster Randomized ◽  
Health Organization

Abstract Background In an experimental setting, a simplified, 3-step hand hygiene technique for applying alcohol-based hand rub was non inferior in terms of reduction of bacterial counts, as compared to the conventional World Health Organization 6-step technique. We therefore compared compliance and microbiological efficacy between both hand hygiene techniques in routine clinical practice. Methods We performed a cluster-randomized trial from October–November 2015 at the University Hospital Basel, Switzerland: a tertiary, academic care center (ISRCTN45923734). We randomly assigned 12 wards to either the 3-step technique or the conventional 6-step technique of hand rubbing. The primary endpoints were compliance with the assigned technique and reduction of bacterial counts on the hands of health-care workers. Results Overall, 2923 hand hygiene indications were observed, and compliance was 70.7% (2066/2923). Compliance with technique and indications was 51.7% (595/1151) and 75.9% (1151/1516) on wards assigned to the 3-step technique, respectively, as compared to 12.7% (116/915) and 65.0% (915/1407) on wards assigned to the 6-step technique (P < .001). The reduction factor (RF) of bacterial colony counts did not differ between techniques (median RF 0.97 log10 colony-forming units [CFU] [interquartile range 0.39–1.59] for the 3-step technique vs median RF 1.04 log10 CFU [interquartile range 0.49–1.52] for the 6-step technique; P = .629). Conclusions In a clinical setting, the simpler hand hygiene technique, consisting of 3 steps, resulted in higher compliance with both hand hygiene indications and technique, as compared to the 6 steps. As the results of the microbiological analyses exclude inferiority, the conventional 6 steps could be safely replaced by a simpler hand hygiene technique. Clinical Trials Registration ISRCTN45923734.

scholarly journals A descriptive analysis of antimicrobial resistance patterns of WHO priority pathogens isolated in children from a tertiary care hospital in India

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Vijayalaxmi V. Mogasale ◽  
Prakash Saldanha ◽  
Vidya Pai ◽  
P. D. Rekha ◽  
Vittal Mogasale
Keyword(s):  
Antimicrobial Resistance ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Care Facility ◽  
Health Care Facility ◽  
World Health ◽  
Care Hospital ◽  
E Coli ◽  
Resistance Patterns ◽  
Health Organization

AbstractThe World Health Organization (WHO) has articulated a priority pathogens list (PPL) to provide strategic direction to research and develop new antimicrobials. Antimicrobial resistance (AMR) patterns of WHO PPL in a tertiary health care facility in Southern India were explored to understand the local priority pathogens. Culture reports of laboratory specimens collected between 1st January 2014 and 31st October 2019 from paediatric patients were extracted. The antimicrobial susceptibility patterns for selected antimicrobials on the WHO PPL were analysed and reported. Of 12,256 culture specimens screened, 2335 (19%) showed culture positivity, of which 1556 (66.6%) were organisms from the WHO-PPL. E. coli was the most common organism isolated (37%), followed by Staphylococcus aureus (16%). Total of 72% of E. coli were extended-spectrum beta-lactamases (ESBL) producers, 55% of Enterobacteriaceae were resistant to 3rd generation cephalosporins due to ESBL, and 53% of Staph. aureus were Methicillin-resistant. The analysis showed AMR trends and prevalence patterns in the study setting and the WHO-PPL document are not fully comparable. This kind of local priority difference needs to be recognised in local policies and practices.

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