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Search Results: 1 - 10 of 200483 matches for " P. Borus "
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The Epidemiology of Smear Positive Tuberculosis in Three TB/HIV High Burden Provinces of Kenya (2003–2009)
J. Sitienei,V. Nyambati,P. Borus
Epidemiology Research International , 2013, DOI: 10.1155/2013/417038
Abstract: Interest in epidemiology of tuberculosis in Sub-Sahara Africa has been activated by its reemergence in the mid-1990s because HIV and poverty have created a lethal combination that propagates TB transmission. Three provinces of Kenya that collectively contribute to about 56% of TB cases notified in Kenya were included in the study. Data for smear positive TB and TB HIV was extracted from existing database between 2003 and 2009. Data was analyzed to produce trends for each of the provinces, and descriptive statistics were calculated. To deduce existence of differences in gender, provinces, and years, analysis of variance was carried out with values and confidence intervals generated. There were more males (56%) than females affected by TB, but more females with dual infection. Females have a bimodal peak in age groups 15–24 and 25–34, while males have one peak age group at 15–24. The rate of decline for males was higher than for females. Significant differences were found in gender ( ), year ( ), and rate of HIV positivity across the provinces ( ). Declining trend in cases is attributed to effects of integrating TB and HIV services and therefore programs need to address barriers to integrate care. 1. Background Interest in the epidemiology of tuberculosis (TB) has recently been activated worldwide by its reemergence especially in Sub-Sahara Africa where the highest case notification rates have been reported. In 2010, Africa contributed 26% of the global burden with nine out of the 22 high burden countries contributing 81% of the global burden coming from Africa. During this time, Kenya was ranked position 10 amongst the high burden countries [1]. From mid-1980s, Sub-Saharan Africa experienced an upsurge in TB cases notified with the upsurge of incident cases being attributed primarily to HIV [2–4]. These countries are low income countries where HIV and poverty have created a lethal combination that propagates TB transmission [5]. Although it is challenging to accurately measure, much of the recorded increase may have actually reflected real changes in the incidence of tuberculosis in the community. Kenya had an average 10% increase in incident TB cases over the last decade before signs of decline began to be seen. The increase is likely to be due to several factors which have been influencing tuberculosis trends for many years. However, the main reason for the increase in tuberculosis has largely been attributed to HIV epidemic and to the growth of poverty in urban settings [6, 7]. Over the years, TB disease seems to be getting more urbanized with time
Intervening on Conflict, Parental Bonds, and Sexual Risk Acts among Adolescent Children of Mothers Living with HIV
Mary Jane Rotheram-Borus, Judith A. Stein, Eric Rice
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0101874
Abstract: Objective In 1993–1994, a psychosocial intervention conducted in New York City significantly improved outcomes for parents living with HIV and their adolescent children over six years. We examine if the intervention benefits are similar for adolescents of mothers living with HIV (MLH) in 2004–2005 in Los Angeles when MLH’s survival had increased substantially. Methods Adolescents of MLH in Los Angeles (N = 256) aged 12–20 years old were randomized with their MLH to either: 1) a standard care condition (n = 120 adolescent-MLH dyads); or 2) an intervention condition consisting of small group activities to build coping skills (n = 136 adolescent-MLH dyads, 78% attended the intervention). At 18 months, 94.7% of adolescents were reassessed. Longitudinal structural equation modeling examined if intervention participation impacted adolescents’ relationships with parents and their sexual risk behaviors. Results Compared to the standard care, adolescents in the intervention condition reported significantly more positive family bonds 18 months later. Greater participation by MLH predicted fewer family conflicts, and was indirectly associated with less adolescent sexual risk behavior at the 18 month follow-up assessment. Anticipated developmental patterns were observed - sexual risk acts increased with age. Reports were also consistent with anticipated gender roles; girls reported better bonds with their mothers at 18 months, compared to boys. Conclusions Adolescents of MLH have better bonds with their mothers as a function of participating in a coping skills intervention and reduced sexual risk-taking as a function of MLH intervention involvement.
Rubella seroprevalence among primary and pre- primary school pupils at Moi's Bridge location, Uasin Gishu District, Kenya
Janeth J Kombich, Paul C Muchai, Peter Tukei, Peter K Borus
BMC Public Health , 2009, DOI: 10.1186/1471-2458-9-269
Abstract: Subjects of the study were 498 pupils from seven primary schools aged 4–20 years. Questionnaire surveys with blood sampling were conducted between January to July 2005. Samples were tested for rubella specific IgG antibody using ELISA test kit (Enzygnost? Behring, Germany).Overall, rubella seropositivity rate was 80% and it increased with age from 59% (among ages 4–6 years) to 94% (ages 14–20 years). Multivariate logistic regression analysis model, showed that age of child and ownership of a television set which is a proxy measure of socio-economic status of family were significantly associated with rubella seropositivity. The odds of rubella seropositivity in a child older than 13 years was more than that in children younger than 7 years (OR = 3.8 95% CI 2.56–5.78). The odds of rubella seropositivity in a child whose family did not own a television set was 3 times higher than that of child whose family owned a set (OR 3.06, 95% CI 1.17–7.97).The study provides important and highly useful information on rubella age specific seroprevalence rates in Kenya. Advancing age was found to be associated with increased risk of rubella. Low socio-economic factors suggest an increased risk of infection in certain categories of society, and control measures need to target this. Overall, the findings can also be used by policy makers to model introduction of routine rubella vaccination in the country and also other developing countries facing similar challenges. More than half of the children got infected in pre-primary and efforts to control rubella should target pre-school children. These data provides pre-vaccination information that can be used to guide immunization strategy as well as to determine success of an immunization programme.Debate on whether or not to introduce rubella vaccination has continued to mount in many countries. While the vaccine is widely used in the developed countries, there are concerns about safety in countries with limited resources [1]. Rubella inf
Value of a mobile information system to improve quality of care by community health workers
Mark Tomlinson,Mary Jane Rotheram-Borus,Tanya Doherty,Dallas Swendeman
South African Journal of Information Management , 2013, DOI: http://dx.doi.org/10.4102/sajim.v15i1.528
Abstract: Background: We will be unable to achieve sustained impact on health outcomes with community health worker (CHW)-based interventions unless we bridge the gap between small scale efficacy studies and large scale interventions. Effective strategies to support the management of CHWs are central to bridging the gap. Mobile phones are broadly available, particularly in low and middle income countries (LAMIC), where the penetration rate approaches 100%.Objectives: In this article, we describe how mobile phones and may be combined with mobile web-based technology to assist in the management of CHWs in two projects in South Africa.Methods: This article is a descriptive study, drawing lessons from two randomised controlled trials outlining how a mobile phone information system can be utilised to enhance the quality of health interventions. We organised our comprehensive management and supervision system around a previously published management framework. The system is composed of mobile phones utilised by CHWs and a web-based interface utilised by CHW supervisors. Computerised algorithms were designed with intervention and assessment protocols to aid in the real-time supervision and management of CHWs.Results: Community health workers used mobile phones to initiate intervention visits and trigger content to be delivered during the course of intervention visits. Supervisors used the web-based interface for real-time monitoring of the location, timing and content of intervention visits. Additional real-time support was provided through direct support calls in the event of crises in the field.Conclusion: Mobile phone-based information system platforms offer significant opportunities to improve CHW-delivered interventions. The extent to which these efficiency gains can be translated into realised health gains for communities is yet to be tested.
Standardized Functions for Smartphone Applications: Examples from Maternal and Child Health
Mary Jane Rotheram-Borus,Mark Tomlinson,Dallas Swendeman,Adabel Lee
International Journal of Telemedicine and Applications , 2012, DOI: 10.1155/2012/973237
Abstract:
Scaling Up mHealth: Where Is the Evidence?
Mark Tomlinson ,Mary Jane Rotheram-Borus,Leslie Swartz,Alexander C. Tsai
PLOS Medicine , 2013, DOI: 10.1371/journal.pmed.1001382
Abstract:
Standardized Functions for Smartphone Applications: Examples from Maternal and Child Health
Mary Jane Rotheram-Borus,Mark Tomlinson,Dallas Swendeman,Adabel Lee,Erynne Jones
International Journal of Telemedicine and Applications , 2012, DOI: 10.1155/2012/973237
Abstract: Millennium Development Goals (MDGs) are unlikely to be met in most low- and middle-income countries (LMIC). Smartphones and smartphone proxy systems using simpler phones, equipped with the capabilities to identify location/time and link to the web, are increasingly available and likely to provide an excellent platform to support healthcare self-management, delivery, quality, and supervision. Smart phones allow information to be delivered by voice, texts, pictures, and videos as well as be triggered by location and date. Prompts and reminders, as well as real-time monitoring, can improve quality of health care. We propose a three-tier model for designing platforms for both professional and paraprofessional health providers and families: (1) foundational functions (informing, training, monitoring, shaping, supporting, and linking to care); (2) content-specific targets (e.g., for MDG; developmentally related tasks); (3) local cultural adaptations (e.g., language). We utilize the Maternal and Child Health (MCH) MDG in order to demonstrate how the existing literature can be organized and leveraged on open-source platforms and provide examples using our own experience in Africa over the last 8 years. 1. Introduction The Millennium Development Goals (MDGs) of the World Health Organization (WHO) are unlikely to be met in most low- and middle-income countries (LMIC) [1, 2]. The rapid diffusion of mobile technologies over the last 10 years [3] creates opportunities for mobile phones to significantly contribute to achieving MDGs. LMIC have bypassed heavy investment in land-line infrastructure and focused instead on wireless mobile phone infrastructure. Mobile phones can be used by providers (physicians, nurses, administrators, lab technicians, or community health workers (CHW)) in hospitals, clinics, or on home visits for surveillance, monitoring health status, and easing emergency situations. For example, several studies show that training CHWs in rural areas via mobile phones can improve health conditions and alleviate financial burdens on understaffed hospitals [4, 5]. Concurrently, mobile phones may improve patients’ access, quality, and utilization of care, as well as allow patients to receive health information, skills, support, and crisis services directly for a specific health condition. A standardized platform model could help mobile designers to leverage their individual applications to address MDGs—rather than replicating a common pattern of siloed or categorical mobile applications—that integrate programming for common functions and specific
Intimate Partner Violence and Depression Symptom Severity among South African Women during Pregnancy and Postpartum: Population-Based Prospective Cohort Study
Alexander C. Tsai?,Mark Tomlinson?,W. Scott Comulada?,Mary Jane Rotheram-Borus
PLOS Medicine , 2016, DOI: 10.1371/journal.pmed.1001943
Abstract: Background Violence against women by intimate partners remains unacceptably common worldwide. The evidence base for the assumed psychological impacts of intimate partner violence (IPV) is derived primarily from studies conducted in high-income countries. A recently published systematic review identified 13 studies linking IPV to incident depression, none of which were conducted in sub-Saharan Africa. To address this gap in the literature, we analyzed longitudinal data collected during the course of a 3-y cluster-randomized trial with the aim of estimating the association between IPV and depression symptom severity. Methods and Findings We conducted a secondary analysis of population-based, longitudinal data collected from 1,238 pregnant women during a 3-y cluster-randomized trial of a home visiting intervention in Cape Town, South Africa. Surveys were conducted at baseline, 6 mo, 18 mo, and 36 mo (85% retention). The primary explanatory variable of interest was exposure to four types of physical IPV in the past year. Depression symptom severity was measured using the Xhosa version of the ten-item Edinburgh Postnatal Depression Scale. In a pooled cross-sectional multivariable regression model adjusting for potentially confounding time-fixed and time-varying covariates, lagged IPV intensity had a statistically significant association with depression symptom severity (regression coefficient b = 1.04; 95% CI, 0.61–1.47), with estimates from a quantile regression model showing greater adverse impacts at the upper end of the conditional depression distribution. Fitting a fixed effects regression model accounting for all time-invariant confounding (e.g., history of childhood sexual abuse) yielded similar findings (b = 1.54; 95% CI, 1.13–1.96). The magnitudes of the coefficients indicated that a one–standard-deviation increase in IPV intensity was associated with a 12.3% relative increase in depression symptom severity over the same time period. The most important limitations of our study include exposure assessment that lacked measurement of sexual violence, which could have caused us to underestimate the severity of exposure; the extended latency period in the lagged analysis, which could have caused us to underestimate the strength of the association; and outcome assessment that was limited to the use of a screening instrument for depression symptom severity. Conclusions In this secondary analysis of data from a population-based, 3-y cluster-randomized controlled trial, IPV had a statistically significant association with depression symptom severity. The
Depressed mood in pregnancy: Prevalence and correlates in two Cape Town peri-urban settlements
Mary Hartley, Mark Tomlinson, Erin Greco, W Scott Comulada, Jacqueline Stewart, Ingrid le Roux, Nokwanele Mbewu, Mary Jane Rotheram-Borus
Reproductive Health , 2011, DOI: 10.1186/1742-4755-8-9
Abstract: This study reports on baseline data collected from the Philani Mentor Mothers Project (PMMP), a community-based, cluster-randomized controlled trial on the outskirts of Cape Town, South Africa. The PMMP aims to evaluate the effectiveness of a home-based intervention for preventing and managing illnesses related to HIV, TB, alcohol use and malnutrition in pregnant mothers and their infants. Participants were 1062 pregnant women from Khayelitsha and Mfuleni, Cape Town. Measures included the Edinburgh Postnatal Depression Scale (EPDS), the Derived AUDIT-C, indices for social support with regards to partner and parents, and questions concerning socio-demographics, intimate partner violence, and the current pregnancy. Data were analysed using bivariate analyses followed by logistic regression.Depressed mood in pregnancy was reported by 39% of mothers. The strongest predictors of depressed mood were lack of partner support, intimate partner violence, having a household income below R2000 per month, and younger age.The high prevalence of depressed mood in pregnancy necessitates early screening and intervention in primary health care and antenatal settings for depression. The effectiveness and scalability of community-based interventions for maternal depression must be developed for pregnant women in peri-urban settlements.ClinicalTrials.gov: NCT00972699.Depression is a leading cause of disability worldwide [1]. Despite its high prevalence and known correlation with poverty [2], data for low and middle income (LAMI) countries is limited. Mental health is neglected in the national policies of many LAMI countries [3], and is of critical public health significance because of its intergenerational impact on infants and children as a result of its impact on disease burden and child health. Regardless of income, postnatal depression negatively affects child development and the mother-infant relationship [4,5]. In LAMI countries, it is also associated with poor child growth [6,7];
Home visits by neighborhood Mentor Mothers provide timely recovery from childhood malnutrition in South Africa: results from a randomized controlled trial
Ingrid M le Roux, Karl le Roux, W Scott Comulada, Erin M Greco, Katherine A Desmond, Nokwanele Mbewu, Mary Rotheram-Borus
Nutrition Journal , 2010, DOI: 10.1186/1475-2891-9-56
Abstract: Mentor Mothers were trained to conduct home visits. Mentor Mothers went from house to house in assigned neighborhoods, weighed children age 5 and younger, and recruited mother-child dyads where there was an underweight child. Participating dyads were assigned in a 2:1 random sequence to the Philani intervention condition (n = 536) or a control condition (n = 252). Mentor Mothers visited dyads in the intervention condition for one year, supporting mothers' problem-solving around nutrition. All children were weighed by Mentor Mothers at baseline and three, six, nine and twelve month follow-ups.By three months, children in the intervention condition were five times more likely to rehabilitate (reach a healthy weight for their ages) than children in the control condition. Throughout the course of the study, 43% (n = 233 of 536) of children in the intervention condition were rehabilitated while 31% (n = 78 of 252) of children in the control condition were rehabilitated.Paraprofessional Mentor Mothers are an effective strategy for delivering home visiting programs by providing the knowledge and support necessary to change the behavior of families at risk.Childhood malnutrition is a serious global problem, causing the deaths of 3.5 million children under 5 years old each year, as well as over a third of the disease burden in this age group [1]. Over one fifth of all children worldwide are underweight [1]. Globally, childhood malnutrition declined somewhat during the 1990's; however, the prevalence of undernourished children in Africa actually increased during that time [2]. In South Africa, 7% of children under 5 die each year; and 12% of under-5 children are underweight; 5% of South African children less than 5 years old suffer from wasting (low weight for height), and over a quarter of under-5 children suffer from stunting (low height for age) [3].The cascading effects of childhood malnutrition include diminished immune functioning; which leads to greater susceptibility
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