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1.  Sex, drugs and prisons: HIV prevention strategies for over 190 000 clients in Ukraine 
Public Health Action  2014;4(2):96-101.
Setting: One hundred and forty non-governmental organisations implementing human immunodeficiency virus (HIV) prevention programmes among clients, including people who inject drugs, prisoners, female sex workers, men who have sex with men and street children in Ukraine, 2010–2011.
Objective: Among enrolled clients, to assess factors associated with HIV testing, HIV retesting within a year of initial testing and HIV seroconversion.
Design: Retrospective cohort study involving record reviews.
Results: Of 192 487 clients, 42 109 (22%) underwent an initial HIV test (22% were positive). Among HIV-negative clients at baseline, 10 858 (27%) were retested within a year: 317 (3%) of these were HIV-positive. HIV testing and retesting rates were lower among prisoners (0.3%) and others (street children and partners of those in risk groups, 6%), and those who did not receive counselling or services such as condom and needle distribution. Individuals who were not counselled were more likely to seroconvert.
Conclusions: In this large cohort of high-risk groups from Eastern Europe, HIV testing was low and HIV sero-conversion was high. This is of public health concern, bringing into question the overall quality of counselling and how well it is tailored to the specific needs of various risk groups. Qualitative studies to understand the reasons for non-testing are urgently required for designing client-specific interventions.
PMCID: PMC4539029  PMID: 26399206
HIV testing; HIV prevention; most-at-risk populations; HIV seroconversion; injection drug users
2.  Active and passive case detection strategies for the control of leishmaniasis in Bangladesh 
Public Health Action  2014;4(1):15-21.
Setting: Two subdistricts in Bangladesh, Fulbaria and Trishal, which are hyperendemic for leishmaniasis.
Objective: To determine 1) the numbers of patients diagnosed with visceral leishmaniasis (VL) and post-kala azar dermal leishmaniasis (PKDL) using an active case detection (ACD) strategy in Fulbaria and a passive case detection (PCD) strategy in Trishal, and 2) the time taken from symptoms to diagnosis in the ACD subdistrict.
Design: A cross-sectional descriptive study of patients diagnosed from May 2010 to December 2011. The ACD strategy involved community education and outreach workers targeting households of index patients using symptom-based screening and rK-39 tests for suspected cases.
Results: In the ACD subdistrict (Fulbaria) and PCD sub-district (Trishal), respectively 1088 and 756 residents were diagnosed with VL and 1145 and 37 with PKDL. In the ACD subdistrict, the median time to diagnosis for patients directly referred by outreach workers or self-referred was similar, at 60 days for VL and respectively 345 and 360 days for PKDL.
Conclusion: An ACD strategy at the subdistrict level resulted in an increased yield of VL and a much higher yield of PKDL. As PKDL acts as a reservoir for infection, a strategy of ACD and treatment can contribute to the regional elimination of leishmaniasis in the Indian sub-continent.
PMCID: PMC4479097  PMID: 26423756
Bangladesh; visceral leishmaniasis; post-kala azar dermal leishmaniasis; case detection strategies
3.  Childhood immunisation in Bungoma County, Kenya, from 2008 to 2011: need for improved uptake 
Public Health Action  2014;4(1):9-11.
Uptake of immunisations in children aged 1–2 years in Bungoma County, Kenya, was determined as part of the 6-monthly Health and Demographic Surveillance System surveys. A total of 2699 children were assessed between 2008 and 2011. During this time period, full immunisation declined significantly from 84% to 58%, and measles vaccine declined uptake from 89% to 60% (P < 0.001). Each year there was a significant fall-off for the third doses of the oral polio and pentavalent vaccines (P < 0.001). These findings are of concern, as low immunisation coverage may lead to vaccine-preventable disease outbreaks. Further investigations into the reasons for declining immunisation trends are required.
PMCID: PMC4479099  PMID: 26423754
childhood vaccinations; measles; operational research; health and demographic surveillance systems
4.  Do non-monetary incentives for pregnant women increase antenatal attendance among Ethiopian pastoralists? 
Public Health Action  2014;4(1):12-14.
In a pastoralist setting in Ethiopia, we assessed changes in attendance between the first and subsequent antenatal care (ANC) visits following the implementation of non-monetary incentives in a primary health care centre over a 3-year period from October 2009 to September 2012. Incentives included the provision of a bar of soap, a bucket, a mosquito net, sugar, cooking oil, a jerrycan and a delivery kit. The first ANC visits increased by 48% in the first year to 60% in the second. Subsequent visits did not show a similar pattern due to ruptures in incentive stocks. Incentives appear to increase ANC attendance; however, ruptures in stock should be avoided to sustain the effect.
PMCID: PMC4479100  PMID: 26423755
Ethiopia; pastoralists; incentives; antenatal care; operational research
5.  Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone 
Public Health Action  2013;3(2):118-124.
A rural paediatric hospital in Bo, Sierra Leone.
To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem.
Secondary analysis of routine programme data.
Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases.
Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.
PMCID: PMC4463113  PMID: 26393013
Sierra Leone; rational drug use; non-adherence; operational research; hospital
6.  Prevalence of anaemia, syphilis and hepatitis B in pregnant women in Nausori, Fiji 
Public Health Action  2013;3(1):72-75.
An antenatal clinic serving a population of 47 604 in Nausori, Fiji.
1) To estimate the prevalence of anaemia, syphilis and hepatitis B in pregnant women attending their first antenatal visit; and 2) to estimate the uptake of treatment for syphilis and for the prevention of hepatitis B transmission in affected individuals.
Retrospective review of the clinic register and patient records for the year 2011.
The prevalence of anaemia, hepatitis B and syphilis were respectively 22%, 2% and 5%. Among women with syphilis, 78% of those for whom data were available received a complete course of three doses of penicillin during their pregnancy, and 83% of babies born to women with hepatitis B received hepatitis B immunoglobulin.
The prevalence of anaemia in pregnant women has declined but remains high, and further research is required to identify the major causes of this condition in Fiji. The prevalence of syphilis has remained static, while hepatitis B has decreased over the past decade. There are some gaps in the implementation of effective interventions to manage these conditions in pregnant women.
PMCID: PMC4463080  PMID: 26393000
antenatal care; community health; maternal and child health; nutrition; sexually transmitted diseases
7.  Nurses graduating in Fiji between 2001 and 2010: sufficient supply for Fiji’s health service demands? 
Public Health Action  2013;3(1):63-67.
Fiji’s schools of nursing and government health services, 2001–2010.
To report on 1) the number and characteristics of nurses who graduated in Fiji, 2) the proportion of vacant nursing positions in the government health services and 3) attrition among nurses.
Descriptive study involving a retrospective record review of Ministry of Health annual reports and nursing registers.
Over the period 2001–2010, a total of 1500 nurses graduated, with the overall trend being a gradual increase in newly qualified nurses year on year. Available data from 2007 onwards showed relatively low vacancy rates (range 0.4–2%), with a sharp rise to 15% in 2009. Complete data on nurse attrition were available only from 2007 onwards, with rates of attrition ranging from 4% to 10%; the most common reason for attrition was resignation.
While it was unable to directly assess whether Fiji’s supply of nursing graduates has been meeting the country’s health service demands, this study provides a series of baseline data on Fiji’s nurse graduate and nursing workforce. In addition, it identifies some of the challenges and gaps that need to be considered to better assess and address nursing staff shortages.
PMCID: PMC4463094  PMID: 26392998
nursing; human resources; attrition; operational research
8.  Detection of malaria in relation to fever and grade of malnutrition among malnourished children in Ethiopia 
Public Health Action  2011;1(1):16-18.
Forty-eight nutritional rehabilitation centres in southern Ethiopia.
To determine 1) the frequency of temperature recording under programme conditions, 2) the proportion of malnourished children with and without fever who had falciparum malaria and 3) the association between malaria and grade of malnutrition.
This was a retrospective analysis of routine programme data.
Of 19 200 malnourished children, 16 716 (mean age 4.4 years, 7412 males) underwent a rapid malaria diagnostic test (Paracheck Pf ®). Malnutrition was graded as severe (38%), moderate (35%) and mild (27%). Temperature was not recorded in 15 248 (91%) children. Malaria was diagnosed in 57 (28%) children with fever (n = 206) and 122 (10%) children with no fever (n = 1262). The prevalence of falciparum malaria was 9%. Malaria prevalence was significantly associated with grade of malnutrition: Paracheck Pf was positive in respectively 5%, 8% and 10% of children with mild, moderate and severe malnutrition (χ2 for trend 78, P < 0.001).
This study shows the value of routine malaria screening in malnourished children, especially those with more severe grades of malnutrition, irrespective of fever. Operational shortcomings are highlighted and ways forward to address these problems are discussed.
PMCID: PMC4547182  PMID: 26392929
Ethiopia; malaria; malnutrition; temperature; rapid diagnostic test
9.  Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting 
Objectives: This paper examines the effect of household crowding on inter-pregnancy spacing and its association with socioeconomic indicators, among parous mothers delivered in an urban environment.
Design: Cross sectional survey.
Methods: Sociodemographic data were obtained on 2466 parous women delivering at eight hospitals in Greater Beirut over a one year period. Statistical methodology comprised Pearson χ2 test and logistic regression analysis.
Main results: A significant inverse relation was observed between household crowding and socioeconomic status, defined as education and occupation of women and their spouses. Inter-pregnancy spacing increased with higher levels of crowding. Further analysis suggested that this positive association was confounded by maternal demographic characteristics.
Conclusions: These data have shown that household crowding, a correlate of low parental socioeconomic status, is associated with longer birth intervals. This association, however, seems to be largely explained by maternal age and parity.
PMCID: PMC1732777  PMID: 15143115
11.  Tuberculosis among immigrants in the United Kingdom: the role of occupational health services. 
Immigrant workers in the United Kingdom account for 7.8% of the working population. Their health problems fall into three groups--imported diseases, occupational accidents, and acquired diseases. In the latter group, tuberculosis is still a major problem. A retrospective study tracing notifiable cases of tuberculosis to points of entry at Heathrow Airport indicates that the majority of immigrants acquire the disease after entry. The occupational health services have a great role to play in detecting the new cases very early and in providing appropriate screening and follow-up. Proper co-ordination between occupational and community health services will give the best results and lead to a rapid decline of the disease.
PMCID: PMC1051937  PMID: 490092
12.  Byssinosis: a follow-up study of cotton ginnery workers in the Sudan. 
A follow-up study of lung function tests and dust measurements was undertaken in ginnery workers employed in five ginning factories. Respiratory symptoms and respiratory function tests (FEV1 and FVC) were first recorded in 1967 on a total of 382 workers (323 permanently employed ginnery workers, 35 seasonal farfara workers, and 24 fire brigade men as controls). In 1969 after a six-month break from ginning before the start of the season, a follow-up study of lung function tests was undertaken on 96% of the same workers (306 ginnery workers, 35 farfara, and 24 fire brigade men). Because of the lapse of two years a new adjustment for age and height was made so as to compare the FEV1 measured in the follow-up study. The fire brigade men showed an expected fall in FEV1 during the two-year period, whereas the ginnery workers showed a rise presumably because they had had no dust exposure during the previous six months. The differences between the degree of change in these groups were statistically significant. In 1967 only the fine dust (less than 7 mum) was measured, while in 1969 the concentration of fine and medium dust, that is, less fly was measured. The factories were divided into three groups according to dust concentration. Comparison between the three factory groups and farfara shows a positive association between the level of dust concentration less fly and the prevalence of cough and phlegm. Since age did not appear to be a significant factor in the prevalence of byssinosis, comparisons between permanent workers in these three groups of factories and farfara workers taken separately were made without age standardization. The overall differences were statistically significant. There was a marked trend showing a positive association between prevalence of byssinosis and level of cotton dust concentration in the factories. The correlation between dust levels and the prevalence of byssinosis was nearly perfect when the time factor was included.
PMCID: PMC1008130  PMID: 963001

Results 1-13 (13)