Pub Date : 2023-10-26DOI: 10.12688/gatesopenres.14896.1
Jolien Freriksen, Joyce van der Heijden, Marika de Hoop-Sommen, Trevor Johnson, Karen R Yeo, Essam Kerwash, Susan Cole, Janet Nooney, Rick Greupink, Ping Zhao, Saskia de Wildt
Physiologically based pharmacokinetic (PBPK) models represent computational technology to characterize drug behavior within the context of detailed human physiology. Today, PBPK is routinely used in drug development and regulatory approval to support decisions on how a medicine can be used under certain clinical conditions. As such, PBPK has the potential to enhance medicine use for populations that are often under-served globally in drug development and clinical care, namely pediatric patients, pregnant and lactating women. To facilitate broader applications of PBPK for these populations, we joined force and organized five hands-on workshops primarily to non-modelers on the principles of PBPK and its potential applications in pediatric and obstetric pharmacology in 2021 and 2022. In this open letter, we report learning objectives and content of such workshops and to highlight the significant value of these educational efforts.
{"title":"Demystifying physiologically based pharmacokinetic modelling among non-modelers towards model-informed medicine use in under-served populations.","authors":"Jolien Freriksen, Joyce van der Heijden, Marika de Hoop-Sommen, Trevor Johnson, Karen R Yeo, Essam Kerwash, Susan Cole, Janet Nooney, Rick Greupink, Ping Zhao, Saskia de Wildt","doi":"10.12688/gatesopenres.14896.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14896.1","url":null,"abstract":"<ns4:p>Physiologically based pharmacokinetic (PBPK) models represent computational technology to characterize drug behavior within the context of detailed human physiology. Today, PBPK is routinely used in drug development and regulatory approval to support decisions on how a medicine can be used under certain clinical conditions. As such, PBPK has the potential to enhance medicine use for populations that are often under-served globally in drug development and clinical care, namely pediatric patients, pregnant and lactating women. To facilitate broader applications of PBPK for these populations, we joined force and organized five hands-on workshops primarily to non-modelers on the principles of PBPK and its potential applications in pediatric and obstetric pharmacology in 2021 and 2022. In this open letter, we report learning objectives and content of such workshops and to highlight the significant value of these educational efforts.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136381905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Despite progressive policies and frameworks on school safety by the Department of Basic Education, safety remains a concern in South African schools. Methods A cross-sectional descriptive design was employed using the National School Safety Framework (NSSF) 152-question learner survey, exploring perceptions and experiences pertaining to eight safety domains: dangerous objects, drugs and alcohol, bullying, verbal abuse, physical violence, discrimination, sexual violence, and journey to and from school. Grade 9-11 learners from 15 government-funded high schools in the Girls Achieve Power trial in Khayelitsha, Soweto, and Thembisa townships were surveyed (March 2018 - April 2019), sampling 10% of the school population. Data analysis included Principal Component Analysis (PCA), reducing correlated variables into fewer questions, then analysis on a scree plot by calculating eigenvalues; repeated PCA with those that had a minimum eigenvalue of 1 and Cronbach Alpha test for internal reliability. Eleven composite variables were included in the final analysis. Results In total, 1034 learners completed the NSSF learner survey; 52.9% were female and the mean age was 16 years (SD=1.36). Results show statistically significant associations between four of the 11 composite variables in relation to sex. Over half (55%) of males have experienced peer provocation and relational aggression (p<0.001). Fifty-eight percent of females reported feeling unsafe on their way to and from school (p<0.003). Over half of males reported that their school was not effective in enforcing discipline (p=0.002) while 58% of females noted they could comfortably report any form of experienced or witnessed violence at school, to their educators (p<0.000). Conclusions Violence continues to be a concern in South African schools. Interventions should work across the ecological model to effectively prevent and reduce violence at school and community levels. Strengthened NSSF implementation is critical to achieving this. We recommend NSSF learner survey adaptations to increase utility and implementation.
{"title":"Learner experiences of safety at public high schools in three South African townships: Baseline findings from the National School Safety Framework learner surveys","authors":"Alison Kutywayo, Khuthala Mabetha, Nicolette P. Naidoo, Tshepo Mahuma, Paseka Njobe, Ronelle Hlongwane, Saiqa Mullick","doi":"10.12688/gatesopenres.13328.2","DOIUrl":"https://doi.org/10.12688/gatesopenres.13328.2","url":null,"abstract":"<ns4:p>Background Despite progressive policies and frameworks on school safety by the Department of Basic Education, safety remains a concern in South African schools. Methods A cross-sectional descriptive design was employed using the National School Safety Framework (NSSF) 152-question learner survey, exploring perceptions and experiences pertaining to eight safety domains: dangerous objects, drugs and alcohol, bullying, verbal abuse, physical violence, discrimination, sexual violence, and journey to and from school. Grade 9-11 learners from 15 government-funded high schools in the Girls Achieve Power trial in Khayelitsha, Soweto, and Thembisa townships were surveyed (March 2018 - April 2019), sampling 10% of the school population. Data analysis included Principal Component Analysis (PCA), reducing correlated variables into fewer questions, then analysis on a scree plot by calculating eigenvalues; repeated PCA with those that had a minimum eigenvalue of 1 and Cronbach Alpha test for internal reliability. Eleven composite variables were included in the final analysis. Results In total, 1034 learners completed the NSSF learner survey; 52.9% were female and the mean age was 16 years (SD=1.36). Results show statistically significant associations between four of the 11 composite variables in relation to sex. Over half (55%) of males have experienced peer provocation and relational aggression (p<0.001). Fifty-eight percent of females reported feeling unsafe on their way to and from school (p<0.003). Over half of males reported that their school was not effective in enforcing discipline (p=0.002) while 58% of females noted they could comfortably report any form of experienced or witnessed violence at school, to their educators (p<0.000). Conclusions Violence continues to be a concern in South African schools. Interventions should work across the ecological model to effectively prevent and reduce violence at school and community levels. Strengthened NSSF implementation is critical to achieving this. We recommend NSSF learner survey adaptations to increase utility and implementation.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134908250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.12688/gatesopenres.14819.1
Memory Melon, Bernadette Kombo, Mary Mugambi, Margaret Njiraini, Kennedy Olango, Manas Migot, Samuel Kuria, Martin Kyana, Peter Mwakazi, Japheth Kioko, Shem Kaosa, Maria Mensah, Matthew Thomann, Janet Musimbi, Helgar Musyoki, Parinita Bhattacharjee, Robert Lorway, Lisa Lazarus
Background Men who have sex with men (MSM) in Kenya continue to face barriers to HIV testing, which leads to delays in HIV prevention and care. An HIV self-testing (HIVST) intervention was implemented in three Kenyan counties to increase coverage and frequency of HIV testing among MSM communities with high HIV prevalence. The evaluation study examined how HIVST can increase testing among MSM who are unaware of their status by increasing coverage, frequency, and early uptake of testing and support linkages to prevention and treatment. We share results from the process evaluation of the intervention implemented in partnership with MSM-led organizations. Methods For a 12-month period between August 2019 and July 2020, the project team conducted in-depth interviews with HIVST users, monthly meetings with programme implementation teams, and monthly monitoring data reviews. Polling booth surveys were also conducted with participants. The process evaluation explored the fidelity, feasibility, coverage, acceptability, quality, and effectiveness of the HIVST intervention. Results An average of 793 MSM received 1,041 HIVST kits on a monthly basis through different distribution channels. Of those who received HIVST kits, 67% were distributed to infrequent testers and non-testers. Testing frequency among users increased to 82% for those who had a recent test during the previous three months, compared to 58% of HIVST non-users. There was a high linkage to care and treatment services (84%) among those who tested reactive for HIV at endline. MSM shared preferring HIVST kits because of its convenience and privacy. During the COVID-19 pandemic, adaptations to the intervention were made to support ongoing HIV testing and linkages to services. Conclusion The introduction of HIVST in MSM-led HIV prevention programmes was feasible with high acceptability. The involvement of the MSM community in the design, implementation and evaluation of the intervention was a key factor to intervention success.
{"title":"Expanding options for HIV testing: A process evaluation of a community-led HIV self-testing intervention among men who have sex with men in Kenya","authors":"Memory Melon, Bernadette Kombo, Mary Mugambi, Margaret Njiraini, Kennedy Olango, Manas Migot, Samuel Kuria, Martin Kyana, Peter Mwakazi, Japheth Kioko, Shem Kaosa, Maria Mensah, Matthew Thomann, Janet Musimbi, Helgar Musyoki, Parinita Bhattacharjee, Robert Lorway, Lisa Lazarus","doi":"10.12688/gatesopenres.14819.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14819.1","url":null,"abstract":"<ns4:p>Background Men who have sex with men (MSM) in Kenya continue to face barriers to HIV testing, which leads to delays in HIV prevention and care. An HIV self-testing (HIVST) intervention was implemented in three Kenyan counties to increase coverage and frequency of HIV testing among MSM communities with high HIV prevalence. The evaluation study examined how HIVST can increase testing among MSM who are unaware of their status by increasing coverage, frequency, and early uptake of testing and support linkages to prevention and treatment. We share results from the process evaluation of the intervention implemented in partnership with MSM-led organizations. Methods For a 12-month period between August 2019 and July 2020, the project team conducted in-depth interviews with HIVST users, monthly meetings with programme implementation teams, and monthly monitoring data reviews. Polling booth surveys were also conducted with participants. The process evaluation explored the fidelity, feasibility, coverage, acceptability, quality, and effectiveness of the HIVST intervention. Results An average of 793 MSM received 1,041 HIVST kits on a monthly basis through different distribution channels. Of those who received HIVST kits, 67% were distributed to infrequent testers and non-testers. Testing frequency among users increased to 82% for those who had a recent test during the previous three months, compared to 58% of HIVST non-users. There was a high linkage to care and treatment services (84%) among those who tested reactive for HIV at endline. MSM shared preferring HIVST kits because of its convenience and privacy. During the COVID-19 pandemic, adaptations to the intervention were made to support ongoing HIV testing and linkages to services. Conclusion The introduction of HIVST in MSM-led HIV prevention programmes was feasible with high acceptability. The involvement of the MSM community in the design, implementation and evaluation of the intervention was a key factor to intervention success.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135569765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.12688/gatesopenres.14795.1
Sarah Lloyd-Fox, Sam McCann, Bosiljka Milosavljevic, Laura Katus, Anna Blasi, Chiara Bulgarelli, Maria Crespo-Llado, Giulia Ghillia, Tijan Fadera, Ebrima Mbye, Luke Mason, Fabakary Njai, Omar Njie, Marta Perapoch-Amado, Maria Rozhko, Fatima Sosseh, Mariama Saidykhan, Ebou Touray, Sophie Moore, Clare Elwell
There is a scarcity of prospective longitudinal research targeted at early postnatal life which maps developmental pathways of early-stage processing and brain specialisation in the context of early adversity. Follow up from infancy into the one-five year age range is key, as it constitutes a critical gap between infant and early childhood studies. Availability of portable neuroimaging (functional near infrared spectroscopy (fNIRS) and electroencephalography (EEG)) has enabled access to rural settings increasing the diversity of our sampling and broadening developmental research to include previously underrepresented ethnic-racial and geographical groups in low- and middle- income countries (LMICs). The primary objective of the Brain Imaging for Global Health (BRIGHT) project was to establish brain function - using longitudinal data from mother - for-age reference curves infant dyads living in the UK and rural Gambia and investigate the association between context-associated moderators and developmental trajectories across the first two years of life in The Gambia. In total, 265 participating families were seen during pregnancy, at 7-14 days, 1-, 5-, 8-, 12-, 18- and 24-months post-partum. An additional visit is now underway at 3–5 years to assess pre-school outcomes. The majority of our Gambian cohort live in poverty, but while resource-poor in many factors they commonly experience a rich and beneficial family and caregiving context with multigenerational care and a close-knit supportive community. Understanding the impact of different factors at play in such an environment (i.e., detrimental undernutrition versus beneficial multigenerational family support) will (i) improve the representativeness of models of general cognitive developmental pathways from birth, (ii) identify causal pathways of altered trajectories associated with early adversity at both individual and group level, and (iii) identify the context-associated moderators (i.e. social context) that protect development despite the presence of poverty-associated challenges. This will in turn contribute to the development of targeted interventions.
{"title":"The Brain Imaging for Global Health (BRIGHT) Project: Longitudinal cohort study protocol","authors":"Sarah Lloyd-Fox, Sam McCann, Bosiljka Milosavljevic, Laura Katus, Anna Blasi, Chiara Bulgarelli, Maria Crespo-Llado, Giulia Ghillia, Tijan Fadera, Ebrima Mbye, Luke Mason, Fabakary Njai, Omar Njie, Marta Perapoch-Amado, Maria Rozhko, Fatima Sosseh, Mariama Saidykhan, Ebou Touray, Sophie Moore, Clare Elwell","doi":"10.12688/gatesopenres.14795.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14795.1","url":null,"abstract":"<ns4:p>There is a scarcity of prospective longitudinal research targeted at early postnatal life which maps developmental pathways of early-stage processing and brain specialisation in the context of early adversity. Follow up from infancy into the one-five year age range is key, as it constitutes a critical gap between infant and early childhood studies. Availability of portable neuroimaging (functional near infrared spectroscopy (fNIRS) and electroencephalography (EEG)) has enabled access to rural settings increasing the diversity of our sampling and broadening developmental research to include previously underrepresented ethnic-racial and geographical groups in low- and middle- income countries (LMICs). The primary objective of the Brain Imaging for Global Health (BRIGHT) project was to establish brain function - using longitudinal data from mother - for-age reference curves infant dyads living in the UK and rural Gambia and investigate the association between context-associated moderators and developmental trajectories across the first two years of life in The Gambia. In total, 265 participating families were seen during pregnancy, at 7-14 days, 1-, 5-, 8-, 12-, 18- and 24-months post-partum. An additional visit is now underway at 3–5 years to assess pre-school outcomes. The majority of our Gambian cohort live in poverty, but while resource-poor in many factors they commonly experience a rich and beneficial family and caregiving context with multigenerational care and a close-knit supportive community. Understanding the impact of different factors at play in such an environment (<ns4:italic>i.e.</ns4:italic>, detrimental undernutrition <ns4:italic>versus</ns4:italic> beneficial multigenerational family support) will (i) improve the representativeness of models of general cognitive developmental pathways from birth, (ii) identify causal pathways of altered trajectories associated with early adversity at both individual and group level, and (iii) identify the context-associated moderators (<ns4:italic>i.e.</ns4:italic> social context) that protect development despite the presence of poverty-associated challenges. This will in turn contribute to the development of targeted interventions.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135888474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-18DOI: 10.12688/gatesopenres.14806.1
Chloe Puett, Jere Behrman, Clint Pecenka, Christopher Sudfeld
The association between adult height and labor-market wages, or the “height premium” (HP), is an important input for quantifying potential economic benefits of nutritional interventions promoting growth. A large economics literature has evaluated this association; however, HP estimates differ greatly depending on the study populations and statistical methodologies used. We conducted a meta-analysis of HP estimates to describe the differences in estimates with different statistical methodologies and to examine potential effect modification of the HP by sex and country income category. We performed meta-analyses for studies using instrumental variables (IV) and ordinary least squares (OLS) methods, separately. OLS estimates were separated into those that were “low-adjusted” for confounding variables and “high-adjusted” for at least one common mediator variable, specifically cognition or schooling. Overall, in a total of 12 studies, the pooled estimates for IV studies indicated that each centimeter increase in height was associated with 3.58% greater wages (95% CI: 1.62-5.54%; I2=97.5%, p<0.001)). In the 24 total OLS studies, low-adjusted estimates indicated an HP of 1.06% (95% CI: 0.85-1.28%, I2=95.5%, p<0.001), while for high-adjusted estimates the HP was only 0.57% (95% CI: 0.41-0.73%, I2=95.8%, p<0.001). Further, the meta-analysis found evidence of effect modification by sex in OLS estimates but not IV, and for both IV and OLS for country income category. Overall, the literature suggests a robust association between adult height and wages; however, the magnitude of the estimate appears to be dependent on statistical methods and covariates selected for multivariable models. Our findings also suggest there may be differences by sex and country income category. Additional analyses are needed taking into account a causal inference framework and, if adult height is being used to capture the cumulative effect on wages of nutritional exposures from conception through adulthood, studies should not adjust for potential mediators including cognition and schooling.
{"title":"The height premium: a literature review and meta-analysis","authors":"Chloe Puett, Jere Behrman, Clint Pecenka, Christopher Sudfeld","doi":"10.12688/gatesopenres.14806.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14806.1","url":null,"abstract":"<ns4:p>The association between adult height and labor-market wages, or the “height premium” (HP), is an important input for quantifying potential economic benefits of nutritional interventions promoting growth. A large economics literature has evaluated this association; however, HP estimates differ greatly depending on the study populations and statistical methodologies used. We conducted a meta-analysis of HP estimates to describe the differences in estimates with different statistical methodologies and to examine potential effect modification of the HP by sex and country income category. We performed meta-analyses for studies using instrumental variables (IV) and ordinary least squares (OLS) methods, separately. OLS estimates were separated into those that were “low-adjusted” for confounding variables and “high-adjusted” for at least one common mediator variable, specifically cognition or schooling. Overall, in a total of 12 studies, the pooled estimates for IV studies indicated that each centimeter increase in height was associated with 3.58% greater wages (95% CI: 1.62-5.54%; I<ns4:sup>2</ns4:sup>=97.5%, p<0.001)). In the 24 total OLS studies, low-adjusted estimates indicated an HP of 1.06% (95% CI: 0.85-1.28%, I<ns4:sup>2</ns4:sup>=95.5%, p<0.001), while for high-adjusted estimates the HP was only 0.57% (95% CI: 0.41-0.73%, I<ns4:sup>2</ns4:sup>=95.8%, p<0.001). Further, the meta-analysis found evidence of effect modification by sex in OLS estimates but not IV, and for both IV and OLS for country income category. Overall, the literature suggests a robust association between adult height and wages; however, the magnitude of the estimate appears to be dependent on statistical methods and covariates selected for multivariable models. Our findings also suggest there may be differences by sex and country income category. Additional analyses are needed taking into account a causal inference framework and, if adult height is being used to capture the cumulative effect on wages of nutritional exposures from conception through adulthood, studies should not adjust for potential mediators including cognition and schooling.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135882921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Effective coverage of Human Immunodeficiency Virus prevention services for Key Populations (KPs) including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) people necessitates periodic validation of physical venues and size estimates. Kenya conducted a robust size estimation of KPs in 2012 and a repeat mapping and size estimation exercise was conducted in 2018 to update KP Size Estimates and sub-typologies within each County for calculation of realistic program indicators. Methods A prospective mixed methods programmatic mapping approach adopted comprised two steps. The first step involved consolidating and documenting all known venues where KPs congregate while the second step included visiting and validating these venues confirming their active status. Data were collected in 34 out of 47 Counties in Kenya between January and March 2018. Data collected included estimated number of KPs (range), venue typology and timing of operation of each venue. Results We estimated a total number of 167,940 (129,271 to 206,609) FSWs; 32,580 (24,704 to 40,455) MSM; 16,063 (12,426 to 19,691) PWIDs; 10,951 (8,160 to 13,742) and 4,305 (2,826 to 5,783) transgender people congregating at 10,250, 1,729, 401 and 1,218 venues respectively. Majority of the venues for FSW (81%), MSM (64%) and transgender people (67%) were bars with and without lodging, PWIDs were mostly found on streets and injecting dens (70%). Around 9% of FSW and MSM and11% of PWIDs were below the age of 18 years. Conclusion This study provided information on young KPs, female PWIDs, MSWs and for the first time, TG people in Kenya. The exercise updated size estimates of KPs by typology and provided new evidence for resource allocation, planning of interventions and targets. Programmatic mapping continues to be a useful approach supporting programs to achieve high levels of coverage and prioritize resources.
{"title":"Programmatic mapping and estimating the population size of female sex workers, men who have sex with men, people who inject drugs and transgender populations in Kenya","authors":"Janet Musimbi, Helgar Musyoki, Mary Mugambi, Shem Kaosa, Japheth Kioko, Diane Aluko, Waruiru Wanjiru, Solomon Wambua, Ravi Prakash, Shajy Isac, Parinita Bhattacharjee, Faran Emmanuel","doi":"10.12688/gatesopenres.13623.3","DOIUrl":"https://doi.org/10.12688/gatesopenres.13623.3","url":null,"abstract":"<ns4:p>Introduction Effective coverage of Human Immunodeficiency Virus prevention services for Key Populations (KPs) including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) people necessitates periodic validation of physical venues and size estimates. Kenya conducted a robust size estimation of KPs in 2012 and a repeat mapping and size estimation exercise was conducted in 2018 to update KP Size Estimates and sub-typologies within each County for calculation of realistic program indicators. Methods A prospective mixed methods programmatic mapping approach adopted comprised two steps. The first step involved consolidating and documenting all known venues where KPs congregate while the second step included visiting and validating these venues confirming their active status. Data were collected in 34 out of 47 Counties in Kenya between January and March 2018. Data collected included estimated number of KPs (range), venue typology and timing of operation of each venue. Results We estimated a total number of 167,940 (129,271 to 206,609) FSWs; 32,580 (24,704 to 40,455) MSM; 16,063 (12,426 to 19,691) PWIDs; 10,951 (8,160 to 13,742) and 4,305 (2,826 to 5,783) transgender people congregating at 10,250, 1,729, 401 and 1,218 venues respectively. Majority of the venues for FSW (81%), MSM (64%) and transgender people (67%) were bars with and without lodging, PWIDs were mostly found on streets and injecting dens (70%). Around 9% of FSW and MSM and11% of PWIDs were below the age of 18 years. Conclusion This study provided information on young KPs, female PWIDs, MSWs and for the first time, TG people in Kenya. The exercise updated size estimates of KPs by typology and provided new evidence for resource allocation, planning of interventions and targets. Programmatic mapping continues to be a useful approach supporting programs to achieve high levels of coverage and prioritize resources.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136116775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: As a Hindu-majority province in Indonesia, Bali presents a unique and distinctive culture. Patrilocal (purusa) marriage and patrilineal inheritance as a continuation of the patriarchal system puts a man in the key role as a family successor. Having a son is a priority for a married couple in Balinese society. As a consequence, Balinese women experience several constraints related to their economic productive, reproductive, and adat (ritual) roles. When a family does not have a male heir, their daughter is pressed to find a spouse willing to accept sentana (matrilocal) marriage. This secondary form of marriage brings another complication for Balinese-Hindu women and does not necessarily relieve their submissive position. This research analyzes Balinese-Hindu women’s perspectives on their marriage experiences and fertility decisions. Methods: The data was collected in two areas representing rural (Banjar Tumbakasa in Gianyar) and urban (Banjar Biaung in Denpasar) locations in Bali Province, Indonesia from November 2019 to February 2020. Primary data was based on in-depth interviews of six rural and six urban married Balinese-Hindu women. Results: This qualitative inquiry into Balinese women's experience of the marriage system and fertility options in urban and rural Bali revealed varying degrees of social expectation to provide male descendants for their families. At the same time, economic burdens still haunt them in this development era, and have conflicting implications for family size. Their stories of purusa (patrilocal) and sentana (matrilocal) marriage were complex, being strongly associated with customary law (adat) in traditional society. Paradoxically, however, it was rural women in the study sample who disproportionately opted for the sentana arrangement and limitation of family size. Conclusions: This study explores women's fertility aspirations, notably regarding son precedence. It problematizes the sentana marriage alternative as a solution to lighten the expectations and burdens affecting women.
{"title":"Stories of women's marriage and fertility experiences: Qualitative research on urban and rural cases in Bali, Indonesia","authors":"Anastasia Septya Titisari, Luh Kadek Ratih Swandewi, Carol Warren, Anja Reid","doi":"10.12688/gatesopenres.14781.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14781.1","url":null,"abstract":"<ns3:p>Background: As a Hindu-majority province in Indonesia, Bali presents a unique and distinctive culture. Patrilocal (purusa) marriage and patrilineal inheritance as a continuation of the patriarchal system puts a man in the key role as a family successor. Having a son is a priority for a married couple in Balinese society. As a consequence, Balinese women experience several constraints related to their economic productive, reproductive, and adat (ritual) roles. When a family does not have a male heir, their daughter is pressed to find a spouse willing to accept sentana (matrilocal) marriage. This secondary form of marriage brings another complication for Balinese-Hindu women and does not necessarily relieve their submissive position. </ns3:p><ns3:p> This research analyzes Balinese-Hindu women’s perspectives on their marriage experiences and fertility decisions. Methods: The data was collected in two areas representing rural (Banjar Tumbakasa in Gianyar) and urban (Banjar Biaung in Denpasar) locations in Bali Province, Indonesia from November 2019 to February 2020. Primary data was based on in-depth interviews of six rural and six urban married Balinese-Hindu women. </ns3:p><ns3:p> Results: This qualitative inquiry into Balinese women's experience of the marriage system and fertility options in urban and rural Bali revealed varying degrees of social expectation to provide male descendants for their families. At the same time, economic burdens still haunt them in this development era, and have conflicting implications for family size. Their stories of purusa (patrilocal) and sentana (matrilocal) marriage were complex, being strongly associated with customary law (adat) in traditional society. Paradoxically, however, it was rural women in the study sample who disproportionately opted for the sentana arrangement and limitation of family size. </ns3:p><ns3:p> Conclusions: This study explores women's fertility aspirations, notably regarding son precedence. It problematizes the sentana marriage alternative as a solution to lighten the expectations and burdens affecting women.</ns3:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136098163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-09DOI: 10.12688/gatesopenres.14684.2
Patrick K. Munywoki, Godfrey Bigogo, Carolyne Nasimiyu, Alice Ouma, George Aol, Clifford O. Oduor, Samuel Rono, Joshua Auko, George O. Agogo, Ruth Njoroge, Dismas Oketch, Dennis Odhiambo, Victor W. Odeyo, Gilbert Kikwai, Clayton Onyango, Bonventure Juma, Elizabeth Hunsperger, Shirley Lidechi, Caroline Apondi Ochieng, Terrence Q. Lo, Peninah Munyua, Amy Herman-Roloff
Background: SARS-CoV-2 has extensively spread in cities and rural communities, and studies are needed to quantify exposure in the population. We report seroprevalence of SARS-CoV-2 in two well-characterized populations in Kenya at two time points. These data inform the design and delivery of public health mitigation measures.Methods: Leveraging on existing population based infectious disease surveillance (PBIDS) in two demographically diverse settings, a rural site in western Kenya in Asembo, Siaya County, and an urban informal settlement in Kibera, Nairobi County, we set up a longitudinal cohort of randomly selected households with serial sampling of all consenting household members in March and June 2021. Both sites included 1,794 and 1,638 participants in March and June 2021, respectively. Individual seroprevalence of SARS-CoV-2 antibodies was expressed as a percentage of the seropositive among the individuals tested, accounting for household clustering and weighted by the PBIDS age and sex distribution.Results: Overall weighted individual seroprevalence increased from 56.2% (95%CI: 52.1, 60.2%) in March 2021 to 63.9% (95%CI: 59.5, 68.0%) in June 2021 in Kibera. For Asembo, the seroprevalence almost doubled from 26.0% (95%CI: 22.4, 30.0%) in March 2021 to 48.7% (95%CI: 44.3, 53.2%) in July 2021. Seroprevalence was highly heterogeneous by age and geography in these populations—higher seroprevalence was observed in the urban informal settlement (compared to the rural setting), and children aged <10 years had the lowest seroprevalence in both sites. Only 1.2% and 1.6% of the study participants reported receipt of at least one dose of the COVID-19 vaccine by the second round of serosurvey—none by the first round.Conclusions: In these two populations, SARS-CoV-2 seroprevalence increased rapidly in the first 16 months of the COVID-19 pandemic in Kenya. It is important to prioritize additional mitigation measures, such as vaccine distribution, in crowded and low socioeconomic settings.
{"title":"Heterogenous transmission and seroprevalence of SARS-CoV-2 in two demographically diverse populations with low vaccination uptake in Kenya, March and June 2021","authors":"Patrick K. Munywoki, Godfrey Bigogo, Carolyne Nasimiyu, Alice Ouma, George Aol, Clifford O. Oduor, Samuel Rono, Joshua Auko, George O. Agogo, Ruth Njoroge, Dismas Oketch, Dennis Odhiambo, Victor W. Odeyo, Gilbert Kikwai, Clayton Onyango, Bonventure Juma, Elizabeth Hunsperger, Shirley Lidechi, Caroline Apondi Ochieng, Terrence Q. Lo, Peninah Munyua, Amy Herman-Roloff","doi":"10.12688/gatesopenres.14684.2","DOIUrl":"https://doi.org/10.12688/gatesopenres.14684.2","url":null,"abstract":"<ns3:p><ns3:bold>Background:</ns3:bold> SARS-CoV-2 has extensively spread in cities and rural communities, and studies are needed to quantify exposure in the population. We report seroprevalence of SARS-CoV-2 in two well-characterized populations in Kenya at two time points. These data inform the design and delivery of public health mitigation measures.</ns3:p><ns3:p> <ns3:bold>Methods:</ns3:bold> Leveraging on existing population based infectious disease surveillance (PBIDS) in two demographically diverse settings, a rural site in western Kenya in Asembo, Siaya County, and an urban informal settlement in Kibera, Nairobi County, we set up a longitudinal cohort of randomly selected households with serial sampling of all consenting household members in March and June 2021. Both sites included 1,794 and 1,638 participants in March and June 2021, respectively. Individual seroprevalence of SARS-CoV-2 antibodies was expressed as a percentage of the seropositive among the individuals tested, accounting for household clustering and weighted by the PBIDS age and sex distribution.</ns3:p><ns3:p> <ns3:bold>Results:</ns3:bold> Overall weighted individual seroprevalence increased from 56.2% (95%CI: 52.1, 60.2%) in March 2021 to 63.9% (95%CI: 59.5, 68.0%) in June 2021 in Kibera. For Asembo, the seroprevalence almost doubled from 26.0% (95%CI: 22.4, 30.0%) in March 2021 to 48.7% (95%CI: 44.3, 53.2%) in July 2021. Seroprevalence was highly heterogeneous by age and geography in these populations—higher seroprevalence was observed in the urban informal settlement (compared to the rural setting), and children aged <10 years had the lowest seroprevalence in both sites. Only 1.2% and 1.6% of the study participants reported receipt of at least one dose of the COVID-19 vaccine by the second round of serosurvey—none by the first round.</ns3:p><ns3:p> <ns3:bold>Conclusions:</ns3:bold> In these two populations, SARS-CoV-2 seroprevalence increased rapidly in the first 16 months of the COVID-19 pandemic in Kenya. It is important to prioritize additional mitigation measures, such as vaccine distribution, in crowded and low socioeconomic settings.</ns3:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135095580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-28DOI: 10.12688/gatesopenres.14856.1
Karen Hardee, Rebecca Rosenberg, John Ross, Imelda Zosa-Feranil
Background: At the beginning of the COVID-19 pandemic fears of severe disruptions to family planning (FP) and access to services abounded. This paper uses a unique data source, a special Supplement added to the 2021 round of the National Composite Index for Family Planning (NCIFP), to assess in depth the resilience of FP programs in the face of the COVID-19 pandemic across 70 countries spanning six regions.Methods: The 2021 NCIFP included 961 key informants who were asked questions to assess interference in the countries’ ability to achieve objectives, ability to maintain commitment to FP, and availability of information and services. Open ended responses added context.Results: All programs were affected; the magnitude of effects varies by region and country. While the average resilience score, at 47 out of 100, implies middling levels of resilience, further analysis showed that despite interference in many components of programming, with some exceptions, the COVID-19 pandemic generally did not diminish government commitment to FP and programs remained resilient in providing access to services. Common themes mentioned by 178 respondents (18.5% of respondents) included: fear of infection; disruption of services / difficulty with lockdown and travel restrictions; staff / facilities diverted to COVID-19; access to reproductive health services and contraceptive methods affected; shifts in services / outreach; interference with logistics & supplies, training & supervision, and M&E; lack of attention to FP/sexual reproductive health; financing reduced or diverted; and effects on existing partnerships. A strong enabling environment for FP, which the NCIFP is designed to measure, was positively correlated with continued government commitment and access to contraceptive methods during COVID-19.Conclusion: These findings are instructive for programming: it will face challenges and ‘interference’ when unanticipated shocks like COVID-19 occur, with strong FP programs best prepared to exhibit resilience.
{"title":"How resilient were family planning programs during the COVID-19 pandemic? Evidence from 70 countries","authors":"Karen Hardee, Rebecca Rosenberg, John Ross, Imelda Zosa-Feranil","doi":"10.12688/gatesopenres.14856.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14856.1","url":null,"abstract":"<ns3:p><ns3:bold>Background: </ns3:bold>At the beginning of the COVID-19 pandemic fears of severe disruptions to family planning (FP) and access to services abounded. This paper uses a unique data source, a special Supplement added to the 2021 round of the National Composite Index for Family Planning (NCIFP), to assess in depth the resilience of FP programs in the face of the COVID-19 pandemic across 70 countries spanning six regions.</ns3:p><ns3:p> <ns3:bold>Methods: </ns3:bold>The 2021 NCIFP included 961 key informants who were asked questions to assess interference in the countries’ ability to achieve objectives, ability to maintain commitment to FP, and availability of information and services. Open ended responses added context.</ns3:p><ns3:p> <ns3:bold>Results: </ns3:bold>All programs were affected; the magnitude of effects varies by region and country. While the average resilience score, at 47 out of 100, implies middling levels of resilience, further analysis showed that despite interference in many components of programming, with some exceptions, the COVID-19 pandemic generally did not diminish government commitment to FP and programs remained resilient in providing access to services. Common themes mentioned by 178 respondents (18.5% of respondents) included: fear of infection; disruption of services / difficulty with lockdown and travel restrictions; staff / facilities diverted to COVID-19; access to reproductive health services and contraceptive methods affected; shifts in services / outreach; interference with logistics & supplies, training & supervision, and M&E; lack of attention to FP/sexual reproductive health; financing reduced or diverted; and effects on existing partnerships. A strong enabling environment for FP, which the NCIFP is designed to measure, was positively correlated with continued government commitment and access to contraceptive methods during COVID-19.</ns3:p><ns3:p> <ns3:bold>Conclusion: </ns3:bold>These findings are instructive for programming: it will face challenges and ‘interference’ when unanticipated shocks like COVID-19 occur, with strong FP programs best prepared to exhibit resilience.</ns3:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135385655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-12DOI: 10.12688/gatesopenres.14695.1
Ezechukwu Nwokoma, Helen Anyasi, Samantha Archie, Chinedu Onyezobi, Funmilola OlaOlorun, Jennifer Anyanti, Anthony Nwala, Kayode Afolabi, Kristen Little, Eden Demise, Kendal Danna, Kate Rademacher, Marya Plotkin
Background: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training.Methods: From September – October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee’s workplace. Skills were assessed using OSCE during the one-day practicum. Results: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE). Conclusions: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies.
{"title":"Use of Objective Structured Clinical Examination (OSCE) in a hybrid digital / in-person training for hormonal IUD in Nigeria: findings and applications of the approach","authors":"Ezechukwu Nwokoma, Helen Anyasi, Samantha Archie, Chinedu Onyezobi, Funmilola OlaOlorun, Jennifer Anyanti, Anthony Nwala, Kayode Afolabi, Kristen Little, Eden Demise, Kendal Danna, Kate Rademacher, Marya Plotkin","doi":"10.12688/gatesopenres.14695.1","DOIUrl":"https://doi.org/10.12688/gatesopenres.14695.1","url":null,"abstract":"<ns4:p><ns4:bold>Background</ns4:bold>: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training.</ns4:p><ns4:p> <ns4:bold>Methods</ns4:bold>: From September – October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee’s workplace. Skills were assessed using OSCE during the one-day practicum. </ns4:p><ns4:p> <ns4:bold>Results</ns4:bold>: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE). </ns4:p><ns4:p> <ns4:bold>Conclusions</ns4:bold>: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies.</ns4:p>","PeriodicalId":12593,"journal":{"name":"Gates Open Research","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135879731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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