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Community health workers: emerging from the shadows?

Sáb, 08/04/2017 - 19:07
Publication date: May 2017
Source:The Lancet Global Health, Volume 5, Issue 5

Author(s): The Lancet Global Health







Categorías: Investigaciones

The strategic geographies of global health partnerships

Vie, 07/04/2017 - 19:01
Publication date: May 2017
Source:Health & Place, Volume 45

Author(s): Clare Herrick

Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the "global" endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need.





Categorías: Investigaciones

Changing health care provider performance through measurement

Vie, 07/04/2017 - 19:01
Publication date: May 2017
Source:Social Science & Medicine, Volume 181

Author(s): Kenneth L. Leonard, Melkiory C. Masatu

Can the quality of care be improved by repeated measurement? We show that measuring protocol adherence repeatedly over ten weeks leads to significant improvements in quality immediately and up to 18 months later without any additional training, equipment, supplies or material incentives. 96 clinicians took part in a study which included information, encouragement, scrutiny and repeated contact with the research team measuring quality. We examine protocol adherence over the course of the study and for 45 of the original clinicians 18 months after the conclusion of the project. Health workers change their behavior significantly over the course of the study, and even eighteen months later demonstrate a five percentage point improvement in quality. The dynamics of clinicians’ reactions to this intervention suggest that quality can be improved by the repeated measurement by external peers in a way that provides reminders of expectations.





Categorías: Investigaciones

National logistics working groups: A landscape analysis study

Vie, 07/04/2017 - 19:01
Publication date: 19 April 2017
Source:Vaccine, Volume 35, Issue 17

Author(s): Dorothy Leab, Benjamin Schreiber, Musonda Kasonde, Olivia Bessat, Son Bui, Carine Loisel

Several countries have acknowledged the contributions made by national logistics working groups (NLWG) to ensure equitable access to the expanded program on immunization’s (EPI) vaccines against preventable diseases. In order to provide key insights to the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) supply chain hub – as well as other players, including national EPI – a landscape analysis study was conducted from September 2015 to February 2016. This is a cross-sectional survey taken by 43 countries that combines qualitative and quantitative approaches. Data was collected through a desk review, consultation, interviews, and distance questioning. References and guidance were used to determine and specify the underlying mechanisms of NLWGs. The key findings are: • Mandate of NLWG commonly declared by countries is improving immunization logistics and supply chain. • Of the 43 countries surveyed, 10 have formal NLWGs, 8 have informal or ad hoc NLWGs, and 25 have none. • The immunization supply chain and logistics (iSCL) decision-making process in countries, regardless of NLWG status, mainly depends on the EPI manager. • In countries with an NLWG, members with logistics and supply chain backgrounds are relatively common; they are mostly from EPI, UNICEF, and WHO. • Almost all NLWGs have terms of reference and primarily operate under EPI governance; however, three NLWGs have standard operation procedures (SOP), and four use monitoring and evaluation tools. • The coordination mechanism of these iSCL activities is mainly built into the immunization Comprehensive Multi-Year Plan (cMYP) and annual EPI plans, and organized by EPI/Immunization Coordination Committee (ICC). • Most countries that participated in this survey expressed their technical requirement for improving the function, positioning and influence of the immunization logistics working group, and capacity building for the group’s members. This study has provided a general overview of the status of NLWGs for immunization in various countries. Based on the key insights of the study, technical assistance needs have been identified, and immunization partners will be required to help countries create and reinforce their NLWGs.





Categorías: Investigaciones

Measuring Iran's success in achieving Millennium Development Goal 4: a systematic analysis of under-5 mortality at national and subnational levels from 1990 to 2015

Vie, 07/04/2017 - 19:01
Publication date: Available online 28 March 2017
Source:The Lancet Global Health

Author(s): Younes Mohammadi, Mahboubeh Parsaeian, Parinaz Mehdipour, Ardeshir Khosravi, Bagher Larijani, Ali Sheidaei, Anita Mansouri, Amir Kasaeian, Kamran Yazdani, Maziar Moradi-Lake, Elaheh Kazemi, Saeideh Aghamohammadi, Nazila Rezaei, Maryam Chegini, Rosa Haghshenas, Hamidreza Jamshidi, Farnaz Delavari, Mohsen Asadi-Lari, Farshad Farzadfar

Background Child mortality as one of the key Millennium Development Goals (MDG 4—to reduce child mortality by two-thirds from 1990 to 2015), is included in the Sustainable Development Goals (SDG 3, target 2—to reduce child mortality to fewer than 25 deaths per 1000 livebirths for all countries by 2030), and is a key indicator of the health system in every country. In this study, we aimed to estimate the level and trend of child mortality from 1990 to 2015 in Iran, to assess the progress of the country and its provinces toward these goals. Methods We used three different data sources: three censuses, a Demographic and Health Survey (DHS), and 5-year data from the death registration system. We used the summary birth history data from four data sources (the three censuses and DHS) and used maternal age cohort and maternal age period methods to estimate the trends in child mortality rates, combining the estimates of these two indirect methods using Loess regression. We also used the complete birth history method to estimate child mortality rate directly from DHS data. Finally, to synthesise different trends into a single trend and calculate uncertainty intervals (UI), we used Gaussian process regression. Findings Under-5 mortality rates (deaths per 1000 livebirths) at the national level in Iran in 1990, 2000, 2010, and 2015 were 63·6 (95% UI 63·1–64·0), 38·8 (38·5–39·2), 24·9 (24·3–25·4), and 19·4 (18·6–20·2), respectively. Between 1990 and 2015, the median annual reduction and total overall reduction in these rates were 4·9% and 70%, respectively. At the provincial level, the difference between the highest and lowest child mortality rates in 1990, 2000, and 2015 were 65·6, 40·4, and 38·1 per 1000 livebirths, respectively. Based on the MDG 4 goal, five provinces had not decreased child mortality by two-thirds by 2015. Furthermore, six provinces had not reached SDG 3 (target 2). Interpretation Iran and most of its provinces achieved MDG 4 and SDG 3 (target 2) goals by 2015. However, at the subnational level in some provinces, there is substantial inequity. Local policy makers should use effective strategies to accelerate the reduction of child mortality for these provinces by 2030. Possible recommendations for such strategies include enhancing the level of education and health literacy among women, tackling sex discrimination, and improving incomes for families. Funding Iran Ministry of Health and Education.





Categorías: Investigaciones

Quality of Life among Women Living with HIV in Rural India

Vie, 07/04/2017 - 19:01
Publication date: Available online 24 March 2017
Source:Journal of the Association of Nurses in AIDS Care

Author(s): Adeline M. Nyamathi, Maria Ekstrand, Kartik Yadav, Padma Ramakrishna, Elsa Heylen, Catherine Carpenter, Sarah Wall, Tanya Oleskowicz, Lenore Arab, Sanjeev Sinha

A cross-sectional examination was conducted on Quality of Life (QOL) among Women Living with HIV (WLWH) in rural Andhra Pradesh, India. Baseline data were collected from 400 WLWH and their children. QOL was measured with 10 items from the Quality of Life Enjoyment and Satisfaction Questionnaire. Findings revealed low QOL scores; on a scale from 0 to 3, the mean QOL score was 0.38 (SD = 0.30). Depression symptoms were reported by 25.5%, internalized stigma was high, and most reported little to no social support. Multivariable analysis revealed positive associations between QOL and CD4+ T cells (b = .0011, p = .021) and social support (b = .260, p < .0001) and a negative relationship between QOL and internalized stigma (b = -.232, p < .0001). Interventions focused on improving QOL for WLWH should incorporate strategies to improve social support and adherence to antiretroviral therapy, while mitigating internalized stigma.





Categorías: Investigaciones

Geographic disparities in pneumonia-specific under-five mortality rates in Mainland China from 1996 to 2015: a population-based study

Vie, 07/04/2017 - 19:01
Publication date: Available online 22 March 2017
Source:International Journal of Infectious Diseases

Author(s): Leni Kang, Chunhua He, Lei Miao, Juan Liang, Jun Zhu, Xiaohong Li, Qi Li, Yanping Wang

Objectives This study aimed to investigate the disparities in pneumonia-specific under-five mortality rates (U5MRs) among and within three geographic regions in Mainland China from 1996 to 2015. Methods Data were obtained from the national Under-Five Child Mortality Surveillance System and grouped into 2-year periods. The Cochran–Armitage trend test and Cochran–Mantel–Haenszel test were used to assess trends and differences in the pneumonia-specific U5MRs among and within geographic regions. Relative risks (RRs) and 95% confidence intervals (95% CIs) were calculated. Results The pneumonia-specific U5MR decreased by 90.6%, 89.0%, and 83.5% in East, Middle, and West China, respectively, with a larger decrease in rural areas. The pneumonia-specific U5MR was highest in West China, and was 7.2 (95% CI 5.9–8.7) times higher than that in East China in 2014–2015. In 2014–2015, the RRs were 1.7 (95% CI 1.2–2.5), 1.6 (95% CI 1.1–2.1), and 3.4 (95% CI 2.8–4.0) between rural and urban areas in East, Middle, and West China, respectively. Conclusions Pneumonia-specific U5MRs decreased from 1996 to 2015 across China, particularly in rural areas. However, disparities remained among and within geographic regions. Additional strategies and interventions should be introduced in West China, especially the rural areas, to further reduce the pneumonia-specific U5MR.





Categorías: Investigaciones

Mortality Associated Characteristics of Traumatic Brain Injury Patients at the University Teaching Hospital of Kigali, Rwanda

Vie, 07/04/2017 - 19:01
Publication date: Available online 21 March 2017
Source:World Neurosurgery

Author(s): Elizabeth Krebs, Charles J. Gerardo, Lawrence P. Park, Joao Ricardo Nickenig Vissoci, Jean Claude Byiringiro, Fidele Byiringiro, Stephen Rulisa, Nathan Thielman, Catherine Staton

Objective Traumatic Brain Injury (TBI) is a leading cause of death and disability. TBI patients in low and middle- income countries have worse outcomes than those in high-income countries. We aimed to evaluate important clinical indicators associated with mortality for TBI patients at the University Teaching Hospital of Kigali (UTHK) Kigali, Rwanda. Methods Prospective consecutive sampling of TBI patients presenting to UTHK Accident and Emergency Department were screened for inclusion criteria: reported head trauma, alteration in consciousness, headache, or visible head trauma. Exclusion criteria were age <10 years, >48 hours after injury, or repeat visit. Data were assessed for association with death using logistic regression. Significant variables were included in an adjusted multivariable logistic regression model then refined via backwards elimination. Results Six hundred and eighty-four patients were enrolled between October 7, 2013 and April 6, 2014, 14 (2%) were excluded due to incomplete data. Eighty-one percent were male with mean age of 31 years (range, 10 – 89, SD 11.8). Most patients (80%) suffered mild TBI (Glasgow Coma Score (GCS) 13-15), 10% suffered moderate (GCS 9-12) and 10% sustained severe TBI (GCS 3-8). Multivariable logistic regression determined that GCS <13, hypoxia, bradycardia, tachycardia and age >50 years were significantly associated with death. Conclusion GCS <13, hypoxia, bradycardia, tachycardia and age >50 years were associated with mortality. These findings inform future research that may guide clinicians in prioritizing care for patients at highest risk of mortality.





Categorías: Investigaciones

Migration and infectious diseases

Vie, 07/04/2017 - 19:01
Publication date: Available online 20 March 2017
Source:Clinical Microbiology and Infection

Author(s): F. Castelli, G. Sulis

Background Infectious diseases still represent an important cause of morbidity and mortality among foreign-born individuals. The rising migration flows towards Europe throughout the last few years are raising renewed concerns about management issues and the potential associated risk for the native population. Aims To discuss the health implications and challenges related to the four phases of migration, from first arrival to stable resettlement. Sources Scientific literature and relevant statistical reports. Content Although infectious diseases are not a health priority at first arrival, a syndromic screening to identify the most common communicable conditions (pulmonary tuberculosis above all) should be promptly conducted. Reception centres where asylum seekers are gathered after arrival may be crowded, so favouring epidemic outbreaks, sometimes caused by incomplete vaccine coverage for preventable diseases. After resettlement, the prevalence of some chronic infections such as human immunodeficiency virus, viral hepatitis or tuberculosis largely reflects the epidemiological pattern in the country of origin, with poor living conditions being an additional driver. Once resettled, migrants usually travel back to their country of origin without seeking pre-travel advice, which results in a high incidence of malaria and other infections. Implications Although infectious diseases among migrants are known to have a negligible impact on European epidemiology, screening programmes need to be implemented and adapted to the different stages of the migratory process to better understand the trends and set priorities for action. Appropriate access to care regardless of the legal status is crucial to improve the health status and prevent the spread of contagious conditions.





Categorías: Investigaciones

Health workers and the weaponisation of health care in Syria: a preliminary inquiry for The Lancet–American University of Beirut Commission on Syria

Vie, 07/04/2017 - 19:01
Publication date: Available online 15 March 2017
Source:The Lancet

Author(s): Fouad M Fouad, Annie Sparrow, Ahmad Tarakji, Mohamad Alameddine, Fadi El-Jardali, Adam P Coutts, Nour El Arnaout, Lama Bou Karroum, Mohammed Jawad, Sophie Roborgh, Aula Abbara, Fadi Alhalabi, Ibrahim AlMasri, Samer Jabbour

The conflict in Syria presents new and unprecedented challenges that undermine the principles and practice of medical neutrality in armed conflict. With direct and repeated targeting of health workers, health facilities, and ambulances, Syria has become the most dangerous place on earth for health-care providers. The weaponisation of health care—a strategy of using people's need for health care as a weapon against them by violently depriving them of it—has translated into hundreds of health workers killed, hundreds more incarcerated or tortured, and hundreds of health facilities deliberately and systematically attacked. Evidence shows use of this strategy on an unprecedented scale by the Syrian Government and allied forces, in what human rights organisations described as a war-crime strategy, although all parties seem to have committed violations. Attacks on health care have sparked a large-scale exodus of experienced health workers. Formidable challenges face health workers who have stayed behind, and with no health care a major factor in the flight of refugees, the effect extends well beyond Syria. The international community has left these violations of international humanitarian and human rights law largely unanswered, despite their enormous consequences. There have been repudiated denunciations, but little action on bringing the perpetrators to justice. This inadequate response challenges the foundation of medical neutrality needed to sustain the operations of global health and humanitarian agencies in situations of armed conflict. In this Health Policy, we analyse the situation of health workers facing such systematic and serious violations of international humanitarian law. We describe the tremendous pressures that health workers have been under and continue to endure, and the remarkable resilience and resourcefulness they have displayed in response to this crisis. We propose policy imperatives to protect and support health workers working in armed conflict zones.





Categorías: Investigaciones

Bidirectional Exchange of Health Professionals’ Students; Ensuring Equity between Partners

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): S.N. Byekwaso







Categorías: Investigaciones

Cultivating the Next Generation of Health Care Providers in Sub-Saharan Africa: The Global Health Service Partnership – Update 2016

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): J. Anathan, E. Cunningham, L. Foradori, E. Stuart-Shor, S. Sayeed, V. Kerry







Categorías: Investigaciones

Effect of Ethiopia's Health Development Army on maternal and newborn health care practices: A multi-level cross-sectional analysis

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): W. Betemariam, Z. Damtew, C. Tesfaye, N. Fesseha, A.M. Karim







Categorías: Investigaciones

A New Cadre of Health Worker: Meeting Health Organization Capacity Needs in East and Southern Africa and the United States via a leadership Development Fellowship program

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): J. Gomez, B. Bush, H. Anderson







Categorías: Investigaciones

A Global Analysis of the Proportion of Surgical Specialists in Relation to Overall Human Resources for Health

Vie, 07/04/2017 - 19:01
Publication date: January–February 2017
Source:Annals of Global Health, Volume 83, Issue 1

Author(s): K. Nyberger, H. Holmer, L. Hagander, S. Mukhopadhyay







Categorías: Investigaciones

Health research capacity building in Georgia: a case-based needs assessment

Lun, 06/03/2017 - 19:19
Publication date: June 2017
Source:Public Health, Volume 147

Author(s): A. Squires, T. Chitashvili, M. Djbouti, L. Ridge, D. Chyun

Objectives Research capacity building in the health sciences in low- and middle-income countries has typically focused on bench-science capacity, but research examining health service delivery and health workforce is equally necessary to determine the best ways to deliver care. The Republic of Georgia, formerly a part of the Soviet Union, has multiple issues within its healthcare system that would benefit from expended research capacity, but the current research environment needs to be explored prior to examining research-focused activities. The purpose of this project was to conduct a needs assessment focused on developing research capacity in the Republic of Georgia with an emphasis on workforce and network development. Study design A case study approach guided by a needs assessment format. Methods We conducted in-country, informal, semi-structured interviews in English with key informants and focus groups with faculty, students, and representatives of local non-governmental organizations. Purposive and snowball sampling approaches were used to recruit participants, with key informant interviews scheduled prior to arrival in country. Documents relevant to research capacity building were also included. Interview results were coded via content analysis. Final results were organized into a SWOT (strengths, weaknesses, opportunities, threat) analysis format, with the report shared with participants. Results There is widespread interest among students and faculty in Georgia around building research capacity. Lack of funding was identified by many informants as a barrier to research. Many critical research skills, such as proposal development, qualitative research skills, and statistical analysis, were reported as very limited. Participants expressed concerns about the ethics of research, with some suggesting that research is undertaken to punish or ‘expose’ subjects. However, students and faculty are highly motivated to improve their skills, are open to a variety of learning modalities, and have research priorities aligned with Georgian health needs. Conclusions This study's findings indicate that while the Georgian research infrastructure needs further development, Georgian students and faculty are eager to supplement its gaps by improving their own skills. These findings are consistent with those seen in other developing country contexts.





Categorías: Investigaciones

Agents of change: The role of healthcare workers in the prevention of nosocomial and occupational tuberculosis

Mar, 28/02/2017 - 18:28
Publication date: Available online 28 February 2017
Source:La Presse Médicale

Author(s): Ruvandhi R. Nathavitharana, Patricia Bond, Angela Dramowski, Koot Kotze, Philip Lederer, Ingrid Oxley, Jurgens A. Peters, Chanel Rossouw, Helene-Mari van der Westhuizen, Bart Willems, Tiong Xun Ting, Arne von Delft, Dalene von Delft, Raquel Duarte, Edward Nardell, Alimuddin Zumla

Healthcare workers (HCWs) play a central role in global tuberculosis (TB) elimination efforts but their contributions are undermined by occupational TB. HCWs have higher rates of latent and active TB than the general population due to persistent occupational TB exposure, particularly in settings where there is a high prevalence of undiagnosed TB in healthcare facilities and TB infection control (TB-IC) programmes are absent or poorly implemented. Occupational health programmes in high TB burden settings are often weak or non-existent and thus data that record the extent of the increased risk of occupational TB globally are scarce. HCWs represent a limited resource in high TB burden settings and occupational TB can lead to workforce attrition. Stigma plays a role in delayed diagnosis, poor treatment outcomes and impaired well-being in HCWs who develop TB. Ensuring the prioritization and implementation of TB-IC interventions and occupational health programmes, which include robust monitoring and evaluation, is critical to reduce nosocomial TB transmission to patients and HCWs. The provision of preventive therapy for HCWs with latent TB infection (LTBI) can also prevent progression to active TB. Unlike other patient groups, HCWs are in a unique position to serve as agents of change to raise awareness, advocate for necessary resource allocation and implement TB-IC interventions, with appropriate support from dedicated TB-IC officers at the facility and national TB programme level. Students and community health workers (CHWs) must be engaged and involved in these efforts. Nosocomial TB transmission is an urgent public health problem and adopting rights-based approaches can be helpful. However, these efforts cannot succeed without increased political will, supportive legal frameworks and financial investments to support HCWs in efforts to decrease TB transmission.





Categorías: Investigaciones

A Comprehensive Needs Assessment Tool for Planning Rheumatic Heart Disease Control Programs in Limited Resource Settings

Lun, 27/02/2017 - 18:17
Publication date: Available online 27 February 2017
Source:Global Heart

Author(s): Liesl J. Zühlke, David A. Watkins, Susan Perkins, Rosemary Wyber, Jeremiah Mwangi, Joanna Markbreiter, Hlengiwe S. Moloi, Mark E. Engel, Thembikile Shato, Tayla Hermanus, Jantina DeVries, Clancy Read

Rheumatic heart disease (RHD) is an important cause of disability and death in low- and middle-income countries. However, evidence-based interventions have not been implemented systematically in many countries. We present a RHD Needs Assessment Tool (NAT) that can be used at country or regional levels to systematically develop and plan comprehensive RHD control programs and to provide baseline data for program monitoring and evaluation. The RHD NAT follows a mixed-methods approach using quantitative and qualitative data collection instruments. Evidence is mapped to a conceptual model that follows a patient through the natural history of RHD. The NAT has 4 phases: 1) situational assessment; 2) facility-based assessment of epidemiology and health system capacity; 3) patient and provider experience of RHD using ethnographic methods; and 4) intervention planning, including stakeholder mapping and development of a monitoring and evaluation framework. The RHD NAT is designed to paint a comprehensive picture of RHD care in an endemic setting and to identify the major gaps to disseminating and implementing evidence-based interventions.





Categorías: Investigaciones

Measuring work engagement among community health workers in Sierra Leone: Validating the Utrecht Work Engagement Scale

Vie, 24/02/2017 - 17:59
Publication date: Available online 24 February 2017
Source:Revista de Psicología del Trabajo y de las Organizaciones

Author(s): Frédérique Vallières, Eilish McAuliffe, Philip Hyland, Marie Galligan, Annette Ghee

This study examines the concept of volunteer work engagement in a sample of 334 community health workers in Bonthe District, Sierra Leone. Structural equation modelling was used to validate both the 9-item and the 17-item Utrecht Work Engagement Scale (UWES-9 and UWES-17, respectively). Results assessing the UWES-17 invalidated the three-factor structure within this cohort of community health workers, as high correlations were found between latent factors. Findings for the validity of the UWES-9 were largely consistent with those of the UWES-17. Model fit for the UWES-9 were generally equivalent for the one-factor, three-factor, and bifactor solutions, however the three-factor model was once again rejected due to high factor correlations. Based on these results, the current sample provides evidence that work engagement is best represented as a unidimensional construct in this context. Findings are considered alongside previous research to offer support for the utilization of the shortened UWES-9 in this context, as it appears to provide a good representation of work engagement and possess a parsimonious unidimensional scoring scheme.





Categorías: Investigaciones

Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study

Jue, 23/02/2017 - 17:56
Publication date: Available online 23 February 2017
Source:The Lancet Global Health

Author(s): Alexandre Delamou, Alison M El Ayadi, Sidikiba Sidibe, Therese Delvaux, Bienvenu S Camara, Sah D Sandouno, Abdoul H Beavogui, Georges W Rutherford, Junko Okumura, Wei-Hong Zhang, Vincent De Brouwere

Background The 2014 west African epidemic of Ebola virus disease posed a major threat to the health systems of the countries affected. We sought to quantify the consequences of Ebola virus disease on maternal and child health services in the highly-affected Forest region of Guinea. Methods We did a retrospective, observational cohort study of women and children attending public health facilities for antenatal care, institutional delivery, and immunisation services in six of seven health districts in the Forest region (Beyla, Guéckédou, Kissidougou, Lola, Macenta, and N'Zérékoré). We examined monthly service use data for eight maternal and child health services indicators: antenatal care (≥1 antenatal care visit and ≥3 antenatal care visits), institutional delivery, and receipt of five infant vaccines: polio, pentavalent (diphtheria, tetanus, pertussis, hepatitis B virus, and Haemophilus influenzae type b), yellow fever, measles, and tuberculosis. We used interrupted time series models to estimate trends in each indicator across three time periods: pre-Ebola virus disease epidemic (January, 2013, to February, 2014), during-epidemic (March, 2014, to February, 2015) and post-epidemic (March, 2015, to Feb, 2016). We used segmented ordinary least-squares (OLS) regression using Newey-West standard errors to accommodate for serial autocorrelation, and adjusted for any potential effect of birth seasonality on our outcomes. Findings In the months before the Ebola virus disease outbreak, all three maternal indicators showed a significantly positive change in trend, ranging from a monthly average increase of 61 (95% CI 38–84) institutional deliveries to 119 (95% CI 79–158) women achieving at least three antenatal care visits. These increasing trends were reversed during the epidemic: fewer institutional deliveries occurred (–240, 95% CI −293 to −187), and fewer women achieved at least one antenatal care visit (–418, 95% CI −535 to −300) or at least three antenatal care visits (–363, 95% CI −485 to −242) per month (p<0·0001 for all). Compared with the negative trend during the outbreak, the change in trend during the post-outbreak period showed that 173 more women per month (95% CI 51–294; p=0·0074) had at least one antenatal care visit, 257 more (95% CI 117–398; p=0·0010) had at least three antenatal care visits and 149 more (95% CI 91–206; p<0·0001) had institutional deliveries. However, although the numbers for these indicators increased in the post-epidemic period, the trends for all stagnated. Similarly, the increasing trend in child vaccination completion during the pre-epidemic period was followed by significant immediate and trend reductions across most vaccine types. Before the outbreak, the number of children younger than 12 months who had completed each vaccination ranged from 5752 (95% CI 2821–8682) for tuberculosis to 8043 (95% CI 7621–8464) for yellow fever. Immediately after the outbreak, significant reductions occurred in the level of all vaccinations except for yellow fever for which the reduction was marginal. The greatest reductions were noted for polio and tuberculosis at −3594 (95% CI −4811 to −2377; p<0·0001) and −3048 (95% CI −5879 to −216; p=0·0362) fewer vaccines administered, respectively. Compared with pre-Ebola virus disease outbreak trends, significant decreases occurred for all vaccines except polio, with the trend of monthly decreases in the number of children vaccinated ranging from −419 (95% CI −683 to −155; p=0·0034) fewer for BCG to −313 (95% CI–446 to −179; p<0·0001) fewer for pentavalent during the outbreak. In the post-Ebola virus disease outbreak period, vaccination coverage for polio, measles, and yellow fever continued to decrease, whereas the trend in coverage for tuberculosis and pentavalent did not significantly differ from zero. Interpretation Most maternal and child health indicators significantly declined during the Ebola virus disease outbreak in 2014. Despite a reduction in this negative trend in the post-outbreak period, the use of essential maternal and child health services have not recovered to their pre-outbreak levels, nor are they all on a course that suggests that they will recover without targeted interventions. Funding University of Conakry and Centre National de Formation et Recherche de Maferinyah (Guinea)





Categorías: Investigaciones

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