Background: Low birthweight is a major contributor to infant mortality. We evaluated the associat... more Background: Low birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso. Methods: We utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8-27 days of age. Data on ANC attendance and birthweight was extracted from each child's carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g). Results: Data from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits. Conclusions: We observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes.
Background Low birthweight (birthweight <2500 grams, g) and underweight (weight-for-age Z-scor... more Background Low birthweight (birthweight <2500 grams, g) and underweight (weight-for-age Z-score, WAZ, < -2) infants have higher risk of poor outcomes compared to their well-nourished peers. We evaluated the role of azithromycin for reducing mortality and improving growth outcomes in low birthweight and/or underweight infants. Methods Infants aged 8–27 days of age weighing ≥2500 g at enrollment in Burkina Faso were randomized 1:1 to a single, oral dose of azithromycin (20 mg/kg) or matching placebo. We evaluated mortality and anthropometric outcomes in four subgroups: 1) both low birthweight and underweight at enrollment; 2) low birthweight-only; 3) underweight-only; 4) neither low birthweight nor underweight. Findings Of 21,832 enrolled infants, 21,320 (98%) had birthweight measurements and included in this analysis. Of these, 747 (3%) were both low birthweight and underweight, 972 (5%) were low birthweight-only, 825 (4%) were underweight-only, and 18,776 (88%) were neither lo...
The American Journal of Tropical Medicine and Hygiene
ABSTRACT. Observational studies have linked early-life antibiotic exposure to increased risk of o... more ABSTRACT. Observational studies have linked early-life antibiotic exposure to increased risk of obesity in children in high income settings. We evaluated whether neonatal antibiotic exposure led to changes in infant growth at 6 months of age in Burkina Faso. Neonates aged 8 to 27 days of age who weighed at least 2,500 g at the time of enrollment were randomized in a 1:1 fashion to a single oral 20-mg/kg dose of azithromycin or equivalent volume of placebo from April 2019 through December 2020. Weight, length, and mid-upper-arm circumference (MUAC) were measured at baseline and 6 months of age. Growth outcomes, including weight gain in grams per day, length change in millimeters per day, and changes in weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), length-for-age Z-score (LAZ), and MUAC were compared among neonates randomized to azithromycin compared with placebo. Among 21,832 neonates enrolled in the trial, median age at enrollment was 11 days, and 50% were female. W...
American Journal of Tropical Medicine and Hygiene, Nov 7, 2022
Mass azithromycin distribution reduces all-cause childhood mortality in some high-mortality setti... more Mass azithromycin distribution reduces all-cause childhood mortality in some high-mortality settings in sub-Saharan Africa. Although the greatest benefits have been shown in children 1 to 5 months old living in areas with high mortality rates, no evidence of a benefit was found of neonatal azithromycin in a low-mortality setting on mortality at 6 months. We conducted a 1:1 randomized, placebo-controlled trial evaluating the effect of a single oral 20-mg/kg dose of azithromycin or matching placebo administered during the neonatal period on all-cause and cause-specific infant mortality at 12 months of age in five regions of Burkina Faso. Neonates were eligible if they were between the ages of 8 and 27 days and weighed at least 2,500 g at enrollment. Cause of death was determined via the WHO 2016 verbal autopsy tool. We compared all-cause and cause-specific mortality using binomial regression. Of 21,832 infants enrolled in the study, 116 died by 12 months of age. There was no significant difference in all-cause mortality between the azithromycin and placebo groups (azithromycin: 52 deaths, 0.5%; placebo, 64 deaths, 0.7%; hazard ratio, 0.81; 95% CI, 0.56-1.17; P 5 0.30). There was no evidence of a difference in the distribution of causes of death (P 5 0.40) and no significant difference in any specific cause of death between groups. Mortality rates were low at 12 months of age, and there was no evidence of an effect of neonatal azithromycin on all-cause or cause-specific mortality.
Background Maternal age is increasingly recognized as a predictor of birth outcomes. Given the im... more Background Maternal age is increasingly recognized as a predictor of birth outcomes. Given the importance of birth and growth outcomes for children’s development, wellbeing and survival, this study examined the effect of maternal age on infant birth and growth outcomes at 6 months and mortality. Additionally, we conducted quantitative bias analysis (QBA) to estimate the role of selection bias and unmeasured confounding on the effect of maternal age on infant mortality. Methods We used data from randomized–controlled trials (RCTs) of 21 555 neonates in Burkina Faso conducted in 2019–2020. Newborns of mothers aged 13–19 years (adolescents) and 20–40 years (adults) were enrolled in the study 8–27 days after birth and followed for 6 months. Measurements of child’s anthropometric measures were collected at baseline and 6 months. We used multivariable linear regression to compare child anthropometric measures at birth and 6 months, and logistic regression models to obtain the odds ratio (...
Background: Despite strong efforts to improve maternal care, its quality remains deficient in man... more Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri-and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration: www.clinicaltrials.gov/NCT01409824.
Contributors: Doris Duke Charitable Foundation, Francis I. Proctor Foundation, University of Cali... more Contributors: Doris Duke Charitable Foundation, Francis I. Proctor Foundation, University of California San Francisco School of Medicine, University of Colorado Anschutz Medical Campus School of Medicine.Our study was designed to assess the feasibility of using smartphone cameras as a diagnostic tool in the validation of the WHO 2020 goal of trachoma elimination.Abstract -- Introduction -- Methods -- Results -- Conclusions -- References & acknowledgments -- Contact information
The American Journal of Tropical Medicine and Hygiene, 2021
Access to improved sanitation and hygiene may improve child nutritional status by reducing exposu... more Access to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6–59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in ...
Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recen... more Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recent studies suggest that live vaccines, such as measles vaccine (MV), have beneficial effects on health, while inactivated vaccines, such as the diphtheria-tetanus-pertussis (DTP) vaccine, may have harmful effects. If this is the case, it should improve child health to move MV closer to the last vaccination with DTP. The objective of this study was to investigate the NSEs of an additional early dose of MV on hospitalization or mortality. Children were randomized to receive either the standard MV at 9 months (control) or an additional early dose of MV 4 weeks after the third dose of DTP-containing Pentavalent vaccine and the standard MV at 9 months (intervention). In this analysis of a secondary outcome in the trial, we investigated the effect of the intervention on a composite endpoint of over-night hospitalization with or without recovery, or death without previous hospitalization, in chi...
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 21, 2017
Besides protecting against measles, measles vaccine (MV) may have beneficial non-specific effects... more Besides protecting against measles, measles vaccine (MV) may have beneficial non-specific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Children aged 4-7 months in two rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomised 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus-influenzae-type-b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrolment to 3 years of age in Cox proportional hazards models, censoring for subsequent non-trial MV. Subgroups of participants had blood sampled at enrolment, before the 9 months MV and in the second year of life to assess measles antibody level. Among 8309 children enrolled July 18, 2012-December 3, 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). T...
Background: Despite strong efforts to improve maternal care, its quality remains deficient in man... more Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri-and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration: www.clinicaltrials.gov/NCT01409824.
International Journal of Medical Informatics, 2014
In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern As... more In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges. To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso. Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; background. Qualitative data were analyzed using manifest content analysis. Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement. The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care.
Background: Maternal and neonatal mortality rates remain high in sub-Saharan Africa. The shortage... more Background: Maternal and neonatal mortality rates remain high in sub-Saharan Africa. The shortage of skilled Healthcare Workers (HCWs) and poor access to guidelines are plausible reasons for the reported low quality in maternal and neonatal services in rural Africa. One strategy to support HCWs at point of care is to provide easy access to guidelines using computerised Clinical Decision Support Systems (CDSS). Still, data are lacking on how such systems are optimally designed and implemented to be useful for HCWs. Aims: The aims were to develop a CDSS to be used in rural Africa (I), to understand perceived needs and attitudes among HCWs to the use of a CDSS based on the WHO guidelines in maternal and neonatal care in Burkina Faso (II), and to explore the reasons why the HCWs failed to use the CDSS as expected (III). Methods: The CDSS was programmed in java software language to be able to run on any hardware (I). The CDSS was part of an intervention to improve quality of care in six rural healthcare facilities in Burkina Faso for 24 months. A total of 45 HCWs were interviewed to capture perceived needs and attitudes to the CDSS. Data were analysed with content analysis (II). To understand any reduced use of the CDSS a workshop was organised (group discussions and a plenary session) with 13 HCWs with data analysed thematically (III). Socio-demographic data were analysed descriptively (II-III). Results: The CDSS was designed with a user interface and an XML database for storing patient data (signs and symptoms) as well as an algorithm to provide advice on recommended care and actions based on WHO guideline information. The CDSS was developed with limited input from HCWs (I). The HCWs expressed willingness to use new technologies such as a CDSS and computers but reported a fear of extra workload as well as a fear that the CDSS should be complicated to use (II). After 12 months, the decreased use of the CDSS was partly explained by unreliable power supply and poor fit between the CDSS and the daily workflow. Still, the HCWs were enthusiastic to learn more by using the CDSS (III). Conclusions: The CDSS was successfully developed and tested in rural Burkina Faso. Despite this, its use was unexpectedly low. It was found that: 1. the design and the implementation of a CDSS have to be contextualised; 2. the usage of the CDSS and the software performance need to be continuously monitored and 3. the HCWs need to be actively consulted during all phases of design and testing of a CDSS to enhance its use.
Background: Validation of trachoma elimination requires monitoring after discontinuation of trach... more Background: Validation of trachoma elimination requires monitoring after discontinuation of trachoma program activities, though such evaluations are not commonly done. Methods: Conjunctival examinations and smartphone photography were performed on a random sample of preschool children from 15 villages in a region of Burkina Faso thought to have eliminated trachoma. Results: No clinically active trachoma was detected by in-field or photographic evaluation. Smartphone images demonstrated high agreement with field grading (>99% concordance). Conclusions: Trachoma appears to have been eliminated from this area of Burkina Faso. Smartphone cameras may be a useful aid for monitoring in resource-limited settings.
Background We evaluated universal insecticide-treated bed net access and use in children <5 y ... more Background We evaluated universal insecticide-treated bed net access and use in children <5 y of age in a rural area of Burkina Faso. Methods A door-to-door enumerative census was conducted in Nouna District, Burkina Faso in December 2018 through April 2019. The most recent mass bed net distribution campaign occurred in June 2016. Heads of households were interviewed about household bed net ownership and use by children <5 y of age. We evaluated the relationship between demographic and socio-economic factors and household universal bed net access and use by children. Results In 23 610 households with at least one child <5 y of age, 71 329 bed nets were reported (94.5% insecticide-treated). One-third (35.2%) of households had universal access and two-thirds (67.0%) of children slept under an insecticide-treated net the previous night. Children in households with universal access more often slept under a net the previous night (adjusted odds ratio 4.81 [95% confidence interva...
Objective: Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare ... more Objective: Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare Workers (HCWs), a computerized decision support system (CDSS) was piloted at six rural maternal care units in Burkina Faso. During the two years of the study period, it was apparent from reports that the CDSS was not used regularly in clinical practice. This study aimed to explore the reasons why HCWs failed to use the CDSS.Methods: A workshop, organised as group discussions and a plenary session, was performed with 13 participants to understand their experience with the CDSS and suggest improvements if pertinent. Workshop transcripts were analysed thematically. Socio-demographic and usage patterns of the CDSS were examined by a questionnaire and analysed descriptively.Results: The participants reported that the contextual basic conditions for using the CDSS were not fulfilled. These included unreliable power supply, none user-friendly partograph, the CDSS was not integrated with workflo...
International Journal of Medical Informatics, 2014
Please cite this article in press as: S.A. Zakane, et al., Guidelines for maternal and neonatal "... more Please cite this article in press as: S.A. Zakane, et al., Guidelines for maternal and neonatal "point of care": Needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso, Int. J. Med. Inform. (2014), http://dx.
Background: Low birthweight is a major contributor to infant mortality. We evaluated the associat... more Background: Low birthweight is a major contributor to infant mortality. We evaluated the association between antenatal care (ANC) attendance and low birthweight among newborns in 5 regions of Burkina Faso. Methods: We utilized data from the baseline assessment of a randomized controlled trial evaluating azithromycin distribution during the neonatal period for prevention of infant mortality. Neonates were eligible for the trial if the weighed at least 2500 g at enrollment and were 8-27 days of age. Data on ANC attendance and birthweight was extracted from each child's carnet de santé, a government-issued health card on which pregnancy and birth-related data are recorded. We used linear and logistic regression models adjusting for potentially confounding variables to evaluate the relationship between ANC attendance (as total number of visits and ≥ 4 antenatal care visits) and birthweight (continuously and categorized into < 2500 g versus ≥2500 g). Results: Data from 21,223 births were included in the analysis. The median number of ANC visits was 4 (interquartile range 3 to 5) and 69% of mothers attended at least 4 visits. Mean birthweight was 2998 g (standard deviation 423) and 8.1% of infants were low birthweight (< 2500 g). Birthweight was 63 g (95% CI 46 to 81 g, P < 0.001) higher in newborns born to mothers who had attended ≥4 ANC visits versus < 4 visits. The odds of low birthweight among infants born to mothers with ≥4 ANC visits was 0.71 (95% CI 0.63 to 0.79, P < 0.001) times the odds of low birthweight among infants born to mothers who attended < 4 ANC visits. Conclusions: We observed a statistically significant association between ANC attendance and birthweight, although absolute differences were small. Improving access to ANC for all women may help improve birth outcomes.
Background Low birthweight (birthweight <2500 grams, g) and underweight (weight-for-age Z-scor... more Background Low birthweight (birthweight <2500 grams, g) and underweight (weight-for-age Z-score, WAZ, < -2) infants have higher risk of poor outcomes compared to their well-nourished peers. We evaluated the role of azithromycin for reducing mortality and improving growth outcomes in low birthweight and/or underweight infants. Methods Infants aged 8–27 days of age weighing ≥2500 g at enrollment in Burkina Faso were randomized 1:1 to a single, oral dose of azithromycin (20 mg/kg) or matching placebo. We evaluated mortality and anthropometric outcomes in four subgroups: 1) both low birthweight and underweight at enrollment; 2) low birthweight-only; 3) underweight-only; 4) neither low birthweight nor underweight. Findings Of 21,832 enrolled infants, 21,320 (98%) had birthweight measurements and included in this analysis. Of these, 747 (3%) were both low birthweight and underweight, 972 (5%) were low birthweight-only, 825 (4%) were underweight-only, and 18,776 (88%) were neither lo...
The American Journal of Tropical Medicine and Hygiene
ABSTRACT. Observational studies have linked early-life antibiotic exposure to increased risk of o... more ABSTRACT. Observational studies have linked early-life antibiotic exposure to increased risk of obesity in children in high income settings. We evaluated whether neonatal antibiotic exposure led to changes in infant growth at 6 months of age in Burkina Faso. Neonates aged 8 to 27 days of age who weighed at least 2,500 g at the time of enrollment were randomized in a 1:1 fashion to a single oral 20-mg/kg dose of azithromycin or equivalent volume of placebo from April 2019 through December 2020. Weight, length, and mid-upper-arm circumference (MUAC) were measured at baseline and 6 months of age. Growth outcomes, including weight gain in grams per day, length change in millimeters per day, and changes in weight-for-age Z-score (WAZ), weight-for-length Z-score (WLZ), length-for-age Z-score (LAZ), and MUAC were compared among neonates randomized to azithromycin compared with placebo. Among 21,832 neonates enrolled in the trial, median age at enrollment was 11 days, and 50% were female. W...
American Journal of Tropical Medicine and Hygiene, Nov 7, 2022
Mass azithromycin distribution reduces all-cause childhood mortality in some high-mortality setti... more Mass azithromycin distribution reduces all-cause childhood mortality in some high-mortality settings in sub-Saharan Africa. Although the greatest benefits have been shown in children 1 to 5 months old living in areas with high mortality rates, no evidence of a benefit was found of neonatal azithromycin in a low-mortality setting on mortality at 6 months. We conducted a 1:1 randomized, placebo-controlled trial evaluating the effect of a single oral 20-mg/kg dose of azithromycin or matching placebo administered during the neonatal period on all-cause and cause-specific infant mortality at 12 months of age in five regions of Burkina Faso. Neonates were eligible if they were between the ages of 8 and 27 days and weighed at least 2,500 g at enrollment. Cause of death was determined via the WHO 2016 verbal autopsy tool. We compared all-cause and cause-specific mortality using binomial regression. Of 21,832 infants enrolled in the study, 116 died by 12 months of age. There was no significant difference in all-cause mortality between the azithromycin and placebo groups (azithromycin: 52 deaths, 0.5%; placebo, 64 deaths, 0.7%; hazard ratio, 0.81; 95% CI, 0.56-1.17; P 5 0.30). There was no evidence of a difference in the distribution of causes of death (P 5 0.40) and no significant difference in any specific cause of death between groups. Mortality rates were low at 12 months of age, and there was no evidence of an effect of neonatal azithromycin on all-cause or cause-specific mortality.
Background Maternal age is increasingly recognized as a predictor of birth outcomes. Given the im... more Background Maternal age is increasingly recognized as a predictor of birth outcomes. Given the importance of birth and growth outcomes for children’s development, wellbeing and survival, this study examined the effect of maternal age on infant birth and growth outcomes at 6 months and mortality. Additionally, we conducted quantitative bias analysis (QBA) to estimate the role of selection bias and unmeasured confounding on the effect of maternal age on infant mortality. Methods We used data from randomized–controlled trials (RCTs) of 21 555 neonates in Burkina Faso conducted in 2019–2020. Newborns of mothers aged 13–19 years (adolescents) and 20–40 years (adults) were enrolled in the study 8–27 days after birth and followed for 6 months. Measurements of child’s anthropometric measures were collected at baseline and 6 months. We used multivariable linear regression to compare child anthropometric measures at birth and 6 months, and logistic regression models to obtain the odds ratio (...
Background: Despite strong efforts to improve maternal care, its quality remains deficient in man... more Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri-and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration: www.clinicaltrials.gov/NCT01409824.
Contributors: Doris Duke Charitable Foundation, Francis I. Proctor Foundation, University of Cali... more Contributors: Doris Duke Charitable Foundation, Francis I. Proctor Foundation, University of California San Francisco School of Medicine, University of Colorado Anschutz Medical Campus School of Medicine.Our study was designed to assess the feasibility of using smartphone cameras as a diagnostic tool in the validation of the WHO 2020 goal of trachoma elimination.Abstract -- Introduction -- Methods -- Results -- Conclusions -- References & acknowledgments -- Contact information
The American Journal of Tropical Medicine and Hygiene, 2021
Access to improved sanitation and hygiene may improve child nutritional status by reducing exposu... more Access to improved sanitation and hygiene may improve child nutritional status by reducing exposure to enteric pathogens. We evaluated this relationship as part of the Community Health with Azithromycin Trial, a community-randomized trial of azithromycin versus placebo for the prevention of child mortality in rural Burkina Faso. Before the baseline study visit, a door-to-door household survey was conducted for all households in the study area. During the baseline study census, which occurred approximately 9 months after the household survey, a mid-upper arm circumference (MUAC) measurement was obtained from each child. We evaluated the relationship between household improved latrine use compared with unimproved latrines or open defecation and MUAC in children aged 6–59 months. Among 32,172 children with household survey data and MUAC measurements, 931 (2.9%) had an MUAC less than 12.5 cm and were classified as having moderate acute malnutrition (MAM). The odds of MAM were higher in ...
Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recen... more Non-specific effects (NSEs) of vaccines have increasingly gained attention in recent years. Recent studies suggest that live vaccines, such as measles vaccine (MV), have beneficial effects on health, while inactivated vaccines, such as the diphtheria-tetanus-pertussis (DTP) vaccine, may have harmful effects. If this is the case, it should improve child health to move MV closer to the last vaccination with DTP. The objective of this study was to investigate the NSEs of an additional early dose of MV on hospitalization or mortality. Children were randomized to receive either the standard MV at 9 months (control) or an additional early dose of MV 4 weeks after the third dose of DTP-containing Pentavalent vaccine and the standard MV at 9 months (intervention). In this analysis of a secondary outcome in the trial, we investigated the effect of the intervention on a composite endpoint of over-night hospitalization with or without recovery, or death without previous hospitalization, in chi...
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 21, 2017
Besides protecting against measles, measles vaccine (MV) may have beneficial non-specific effects... more Besides protecting against measles, measles vaccine (MV) may have beneficial non-specific effects. We tested the effect of an additional early MV on mortality and measles antibody levels. Children aged 4-7 months in two rural health and demographic surveillance sites in Burkina Faso and Guinea-Bissau were randomised 1:1 to an extra early standard dose of MV (Edmonston-Zagreb strain) or no extra MV 4 weeks after the third diphtheria-tetanus-pertussis-hepatitis B-Haemophilus-influenzae-type-b vaccine. All children received routine MV at 9 months. We assessed mortality through home visits and compared mortality from enrolment to 3 years of age in Cox proportional hazards models, censoring for subsequent non-trial MV. Subgroups of participants had blood sampled at enrolment, before the 9 months MV and in the second year of life to assess measles antibody level. Among 8309 children enrolled July 18, 2012-December 3, 2015, we registered 145 deaths (mortality rate: 16/1000 person-years). T...
Background: Despite strong efforts to improve maternal care, its quality remains deficient in man... more Background: Despite strong efforts to improve maternal care, its quality remains deficient in many countries of Sub-Saharan Africa as persistently high maternal mortality rates testify. The QUALMAT study seeks to improve the performance and motivation of rural health workers and ultimately quality of primary maternal health care services in three African countries Burkina Faso, Ghana, and Tanzania. One major intervention is the introduction of a computerized Clinical Decision Support System (CDSS) for rural primary health care centers to be used by health care workers of different educational levels. Methods: A stand-alone, java-based software, able to run on any standard hardware, was developed based on assessment of the health care situation in the involved countries. The software scope was defined and the final software was programmed under consideration of test experiences. Knowledge for the decision support derived from the World Health Organization (WHO) guideline "Pregnancy, Childbirth, Postpartum and Newborn Care; A Guide for Essential Practice". Results: The QUALMAT CDSS provides computerized guidance and clinical decision support for antenatal care, and care during delivery and up to 24 hours post delivery. The decision support is based on WHO guidelines and designed using three principles: (1) Guidance through routine actions in maternal and perinatal care, (2) integration of clinical data to detect situations of concern by algorithms, and (3) electronic tracking of peri-and postnatal activities. In addition, the tool facilitates patient management and is a source of training material. The implementation of the software, which is embedded in a set of interventions comprising the QUALMAT study, is subject to various research projects assessing and quantifying the impact of the CDSS on quality of care, the motivation of health care staff (users) and its health economic aspects. The software will also be assessed for its usability and acceptance, as well as for its influence on workflows in the rural setting of primary health care in the three countries involved. Conclusion: The development and implementation of a CDSS in rural primary health care centres presents challenges, which may be overcome with careful planning and involvement of future users at an early stage. A tailored software with stable functionality should offer perspectives to improve maternal care in resource-poor settings. Trial registration: www.clinicaltrials.gov/NCT01409824.
International Journal of Medical Informatics, 2014
In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern As... more In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges. To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso. Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; background. Qualitative data were analyzed using manifest content analysis. Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement. The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care.
Background: Maternal and neonatal mortality rates remain high in sub-Saharan Africa. The shortage... more Background: Maternal and neonatal mortality rates remain high in sub-Saharan Africa. The shortage of skilled Healthcare Workers (HCWs) and poor access to guidelines are plausible reasons for the reported low quality in maternal and neonatal services in rural Africa. One strategy to support HCWs at point of care is to provide easy access to guidelines using computerised Clinical Decision Support Systems (CDSS). Still, data are lacking on how such systems are optimally designed and implemented to be useful for HCWs. Aims: The aims were to develop a CDSS to be used in rural Africa (I), to understand perceived needs and attitudes among HCWs to the use of a CDSS based on the WHO guidelines in maternal and neonatal care in Burkina Faso (II), and to explore the reasons why the HCWs failed to use the CDSS as expected (III). Methods: The CDSS was programmed in java software language to be able to run on any hardware (I). The CDSS was part of an intervention to improve quality of care in six rural healthcare facilities in Burkina Faso for 24 months. A total of 45 HCWs were interviewed to capture perceived needs and attitudes to the CDSS. Data were analysed with content analysis (II). To understand any reduced use of the CDSS a workshop was organised (group discussions and a plenary session) with 13 HCWs with data analysed thematically (III). Socio-demographic data were analysed descriptively (II-III). Results: The CDSS was designed with a user interface and an XML database for storing patient data (signs and symptoms) as well as an algorithm to provide advice on recommended care and actions based on WHO guideline information. The CDSS was developed with limited input from HCWs (I). The HCWs expressed willingness to use new technologies such as a CDSS and computers but reported a fear of extra workload as well as a fear that the CDSS should be complicated to use (II). After 12 months, the decreased use of the CDSS was partly explained by unreliable power supply and poor fit between the CDSS and the daily workflow. Still, the HCWs were enthusiastic to learn more by using the CDSS (III). Conclusions: The CDSS was successfully developed and tested in rural Burkina Faso. Despite this, its use was unexpectedly low. It was found that: 1. the design and the implementation of a CDSS have to be contextualised; 2. the usage of the CDSS and the software performance need to be continuously monitored and 3. the HCWs need to be actively consulted during all phases of design and testing of a CDSS to enhance its use.
Background: Validation of trachoma elimination requires monitoring after discontinuation of trach... more Background: Validation of trachoma elimination requires monitoring after discontinuation of trachoma program activities, though such evaluations are not commonly done. Methods: Conjunctival examinations and smartphone photography were performed on a random sample of preschool children from 15 villages in a region of Burkina Faso thought to have eliminated trachoma. Results: No clinically active trachoma was detected by in-field or photographic evaluation. Smartphone images demonstrated high agreement with field grading (>99% concordance). Conclusions: Trachoma appears to have been eliminated from this area of Burkina Faso. Smartphone cameras may be a useful aid for monitoring in resource-limited settings.
Background We evaluated universal insecticide-treated bed net access and use in children <5 y ... more Background We evaluated universal insecticide-treated bed net access and use in children <5 y of age in a rural area of Burkina Faso. Methods A door-to-door enumerative census was conducted in Nouna District, Burkina Faso in December 2018 through April 2019. The most recent mass bed net distribution campaign occurred in June 2016. Heads of households were interviewed about household bed net ownership and use by children <5 y of age. We evaluated the relationship between demographic and socio-economic factors and household universal bed net access and use by children. Results In 23 610 households with at least one child <5 y of age, 71 329 bed nets were reported (94.5% insecticide-treated). One-third (35.2%) of households had universal access and two-thirds (67.0%) of children slept under an insecticide-treated net the previous night. Children in households with universal access more often slept under a net the previous night (adjusted odds ratio 4.81 [95% confidence interva...
Objective: Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare ... more Objective: Maternal and neonatal mortality is high in sub-Saharan Africa. To support Healthcare Workers (HCWs), a computerized decision support system (CDSS) was piloted at six rural maternal care units in Burkina Faso. During the two years of the study period, it was apparent from reports that the CDSS was not used regularly in clinical practice. This study aimed to explore the reasons why HCWs failed to use the CDSS.Methods: A workshop, organised as group discussions and a plenary session, was performed with 13 participants to understand their experience with the CDSS and suggest improvements if pertinent. Workshop transcripts were analysed thematically. Socio-demographic and usage patterns of the CDSS were examined by a questionnaire and analysed descriptively.Results: The participants reported that the contextual basic conditions for using the CDSS were not fulfilled. These included unreliable power supply, none user-friendly partograph, the CDSS was not integrated with workflo...
International Journal of Medical Informatics, 2014
Please cite this article in press as: S.A. Zakane, et al., Guidelines for maternal and neonatal "... more Please cite this article in press as: S.A. Zakane, et al., Guidelines for maternal and neonatal "point of care": Needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso, Int. J. Med. Inform. (2014), http://dx.
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Papers by Alphonse Zakane