Suchergebnisse

People living with disabilities (PLWDs) have poor access to health services compared to people without disabilities. As a result, PLWDs do not benefit from some of the services provided at health facilities; therefore, new methods need to be developed to deliver these services where PLWDs reside. This case study reports a household-based screening programme targeting PLWDs in a rural district in Malawi. Between March and November 2016, a household-based and integrated screening programme was conducted by community health workers, HIV testing counsellors and a clinic clerk. The programme provided integrated home-based screening for HIV, tuberculosis, hypertension and malnutrition for PLWDs. The programme was designed and implemented for a population of 37 000 people. A total of 449 PLWDs, with a median age of 26 years and about half of them women, were screened. Among the 404 PLWDs eligible for HIV testing, 399 (99%) agreed for HIV testing. Sixty-nine per cent of PLWDs tested for HIV had never previously been tested for HIV. Additionally, 14 patients self-reported to be HIV-positive and all but one were verified to be active in HIV care. A total of 192 of all eligible PLWDs above 18 years old were screened for hypertension, with 9% (n = 17) referred for further follow-up at the nearest facility. In addition, 274 and 371 PLWDs were screened for malnutrition and tuberculosis, respectively, with 6% (n = 18) of PLWDs referred for malnutrition, and 2% (n = 10) of PLWDs referred for tuberculosis testing. We successfully implemented an integrated home-based screening programme in rural Malawi.

INTRODUCTION: Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone. PURPOSE: To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone. PATIENTS AND METHODS: A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60–89 min/mL/1.73m(2) and <60 min/mL/1.73m(2) defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m(2) measured two times at least 3 months apart was used to define CKD. RESULTS: Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m(2) and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2–57.7) and 29.9% (91/304, CI 24.8–34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14–14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24–3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29–0.91), p = 0.02) reduced likelihood of CKD. CONCLUSION: The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was ...

Chiyembekezo Kachimanga,1,2 Anu Jegede Williams,3 Musa Bangura,1 Marta Lado,4 Sahr Kanawa,5 Daniel Lavallie,5 Michael Mhango,1 Haja Isatta Wurie,6 Marta Patiño Rodriguez1 1Partners in Health Sierra Leone, Koidu City, Sierra Leone; 2Partners in Health Malawi, Neno, Malawi; 3Central Public Health Reference Laboratory, Ministry of Health and Sanitation, Freetown, Sierra Leone; 4World Health Organization, Geneva, Switzerland; 5Koidu Government Hospital, Ministry of Health and Sanitation, Koidu City, Sierra Leone; 6Laboratory Science Unit, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra LeoneCorrespondence: Chiyembekezo Kachimanga Tel +265 887247777Email chembekachimanga@yahoo.co.ukIntroduction: Currently, there are no data on prevalence and associated risk factors of chronic kidney disease (CKD) among patients with hypertension in rural Sierra Leone.Purpose: To estimate the prevalence and associated risk factors of CKD in rural Sierra Leone.Patients and Methods: A cross-sectional study of hypertension patients aged between 18 and 75 years attending a non-communicable disease clinic at Koidu Government Hospital, Kono District, Sierra Leone was conducted between February and December 2020. Using systematic random sampling, a structured questionnaire, which comprised of questions on social demographic characteristics and past and current clinical history, was administered followed by measurement of creatinine and urinary protein and glucose. Estimated glomerular filtration rate (eGFR) was estimated using CKD-epidemiology formula without race as a factor. Baseline eGFR between 60– 89 min/mL/1.73m2 and < 60 min/mL/1.73m2 defined reduced eGFR and renal impairment, respectively. Estimated GFR less than 60 min/mL/1.73m2 measured two times at least 3 months apart was used to define CKD.Results: Ninety-six percent (n = 304) patients out of 317 patients were included in the study. Among all included patients, only 3.9% (n = 12) had eGFR of 90 min/mL/1.73m2 and above. The prevalence of renal impairment and CKD was 52% (158/304, CI 46.2– 57.7) and 29.9% (91/304, CI 24.8– 34.5), respectively. In adjusted logistic regression analysis, currently taking herbal medications as treatment of hypertension (OR 4.11 (CI 1.14– 14.80), p = 0.03) and being overweight and/or obese (OR 2.16 (CI 1.24– 3.78), p < 0.001) was associated with CKD. Additionally, receiving some education was associated with a 48% (OR 0.52 (CI 0.29– 0.91), p = 0.02) reduced likelihood of CKD.Conclusion: The prevalence of renal impairment and CKD is high among hypertensive patients in rural Sierra Leone. CKD was associated with current history of taking herbal medications and being overweight and/or obese. Additionally, CKD was associated with reduced likelihood in patients who received some education.Keywords: hypertension, non-communicable diseases, CKD, renal impairment, screening, Sierra Leone

This study reports on the prevalence and risk factors of chronic HBV among health care workers (HCWs) in a rural secondary hospital in Sierra Leone. Additionally, data on the uptake of HBV vaccination among negatively tested HCWs and on the linkage to care among positively tested HCWs are presented. In December 2019, 781 HCWs were invited to a screening and vaccination campaign at Koidu Government Hospital in Kono District. For each HCW, demographic information and data on their HBV risk history were captured, followed by a hepatitis B surface antigen (HBsAg) test. HCWs with a negative test result were offered an HBV vaccine on the same day, after one and six months. HCWs that were HBsAg positive were linked to a free HBV clinic. In total, 80% (632) of HCWs were screened. Among the screened, 97% had never received an HBV vaccine and 10.3% (n = 65) had chronic HBV. The following characteristics were associated with being HBsAg positive: aged less than 30 years old (aOR 2.17, CI 1.16–4.03, p = 0.01), male gender (aOR 2.0, CI 1.06–3.78, p = 0.03), working experience of 1–4 years (aOR 3.99, CI 1.15–13.73, p = 0.03) and over 9 years (aOR 6.16, CI 1.41–26.9, p = 0.02). For HBsAg-negative HCWs (n = 567), 99.8% (n = 566), 97.5% (n = 553) and 82.7% (n = 469) received their first, second and third dose of the vaccine, respectively. For HBsAg-positive HCWs (n = 65), 73.9% (n = 48) were successfully linked to an HBV clinic for further care. Most HCWs are unvaccinated for HBV, and the HBV prevalence amongst this at-risk group is high. Uptake of vaccination and linkage to care was successful.

Accurate and efficient record linkage methods are essential to link patients between community health worker digital health apps and an EMR system, facilitating information flow and improving coordination of care. This study presents the eTrace workflow as an illustrative example, highlighting the benefits of enhanced coordination of care for patients in antiretroviral and non-communicable disease programs in rural Neno district, Malawi. This research focuses on the following major contributions: (1) development of a machine learning-based record linkage model for electronic health information systems, (2) comparison between the machine learning-based and probabilistic approaches to record linkage and (3) a concrete evaluation of our approach on real data for the eTrace workflow. A review of the standard record linkage architecture and its application to health information exchange systems is also presented. An empirical comparison conducted of logistic regression and the Fellegi-Sunter algorithms for this use case reveals comparable results. Both classifiers demonstrate an average precision of 0.86, while logistic regression achieves a higher recall at a fixed 0.90 precision of 0.74.