Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence

1. J Urban Health. 2011 Jun 29. [Epub ahead of print]

Monitoring of Health and Demographic Outcomes in Poor Urban Settlements: Evidence

from the Nairobi Urban Health and Demographic Surveillance System.

Emina J, Beguy D, Zulu EM, Ezeh AC, Muindi K, Elung'ata P, Otsola JK, Yé Y.

African Population and Health Research Center (APHRC), Shelter Afrique Center,

Longonot Road, Nairobi, Kenya, .

The Nairobi Urban Health and Demographic Surveillance System (NUHDSS) was set up

in Korogocho and Viwandani slum settlements to provide a platform for

investigating linkages between urban poverty, health, and demographic and other

socioeconomic outcomes, and to facilitate the evaluation of interventions to

improve the wellbeing of the urban poor. Data from the NUHDSS confirm the high

level of population mobility in slum settlements, and also demonstrate that slum

settlements are long-term homes for many people. Research and intervention

programs should take account of the duality of slum residency. Consistent with

the trends observed countrywide, the data show substantial improvements in

measures of child mortality, while there has been limited decline in fertility in

slum settlements. The NUHDSS experience has shown that it is feasible to set up

and implement long-term health and demographic surveillance system in urban slum

settlements and to generate vital data for guiding policy and actions aimed at

improving the wellbeing of the urban poor.

PMID: 21713553 [PubMed - as supplied by publisher]

2. PLoS One. 2011;6(6):e21040. Epub 2011 Jun 21.

Population-based biochemistry, immunologic and hematological reference values for

adolescents and young adults in a rural population in Western kenya.

Zeh C, Amornkul PN, Inzaule S, Ondoa P, Oyaro B, Mwaengo DM, Vandenhoudt H,

Gichangi A, Williamson J, Thomas T, Decock KM, Hart C, Nkengasong J, Laserson K.

U.S. Centers for Disease Control and Prevention (CDC-Kenya), Kisumu, Kenya.

BACKGROUND: There is need for locally-derived age-specific clinical laboratory

reference ranges of healthy Africans in sub-Saharan Africa. Reference values from

North American and European populations are being used for African subjects

despite previous studies showing significant differences. Our aim was to

establish clinical laboratory reference values for African adolescents and young

adults that can be used in clinical trials and for patient management.

METHODS AND FINDINGS: A panel of 298, HIV-seronegative individuals aged 13-34

years was randomly selected from participants in two population-based

cross-sectional surveys assessing HIV prevalence and other sexually transmitted

infections in western Kenya. The adolescent (<18 years)-to-adults (≥18 years)

ratio and the male-to-female ratio was 1∶1. Median and 95% reference ranges were

calculated for immunohematological and biochemistry values. Compared with

U.S-derived reference ranges, we detected lower hemoglobin (HB), hematocrit

(HCT), red blood cells (RBC), mean corpuscular volume (MCV), neutrophil, glucose,

and blood urea nitrogen values but elevated eosinophil and total bilirubin

values. Significant gender variation was observed in hematological parameters in

addition to T-bilirubin and creatinine indices in all age groups, AST in the

younger and neutrophil, platelet and CD4 indices among the older age group. Age

variation was also observed, mainly in hematological parameters among males.

Applying U.S. NIH Division of AIDS (DAIDS) toxicity grading to our results, 40%

of otherwise healthy study participants were classified as having an abnormal

laboratory parameter (grade 1-4) which would exclude them from participating in

clinical trials.

CONCLUSION: Hematological and biochemistry reference values from African

population differ from those derived from a North American population, showing

the need to develop region-specific reference values. Our data also show

variations in hematological indices between adolescent and adult males which

should be considered when developing reference ranges. This study provides the

first locally-derived clinical laboratory reference ranges for adolescents and

young adults in western Kenya.

PMID: 21713038 [PubMed - in process]

3. J Acquir Immune Defic Syndr. 2011 Jun 18. [Epub ahead of print]

Unnecessary antiretroviral treatment switches and accumulation of HIV resistance

mutations; two arguments for viral load monitoring in Africa.

Sigaloff KC, Hamers RL, Wallis CL, Kityo C, Siwale M, Ive P, Botes ME, Mandaliya

K, Wellington M, Osibogun A, Stevens WS, Vugt MV, Wit TF; for the PharmAccess

African Studies to Evaluate Resistance (PASER).

1PharmAccess Foundation, Amsterdam, The Netherlands; 2 Department of Global

Health, Academic Medical Center of the University of Amsterdam, Amsterdam

Institute for Global Health and Development, Amsterdam, The Netherlands;

3University of the Witwatersrand, Johannesburg, South Africa; 4Joint Clinical

Research Centre, Kampala, Uganda; 5Lusaka Trust Hospital, Lusaka, Zambia;

6Muelmed Hospital, Pretoria, South Africa; 7Coast Province General Hospital,

International Center for Reproductive Health, Mombasa, Kenya; 8Newlands Clinic,

Harare, Zimbabwe; 9Lagos University Teaching Hospital, Lagos, Nigeria.

OBJECTIVES:: This study aimed to investigate the consequences of using

clinico-immunological criteria to detect antiretroviral treatment (ART) failure

and guide regimen switches in HIV-infected adults in sub-Saharan Africa.

Frequencies of unnecessary switches, patterns of HIV drug resistance and risk

factors for the accumulation of nucleoside reverse transcriptase inhibitor

(NRTI)-associated mutations were evaluated. METHODS:: Cross-sectional analysis of

adults switching ART regimens at 13 clinical sites in 6 African countries was

performed. Two types of failure identification were compared: diagnosis of

clinico-immunological failure without viral load testing ("CIF only") or

clinico-immunological failure with local targeted viral load testing ("targeted

VL"). After study enrolment, reference HIV-RNA and genotype were determined

retrospectively. Logistic regression assessed factors associated with multiple

thymidine analogue mutations (TAMs) and NRTI cross-resistance (≥2 TAMs or Q151M

or K65R/K70E). RESULTS:: Of 250 patients with CIF switching to second-line ART,

targeted VL was performed in 186. Unnecessary switch at reference HIV-RNA <1000

copies/ml occurred in 46.9% of CIF only patients versus 12.4% of patients with

targeted VL (p<0.001). NRTI cross-resistance was observed in 48.0% of 183

specimens available for genotypic analysis, comprising ≥2 TAMs (37.7%), K65R

(7.1%), K70E (3.3%) or Q151M (3.3%). The presence of NRTI cross-resistance was

associated with the duration of ART exposure and zidovudine use. CONCLUSIONS::

Clinico-immunological monitoring without viral load testing resulted in frequent

unnecessary regimen switches. Prolonged treatment failure was indicated by

extensive NRTI cross-resistance. Access to virological monitoring should be

expanded to prevent inappropriate switches, enable early failure detection and

preserve second-line treatment options in Africa.

PMID: 21694603 [PubMed - as supplied by publisher]

4. Health Res Policy Syst. 2011 Jun 16;9 Suppl 1:S7.

Engaging media in communicating research on sexual and reproductive health and

rights in sub-Saharan Africa: experiences and lessons learned.

Oronje RN, Undie CC, Zulu EM, Crichton J.

Institute of Development Studies, at the University of Sussex, Brighton, BN1 9RE,

UK. .

BACKGROUND: The mass media have excellent potential to promote good sexual and

reproductive health outcomes, but around the world, media often fail to

prioritize sexual and reproductive health and rights issues or report them in an

accurate manner. In sub-Saharan Africa media coverage of reproductive health

issues is poor due to the weak capacity and motivation for reporting these issues

by media practitioners. This paper describes the experiences of the African

Population and Health Research Center and its partners in cultivating the

interest and building the capacity of the media in evidence-based reporting of

reproductive health issues in sub-Saharan Africa.

METHODS: The paper utilizes a case study approach based primarily on the personal

experiences and reflections of the authors (who played a central role in

developing and implementing the Center's communication and policy engagement

strategies), a survey that the Center carried out with science journalists in

Kenya, and literature review.

RESULTS: The African Population and Health Research Center's media strategy

evolved over the years, moving beyond conventional ways of communicating research

through the media via news releases and newspaper stories, to varying approaches

that sought to inspire and build the capacity of journalists to do evidence-based

reporting of reproductive health issues. Specifically, the approach included 1)

enhancing journalists' interest in and motivation for reporting on reproductive

health issues through training and competitive grants for outstanding reporting ;

2) building the capacity of journalists to report reproductive health research

and the capacity of reproductive health researchers to communicate their research

to media through training for both parties and providing technical assistance to

journalists in obtaining and interpreting evidence; and 3) establishing and

maintaining trust and mutual relationships between journalists and researchers

through regular informal meetings between journalists and researchers, organizing

field visits for journalists, and building formal partnerships with professional

media associations and individual journalists.

CONCLUSION: Our experiences and reflections, and the experiences of others

reviewed in this paper, indicate that a sustained mix of strategies that

motivate, strengthen capacity of, and build relationships between journalists and

researchers can be effective in enhancing quality and quantity of media coverage

of research.

PMCID: PMC3121138

PMID: 21679388 [PubMed - in process]

5. Health Res Policy Syst. 2011 Jun 16;9 Suppl 1:S2.

Strengthening the research to policy and practice interface: exploring strategies

used by research organisations working on sexual and reproductive health and

HIV/AIDS.

Theobald S, Tulloch O, Crichton J, Hawkins K, Zulu E, Mayaud P, Parkhurst J,

Whiteside A, Standing H.

International Health Research Group, Liverpool School of Tropical Medicine,

Pembroke Place, Liverpool, L3 5QA, UK. .

This commentary introduces the HARPS supplement on getting research into policy

and practice in sexual and reproductive health (SRH). The papers in this

supplement have been produced by the Sexual Health and HIV Evidence into Practice

(SHHEP) collaboration of international research, practitioner and advocacy

organizations based in research programmes funded by the UK Department for

International Development.The commentary describes the increasing interest from

research and communication practitioners, policy makers and funders in expanding

the impact of research on policy and practice. It notes the need for contextually

embedded understanding of ways to engage multiple stakeholders in the

politicized, sensitive and often contested arenas of sexual and reproductive

health. The commentary then introduces the papers under their respective themes:

(1) The theory and practice of research engagement (two global papers); (2)

Applying policy analysis to explore the role of research evidence in SRH and

HIV/AIDS policy (two papers with examples from Ghana, Malawi, Uganda and Zambia);

(3) Strategies and methodologies for engagement (five papers on Kenya, South

Africa, Ghana, Tanzania and Swaziland respectively); (4) Advocacy and engagement

to influence attitudes on controversial elements of sexual health (two papers,

Bangladesh and global); and (5) Institutional approaches to inter-sectoral

engagement for action and strengthening research communications (two papers,

Ghana and global).The papers illustrate the many forms research impact can take

in the field of sexual and reproductive health. This includes discursive changes

through carving out legitimate spaces for public debate; content changes such as

contributing to changing laws and practices, procedural changes such as

influencing how data on SRH are collected, and behavioural changes through

partnerships with civil society actors such as advocacy groups and

journalists.The contributions to this supplement provide a body of critical

analysis of communication and engagement strategies across the spectrum of SRH

and HIV/AIDS research through the testing of different models for the

research-to-policy interface. They provide new insights on how researchers and

communication specialists can respond to changing policy climates to create

windows of opportunity for influence.

PMCID: PMC3121133

PMID: 21679383 [PubMed - in process]

6. BMC Public Health. 2011 Jun 9;11(1):456. [Epub ahead of print]

Do improvements in outreach, clinical, and family and community-based services

predict improvements in child survival? An analysis of serial cross-sectional

national surveys.

Binkin N, Chopra M, Simen-Kapeu A, Westhof D.

ABSTRACT: BACKGROUND: There are three main service delivery channels: clinical,

outreach, and family and community. To determine which delivery channels are

associated with the greatest reductions in under-5 mortality rates (U5MR), we

used data from sequential population-based surveys to examine the correlation

between changes in coverage of clinical, outreach, and family and community

services and in U5MR for 27 high-burden countries. METHODS: Household survey data

were abstracted from serial surveys in 27 countries. Average annual changes (AAC)

between the most recent and penultimate survey were calculated for under-five

mortality rates and for 22 variables in the domains of clinical, outreach, and

family- and community-based services. For all 27 countries and a subset of 19

African countries, we conducted principal component analysis to reduce the

variables into a few components in each domain and applied linear regression to

assess the correlation between changes in the principal components and changes in

under-five mortality rates after controlling for multiple potential confounding

factors RESULTS: AAC in under 5-mortality varied from 6.6% in Nepal to -0.9% in

Kenya, with six of the 19 African countries all experiencing less than a 1%

decline in mortality. The strongest correlation with reductions in U5MR was

observed for access to clinical services (all countries: p=0.02, r2=0.58; 19

African countries p< 0.001, r2=0.67). For outreach activities, AAC U5MR was

significantly correlated with antenatal care and family planning services, while

AAC in immunization services showed no association. In the family- and community

services domain, improvements in breastfeeding were associated with significant

changes in mortality in the 30 countries but not in the African subset, while in

the African countries nutritional status improvements were associated with a

significant decline in mortality. CONCLUSIONS: Our findings support the

importance of increasing access to clinical services, certain outreach services

and breastfeeding and, in Africa, of improving nutritional status. Integrated

programs that emphasize these services may lead to substantial mortality

declines.

PMID: 21658267 [PubMed - as supplied by publisher]

7. Int J Gynaecol Obstet. 2011 May 25. [Epub ahead of print]

Building capacity for cervical cancer screening in outpatient HIV clinics in the

Nyanza province of western Kenya.

Huchko MJ, Bukusi EA, Cohen CR.

Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for

Global Reproductive Health, University of California, San Francisco, USA.

OBJECTIVE: To evaluate outcomes of cervical cancer screening within HIV care and

treatment clinics in Kenya. METHODS: Beginning in October 2007, visual inspection

with acetic acid (VIA), colposcopy, and loop electrosurgical excision procedure

(LEEP) were added to the clinical services offered at Family AIDS Care and

Education Services (FACES) clinics in Kisumu, Kenya, after a systematic campaign

to build capacity and community awareness. RESULTS: From October 2007 to October

2010, 3642 women underwent VIA as part of routine HIV care. Cervical

intraepithelial neoplasia 2/3 was identified in 259 (7.1%) women, who were

offered excisional treatment by LEEP in the clinic. Among those women offered

screening, uptake was 87%. Clinical staff reported a high level of satisfaction

with training for and implementation of cervical cancer screening strategies.

CONCLUSION: Cervical cancer screening and prevention are feasible, acceptable,

and effective within HIV care and treatment clinics. Screening test performance

characteristics need to be defined for an HIV-positive population to determine

the cost/benefit ratio of lower cost strategies that will ultimately be necessary

to provide universal access to cervical cancer screening in low-resource

settings.

PMID: 21620403 [PubMed - as supplied by publisher]

8. BMC Public Health. 2011 May 26;11:396.

Patterns and determinants of breastfeeding and complementary feeding practices in

urban informal settlements, Nairobi Kenya.

Kimani-Murage EW, Madise NJ, Fotso JC, Kyobutungi C, Mutua MK, Gitau TM, Yatich

N.

African Population and Health Research Center (APHRC), Nairobi, Kenya.

.

ABSTRACT:BACKGROUND: The World Health Organisation (WHO) recommends exclusive

breastfeeding during the first six months of life for optimal growth, development

and health. Breastfeeding should continue up to two years or more and

nutritionally adequate, safe, and appropriately-fed complementary foods should be

introduced at the age of six months to meet the evolving needs of the growing

infant. Little evidence exists on breastfeeding and infant feeding practices in

urban slums in sub-Saharan Africa. Our aim was to assess breastfeeding and infant

feeding practices in Nairobi slums with reference to WHO recommendations.

METHODS: Data from a longitudinal study conducted in two Nairobi slums are used.

The study used information on the first year of life of 4299 children born

between September 2006 and January 2010. All women who gave birth during this

period were interviewed on breastfeeding and complementary feeding practices at

recruitment and this information was updated twice, at four-monthly intervals.

Cox proportional hazard analysis was used to determine factors associated with

cessation of breastfeeding in infancy and early introduction of complementary

foods.

RESULTS: There was universal breastfeeding with almost all children (99%) having

ever been breastfed. However, more than a third (37%) were not breastfed in the

first hour following delivery, and 40% were given something to drink other than

the mothers' breast milk within 3 days after delivery. About 85% of infants were

still breastfeeding by the end of the 11th month. Exclusive breastfeeding for the

first six months was rare as only about 2% of infants were exclusively breastfed

for six months. Factors associated with sub-optimal infant breastfeeding and

feeding practices in these settings include child's sex; perceived size at birth;

mother's marital status, ethnicity; education level; family planning (pregnancy