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Item Advanced HIV disease during the first six months on antiretroviral therapy in Zambia: research protocol for a prospective, observational, multi-cohort study(2025) Rosen, SydneyBackground: The proportion of HIV-positive individuals who present for initiation or re-initiation of antiretroviral therapy (ART) with advanced HIV disease (AHD) and are thus at risk for morbidity and mortality remains high throughout sub-Saharan Africa. In Zambia, where 20% of ART initiators are diagnosed with AHD, little is known about the characteristics of those starting ART with AHD, why treatment initiation is delayed, how AHD clinical management influences clinical and non-clinical outcomes, or implementation of national AHD guidelines at facility level. Protocol: AHD-Zambia is a mixed-methods observational study to describe AHD clients and care during the first six months after starting or re-starting ART in Zambia. The study will be conducted at 24 public sector primary health facilities in four provinces. It will enroll ART clients screened for AHD during a three-month data collection period (Cohort 1), clients screened for AHD in the 12 months prior to the data collection period (Cohort 2), patients hospitalized for AHD-related conditions (Cohort 3); and clinical providers at the study sites who manage clients with AHD (Cohort 4). Data collection will include quantitative surveys, medical record review during the 12 months before and after enrollment, qualitative interviews, and focus group discussions. Facility-level indicators will also be collected. Outcomes will include detailed profiles of AHD clients and their 6 and 12-month retention in care and viral suppression, provider and client views on barriers to and preferences for AHD care, and an assessment of facility fidelity to AHD guidelines. Discussion: This study will generate a comprehensive profile of clients presenting with AHD in Zambia, including clinical, demographic, social, and behavioral characteristics, treatment outcomes, and barriers to providing guideline-compliant care. Findings will provide insight into the delivery of AHD services, identify gaps in implementation, and support improvements to retention and care during the early treatment period.Item The identifying efficient linkage strategies for men (IDEaL) study in Malawi: A detailed review of methods used to estimate costs of IDEaL services and evaluate cost effectiveness(2025-05-14) Larson, Bruce A.; Hariprasad, Santhi; Robson, Isabella; Balakasi, Kelvin; Dovel, KathrynThis manuscript walks the interested reader through the methods and assumptions used to estimate the cost per client (study subject), summarize costs by study arm, and evaluate cost effectiveness. This review also highlights methodological issues that arise when evaluating interventions requiring significant additions to health care worker responsibilities. Main audiences for this manuscript are likely: (1) analysts wishing to review the cost analysis and results presented as part of the IDEaL study main outcomes paper (which provide summary results but little detail); and (2) analysts wishing to develop their own skills in economic evaluation who might benefit from a detailed, practical example that can be adapted and replicated in other clinical trial settings.Item Implementation of tools for predicting future risks of poor HIV care outcomes in primary healthcare facilities in Sub-Saharan Africa: A narrative review and discussion of lessons learned - supporting files for submission to Gates Open Research(Gates Open Research, 2025) Maskew, Mhairi; Sande, Linda; Benade, Mariet; Ntjiekelane, Vinolia; Scott, Nancy; Mutanda, Nyasha; Morgan, Allison; Marri, Anushka Reddy; Flynn, David; Rosen, SydneyItem Preferences for services in a patient’s first six months on antiretroviral therapy for HIV in South Africa and Zambia (PREFER): research protocol for a prospective observational cohort studyMaskew, Mhairi; Ntjikelane, Vinolia; Juntunen, Allison; Scott, Nancy A.; Benade, Mariet; Hasweeka, Pamfred; Sande, Linda; Haimbe, Prudence; Lumano-Mulenga, Priscilla; Shakewelele, Hilda; Mukumbwa-Mwenechanya, Mpande; Rosen, SydneyBACKGROUND: For patients on HIV treatment in sub-Saharan Africa (SSA), the highest risk for loss from care consistently remains the first six months after antiretroviral (ART) initiation, when patients are not yet eligible for most existing differentiated service delivery (DSD) models. To reduce disengagement from care during this period, we must gain a comprehensive understanding of patients’ needs, concerns, resources, and preferences for service delivery during this period. The PREFER study will use a sequential mixed-methods approach to survey a sample of patients in South Africa and Zambia 0-6 months after ART initiation to develop a detailed profile of patient characteristics and needs. PROTOCOL: PREFER is an observational, prospective cohort study of adult patients on ART for ≤6 months at 12 public sector healthcare facilities in Zambia and 18 in South Africa that aims to inform the design of DSD models for the early HIV treatment period. It has four components: 1) survey of clients 0-6 months after ART initiation; 2) follow up through routinely collected medical records for <12 or <24 months after enrollment; 3) focus group discussions to explore specific issues raised in the survey; and 4) in South Africa only, collection of blood samples self-reported naïve participants to assess the prevalence of ARV metabolites indicating prior ART use. Results will include demographic and clinical characteristics of patients, self-reported HIV care histories, preferences for treatment delivery, and predictors of disengagement. CONCLUSIONS: PREFER aims to understand why the early treatment period is so challenging and how service delivery can be amended to address the obstacles that lead to early disengagement from care and to distinguish the barriers encountered by naïve patients to those facing re-initiators. The information collected by PREFER will help respond to patients’ needs and design better strategies for service delivery and improve resource allocation going forward.Item Mission hospital responses to challenges and implications for their future role in India’s health system(Christian Journal for Global Health) Long, Kate; Chandy, Sujith; Feeley III, Frank G.Rich; Laing, Richard; Laird, Lance D.; Wirtz, Veronika J.BACKGROUND: India’s health system is currently experiencing rapid change. Achieving India’s aspirations for improved population health and universal health coverage will require the contribution of all health providers; public, private-for-profit, not-for-profit and charitable providers. Among the largest charitable providers in India are Christian mission hospitals, who have played a historic role in healthcare delivery to the poor and underserved. This study explored the main internal and external challenges facing mission hospitals, their response to those challenges, and the role they might play in the broader health system going forward. METHODS: The study employed interdisciplinary, mixed methodology to assess the top challenges and responses between 2010-2017. The theory of everyday resilience was used to categorize challenges as chronic stresses or acute shocks and to explore features of resilience in responses to challenges, along with the underlying capabilities that enable resilience responses. RESULTS AND DISCUSSION: Mission hospitals were impacted by social, political, and health system challenges. Most operated as “stressors”, for example, strained governance structures and human resource shortages. “Shocks” included major changes in health policy and increasing competition from for-profit providers. In response, some mission hospitals exhibited features of everyday resilience, traversing between absorptive, adaptive, and transformative strategies. Among mission hospitals that appeared to be successfully navigating challenges, three core capacities were present: 1) cognitive capacity, understanding the challenge and developing appropriate response strategies; 2) behavioral capacity, having agency to deploy context-specific responses; and 3) contextual capacity, having adequate resources, including hardware (money, people, infrastructure) and software (e.g. values, relationships, networks), to exercise the first two capacities. Building on their history and current examples of everyday resilience, mission hospitals can contribute to the larger health system by attending to health and well-being at the margins of society, encouraging innovation, developing human resources, and engaging in policy and advocacy. CONCLUSION: While mission hospitals face pressing internal and external challenges, many exhibit features of everyday resilience and retain strong commitment to population health and service to the poor. These features make them potentially strong actors in their local contexts as well as potential partners in the realization of improved population health across India.Item Lessons learned from Boston University School of Public Health Peer Coach Writing Program(Association of Schools & Programs of Public Health Conference, 2019-03-20) Monteiro, Ryann; Beard, Jennifer; Price, Mahogany; Murphy-Phillips, MaryBACKGROUND: Public health is only as effective as its communication. The ability to convey information in an engaging, insightful, and concise manner often heavily influences stakeholder engagement. It is the backbone of program and policy development, organization, and implementation. To help MPH students adapt their writing skills to these specialized demands, Boston University School of Public Health (BUSPH) launched a Peer Coach Writing Program (PCWP) in 2010. To our knowledge, ours is the first and currently the only peer writing program to be developed within a school of public health staffed by public health students. We will present information about the history, theoretical foundation, goals, management, logistics, challenges and adaptations of the program. PROGRAM LOGISTICS: The PCWP is open to all SPH students and they can schedule up to two appointments per assignment, whether it be an individual or team writing assignment. Appointments are scheduled through WCONLINE, a scheduling software that collects program data including appointment request forms; client report forms submitted by the peer coaches after each session; and trends in appointments. STUDENT USE & OUTCOMES: Student use of the program has increased from 117 appointments in 2012 to 712 during the 2017-2018 academic year. Sixty percent of students who utilize the resource request an appointment for assistance with organization & synthesizing, and 68% request help with making their prose more clear and concise. Three-quarters of students who have worked with a peer coach reported feeling more confident about their assignment. CHALLENGES & ADAPTATIONS: Creating an open communication channel between instructors and the program manager has been a key priority. Sharing and making available course schedules, and assignment instructions, and feedback has been critical in the organization and scheduling of the program. In response to the high demand for appointments, virtual appointments were made available in Fall of 2018.Item Smoking Status and Cessation Counseling Practices Among Physicians, Guangxi, China, 2007(Centers for Disease Control and Prevention, 2009-12-15) Abdullah, Abu Saleh M.; Zhou, Jiatong; Huang, Dongmei; Lu, Songyi; Luo, Shuiying; Pun, Vivian C.INTRODUCTION. We examined Chinese physicians' smoking behavior, knowledge of smoking's health effects, and compliance with accepted cessation counseling practices. METHODS. We used a structured questionnaire adapted from the Global Health Professionals Survey of the World Health Organization to survey Chinese physicians based at 5 hospitals in Nanning, Guangxi Province, China. RESULTS. The response rate was 85% for a total of 673 completed questionnaires. Of the 673 respondents, 73% were men, 42% were aged 30 years or younger, and 26% were smokers (men, 35%; women, 3%). Only 28% of the smokers were ready to quit immediately. A substantial proportion of physicians did not have adequate knowledge of smoking-related health hazards or favorable attitudes toward smoking cessation counseling. Asking patients whether they smoked and recording smoking status in the medical record were significantly associated with being female and being very well or somewhat prepared to counsel patients about smoking cessation. Advising patients to quit smoking was significantly associated with being female, being a nonsmoker, being very well or somewhat prepared to counsel patients about smoking cessation, and having read any smoking cessation guidelines. CONCLUSIONS. Our findings suggest that smoking is common among male Chinese physicians and that Chinese physicians have inadequate knowledge of smoking's health hazards and of how to help smokers quit. Physicians in China and their patients who smoke would benefit from widely accessible Chinese clinical practice guidelines on smoking cessation, better medical school education about the health risks of smoking, and government funding of cessation medications.Item Assessment of Tobacco Control Advocacy Behavioural Capacity among Students at Schools of Public Health in China(BMJ Group, 2010-9-21) Yang, Tingzhong; Abdullah, Abu Saleh M.; Rockett, Ian R H; Li, Mu; Zhou, Yuhua; Ma, Jun; Ji, Huaping; Zheng, Jianzhong; Zhang, Yuhong; Wang, LimingOBJECTIVES. To evaluate student tobacco control advocacy behavioural capacity using longitudinal trace data. METHODS. A tobacco control advocacy curriculum was developed and implemented at schools of public health (SPH) or departments of public health in seven universities in China. Participants comprised undergraduate students studying the public health curriculum in these 13 Universities. A standardised assessment tool was used to evaluate their tobacco control advocacy behavioural capacity. Repeated measures analysis of variance, paired t tests and paired ?2 tests were used to determine differences between dependent variables across time. Multivariate analysis of variance (MANOVA) and multivariate logistic regression were used to assess treatment effects between intervention and control sites. RESULTS. Respective totals of 426 students in the intervention group and 338 in the control group were available for the evaluation. Approximately 90% of respondents were aged 21 years or older and 56% were women. Findings show that the capacity building program significantly improved public health student advocacy behavioural capacity, including advocacy attitude, interest, motivation and anti-secondhand smoke behaviours. The curriculum did not impact student smoking behaviour. CONCLUSIONS. This study provides sufficient evidence to support the implementation of tobacco control advocacy training at Chinese schools of public health.Item The Global Health System: Linking Knowledge with Action—Learning from Malaria(Public Library of Science, 2010-1-19) Keusch, Gerald T.; Kilama, Wen L.; Moon, Suerie; Szlezák, Nicole A.; Michaud, Catherine M.In the third in a series of articles on the changing nature of global health institutions, Gerald Keusch and colleagues examine institutional arrangements for malaria research.Item Intimate Partner Violence and Health Care-Seeking Patterns Among Female Users of Urban Adolescent Clinics(Springer US, 2009-9-17) Miller, Elizabeth; Decker, Michele R.; Raj, Anita; Reed, Elizabeth; Marable, Danelle; Silverman, Jay G.To assess the prevalence of intimate partner violence (IPV) and associations with health care-seeking patterns among female patients of adolescent clinics, and to examine screening for IPV and IPV disclosure patterns within these clinics. A self-administered, anonymous, computerized survey was administered to female clients ages 14–20 years (N = 448) seeking care in five urban adolescent clinics, inquiring about IPV history, reasons for seeking care, and IPV screening by and IPV disclosure to providers. Two in five (40%) female urban adolescent clinic patients had experienced IPV, with 32% reporting physical and 21% reporting sexual victimization. Among IPV survivors, 45% reported abuse in their current or most recent relationship. IPV prevalence was equally high among those visiting clinics for reproductive health concerns as among those seeking care for other reasons. IPV victimization was associated with both poor current health status (AOR 1.57, 95% CI 1.03–2.40) and having foregone care in the past year (AOR 2.59, 95% CI 1.20–5.58). Recent IPV victimization was associated only with past 12 month foregone care (AOR 2.02, 95% CI 1.18–3.46). A minority (30%) reported ever being screened for IPV in a clinical setting. IPV victimization is pervasive among female adolescent clinic attendees regardless of visit type, yet IPV screening by providers appears low. Patients reporting poor health status and foregone care are more likely to have experienced IPV. IPV screening and interventions tailored for female patients of adolescent clinics are needed.Item Are Patents Impeding Medical Care and Innovation?(Public Library of Science, 2010-1-5) Gold, E. Richard; Kaplan, Warren; Orbinski, James; Harland-Logan, Sarah; N-Marandi, SevilThis month's debate examines whether the current patent system is crucial for stimulating health research or whether it is stifling biomedical research and impeding medical care. Background to the debate: Pharmaceutical and medical device manufacturers argue that the current patent system is crucial for stimulating research and development (R&D), leading to new products that improve medical care. The financial return on their investments that is afforded by patent protection, they claim, is an incentive toward innovation and reinvestment into further R&D. But this view has been challenged in recent years. Many commentators argue that patents are stifling biomedical research, for example by preventing researchers from accessing patented materials or methods they need for their studies. Patents have also been blamed for impeding medical care by raising prices of essential medicines, such as antiretroviral drugs, in poor countries. This debate examines whether and how patents are impeding health care and innovation.Item Malaria Misdiagnosis in Uganda – Implications for Policy Change(BioMed Central, 2009-4-16) Nankabirwa, Joan; Zurovac, Dejan; Njogu, Julius N.; Rwakimari, John B.; Counihan, Helen; Snow, Robert W.; Tibenderana, James K.BACKGROUND In Uganda, like in many other countries traditionally viewed as harbouring very high malaria transmission, the norm has been to recommend that febrile episodes are diagnosed as malaria. In this study, the policy implications of such recommendations are revisited. METHODS A cross-sectional survey was undertaken at outpatient departments of all health facilities in four Ugandan districts. The routine diagnostic practices were assessed for all patients during exit interviews and a research slide was obtained for later reading. Primary outcome measures were the accuracy of national recommendations and routine malaria diagnosis in comparison with the study definition of malaria (any parasitaemia on expert slide examination in patient with fever) stratified by age and intensity of malaria transmission. Secondary outcome measures were the use, interpretation and accuracy of routine malaria microscopy. RESULTS 1,763 consultations undertaken by 233 health workers at 188 facilities were evaluated. The prevalence of malaria was 24.2% and ranged between 13.9% in patients ≥5 years in medium-to-high transmission areas to 50.5% for children <5 years in very high transmission areas. Overall, the sensitivity and negative predictive value (NPV) of routine malaria diagnosis were high (89.7% and 91.6% respectively) while the specificity and positive predictive value (PPV) were low (35.6% and 30.8% respectively). However, malaria was under-diagnosed in 39.9% of children less than five years of age in the very high transmission area. At 48 facilities with functional microscopy, the use of malaria slide examination was low (34.5%) without significant differences between age groups, or between patients for whom microscopy is recommended or not. 96.2% of patients with a routine positive slide result were treated for malaria but also 47.6% with a negative result. CONCLUSION Current recommendations and associated clinical practices result in massive laria over-diagnosis across all age groups and transmission areas in Uganda. Yet, under-diagnosis is also common in children <5 years. The potential benefits of malaria microscopy are not realized. To address malaria misdiagnosis, Uganda's policy shift from presumptive to parasitological diagnosis should encompass introduction of malaria rapid diagnostic tests and substantial strengthening of malaria microscopy.Item Smoking Patterns and Sociodemographic Factors Associated with Tobacco Use among Chinese Rural Male Residents: A Descriptive Analysis(BioMed Central, 2008-7-21) Yang, Tingzhong; Li, Fuzhong; Yang, Xiaozhao; Wu, Zhenyi; Feng, Xiangxian; Wang, Yibo; Wang, Xuhui; Abdullah, Abu Saleh M.BACKGROUND. Although evidence has shown high prevalence rates of tobacco use in the general urban populations in China, relatively little is known in its rural population. The purposes of this study were to examine smoking patterns and sociodemographic correlates of smoking in a sample of rural Chinese male residents. METHODS. The study employed a cross-sectional, multi-stage sampling design. Residents (N = 4,414; aged 15 years and older) were recruited from four geographic regions in China. Information on participants' tobacco use (of all forms), including their daily use, and sociodemographic characteristics were collected via survey questionnaires and the resultant data were analyzed using chi-square tests and logistic regression procedures. RESULTS. The overall smoking prevalence in the study sample was 66.8% (n = 2,950). Of these, the average use of tobacco products per day was 12.70 (SD = 7.99) and over 60% reported daily smoking of more than 10 cigarettes. Geographic regions of the study areas, age of the participants, marital status, ethnicity, education, occupation, and average personal annual income were found to be significantly associated with an increased likelihood of smoking among rural Chinese male residents. CONCLUSION. There is a high smoking prevalence in the Chinese rural population and smoking behaviors are associated with important sociodemographic factors. Findings suggest the need for tobacco control and intervention policies aimed at reducing tobacco use in Chinese rural smoking populations.Item Rates of Virological Failure in Patients Treated in a Home-Based Versus a Facility-Based HIV-Care Model in Jinja, Southeast Uganda: A Cluster-Randomised Equivalence Trial(Lancet Publishing Group, 2009-12-19) Jaffar, Shabbar; Amuron, Barbara; Foster, Susan; Birungi, Josephine; Levin, Jonathan; Namara, Geoffrey; Nabiryo, Christine; Ndembi, Nicaise; Kyomuhangi, Rosette; Opio, Alex; Bunnell, Rebecca; Tappero, Jordan W; Mermin, Jonathan; Coutinho, Alex; Grosskurth, HeinerBACKGROUND. Identification of new ways to increase access to antiretroviral therapy in Africa is an urgent priority. We assessed whether home-based HIV care was as effective as was facility-based care. METHODS We undertook a cluster-randomised equivalence trial in Jinja, Uganda. 44 geographical areas in nine strata, defined according to ratio of urban and rural participants and distance from the clinic, were randomised to home-based or facility-based care by drawing sealed cards from a box. The trial was integrated into normal service delivery. All patients with WHO stage IV or late stage III disease or CD4-cell counts fewer than 200 cells per μL who started antiretroviral therapy between Feb 15, 2005, and Dec 19, 2006, were eligible, apart from those living on islands. Follow-up continued until Jan 31, 2009. The primary endpoint was virological failure, defined as RNA more than 500 copies per mL after 6 months of treatment. The margin of equivalence was 9% (equivalence limits 0·69–1·45). Analyses were by intention to treat and adjusted for baseline CD4-cell count and study stratum. This trial is registered at http://isrctn.org, number ISRCTN 17184129. FINDINGS 859 patients (22 clusters) were randomly assigned to home and 594 (22 clusters) to facility care. During the first year, 93 (11%) receiving home care and 66 (11%) receiving facility care died, 29 (3%) receiving home and 36 (6%) receiving facility care withdrew, and 8 (1%) receiving home and 9 (2%) receiving facility care were lost to follow-up. 117 of 729 (16%) in home care had virological failure versus 80 of 483 (17%) in facility care: rates per 100 person-years were 8·19 (95% CI 6·84–9·82) for home and 8·67 (6·96–10·79) for facility care (rate ratio [RR] 1·04, 0·78–1·40; equivalence shown). Two patients from each group were immediately lost to follow-up. Mortality rates were similar between groups (0·95 [0·71–1·28]). 97 of 857 (11%) patients in home and 75 of 592 (13%) in facility care were admitted at least once (0·91, 0·64–1·28). INTERPRETATION This home-based HIV-care strategy is as effective as is a clinic-based strategy, and therefore could enable improved and equitable access to HIV treatment, especially in areas with poor infrastructure and access to clinic care. FUNDING US Centers for Disease Control and Prevention and UK Medical Research Council.Item Malaria Case-Management under Artemether-Lumefantrine Treatment Policy in Uganda(BioMed Central, 2008-9-19) Zurovac, Dejan; Tibenderana, James K.; Nankabirwa, Joan; Ssekitooleko, James; Njogu, Julius N.; Rwakimari, John B.; Meek, Sylvia; Talisuna, Ambrose; Snow, Robert W.BACKGROUND Case-management with artemether-lumefantrine (AL) is one of the key strategies to control malaria in many African countries. Yet, the reports on translation of AL implementation activities into clinical practice are scarce. Here the quality of AL case-management is reported from Uganda; approximately one year after AL replaced combination of chloroquine and sulphadoxine-pyrimethamine (CQ+SP) as recommended first line treatment for uncomplicated malaria. METHODS A cross-sectional survey, using a range of quality of care assessment tools, was undertaken at all government and private-not-for-profit facilities in four Ugandan districts. Main outcome measures were AL prescribing, dispensing and counseling practices in comparison with national guidelines, and factors influencing health workers decision to 1) treat for malaria, and 2) prescribe AL. RESULTS 195 facilities, 232 health workers and 1,763 outpatient consultations were evaluated. Of 1,200 patients who needed treatment with AL according to guidelines, AL was prescribed for 60%, CQ+SP for 14%, quinine for 4%, CQ for 3%, other antimalarials for 3%, and 16% of patients had no antimalarial drug prescribed. AL was prescribed in the correct dose for 95% of patients. Only three out of seven AL counseling and dispensing tasks were performed for more than 50% of patients. Patients were more likely to be treated for malaria if they presented with main complaint of fever (OR = 5.22; 95% CI: 3.61–7.54) and if they were seen by supervised health workers (OR = 1.63; 95% CI: 1.06–2.50); however less likely if they were treated by more qualified health workers (OR = 0.61; 95% CI: 0.40–0.93) and presented with skin problem (OR = 0.29; 95% CI: 0.15–0.55). AL was more likely prescribed if the appropriate weight-specific AL pack was in stock (OR = 6.15; 95% CI: 3.43–11.05) and when CQ was absent (OR = 2.16; 95% CI:1.09–4.28). Routine AL implementation activities were not associated with better performance. CONCLUSION Although the use of AL was predominant over non-recommended therapies, the quality of AL case-management at the point of care is not yet optimal. There is an urgent need for innovative quality improvement interventions, which should be rigorously tested. Adequate availability of ACTs at the point of care will, however, ultimately determine the success of any performance interventions and ACT policy transitions.Item Attitudes and Behavioral Response Toward Key Tobacco Control Measures from the FCTC among Chinese Urban Residents(BioMed Central, 2007-9-18) Yang, Tingzhong; Wu, Yanwei; Abdullah, Abu Saleh M.; Dai, Di; Li, Fuzhong; Wu, Junqing; Xiang, HaiqingBACKGROUND. The Chinese National People's Congress ratified the WHO Framework Convention on Tobacco Control (FCTC) on 27 August 2005, signaling China's commitment to implement tobacco control policies and legislation consistent with the treaty. This study was designed to examine attitudes towards four WHO FCTC measures among Chinese urban residents. METHODS. In a cross-sectional design study, survey data were collected from two Chinese urban cities involving a sample of 3,003 residents aged 15 years or older. Through a face-to-face interview, respondents were asked about attitudes toward four tobacco control measures developed by the WHO FCTC. Data on the four dependent measures were analyzed using multivariate logistic regression analyses. Using descriptive statistics, potential change in smoking behavior that smokers might make in response to increasing cigarette prices is also reported. RESULTS. 81.8% of the respondents in the study sample supported banning smoking in public places, 68.8% favored increasing the cigarette tax, 85.1% supported health warnings on cigarette packages, and 85.7% favored banning tobacco advertising. The likelihood to support these measures was associated with gender, educational level, and personal income. Smokers were less likely to support these measures than non-smokers, with decreased support expressed by daily smokers compared to occasional smokers, and heavy smokers compared to light smokers. The proportion of switching to cheaper cigarette brands, decreasing smoking, and quitting smoking altogether with increased cigarette prices were 29.1%, 30.90% and 40.0% for occasional smokers, respectively; and 30.8%, 32.7% and 36.5% for daily smokers, respectively. CONCLUSION. Results from this study indicate strong public support in key WHO FCTC measures and that increases in cigarette price may reduce tobacco consumption among Chinese urban residents. Findings from this study have implications with respect to policymaking and legislation for tobacco control in China.Item Intimate Partner Violence against Women in Eastern Uganda: Implications for HIV Prevention(BioMed Central, 2006-11-20) Karamagi, Charles A. S.; Tumwine, James K.; Tylleskar, Thorkild; Heggenhougen, KristianBACKGROUND. We were interested in finding out if the very low antenatal VCT acceptance rate reported in Mbale Hospital was linked to intimate partner violence against women. We therefore set out to i) determine the prevalence of intimate partner violence, ii) identify risk factors for intimate partner violence and iii) look for association between intimate partner violence and HIV prevention particularly in the context of the prevention of mother-to-child transmission of HIV programme (PMTCT). METHODS. The study consisted of a household survey of rural and urban women with infants in Mbale district, complemented with focus group discussions with women and men. Women were interviewed on socio-demographic characteristics of the woman and her husband, antenatal and postnatal experience related to the youngest child, antenatal HIV testing, perceptions regarding the marital relationship, and intimate partner violence. We obtained ethical approval from Makerere University and informed consent from all participants in the study. RESULTS. During November and December 2003, we interviewed 457 women in Mbale District. A further 96 women and men participated in the focus group discussions. The prevalence of lifetime intimate partner violence was 54% and physical violence in the past year was 14%. Higher education of women (OR 0.3, 95% CI 0.1–0.7) and marriage satisfaction (OR 0.3, 95% CI 0.1–0.7) were associated with lower risk of intimate partner violence, while rural residence (OR 4.4, 95% CI 1.2–16.2) and the husband having another partner (OR 2.4, 95% CI 1.02–5.7) were associated with higher risk of intimate partner violence. There was a strong association between sexual coercion and lifetime physical violence (OR 3.8, 95% CI 2.5–5.7). Multiple partners and consumption of alcohol were major reasons for intimate partner violence. According to the focus group discussions, women fear to test for HIV, disclose HIV results, and request to use condoms because of fear of intimate partner violence. CONCLUSION. Intimate partner violence is common in eastern Uganda and is related to gender inequality, multiple partners, alcohol, and poverty. Accordingly, programmes for the prevention of intimate partner violence need to target these underlying factors. The suggested link between intimate partner violence and HIV risky behaviours or prevention strategies calls for further studies to clearly establish this relationship.Item Intimate partner violence and infant morbidity: evidence of an association from a population-based study in eastern Uganda in 2003(BioMed Central, 2007-11-7) Karamagi, Charles A. S.; Tumwine, James K.; Tylleskar, Thorkild; Heggenhougen, KristianBACKGROUND. Although recent studies suggest that there is an association between intimate partner violence and child mortality, the underlying mechanisms are still unknown. It is against this background that as a secondary objective, we set out to explore whether an association exists between intimate partner violence and illness in infants. METHODS. We conducted a population based household survey in Mbale, eastern Uganda in 2003. Participants were 457 women (with 457 infants) who consented to participate in the study. We measured socio-demographics of women and occurrence of intimate partner violence. We measured socio-demographics, immunization, nutritional status, and illness in the previous two weeks of the children. RESULTS. The mean age of the women was 25 years (SD 5.7) while the mean age of the infants was 6 months (SD 3.5). The prevalence of lifetime intimate partner violence was 54% (95% CI 48%–60%). During the previous two weeks, 50% (95% CI 50%–54%) of the children had illness (fever, diarrhoea, cough and fast breathing). Lifetime intimate partner violence was associated with infant illness (OR 1.8, 95% CI 1.2–2.8) and diarrhoea (OR 2.0, 95% CI 1.2–3.4). CONCLUSION. Our findings suggest that infant illnesses (fever, diarrhoea, cough and fast breathing) are associated with intimate partner violence, and provide insights into previous reports that have shown an association between intimate partner violence and child mortality, suggesting possible underlying mechanisms. Our findings also highlight the importance of intimate partner violence on the health of children, and the need for further research in this area.Item The Experience of "Medicine Companions" to Support Adherence to Antiretroviral Therapy: Quantitative and Qualitative Data from a Trial Population in Uganda(Taylor & Francis, 2010-8-2) Foster, S. D.; Nakamanya, S.; Kyomuhangi, R.; Amurwon, J.; Namara, G.; Amuron, Barbara; Nabiryo, C.; Birungi, Josephine; Wolff, B.; Jaffar, S.; Grosskurth, H.Good adherence is critical for antiretroviral therapy (ART) in sub-Saharan Africa. We report on the characteristics of medicine companions (MCs) chosen by Ugandan patients enrolling on ART, and on how MCs were chosen, and what roles they played. Baseline data on MCs of 1453 participants in a randomized controlled trial comparing facility and home-based delivery of ART in Jinja, Uganda were analyzed. Textual data on experience with MCs were collected through in-depth interviews among a subsample of 40 trial participants equally divided by sex and trial arm. Significantly more women (71%) than men (29%) were recruited. The majority (75%) of women participants were either widowed (51%) or separated or divorced (24%), whereas most of the men (66%) were married. Women were most likely to choose a child as their MC while men were most likely to choose their spouse; 41% of women chose an MC under 21 compared with only 14% of men. Only 31% of married women chose their husband, compared with 66% of married men who chose their wife. Qualitative interviews suggested MCs proved useful for reminding and other supportive tasks in the first three months but were generally less essential by six months and beyond. Convenience, reliability, and trust were key considerations in choosing an MC. Children provided the only alternative for many unmarried women, but even some married women felt children made more reliable MCs than husbands. Participants who had disclosed their serostatus usually received drug-taking reminders from multiple household members. One participant in the qualitative sample with poor family relations delayed starting treatment due to unwillingness to identify an MC. MCs were generally welcome and useful in supporting early adherence. However, disclosure to an MC should not be a condition of obtaining treatment.Item Exploring the Relationship between Chronic Undernutrition and Asymptomatic Malaria in Ghanaian Children(BioMed Central, 2010-2-2) Crookston, Benjamin T.; Alder, Stephen C.; Boakye, Isaac; Merrill, Ray M.; Amuasi, John H.; Porucznik, Christina A.; Stanford, Joseph B.; Dickerson, Ty T.; Dearden, Kirk A.; Hale, DeVon C.; Sylverken, Justice; Snow, Bryce S.; Osei-Akoto, Alex; Ansong, DanielBACKGROUND A moderate association has been found between asymptomatic parasitaemia and undernutrition. However, additional investigation using the gold standard for asymptomatic parasitaemia confirmation, polymerase chain reaction (PCR), is needed to validate this association. Anthropometric measurements and blood samples from children less than five years of age in a rural Ghanaian community were used to determine if an association exists between chronic undernutrition and PCR-confirmed cases of asymptomatic malaria. METHODS This was a descriptive cross-sectional study of 214 children less than five years of age from a community near Kumasi, Ghana. Blood samples and anthropometric measurements from these children were collected during physical examinations conducted in January 2007 by partners of the Barekuma Collaborative Community Development Programme. RESULTS Findings from the logistic model predicting the odds of asymptomatic malaria indicate that children who experienced mild, moderate or severe stunting were not more likely to have asymptomatic malaria than children who were not stunted. Children experiencing anaemia had an increased likelihood (OR = 4.15; 95% CI: 1.92, 8.98) of asymptomatic malaria. Similarly, increased spleen size, which was measured by ultrasound, was also associated with asymptomatic malaria (OR = 2.17; 95% CI: 1.44, 3.28). Fast breathing, sex of the child, and age of the child were not significantly associated with the asymptomatic malaria. CONCLUSIONS No significant association between chronic undernutrition and presence of asymptomatic malaria was found. Children who experience anaemia and children who have splenomegaly are more likely to present asymptomatic malaria. Programmes aimed at addressing malaria should continue to include nutritional components, especially components that address anaemia.