438 results on '"William Checkley"'
Search Results
2. Data management plan and REDCap mobile data capture for a multi-country Household Air Pollution Intervention Network (HAPIN) trial
- Author
-
Shirin Jabbarzadeh, Lindsay M Jaacks, Amy Lovvorn, Yunyun Chen, Jiantong Wang, Lisa Elon, Azhar Nizam, Vigneswari Aravindalochanan, Jean de Dieu Ntivuguruzwa, Kendra N Willams, Alexander Ramirez, Michael A Johnson, Ajay Pillarisetti, Thangavel Gurusamy, Ghislaine Rosa, Anaité Diaz-Artiga, Juan C Romero, Kalpana Balakrishnan, William Checkley, Jennifer L Peel, Thomas F Clasen, and Lance A Waller
- Subjects
Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
Background Household air pollution (HAP) is a leading environmental risk factor accounting for about 1.6 million premature deaths mainly in low- and middle-income countries (LMICs). However, no multicounty randomized controlled trials have assessed the effect of liquefied petroleum gas (LPG) stove intervention on HAP and maternal and child health outcomes. The Household Air Pollution Intervention Network (HAPIN) was the first to assess this by implementing a common protocol in four LMICs. Objective This manuscript describes the implementation of the HAPIN data management protocol via Research Electronic Data Capture (REDCap) used to collect over 50 million data points in more than 4000 variables from 80 case report forms (CRFs). Methods We recruited 800 pregnant women in each study country (Guatemala, India, Peru, and Rwanda) who used biomass fuels in their households. Households were randomly assigned to receive LPG stoves and 18 months of free LPG supply (intervention) or to continue using biomass fuels (control). Households were followed for 18 months and assessed for primary health outcomes: low birth weight, severe pneumonia, and stunting. The HAPIN Data Management Core (DMC) implemented identical REDCap projects for each study site using shared variable names and timelines in local languages. Field staff collected data offline using tablets on the REDCap Mobile Application. Results Utilizing the REDCap application allowed the HAPIN DMC to collect and store data securely, access data (near real-time), create reports, perform quality control, update questionnaires, and provide timely feedback to local data management teams. Additional REDCap functionalities (e.g. scheduling, data validation, and barcode scanning) supported the study. Conclusions While the HAPIN trial experienced some challenges, REDCap effectively met HAPIN study goals, including quality data collection and timely reporting and analysis on this important global health trial, and supported more than 40 peer-reviewed scientific publications to date.
- Published
- 2024
- Full Text
- View/download PDF
3. Health system barriers to hypertension care in Peru: Rapid assessment to inform organizational-level change.
- Author
-
Kendra N Williams, Janeth Tenorio-Mucha, Karina Campos-Blanco, Lindsay J Underhill, Armando Valdés-Velásquez, Antonia Fuentes Herbozo, Laura K Beres, Lisa de Las Fuentes, Lucy Cordova-Ascona, Zoila Vela-Clavo, Gonzalo Mariano Cuentas-Canal, Juan Carlos Mendoza-Velasquez, Sonia Mercedes Paredes-Barriga, Raquel Hurtado La Rosa, Makeda Williams, Elvin H Geng, William Checkley, Joel Gittelsohn, Victor G Davila-Roman, and Stella M Hartinger-Peña
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Traditional patient- and provider-level hypertension interventions have proven insufficient to halt hypertension as the leading cause of morbidity and mortality globally. Systems-level interventions are required to address factors challenging hypertension control across a social ecological framework, an under-studied topic particularly salient in low- and middle-income countries (LMICs) such as Peru. To inform such interventions, we sought to identify key health systems barriers to hypertension care in Puno, Peru. A participatory stakeholder workshop (October 2021) and 21 in-depth interviews (October 2021-March 2022) were conducted with 55 healthcare professionals (i.e., doctors, nurses, midwives, dentists, nutritionists), followed by a deductive qualitative analysis of transcripts and notes. Participating healthcare providers indicated that low prioritization and lack of national policies for hypertension care have resulted in limited funding and lack of societal-level prevention efforts. Additionally, limited cultural consideration, both in national guidelines as well as by some providers in Puno, results in inadequate care that may not align with local traditions. Providers highlighted that patient care is also hampered by inadequate distribution and occasional shortages of medications and equipment, as well as a lack of personnel and limited opportunities for training in hypertension. Multiple incompatible health information systems, complicated referral systems, and geographic barriers additionally hinder continuity of care and care seeking. Insights gained from health providers on the healthcare system in Puno provide essential contextual information to inform development of organizational-level strategies necessary to improve provider and patient behaviors to achieve better hypertension care outcomes.
- Published
- 2024
- Full Text
- View/download PDF
4. Health-related quality of life and hypertension in people with HIV on long-term antiretroviral therapy in Uganda.
- Author
-
Charles Batte, Andrew Weil Semulimi, John Mukisa, Mariam Nakabuye, Jasper Nidoi, David Mukunya, Rosalind Parkes Ratanshi, Barbara Castelnuovo, Mohammed Lamorde, David Meya, William Checkley, Robert Kalyesubula, Trishul Siddharthan, and Joseph B Babigumira
- Subjects
Medicine ,Science - Abstract
IntroductionThe presence of hypertension could reduce the health-related quality of life (HRQoL) of people with HIV (PWH). Yet, literature describing the HRQoL of PWH who have hypertension in Uganda is scarce making the design of locally adapted interventions cumbersome. In our study, we compared HRQoL scores of people with HIV with and without hypertension on long term antiretroviral therapy (ART) in Uganda.MethodsWe recruited 149 PWH with hypertension and 159 PWH without hypertension in the long-term ART cohort at an urban clinic in Kampala, Uganda. Data on socio-demographics were collected using an interviewer designed questionnaire while data on the World Health Organisation clinical stage viral load and CD4 count as well as ART duration were extracted from clinic electronic database and a generic EuroQol -5D- 5L (EQ-5D- 5L) and Medical Outcome Study (MOS-HIV) questionnaire used to collect HRQoL data. Data were summarized using descriptive statistics while inferential statistics were used to determine associations between key variables and HRQoL. Mann-Whitney U tests were used to compare HRQoL between groups of interest.ResultsOne hundred ninety (61.7%) participants were female. PWH who had hypertension were older (Mean ± SD: 53.7 ± 8.3 vs 49.9 ± 8.6, p value 70,000 UGX, (p value = 0.044), disclosure of the HIV status of the participants to their partner (p value = 0.026), and current history of smoking (p value = 0.029) were associated with low HRQoL scores.ConclusionAmong people with HIV, those with hypertension had lower HRQoL compared to those without. This calls for inclusion of quality-of-life assessment in the management of PWH who have been diagnosed with hypertension to identify those at risk and plan early interventions.
- Published
- 2024
- Full Text
- View/download PDF
5. Sarcopenia and sarcopenic obesity among community-dwelling Peruvian adults: A cross-sectional study
- Author
-
Oscar Flores-Flores, Alejandro Zevallos-Morales, Suzanne L. Pollard, William Checkley, Trishul Siddharthan, John R. Hurst, Antonio Bernabé-Ortiz, Fernando M. Runzer-Colmenares, Miles D. Witham, and Jose F. Parodi
- Subjects
Medicine ,Science - Published
- 2024
6. Effects of a household air pollution intervention using liquefied petroleum gas stoves, continuous fuel distribution and behavioural messaging on dietary and sodium intake of adult women in Puno, Peru: a randomised controlled trial
- Author
-
Carla Tarazona-Meza, Kendra N Williams, Gary Malpartida, Josiah L Kephart, Magdalena Fandiño-Del-Río, Suzanne Simkovich, Shakir Hossen, Marilu Chiang, Kirsten Koehler, William Checkley, and Cardiopulmonary Outcomes and Household Air Pollution (CHAP) trial Investigators
- Subjects
24-h Recall ,Dietary intake ,Liquefied petroleum gas ,Clean cookstoves ,Sodium ,Household air pollution ,Public aspects of medicine ,RA1-1270 ,Nutritional diseases. Deficiency diseases ,RC620-627 - Abstract
Abstract Objective: Household air pollution (HAP) is a widespread environmental exposure worldwide. While several cleaner fuel interventions have been implemented to reduce personal exposures to HAP, it is unclear if cooking with cleaner fuels also affects the choice of meals and dietary intake. Design: Individually randomised, open-label controlled trial of a HAP intervention. We aimed to determine the effect of a HAP intervention on dietary and Na intake. Intervention participants received a liquefied petroleum gas (LPG) stove, continuous fuel delivery and behavioural messaging during 1 year whereas control participants continued with usual cooking practices that involved the use of biomass-burning stoves. Dietary outcomes included energy, energy-adjusted macronutrients and Na intake at baseline, 6 months and 12 months post-randomisation using 24-h dietary recalls and 24-h urine. We used t-tests to estimate differences between arms in the post-randomisation period. Setting: Rural settings in Puno, Peru. Participants: One hundred women aged 25–64 years. Results: At baseline, control and intervention participants were similar in age (47·4 v. 49·5 years) and had similar daily energy (8894·3 kJ v. 8295·5 kJ), carbohydrate (370·8 g v. 373·3 g) and Na intake (4·9 g v. 4·8 g). One year after randomisation, we did not find differences in average energy intake (9292·4 kJ v. 8788·3 kJ; P = 0·22) or Na intake (4·5 g v. 4·6 g; P = 0·79) between control and intervention participants. Conclusions: Our HAP intervention consisting of an LPG stove, continuous fuel distribution and behavioural messaging did not affect dietary and Na intake in rural Peru.
- Published
- 2023
- Full Text
- View/download PDF
7. Clinical hypoxemia score for outpatient child pneumonia care lacking pulse oximetry in Africa and South Asia
- Author
-
Holly B. Schuh, Shubhada Hooli, Salahuddin Ahmed, Carina King, Arunangshu D. Roy, Norman Lufesi, ASMD Ashraful Islam, Tisungane Mvalo, Nabidul H. Chowdhury, Amy Sarah Ginsburg, Tim Colbourn, William Checkley, Abdullah H. Baqui, and Eric D. McCollum
- Subjects
hypoxia ,clinical decision rules ,pediatrics ,primary health care ,low-income countries ,respiratory tract infection (RTI) ,Pediatrics ,RJ1-570 - Abstract
BackgroundPulse oximeters are not routinely available in outpatient clinics in low- and middle-income countries. We derived clinical scores to identify hypoxemic child pneumonia.MethodsThis was a retrospective pooled analysis of two outpatient datasets of 3–35 month olds with World Health Organization (WHO)-defined pneumonia in Bangladesh and Malawi. We constructed, internally validated, and compared fit & discrimination of four models predicting SpO2
- Published
- 2023
- Full Text
- View/download PDF
8. Testing the effectiveness of household fuel conservation strategies: Policy implications for increasing the affordability of exclusive clean cooking
- Author
-
Kendra N. Williams, Katarina Kamenar, Josiah L. Kephart, Marilu Chiang, Stella M. Hartinger, and William Checkley
- Subjects
Household energy ,Fuel conservation ,Liquefied petroleum gas ,Behavior change ,Household air pollution ,Clean cooking ,Environmental sciences ,GE1-350 - Abstract
Background: Exclusive clean fuel use is essential for realizing health and other benefits but is often unaffordable. Decreasing household-level fuel needs could make exclusive clean fuel use more affordable, but there is a lack of knowledge on the amount of fuel savings that could be achieved through fuel conservation behaviors relevant to rural settings in low- and middle-income countries. Methods: Within a trial in Peru, we trained a random half of intervention participants, who had previously received a liquefied petroleum gas (LPG) stove and were purchasing their own fuel, on fuel conservation strategies. We measured the amount of fuel and mega joules (MJ) of energy consumed by all participants, including control participants who were receiving free fuel from the trial. We administered surveys on fuel conservation behaviors and assigned a score based on the number of behaviors performed. Results: Intervention participants with the training had a slightly higher conservation score than those without (7.2 vs. 6.6 points; p = 0.07). Across all participants, average daily energy consumption decreased by 9.5 MJ for each 1-point increase in conservation score (p
- Published
- 2023
- Full Text
- View/download PDF
9. Fidelity and adherence to a liquefied petroleum gas stove and fuel intervention: The multi-country Household Air Pollution Intervention Network (HAPIN) trial
- Author
-
Kendra N. Williams, Ashlinn Quinn, Hayley North, Jiantong Wang, Ajay Pillarisetti, Lisa M. Thompson, Anaité Díaz-Artiga, Kalpana Balakrishnan, Gurusamy Thangavel, Ghislaine Rosa, Florien Ndagijimana, Lindsay J. Underhill, Miles A. Kirby, Elisa Puzzolo, Shakir Hossen, Lance A. Waller, Jennifer L. Peel, Joshua P. Rosenthal, Thomas F. Clasen, Steven A. Harvey, and William Checkley
- Subjects
Liquefied petroleum gas ,Intervention fidelity ,Adherence ,Household air pollution ,Clean cooking ,Health behavior change ,Environmental sciences ,GE1-350 - Abstract
Background: Reducing household air pollution (HAP) to levels associated with health benefits requires nearly exclusive use of clean cooking fuels and abandonment of traditional biomass fuels. Methods: The Household Air Pollution Intervention Network (HAPIN) trial randomized 3,195 pregnant women in Guatemala, India, Peru, and Rwanda to receive a liquefied petroleum gas (LPG) stove intervention (n = 1,590), with controls expected to continue cooking with biomass fuels (n = 1,605). We assessed fidelity to intervention implementation and participant adherence to the intervention starting in pregnancy through the infant’s first birthday using fuel delivery and repair records, surveys, observations, and temperature-logging stove use monitors (SUMs). Results: Fidelity and adherence to the HAPIN intervention were high. Median time required to refill LPG cylinders was 1 day (interquartile range 0–2). Although 26% (n = 410) of intervention participants reported running out of LPG at some point, the number of times was low (median: 1 day [Q1, Q3: 1, 2]) and mostly limited to the first four months of the COVID-19 pandemic. Most repairs were completed on the same day as problems were reported. Traditional stove use was observed in only 3% of observation visits, and 89% of these observations were followed up with behavioral reinforcement. According to SUMs data, intervention households used their traditional stove a median of 0.4% of all monitored days, and 81% used the traditional stove
- Published
- 2023
- Full Text
- View/download PDF
10. Effects of a LPG stove and fuel intervention on adverse maternal outcomes: A multi-country randomized controlled trial conducted by the Household Air Pollution Intervention Network (HAPIN)
- Author
-
Ashley Younger, Abbey Alkon, Kristen Harknett, Miles A. Kirby, Lisa Elon, Amy E. Lovvorn, Jiantong Wang, Wenlu Ye, Anaité Diaz-Artiga, John P. McCracken, Adly Castañaza Gonzalez, Libny Monroy Alarcon, Alexie Mukeshimana, Ghislaine Rosa, Marilu Chiang, Kalpana Balakrishnan, Sarada S. Garg, Ajay Pillarisetti, Ricardo Piedrahita, Michael Johnson, Rachel Craik, Aris T. Papageorghiou, Ashley Toenjes, Ashlinn Quinn, Kendra N. Williams, Lindsay Underhill, Howard H. Chang, Luke P. Naeher, Joshua Rosenthal, William Checkley, Jennifer L. Peel, Thomas F. Clasen, and Lisa M. Thompson
- Subjects
Cooking fuel ,Birth outcomes ,Household air pollution ,Low- and middle-income countries ,Spontaneous abortion ,Hypertensive disorders of pregnancy ,Environmental sciences ,GE1-350 - Abstract
Household air pollution from solid cooking fuel use during gestation has been associated with adverse pregnancy and birth outcomes. The Household Air Pollution Intervention Network (HAPIN) trial was a randomized controlled trial of free liquefied petroleum gas (LPG) stoves and fuel in Guatemala, Peru, India, and Rwanda. A primary outcome of the main trial was to report the effects of the intervention on infant birth weight. Here we evaluate the effects of a LPG stove and fuel intervention during pregnancy on spontaneous abortion, postpartum hemorrhage, hypertensive disorders of pregnancy, and maternal mortality compared to women who continued to use solid cooking fuels. Pregnant women (18–34 years of age; gestation confirmed by ultrasound at 9–19 weeks) were randomly assigned to an intervention (n = 1593) or control (n = 1607) arm. Intention-to-treat analyses compared outcomes between the two arms using log-binomial models. Among the 3195 pregnant women in the study, there were 10 spontaneous abortions (7 intervention, 3 control), 93 hypertensive disorders of pregnancy (47 intervention, 46 control), 11 post postpartum hemorrhage (5 intervention, 6 control) and 4 maternal deaths (3 intervention, 1 control). Compared to the control arm, the relative risk of spontaneous abortion among women randomized to the intervention was 2.32 (95% confidence interval (CI): 0.60, 8.96), hypertensive disorders of pregnancy 1.02 (95% CI: 0.68, 1.52), postpartum hemorrhage 0.83 (95% CI: 0.25, 2.71) and 2.98 (95% CI: 0.31, 28.66) for maternal mortality. In this study, we found that adverse maternal outcomes did not differ based on randomized stove type across four country research sites.
- Published
- 2023
- Full Text
- View/download PDF
11. Effectiveness of the 10-valent pneumococcal conjugate vaccine on pediatric pneumonia confirmed by ultrasound: a matched case–control study
- Author
-
William Checkley, Shakir Hossen, Eric D. McCollum, Farhan Pervaiz, Catherine H. Miele, Miguel A. Chavez, Lawrence H. Moulton, Nicole Simmons, Arunangshu D. Roy, Nabidul H. Chowdhury, Salahuddin Ahmed, Nazma Begum, Abdul Quaiyum, Mathuram Santosham, and Abdullah H. Baqui
- Subjects
Child health ,Pneumonia ,Vaccine effectiveness ,South Asia ,Pneumococcal conjugate vaccine ,Ultrasound ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV10) for children aged
- Published
- 2022
- Full Text
- View/download PDF
12. Mechanisms of lung damage in tuberculosis: implications for chronic obstructive pulmonary disease
- Author
-
Alex Kayongo, Brian Nyiro, Trishul Siddharthan, Bruce Kirenga, William Checkley, Moses Lutaakome Joloba, Jerrold Ellner, and Padmini Salgame
- Subjects
Tuberculosis ,COPD - chronic obstructive pulmonary disease ,adaptive immunity ,innate immunity ,host-directed therapy (HDT) ,Microbiology ,QR1-502 - Abstract
Pulmonary tuberculosis is increasingly recognized as a risk factor for COPD. Severe lung function impairment has been reported in post-TB patients. Despite increasing evidence to support the association between TB and COPD, only a few studies describe the immunological basis of COPD among TB patients following successful treatment completion. In this review, we draw on well-elaborated Mycobacterium tuberculosis-induced immune mechanisms in the lungs to highlight shared mechanisms for COPD pathogenesis in the setting of tuberculosis disease. We further examine how such mechanisms could be exploited to guide COPD therapeutics.
- Published
- 2023
- Full Text
- View/download PDF
13. Development and validation of an interstitial lung disease exposure questionnaire for sub-Saharan Africa
- Author
-
Peter Jackson, Roma Padalkar, Winceslaus Katagira, Kevin Mortimer, Natalie A. Rykiel, Nicole M. Robertson, Suzanne L. Pollard, Patricia Alupo, William Checkley, Bruce Kirenga, and Trishul Siddharthan
- Subjects
Medicine - Abstract
Background American Thoracic Society/European Respiratory Society guidelines recommend context-specific exposure assessments to diagnose interstitial lung disease (ILD). In sub-Saharan Africa, ILD diagnoses are rare, and locally validated ILD exposure questionnaires are not used. Methods A physician-administered ILD exposure questionnaire was developed using a four-step mixed-methods modified Delphi approach. First, ILD questionnaires from high-income countries and data from Pneumotox were reviewed, compiled and face-validated. Second, a local pilot group of ILD experts ranked item relevance using a Likert scale and suggested additions. Third, the questionnaire format and pilot rankings were addressed in a focus group discussion that was analysed using grounded theory. Finally, following focus group discussion modifications, the resulting items (with three duplicate item groups for evaluation of internal consistency) were ranked for importance by members of the Pan-African Thoracic Society (PATS). Results Face validation resulted in 82 items in four categories: “Smoking and Drugs”, “Environmental Exposures”, “Occupations” and “Medications”. Pilot group (n=10) ranking revealed 27 outliers and 30 novel suggestions. Focus group (n=12) discussion resulted in 10 item deletions, 14 additions and 22 re-wordings; themes included desire for extensive questionnaires and stigma sensitivity. Final validation involved 58 PATS members (mean±sd age 46±10.6 years, 76% male, from 17 countries) ranking 84 items derived from previous steps and three duplicate question groups. The questionnaire was internally consistent (Cronbach's α >0.80) and ultimately included 73 items. Conclusion This mixed-methods study included experts from 17 countries in sub-Saharan Africa and successfully developed a 73-item ILD exposure questionnaire for sub-Saharan Africa. African pulmonary experts valued region-specific additions and ranked several items from existing ILD questionnaires as unimportant.
- Published
- 2022
- Full Text
- View/download PDF
14. Home-Based Respiratory Physiotherapy and Telephone-Based Psychological Support for COVID-19 Survivors in Peru: Protocol for a Randomized Controlled Trial
- Author
-
Anderson N Soriano-Moreno, Elaine C Flores, Stella M Hartinger, Claudia Y Mallma, Arnold A Diaz, Gonzalo E Gianella, Juan A Galvez-Buccollini, Abdiel H Coico-Lama, German Malaga, Eufemia Fajardo, Rubí Paredes-Angeles, Sharlyn Otazú-Alfaro, Andres G Lescano, and William Checkley
- Subjects
Medicine ,Computer applications to medicine. Medical informatics ,R858-859.7 - Abstract
BackgroundBoth pulmonary and mental health are affected following hospitalization for COVID-19 pneumonia. Pulmonary rehabilitation therapy has demonstrated benefits in improving mental health, but no validated combined programs that include mental health have been proposed. ObjectiveThis article presents the design of a trial that aimed to assess whether the participation in a combined rehabilitation program that includes home-based respiratory physiotherapy and telephone-based psychological support is associated with a greater improvement of pulmonary and mental health outcomes 7-12 weeks after COVID-19 hospitalization discharge compared with posthospital usual care provided by a public Peruvian hospital. MethodsWAYRA (the word for air in the Quechua language) was an open-label, unblinded, two-arm randomized controlled trial. We recruited 108 participants aged 18-75 years who were discharged from the hospital after COVID-19 pneumonia that required >6 liters/minute of supplemental oxygen during treatment. Participants were randomly assigned at a 1:1 ratio to receive the combined rehabilitation program or usual posthospital care provided by a public Peruvian hospital. The intervention consisted of 12 at-home respiratory rehabilitation sessions and 6 telephone-based psychological sessions. The primary outcome was the 6-minute walk distance. Secondary outcomes included lung function, mental health status (depression, anxiety, and trauma), and quality of life. Outcomes were assessed at baseline (before randomization) and at 7 and 12 weeks after hospital discharge to assess the difference between arms. ResultsThis study was funded by the Peruvian National Council of Science Technology and Technology Innovation in July 2020. Ethics approval was obtained on September 2, 2020. Recruitment and data collection occurred between October 2020 and June 2021. Results are expected to be published by the end of 2022. ConclusionsWAYRA was the first randomized controlled trial evaluating combined pulmonary-mental health rehabilitation for hospitalized COVID-19 survivors in resource-limited settings, potentially providing a foundation for the cost-effective scale-up of similar multidisciplinary rehabilitation programs. Trial RegistrationClinicalTrials.gov NCT04649736; https://clinicaltrials.gov/ct2/show/NCT04649736 International Registered Report Identifier (IRRID)RR1-10.2196/36001
- Published
- 2022
- Full Text
- View/download PDF
15. Association Between Depressive Symptoms and Cardiac Structure and Function in a Peruvian Population
- Author
-
Christine Santiago, Melissa Burroughs Peña, Timothy Brown, Saate Shakil, James Januzzi, Eric Velazquez, J. Jaime Miranda, Danny Rivera, and William Checkley
- Subjects
echocardiography ,depression ,diastolic function ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Public aspects of medicine ,RA1-1270 - Abstract
Depressive disorders are a leading cause of disability and are globally pervasive. It is estimated that 80% of depression occurs in low-income and middle-income countries. Depression is associated with worse outcomes in patients with cardiac disease including heart failure (HF); however, mechanistic understanding to explain heightened risk in HF remains poorly characterized. We examined the association between depressive symptoms and cardiac structure and function by transthoracic echocardiography. We selected a random sample of adult participants in Puno and Pampas de San Juan de Miraflores, Peru, from the CRONICAS cohort study. Depression symptoms were self-reported and measured with the Center for Epidemiological Studies Depression Scale in 2010. Participants underwent transthoracic echocardiography in 2014. Multivariable linear regression was used to examine the relationship between depressive symptoms and echocardiographic measures of cardiac structure and function and was adjusted for relevant covariates. Three hundred and seventy-three participants (mean age 56.7 years, 57% female) were included in this analysis of which 91 participants (24%) had clinically significant depressive symptoms. After adjustment, clinically significant depressive symptoms were associated with a reduced diastolic relaxation velocity compared to non-depressed subjects (–0.72 cm/s, 95% CI –1.21 to –0.24, p = 0.004). Other differences between depressed and non- depressed participants were less obvious. In conclusion, clinically significant depressive symptoms were associated with a lower septal e’ velocity in the Peruvian population. Depressive symptoms were not obviously associated with other abnormalities in cardiac structure or function.
- Published
- 2022
- Full Text
- View/download PDF
16. Acceptability of patient-centered hypertension education delivered by community health workers among people living with HIV/AIDS in rural Uganda
- Author
-
Charles Batte, John Mukisa, Natalie Rykiel, David Mukunya, William Checkley, Felix Knauf, Robert Kalyesubula, and Trishul Siddharthan
- Subjects
Acceptability ,PLWHA ,Patient education ,PocketDoktor™ ,Hypertension ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The prevalence of hypertension is increasing among people living with HIV/AIDS (PLWHA) in low- and middle-income countries (LMICs). However, knowledge of the complications and management of hypertension among PLWHA in Uganda remains low. We explored the acceptability of implementing hypertension (HTN) specific health education by community health workers (CHWs) among PLWHA in rural Uganda. Methods We conducted a qualitative study consisting of 22 in-depth interviews (14 PLWHA/HTN and 8 CHWs), 3 focus group discussions (FGDs), 2 with PLWHA/HTN and 1 with CHWs from Nakaseke district, Uganda. Participants were interviewed after a single session interaction with the CHW. Data were transcribed from luganda (local language) into English and analyzed using thematic analysis. We used Sekhon’s model of acceptability of health Interventions to explore participants’ perceptions. Results Participants believed CHWs utilized easy-to-understand, colloquial, non-technical language during education delivery, had a pre-existing rapport with the CHWs that aided faster communication, and had more time to explain illness than medical doctors had. Participants found the educational material (PocketDoktor™) to be simple and easy to understand, and perceived that the education would lead to improved health outcomes. Participants stated their health was a priority and sought further disease-specific information. We also found that CHWs were highly motivated to carry out the patient-centered education. While delivering the education, CHWs experienced difficulties in keeping up with the technical details regarding hypertension in the PocketDoktor™, financial stress and patient questions beyond their self-perceived skill level and experience. PLWHA/HTN had challenges accessing the health facility where the intervention was delivered and preferred a household setting. Conclusions Hypertension patient-centered education delivered by CHWs using the PocketDoktor™ was acceptable to PLWHA and hypertension in Nakaseke area in rural, Uganda. There is need for further studies to determine the cost implications of delivering this intervention among PLWHA across LMIC settings.
- Published
- 2021
- Full Text
- View/download PDF
17. A risk assessment tool for resumption of research activities during the COVID-19 pandemic for field trials in low resource settings
- Author
-
Suzanne M. Simkovich, Lisa M. Thompson, Maggie L. Clark, Kalpana Balakrishnan, Alejandra Bussalleu, William Checkley, Thomas Clasen, Victor G. Davila-Roman, Anaite Diaz-Artiga, Ephrem Dusabimana, Lisa de las Fuentes, Steven Harvey, Miles A. Kirby, Amy Lovvorn, Eric D. McCollum, Erick E. Mollinedo, Jennifer L. Peel, Ashlinn Quinn, Ghislaine Rosa, Lindsay J. Underhill, Kendra N. Williams, Bonnie N. Young, Joshua Rosenthal, and HAPIN Investigators
- Subjects
Risk assessment ,Biosafety ,Research ,COVID-19 ,SARS-CoV-2 ,Medicine (General) ,R5-920 - Abstract
Abstract Rationale The spread of severe acute respiratory syndrome coronavirus-2 has suspended many non-COVID-19 related research activities. Where restarting research activities is permitted, investigators need to evaluate the risks and benefits of resuming data collection and adapt procedures to minimize risk. Objectives In the context of the multicountry Household Air Pollution Intervention (HAPIN) trial conducted in rural, low-resource settings, we developed a framework to assess the risk of each trial activity and to guide protective measures. Our goal is to maximize the integrity of reseach aims while minimizing infection risk based on the latest scientific understanding of the virus. Methods We drew on a combination of expert consultations, risk assessment frameworks, institutional guidance and literature to develop our framework. We then systematically graded clinical, behavioral, laboratory and field environmental health research activities in four countries for both adult and child subjects using this framework. National and local government recommendations provided the minimum safety guidelines for our work. Results Our framework assesses risk based on staff proximity to the participant, exposure time between staff and participants, and potential viral aerosolization while performing the activity. For each activity, one of four risk levels, from minimal to unacceptable, is assigned and guidance on protective measures is provided. Those activities that can potentially aerosolize the virus are deemed the highest risk. Conclusions By applying a systematic, procedure-specific approach to risk assessment for each trial activity, we were able to protect our participants and research team and to uphold our ability to deliver on the research commitments we have made to our staff, participants, local communities, and funders. This framework can be tailored to other research studies conducted in similar settings during the current pandemic, as well as potential future outbreaks with similar transmission dynamics. The trial is registered with clinicaltrials.gov NCT02944682 on October 26. 2016 .
- Published
- 2021
- Full Text
- View/download PDF
18. Comparing Prone Positioning Use in COVID-19 Versus Historic Acute Respiratory Distress Syndrome
- Author
-
Chad H. Hochberg, MD, MHS, Kevin J. Psoter, PhD, Sarina K. Sahetya, MD, MHS, Eric P. Nolley, MD, Shakir Hossen, MBBS, MSPH, William Checkley, MD, PhD, Meeta P. Kerlin, MD, MSCE, Michelle N. Eakin, PhD, and David N. Hager, MD, PhD
- Subjects
Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
IMPORTANCE:. Use of prone positioning in patients with acute respiratory distress syndrome (ARDS) from COVID-19 may be greater than in patients treated for ARDS before the pandemic. However, the magnitude of this increase, sources of practice variation, and the extent to which use adheres to guidelines is unknown. OBJECTIVES:. To compare prone positioning practices in patients with COVID-19 ARDS versus ARDS treated before the pandemic. DESIGN, SETTING, AND PARTICIPANTS:. We conducted a multicenter retrospective cohort study of mechanically ventilated patients with early moderate-to-severe ARDS from COVID-19 (2020–2021) or ARDS from non-COVID-19 pneumonia (2018–2019) across 19 ICUs at five hospitals in Maryland. MAIN OUTCOMES AND MEASURES:. The primary outcome was initiation of prolonged prone positioning (≥ 16 hr) within 48 hours of meeting oxygenation criteria. Comparisons were made between cohorts and within subgroups including academic versus community hospitals, and medical versus nonmedical ICUs. Other outcomes of interest included time to proning initiation, duration of prone sessions and temporal trends in proning frequency. RESULTS:. Proning was initiated within 48 hours in 227 of 389 patients (58.4%) with COVID-19 and 11 of 123 patients (8.9%) with historic ARDS (49.4% absolute increase [95% CI for % increase, 41.7–57.1%]). Comparing COVID-19 to historic ARDS, increases in proning were similar in academic and community settings but were larger in medical versus nonmedical ICUs. Proning was initiated earlier in COVID-19 versus historic ARDS (median hours (hr) from oxygenation criteria, 12.9 vs 30.6; p = 0.002) and proning sessions were longer (median hr, 43.0 vs 28.0; p = 0.01). Proning frequency increased rapidly at the beginning of the pandemic and was sustained. CONCLUSIONS AND RELEVANCE:. We observed greater overall use of prone positioning, along with shorter time to initiation and longer proning sessions in ARDS from COVID-19 versus historic ARDS. This rapid practice change can serve as a model for implementing evidence-based practices in critical care.
- Published
- 2022
- Full Text
- View/download PDF
19. Effectiveness of low-dose theophylline for the management of biomass-associated COPD (LODOT-BCOPD): study protocol for a randomized controlled trial
- Author
-
Trishul Siddharthan, Suzanne L. Pollard, Peter Jackson, Nicole M. Robertson, Adaeze C. Wosu, Nihaal Rahman, Roma Padalkar, Isaac Sekitoleko, Esther Namazzi, Patricia Alupo, John R. Hurst, Robert Kalyesubula, David Dowdy, Robert Wise, Peter J. Barnes, William Checkley, and Bruce Kirenga
- Subjects
Biomass ,COPD ,Theophylline ,Medicine (General) ,R5-920 - Abstract
Abstract Background COPD is a leading cause of death globally, with the majority of morbidity and mortality occurring in low- and middle-income country (LMIC) settings. While tobacco-smoke exposure is the most important risk factor for COPD in high-income settings, household air pollution from biomass smoke combustion is a leading risk factor for COPD in LMICs. Despite the high burden of biomass smoke-related COPD, few studies have evaluated the efficacy of pharmacotherapy in this context. Currently recommended inhaler-based therapy for COPD is neither available nor affordable in most resource-limited settings. Low-dose theophylline is an oral, once-a-day therapy, long used in high-income countries (HICs), which has been proposed for the management of COPD in LMICs in the absence of inhaled steroids and/or bronchodilators. The Low-dose Theophylline for the Management of Biomass-Associated COPD (LODOT-BCOPD) trial investigates the clinical efficacy and cost-effectiveness of low-dose theophylline for the management of biomass-related COPD in a low-income setting. Methods LODOT-BCOPD is a randomized, double-blind, placebo-controlled trial to test the efficacy of low-dose theophylline in improving respiratory symptoms in 110 participants with moderate to severe COPD in Central Uganda. The inclusion criteria are as follows: (1) age 40 to 80 years, (2) full-time resident of the study area, (3) daily biomass exposure, (4) post-bronchodilator FEV1/FVC below the 5th percentile of the Global Lung Initiative mixed ethnic reference population, and (5) GOLD Grade B-D COPD. Participants will be randomly assigned to receive once daily low-dose theophylline (200 mg ER, Unicontin-E) or placebo for 52 weeks. All participants will receive education about self-management of COPD and rescue salbutamol inhalers. We will measure health status using the St. George’s Respiratory Questionnaire (SGRQ) and quality of life using the EuroQol-5D (EQ-5D) at baseline and every 6 months. In addition, we will assess household air pollution levels, serum inflammatory biomarkers (fibrinogen, hs-CRP), and theophylline levels at baseline, 1 month, and 6 months. The primary outcome is change in SGRQ score at 12 months. Lastly, we will assess the cost-effectiveness of the intervention by calculating quality-adjusted life years (QALYs) from the EQ-5D. Trial registration ClinicalTrials.gov NCT03984188 . Registered on June 12, 2019 Trial acronym Low-dose Theophylline for the Management of Biomass-Associated COPD (LODOT-BCOPD)
- Published
- 2021
- Full Text
- View/download PDF
20. Exposure contrasts associated with a liquefied petroleum gas (LPG) intervention at potential field sites for the multi-country household air pollution intervention network (HAPIN) trial in India: results from pilot phase activities in rural Tamil Nadu
- Author
-
Sankar Sambandam, Krishnendu Mukhopadhyay, Saritha Sendhil, Wenlu Ye, Ajay Pillarisetti, Gurusamy Thangavel, Durairaj Natesan, Rengaraj Ramasamy, Amudha Natarajan, Vigneswari Aravindalochanan, A. Vinayagamoorthi, S. Sivavadivel, R. Uma Maheswari, Lingeswari Balakrishnan, S. Gayatri, Srinivasan Nargunanathan, Sathish Madhavan, Naveen Puttaswamy, Sarada S. Garg, Ashlinn Quinn, Josh Rosenthal, Michael Johnson, Jiawen Liao, Kyle Steenland, Ricardo Piedhrahita, Jennifer Peel, William Checkley, Thomas Clasen, and Kalpana Balakrishnan
- Subjects
HAPIN trial ,LPG intervention ,Household air pollution ,PM2.5 ,Personal exposures ,Pregnant women ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The Household Air Pollution Intervention Network (HAPIN) trial aims to assess health benefits of a liquefied petroleum gas (LPG) cookfuel and stove intervention among women and children across four low- and middle-income countries (LMICs). We measured exposure contrasts for women, achievable under alternative conditions of biomass or LPG cookfuel use, at potential HAPIN field sites in India, to aid in site selection for the main trial. Methods We recruited participants from potential field sites within Villupuram and Nagapattinam districts in Tamil Nadu, India, that were identified during a feasibility assessment. We performed. (i) cross-sectional measurements on women (N = 79) using either biomass or LPG as their primary cookfuel and (ii) before-and-after measurements on pregnant women (N = 41), once at baseline while using biomass fuel and twice – at 1 and 2 months – after installation of an LPG stove and free fuel intervention. We involved participants to co-design clothing and instrument stands for personal and area sampling. We measured 24 or 48-h personal exposures and kitchen and ambient concentrations of fine particulate matter (PM2.5) using gravimetric samplers. Results In the cross-sectional analysis, median (interquartile range, IQR) kitchen PM2.5 concentrations in biomass and LPG using homes were 134 μg/m3 [IQR:71–258] and 27 μg/m3 [IQR:20–47], while corresponding personal exposures were 75 μg/m3 [IQR:55–104] and 36 μg/m3 [IQR:26–46], respectively. In before-and-after analysis, median 48-h personal exposures for pregnant women were 72 μg/m3 [IQR:49–127] at baseline and 25 μg/m3 [IQR:18–35] after the LPG intervention, with a sustained reduction of 93% in mean kitchen PM2.5 concentrations and 78% in mean personal PM2.5 exposures over the 2 month intervention period. Median ambient concentrations were 23 μg/m3 [IQR:19–27). Participant feedback was critical in designing clothing and instrument stands that ensured high compliance. Conclusions An LPG stove and fuel intervention in the candidate HAPIN trial field sites in India was deemed suitable for achieving health-relevant exposure reductions. Ambient concentrations indicated limited contributions from other sources. Study results provide critical inputs for the HAPIN trial site selection in India, while also contributing new information on HAP exposures in relation to LPG interventions and among pregnant women in LMICs. Trial registration ClinicalTrials.Gov. NCT02944682 ; Prospectively registered on October 17, 2016.
- Published
- 2020
- Full Text
- View/download PDF
21. Availability, affordability and access to essential medications for asthma and chronic obstructive pulmonary disease in three low- and middle-income country settings.
- Author
-
Trishul Siddharthan, Nicole M Robertson, Natalie A Rykiel, Lindsay J Underhill, Nihaal Rahman, Sujan Kafle, Sakshi Mohan, Roma Padalkar, Sarah McKeown, Oscar Flores-Flores, Shumonta A Quaderi, Patricia Alupo, Robert Kalyesubula, Bruce Kirenga, Jing Luo, Maria Kathia Cárdenas, Gonzalo Gianella, J Jaime Miranda, William Checkley, John R Hurst, and Suzanne L Pollard
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
IntroductionDespite the rising burden of chronic respiratory disease globally, and although many respiratory medications are included in the World Health Organization Essential Medications List (WHO-EML), there is limited information concerning the availability and affordability of treatment drugs for respiratory conditions in low- and middle-income countries (LMICs).MethodsAll public and private pharmacies in catchment areas of the Global Excellence in COPD outcomes (GECo) study sites in Bhaktapur, Nepal, Lima, Peru, and Nakaseke, Uganda, were approached in 2017-2019 to assess pricing and availability of medications for the management of asthma and COPD.ResultsWe surveyed all 63 pharmacies in respective study areas in Nepal (95.2% private), 104 pharmacies in Peru (94.2% private) and 53 pharmacies in Uganda (98.1% private). The availability of any medication for respiratory disease was higher in private (93.3%) compared to public (73.3%) pharmacies. Salbutamol (WHO-EML) monotherapy in any formulation was the most commonly available respiratory medication among the three sites (93.7% Nepal, 86.5% Peru and 79.2% Uganda) while beclomethasone (WHO-EML) was only available in Peru (33.7%) and Nepal (22%). LABA-LAMA combination therapy was only available in Nepal (14.3% of pharmacies surveyed). The monthly treatment cost of respiratory medications was lowest in Nepal according to several cost metrics: the overall monthly cost, the median price ratio comparing medication costs to international reference prices at time of survey in dollars, and in terms of days' wages of the lowest-paid government worker. For the treatment of intermittent asthma, defined as 100 mcg Salbutamol/Albuterol inhaler, days' wages ranged from 0.47 days in Nepal and Peru to 3.33 days in Uganda.ConclusionThe availability and pricing of respiratory medications varied across LMIC settings, with medications for acute care of respiratory diseases being more widely available than those for long-term management.
- Published
- 2022
- Full Text
- View/download PDF
22. Population-based stroke incidence estimates in Peru: Exploratory results from the CRONICAS cohort study
- Author
-
Maria Lazo-Porras, Antonio Bernabe-Ortiz, Robert H. Gilman, William Checkley, Liam Smeeth, and J. Jaime Miranda
- Subjects
Stroke ,Incidence ,Peru ,Risk Factors ,Hypertension ,Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Limited information exists about the incidence of first-ever stroke at the population level, particularly in low- and middle-income countries (LMIC). Longitudinal data from the CRONICAS Cohort Study includes both altitude and urbanization and allows a detailed assessment of stroke incidence in resource constrained settings. The aim of this study was to estimate the incidence and explore risk factors of first-ever stroke at the population level in Peru. Methods: Stroke was defined using a standardised approach based on information from cohort participants or family members. This information was adjudicated centrally by trained physicians using common definitions. Time of follow-up was calculated as the difference between date of enrolment and the reported date of the stroke event. Unstandardised and age-standardised, first-ever stroke incidence rate and 95% confidence intervals (95% CI) were calculated. Generalized linear models, assuming Poisson distribution and link log, were utilized to determine potential factors to develop stroke. Findings: 3,601 individuals were originally enrolled in the cohort and 2,471 provided data for the longitudinal analysis. The median time of follow-up was 7.0 (range: 1 - 9) years, accruing a total of 17,308 person-years. During follow-up, there were 25 incident cases of stroke, resulting in an age-standardised incidence of stroke of 98.8 (95% CI: 63.8–154.0) per 100,000 person-years. After adjustment by age and sex, stroke incidence was higher among people with hypertension (incidence risk ratio (IRR) = 5.18; 95% CI: 1.89 – 14.16), but lower among people living at high altitude (IRR = 0.09; 95% CI: 0.01 – 0.63). Interpretation: Our results indicate a high incidence of first-ever strokes in Peruvian general population. These results are consistent with the estimates found in previous LMIC reports. Our study also found a contributing role of hypertension, increasing the risk of having a first-ever stroke. This work further advances the field of stroke epidemiology by identifying high altitude as a factor related to lower incidence of stroke in a longitudinal study. However, this information needs to be considered with cautions because of the study limitations.
- Published
- 2022
- Full Text
- View/download PDF
23. Indoor air pollution concentrations and cardiometabolic health across four diverse settings in Peru: a cross-sectional study
- Author
-
Josiah L. Kephart, Magdalena Fandiño-Del-Rio, Kirsten Koehler, Antonio Bernabe-Ortiz, J. Jaime Miranda, Robert H. Gilman, and William Checkley
- Subjects
Indoor air pollution ,Particulate matter ,Carbon monoxide ,Blood pressure ,Exhaled carbon monoxide ,C-reactive protein ,Industrial medicine. Industrial hygiene ,RC963-969 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Indoor air pollution is an important risk factor for health in low- and middle-income countries. Methods We measured indoor fine particulate matter (PM2.5) and carbon monoxide (CO) concentrations in 617 houses across four settings with varying urbanisation, altitude, and biomass cookstove use in Peru, between 2010 and 2016. We assessed the associations between indoor pollutant concentrations and blood pressure (BP), exhaled carbon monoxide (eCO), C-reactive protein (CRP), and haemoglobin A1c (HbA1c) using multivariable linear regression among all participants and stratifying by use of biomass cookstoves. Results We found high concentrations of indoor PM2.5 across all four settings (geometric mean ± geometric standard deviation of PM2.5 daily average in μg/m3): Lima 41.1 ± 1.3, Tumbes 35.8 ± 1.4, urban Puno 14.1 ± 1.7, and rural Puno 58.8 ± 3.1. High indoor CO concentrations were common in rural households (geometric mean ± geometric standard deviation of CO daily average in ppm): rural Puno 4.9 ± 4.3. Higher indoor PM2.5 was associated with having a higher systolic BP (1.51 mmHg per interquartile range (IQR) increase, 95% CI 0.16 to 2.86), a higher diastolic BP (1.39 mmHg higher DBP per IQR increase, 95% CI 0.52 to 2.25), and a higher eCO (2.05 ppm higher per IQR increase, 95% CI 0.52 to 3.57). When stratifying by biomass cookstove use, our results were consistent with effect measure modification in the association between PM2.5 and eCO: among biomass users eCO was 0.20 ppm higher per IQR increase in PM2.5 (95% CI − 2.05 to 2.46), and among non-biomass users eCO was 5.00 ppm higher per IQR increase in PM2.5 (95% CI 1.58 to 8.41). We did not find associations between indoor air concentrations and CRP or HbA1c outcomes. Conclusions Excessive indoor concentrations of PM2.5 are widespread in homes across varying levels of urbanisation, altitude, and biomass cookstove use in Peru and are associated with worse BP and higher eCO.
- Published
- 2020
- Full Text
- View/download PDF
24. Dietary patterns and asthma among Peruvian children and adolescents
- Author
-
Carla E. Tarazona-Meza, Corrine Hanson, Suzanne L. Pollard, Karina M. Romero Rivero, Rocio M. Galvez Davila, Sameera Talegawkar, Carlos Rojas, Jessica L. Rice, William Checkley, and Nadia N. Hansel
- Subjects
Asthma ,Children ,Adolescents ,Diet ,Peruvian ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Asthma is one of the conditions that contributes to the global burden of respiratory diseases and has been previously associated with diet intake. The goal of this study was to determine the relationship between diet, assessed by a developed score, and asthma in Peruvian children. Methods This study was a cross sectional analysis nested within an unmatched case-control study of children in two peri-urban communities of Lima, Peru. We evaluated 767 children and adolescents (573 with asthma, 194 controls) between 9 and 19 years. Diet was assessed using a food frequency questionnaire (FFQ), with food groups classified as “healthy” or “unhealthy”. Asthma control, Lung function and atopy were assessed by Asthma Control Test, Spirometry and InmunoCAP 250 test, respectively. Results Mean age of participants was 13.8 years (SD 2.6). Mean diet score was 5 (SD 1.23; range 2–8). Healthy Diet Score was associated with asthma status [OR 0.83, 95% CI (0.72, 0.95), p = 0.009] in adjusted analysis. Thus, participants with higher HDS, had lower odds of asthma. In sensitivity analyses, when adjusting for atopy, results did not change significantly. [OR 0.85, 95% CI (0.72, 0.99); p = 0.04]. No association between the HDS and asthma control, FEV1, nor FeNO were observed. Atopy did not modify the association between diet and asthma outcomes. Conclusions In our study cohort, better diet quality was associated with lower odds of asthma, but was not associated with asthma control. Diet modification may be a potential intervention to impact the increasing prevalence of this disease.
- Published
- 2020
- Full Text
- View/download PDF
25. Risk factors for the development of acute respiratory distress syndrome in mechanically ventilated adults in Peru: a multicenter observational study
- Author
-
Ena Gupta, Shakir Hossen, Matthew R. Grigsby, Phabiola Herrera, Rollin Roldan, Enrique Paz, Amador A. Jaymez, Eduardo E. Chirinos, Jose Portugal, Rocio Quispe, Roy G. Brower, William Checkley, and INTENSIVOS Cohort Study
- Subjects
Acute respiratory distress syndrome ,Prevention ,Critically ill ,Mechanical ventilation ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Clinical and epidemiological differences between acute respiratory distress syndrome (ARDS) that presents at the initiation of mechanical ventilation [MV] (ARDS at MV onset) and that which develops during the course of MV (ARDS after MV onset) are not well understood. We conducted an observational study in five Peruvian ICUs to characterize differences between ARDS at MV onset and after MV onset and identify risk factors for the development of ARDS after MV onset. Methods We consecutively enrolled critically ill patients with acute respiratory failure requiring at least 24 h of mechanical ventilation and followed them prospectively during the first 28 days and compared baseline characteristics and clinical outcomes by ARDS status. Results We enrolled 1657 participants on MV (mean age 60.0 years, 55% males) of whom 334 (20.2%) had ARDS at MV onset and 180 (10.9%) developed ARDS after MV onset. Average tidal volume at the initiation of MV was 8.7 mL/kg of predicted body weight (PBW) for participants with ARDS at MV onset, 8.6 mL/kg PBW for those who developed ARDS after MV onset, and 8.5 mL/kg PBW for those who never developed ARDS (p = 0.23). Overall, 90-day mortality was 56% and 55% for ARDS after MV onset and ARDS at MV onset, respectively, as compared to 46% among those who never developed ARDS (p
- Published
- 2019
- Full Text
- View/download PDF
26. Association between hospital mortality and inspiratory airway pressures in mechanically ventilated patients without acute respiratory distress syndrome: a prospective cohort study
- Author
-
Sarina K. Sahetya, Christopher Mallow, Jonathan E. Sevransky, Greg S. Martin, Timothy D. Girard, Roy G. Brower, William Checkley, and Society of Critical Care Medicine Discovery Network Critical Illness Outcomes Study Investigators
- Subjects
Driving pressure ,Mechanical ventilation ,Acute respiratory failure ,ARDS ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Background Higher inspiratory airway pressures are associated with worse outcomes in mechanically ventilated patients with the acute respiratory distress syndrome (ARDS). This relationship, however, has not been well investigated in patients without ARDS. We hypothesized that higher driving pressures (ΔP) and plateau pressures (Pplat) are associated with worse patient-centered outcomes in mechanically ventilated patients without ARDS as well as those with ARDS. Methods Using data collected during a prospective, observational cohort study of 6179 critically ill participants enrolled in 59 ICUs across the USA, we used multivariable logistic regression to determine whether ΔP and Pplat at enrollment were associated with hospital mortality among 1132 mechanically ventilated participants. We stratified analyses by ARDS status. Results Participants without ARDS (n = 822) had lower average severity of illness scores and lower hospital mortality (27.3% vs. 38.7%; p
- Published
- 2019
- Full Text
- View/download PDF
27. Sedation practices and clinical outcomes in mechanically ventilated patients in a prospective multicenter cohort
- Author
-
Romina E. Aragón, Alvaro Proaño, Nicole Mongilardi, Aldo de Ferrari, Phabiola Herrera, Rollin Roldan, Enrique Paz, Amador A. Jaymez, Eduardo Chirinos, Jose Portugal, Rocio Quispe, Roy G. Brower, and William Checkley
- Subjects
Sedation ,Clinical outcomes ,Critical illness ,Medical emergencies. Critical care. Intensive care. First aid ,RC86-88.9 - Abstract
Abstract Objectives We sought to study the association between sedation status, medications (benzodiazepines, opioids, and antipsychotics), and clinical outcomes in a resource-limited setting. Design A longitudinal study of critically ill participants on mechanical ventilation. Setting Five intensive care units (ICUs) in four public hospitals in Lima, Peru. Patients One thousand six hundred fifty-seven critically ill participants were assessed daily for sedation status during 28 days and vital status by day 90. Results After excluding data of participants without a Richmond Agitation Sedation Scale score and without sedation, we followed 1338 (81%) participants longitudinally for 18,645 ICU days. Deep sedation was present in 98% of participants at some point of the study and in 12,942 ICU days. Deep sedation was associated with higher mortality (interquartile odds ratio (OR) = 5.42, 4.23–6.95; p
- Published
- 2019
- Full Text
- View/download PDF
28. Challenges to hypertension and diabetes management in rural Uganda: a qualitative study with patients, village health team members, and health care professionals
- Author
-
Haeyoon Chang, Nicola L. Hawley, Robert Kalyesubula, Trishul Siddharthan, William Checkley, Felix Knauf, and Tracy L. Rabin
- Subjects
Hypertension ,Diabetes ,Uganda ,Rural health ,Chronic diseases ,Qualitative ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The prevalence of hypertension and diabetes are expected to increase in sub-Saharan Africa over the next decade. Some studies have documented that lifestyle factors and lack of awareness are directly influencing the control of these diseases. Yet, few studies have attempted to understand the barriers to control of these conditions in rural settings. The main objective of this study was to understand the challenges to hypertension and diabetes care in rural Uganda. Methods We conducted semi-structured interviews with 24 patients with hypertension and/or diabetes, 11 health care professionals (HCPs), and 12 community health workers (known as village health team members [VHTs]) in Nakaseke District, Uganda. Data were coded using NVivo software and analyzed using a thematic approach. Results The results replicated several findings from other settings, and identified some previously undocumented challenges including patients’ knowledge gaps regarding the preventable aspects of HTN and DM, patients’ mistrust in the Ugandan health care system rather than in individual HCPs, and skepticism from both HCPs and patients regarding a potential role for VHTs in HTN and DM management. Conclusions In order to improve hypertension and diabetes management in this setting, we recommend taking actions to help patients to understand NCDs as preventable, for HCPs and patients to advocate together for health system reform regarding medication accessibility, and for promoting education, screening, and monitoring activities to be conducted on a community level in collaboration with village health team members.
- Published
- 2019
- Full Text
- View/download PDF
29. Effectiveness-implementation of COPD case finding and self-management action plans in low- and middle-income countries: global excellence in COPD outcomes (GECo) study protocol
- Author
-
Trishul Siddharthan, Suzanne L Pollard, Shumonta A Quaderi, Andrew J Mirelman, Maria Kathia Cárdenas, Bruce Kirenga, Natalie A Rykiel, J Jaime Miranda, Laxman Shrestha, Ram K Chandyo, Adithya Cattamanchi, Susan Michie, Julie Barber, William Checkley, John R Hurst, and GECo Study Investigators
- Subjects
COPD ,COPD exacerbations ,COPD case finding ,COPD action plan ,Non-communicable disease ,Self-management ,Medicine (General) ,R5-920 - Abstract
Abstract Background Chronic obstructive pulmonary disease (COPD) is the end result of a susceptible individual being exposed to sufficiently deleterious environmental stimuli. More than 90% of COPD-related deaths occur in low- and middle-income countries (LMICs). LMICs face unique challenges in managing COPD; for example, deficient primary care systems present challenges for proper diagnosis and management. Formal diagnosis of COPD requires quality-assured spirometry, which is often limited to urban health centres. Similarly, standard treatment options for COPD remain limited where few providers are trained to manage COPD. The Global Excellence in COPD Outcomes (GECo) studies aim to assess the performance of a COPD case-finding questionnaire with and without peak expiratory flow (PEF) to diagnose COPD, and inform the effectiveness and implementation of COPD self-management Action Plans in LMIC settings. The ultimate goal is to develop simple, low-cost models of care that can be implemented in LMICs. This study will be carried out in Nepal, Peru and Uganda, three distinct LMIC settings. Methods/design We aim to assess the diagnostic accuracy of a simple questionnaire with and without PEF to case-find COPD (GECo1), and examine the effectiveness, cost-effectiveness and implementation of a community-health-worker-supported self-management Action Plan strategy for managing exacerbations of COPD (GECo2). To achieve the first aim, we will enrol a randomly selected sample of up to 10,500 adults aged ≥ 40 years across our three sites, with the goal to enrol 240 participants with moderate-to-severe COPD in to GECo2. We will apply two case-finding questionnaires (Lung Function Questionnaire and CAPTURE) with and without PEF and compare performance against spirometry. We will report ROC areas, sensitivity and specificity. Individuals who are identified as having COPD grades B–D will be invited to enrol in an effectiveness-implementation hybrid randomised trial of a multi-faceted COPD self-management Action Plan intervention delivered by CHWs. The intervention group will receive (1) COPD education, (2) facilitated-self management Action Plans for COPD exacerbations and (3) monthly visits by community health workers. The control group will receive COPD education and standard of care treatment provided by local health providers. Beginning at baseline, we will measure quality of life with the EuroQol-5D (EQ-5D) and St. George’s Respiratory Questionnaire (SGRQ) every 3 months over a period of 1 year. The primary endpoint is SGRQ at 12 months. Quality-adjusted life years (QALYs) using the Short-Form 36 version 2 will also be calculated. We will additionally assess the acceptability and feasibility of implementing COPD Action Plans in each setting among providers and individuals with COPD. Discussion This study should provide evidence to inform the use of pragmatic models of COPD diagnosis and management in LMIC settings. Trial registration NCT03359915 (GECo1). Registered on 2 December 2017 and NCT03365713 (GECo2). Registered on 7 December 2017. Trial acronym: Global Excellence in COPD Outcomes (GECo1; GECo2).
- Published
- 2018
- Full Text
- View/download PDF
30. Association between Blood Pressure and HIV Status in Rural Uganda: Results of Cross-Sectional Analysis
- Author
-
Anxious J. Niwaha, Adaeze C. Wosu, Alex Kayongo, Charles Batte, Trishul Siddharthan, Robert Kalyesubula, Bruce Kirenga, and William Checkley
- Subjects
hiv ,hypertension ,blood pressure ,non-communicable diseases ,ncds ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 ,Public aspects of medicine ,RA1-1270 - Abstract
Introduction: The association between HIV status and hypertension is not well described within sub-Saharan Africa. We examined prevalence and risk factors for hypertension among HIV positive and negative individuals living in a rural district of Uganda. Methods: We conducted a cross-sectional analysis in two concurrent cohorts of 600 HIV negative and 721 HIV seropositive individuals aged ≥35 years. Results: Of the 721 HIV positive participants, 59.8% were women and the median age was 44.3 years, while for HIV negative individuals, 55% were women and the median age was 47.8 years. Over 90% of HIV positive individuals were on antiretroviral treatment. The prevalence of hypertension (≥140/≥90 mmHg) was 33.5% in HIV negative individuals and 23.9% in HIV positive individuals. Age (adjusted OR = 1.05, 95% CI 1.03 to 1.06) and BMI (adjusted OR = 1.08, 95% CI 1.05 to 1.12) were associated with higher odds of hypertension. Having HIV was associated with lower odds of hypertension (adjusted OR = 0.66, 95% CI 0.50 to 0.88), lower systolic blood pressure (–5.1 mmHg, 95% CI: –7.4 to –2.4) and lower diastolic blood pressure (–4.0 mmHg, 95% CI: –5.6 to –2.5). We did not observe differences in the odds of hypertension by CD4 count, viral load or ART among HIV positive individuals in this sample. Conclusions: Hypertension was prevalent in one third of HIV negative individuals and in one fourth of HIV positive patients. While access to health information among individuals attending HIV clinics may explain observed differences, more research is needed to understand plausible biological and social mechanisms that could explain lower blood pressure among people living with HIV in Uganda.
- Published
- 2021
- Full Text
- View/download PDF
31. Nitrogen dioxide exposures from LPG stoves in a cleaner-cooking intervention trial
- Author
-
Josiah L. Kephart, Magdalena Fandiño-Del-Rio, Kendra N. Williams, Gary Malpartida, Alexander Lee, Kyle Steenland, Luke P. Naeher, Gustavo F. Gonzales, Marilu Chiang, William Checkley, and Kirsten Koehler
- Subjects
Nitrogen dioxide ,Biomass cookstove ,Liquefied petroleum gas ,Household air pollution ,Clean cooking ,Environmental sciences ,GE1-350 - Abstract
Background: Liquefied petroleum gas (LPG) stoves have been promoted in low- and middle-income countries (LMICs) as a clean energy alternative to biomass burning cookstoves. Objective: We sought to characterize kitchen area concentrations and personal exposures to nitrogen dioxide (NO2) within a randomized controlled trial in the Peruvian Andes. The intervention included the provision of an LPG stove and continuous fuel distribution with behavioral messaging to maximize compliance. Methods: We measured 48-hour kitchen area NO2 concentrations at high temporal resolution in homes of 50 intervention participants and 50 control participants longitudinally within a biomass-to-LPG intervention trial. We also collected 48-hour mean personal exposures to NO2 among a subsample of 16 intervention and 9 control participants. We monitored LPG and biomass stove use continuously throughout the trial. Results: In 367 post-intervention 24-hour kitchen area samples of 96 participants’ homes, geometric mean (GM) highest hourly NO2 concentration was 138 ppb (geometric standard deviation [GSD] 2.1) in the LPG intervention group and 450 ppb (GSD 3.1) in the biomass control group. Post-intervention 24-hour mean NO2 concentrations were a GM of 43 ppb (GSD 1.7) in the intervention group and 77 ppb (GSD 2.0) in the control group. Kitchen area NO2 concentrations exceeded the WHO indoor hourly guideline an average of 1.3 h per day among LPG intervention participants. GM 48-hour personal exposure to NO2 was 5 ppb (GSD 2.4) among 35 48-hour samples of 16 participants in the intervention group and 16 ppb (GSD 2.3) among 21 samples of 9 participants in the control group. Discussion: In a biomass-to-LPG intervention trial in Peru, kitchen area NO2 concentrations were substantially lower within the LPG intervention group compared to the biomass-using control group. However, within the LPG intervention group, 69% of 24-hour kitchen area samples exceeded WHO indoor annual guidelines and 47% of samples exceeded WHO indoor hourly guidelines. Forty-eight-hour NO2 personal exposure was below WHO indoor annual guidelines for most participants in the LPG intervention group, and we did not measure personal exposure at high temporal resolution to assess exposure to cooking-related indoor concentration peaks. Further research is warranted to understand the potential health risks of LPG-related NO2 emissions and inform current campaigns which promote LPG as a clean-cooking option.
- Published
- 2021
- Full Text
- View/download PDF
32. Higher interleukin-6 levels and changes in transforming growth factor-β are associated with lung impairment in pulmonary tuberculosis
- Author
-
Akshay N. Gupte, Sriram Selvaraju, Sanjay Gaikwad, Vidya Mave, Pavan Kumar, Subash Babu, Bruno B. Andrade, William Checkley, Robert Bollinger, and Amita Gupta
- Subjects
Medicine - Published
- 2021
- Full Text
- View/download PDF
33. Exploring the impact of a liquefied petroleum gas intervention on time use in rural Peru: A mixed methods study on perceptions, use, and implications of time savings
- Author
-
Kendra N. Williams, Josiah L. Kephart, Magdalena Fandiño-Del-Rio, Suzanne M. Simkovich, Kirsten Koehler, Steven A. Harvey, and William Checkley
- Subjects
Household air pollution ,Liquefied petroleum gas (LPG) ,Clean cookstoves ,Time savings ,Fuel collection ,Mixed methods ,Environmental sciences ,GE1-350 - Abstract
Background: Efforts to promote clean cooking through adoption of clean-burning fuels such as liquefied petroleum gas (LPG) are often based on the idea that near-exclusive use of LPG could lead to health improvements. However, benefits beyond health, such as time savings, could be more tangible and meaningful to LPG users. Objectives: This study investigated the effect of an LPG intervention on time spent cooking and collecting fuel, using objective measures of stove temperatures combined with self-reports under conditions of near-exclusive LPG use. We also investigated the perceived value of any time savings and potential economic and quality of life implications. Methods: We analyzed data from the Cardiopulmonary outcomes and Household Air Pollution trial in Puno, Peru, a randomized controlled trial with 180 participants assessing exposure and health impacts of an LPG stove, fuel, and behavioral intervention. Surveys conducted with 90 intervention women receiving free LPG and 90 control women cooking primarily with biomass assessed time spent cooking and collecting biomass fuel and use of time savings. Cooking time was objectively measured with temperature sensors on all stoves. Qualitative interviews explored perceptions and use of time savings in more depth. Results: Intervention women spent 3.2 fewer hours cooking and 1.9 fewer hours collecting fuel per week compared to control women, but cooked on average 1.0 more meals per day. Participants perceived time saved from LPG positively, reporting more time for household chores, leisure activities, and activities with income-generating potential such as caring for animals and working in fields. Discussion: This paper suggests that the benefits of LPG extend beyond health and the environment. LPG use could also lead to economic and quality of life gains, through increased time for work, rest, and consumption of hot meals, and reduced arduous biomass fuel collection.
- Published
- 2020
- Full Text
- View/download PDF
34. Factors associated with head circumference and indices of cognitive development in early childhood
- Author
-
Matthew R Grigsby, William Checkley, Tahmeed Ahmed, Zulfiqar Ahmed Bhutta, Laura Nicolaou, Pascal Bessong, Margaret Kosek, Aldo A M Lima, Sanjaya Shrestha, Ram Chandyo, Estomih R Mduma, Laura Murray-Kolb, and Brooks Morgan
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Background While head circumference (HC) has been related to intracranial volume and brain size, its association with cognitive function remains unclear. We sought to understand the relationship among various biological and socioeconomic risk factors, HC and cognitive development.Methods We analysed data across resource-poor settings in Bangladesh, India, Nepal, Peru, South Africa and Tanzania from the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development longitudinal birth cohort study. Participating children were enrolled and followed up between 2009 and 2014. A final sample of 1210 children aged 0–24 months were included in the analyses. The main outcomes were HC for age Z-score and cognitive, gross motor and language scores from Bayley Scales of Infant Development-III tests. Length, weight and HC were measured monthly, and cognitive tests were administered at 6, 15 and 24 months of age. To disentangle the associations between risk factors and HC from linear growth and to distinguish the direct and indirect effects of these risk factors on cognitive function, we conducted mediation analysis using longitudinal models to account for all data measured during follow-up.Results Average HC-for-age Z-score (HCAZ) was −0.54 (95% CI −0.47 to −0.62) near birth and −1.01 (95% CI −0.94 to −1.08) at 24 months. Children with higher enrolment weight (p
- Published
- 2020
- Full Text
- View/download PDF
35. Protecting children in low-income and middle-income countries from COVID-19
- Author
-
Heather J Zar, Trevor Duke, William Checkley, Samuel Akech, Mike English, Hamish R Graham, Adegoke G Falade, Peter P Moschovis, Norman Lufesi, Anneke C Hesseling, Tim Colbourn, Eric D McCollum, Salahuddin Ahmed, Mathuram Santosham, Tisungane Mvalo, Naor Bar-Zeev, Harish Nair, Madhu Gupta, Ambrose Agweyu, Steve Cunningham, Harry Campbell, Carina King, Kevin Baker, Mohammod Jobayer Chisti, Nicholas SS Fancourt, Amy S Ginsburg, Diane M Gray, Laura Hammitt, Shubhada Hooli, Abdul-Wahab BR Johnson, Miles A Kirby, Claudio F Lanata, Grant A Mackenzie, John P McCracken, Osawaru Oviawe, William S Pomat, James A Seddon, Lineo Keneuoe Thahane, Brian Wahl, Marieke Van der Zalm, Charl Verwey, Lay-Myint Yoshida, and Stephen RC Howie
- Subjects
Medicine (General) ,R5-920 ,Infectious and parasitic diseases ,RC109-216 - Published
- 2020
- Full Text
- View/download PDF
36. Effects of high altitude on respiratory rate and oxygen saturation reference values in healthy infants and children younger than 2 years in four countries: a cross-sectional study
- Author
-
Mary E Crocker, MD, Shakir Hossen, MBBS, Dina Goodman, MSPH, Suzanne M Simkovich, MD, Miles Kirby, PhD, Lisa M Thompson, PhD, Ghislaine Rosa, PhD, Sarada S Garg, DNB, Gurusamy Thangavel, MSc, Eric D McCollum, MD, Jennifer Peel, ProfPhD, Thomas Clasen, ProfPhD, and William Checkley, MD
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: In resource-limited settings, pneumonia diagnosis and management are based on thresholds for respiratory rate (RR) and oxyhaemoglobin saturation (SpO2) recommended by WHO. However, as RR increases and SpO2 decreases with elevation, these thresholds might not be applicable at all altitudes. We sought to determine upper thresholds for RR and lower thresholds for SpO2 by age and altitude at four sites, with altitudes ranging from sea level to 4348 m. Methods: In this cross-sectional study, we enrolled healthy children aged 0–23 months who lived within the study areas in India, Guatemala, Rwanda, and Peru. Participants were excluded if they had been born prematurely (
- Published
- 2020
- Full Text
- View/download PDF
37. Design and conduct of facility-based surveillance for severe childhood pneumonia in the Household Air Pollution Intervention Network (HAPIN) trial
- Author
-
Suzanne M. Simkovich, Lindsay J. Underhill, Miles A. Kirby, Dina Goodman, Mary E. Crocker, Shakir Hossen, John P. McCracken, Oscar de León, Lisa M. Thompson, Sarada S. Garg, Kalpana Balakrishnan, Gurusamy Thangavel, Ghislaine Rosa, Jennifer L. Peel, Thomas F. Clasen, Eric D. McCollum, and William Checkley
- Subjects
Medicine - Abstract
Pneumonia is both a treatable and preventable disease but remains a leading cause of death in children worldwide. Household air pollution caused by burning biomass fuels for cooking has been identified as a potentially preventable risk factor for pneumonia in low- and middle-income countries. We are conducting a randomised controlled trial of a clean energy intervention in 3200 households with pregnant women living in Guatemala, India, Peru and Rwanda. Here, we describe the protocol to ascertain the incidence of severe pneumonia in infants born to participants during the first year of the study period using three independent algorithms: the presence of cough or difficulty breathing and hypoxaemia (≤92% in Guatemala, India and Rwanda and ≤86% in Peru); presence of cough or difficulty breathing along with at least one World Health Organization-defined general danger sign and consolidation on chest radiography or lung ultrasound; and pneumonia confirmed to be the cause of death by verbal autopsy. Prior to the study launch, we identified health facilities in the study areas where cases of severe pneumonia would be referred. After participant enrolment, we posted staff at each of these facilities to identify children enrolled in the trial seeking care for severe pneumonia. To ensure severe pneumonia cases are not missed, we are also conducting home visits to all households and providing education on pneumonia to the mother. Severe pneumonia reduction due to mitigation of household air pollution could be a key piece of evidence that sways policymakers to invest in liquefied petroleum gas distribution programmes.
- Published
- 2020
- Full Text
- View/download PDF
38. Population-based incidence and serotype distribution of invasive pneumococcal disease prior to introduction of conjugate pneumococcal vaccine in Bangladesh.
- Author
-
Abdullah H Baqui, Eric D McCollum, Arif Mahmud, Arunangshu Roy, Nabidul H Chowdhury, Iftekhar Rafiqullah, Syed Jafar Raza Rizvi, Nazma Begum, Dipak K Mitra, Rasheda Khanam, Meagan Harrison, Salahuddin Ahmed, Md Hasanuzzaman, Hafizur Rahman, Maksuda Islam, Zabed B Ahmed, Md Abdul Quaiyum, Alain Koffi, Nicole Simmons, William Checkley, Lawrence H Moulton, Mathuram Santosham, Samir K Saha, and Projahnmo Study Group in Bangladesh
- Subjects
Medicine ,Science - Abstract
BACKGROUND:Bangladesh introduced the 10-valent pneumococcal conjugate vaccine (PCV-10) in 2015. We measured population-based incidence of invasive pneumococcal disease (IPD) prior to introduction of PCV-10 to provide a benchmark against which the impact of PCV-10 can be assessed. METHODS:We conducted population, facility and laboratory-based surveillance in children 0-59 months of age in three rural sub-districts of Sylhet district of Bangladesh from January 2014 to June 2015. All children received two-monthly home visits with one week recall for morbidity and care seeking. Children attending the three Upazilla Health Complexes (UHC, sub-district hospitals) in the surveillance area were screened for suspected IPD. Blood samples were collected from suspected IPD cases for culture and additionally, cerebrospinal fluid (CSF) was collected from suspected meningitis cases for culture and molecular testing. Pneumococcal isolates were serotyped by Quellung. Serotyping of cases detected by molecular testing was done by sequential multiplex polymerase chain reaction. RESULTS:Children under surveillance contributed to 126,657 child years of observations. Sixty-three thousand three hundred eighty-four illness episodes were assessed in the UHCs. Blood specimens were collected from 8,668 suspected IPD cases and CSF from 177 suspected meningitis cases. Streptococcus pneumoniae was isolated from 46 cases; 32 (70%) were vaccine serotype. The population-based incidence of IPD was 36.3/100,000 child years of observations. About 80% of the cases occurred in children below two years of age. DISCUSSION:IPD was common in rural Bangladesh suggesting the potential benefit of an effective vaccine. Measurement of the burden of IPD requires multiple surveillance modalities.
- Published
- 2020
- Full Text
- View/download PDF
39. Multimorbidity at sea level and high-altitude urban and rural settings: The CRONICAS Cohort Study
- Author
-
J Jaime Miranda, Antonio Bernabe-Ortiz, Robert H Gilman, Liam Smeeth, German Malaga, Robert A Wise, and William Checkley
- Subjects
Medicine - Abstract
Objective: To characterize the prevalence and clustering of multimorbidity in four diverse geographical settings in Peru. Methods: Multimorbidity, defined as having ≥2 chronic conditions, was studied in adults aged ≥35 years in four diverse settings in Peru: Lima, Tumbes, and urban and rural Puno. Six of these conditions (alcohol disorder, asthma, chronic obstructive pulmonary disease, depression, diabetes, and hypertension) were cataloged as objectively ascertained chronic conditions and paired in dyads to explore clusters of multimorbidity. Results: We analyzed data from 2890 adults, mean age 55.2 years, 49% males. Overall, 19.1% of participants had multimorbidity, ranging from 14.7% in semi-urban Tumbes to 22.8% in Lima. The dyads with the highest coexistence (approximately 20%) were observed in hypertension and diabetes in Tumbes, whereas the dyads with lowest coexistence (approximately 1%) were those involving asthma in all study sites. In terms of clusters, Tumbes showed a predominance of hypertension and diabetes, urban and rural Puno a predominance of depression and alcohol disorders, and Lima a higher degree of coexistence of all of the six conditions than in the other clusters. Conclusion: Multimorbidity is common and the pattern of clusters is highly heterogeneous. The conditions to prioritize will vary in each setting.
- Published
- 2019
- Full Text
- View/download PDF
40. Novel metrics for growth model selection
- Author
-
Matthew R. Grigsby, Junrui Di, Andrew Leroux, Vadim Zipunnikov, Luo Xiao, Ciprian Crainiceanu, and William Checkley
- Subjects
Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Literature surrounding the statistical modeling of childhood growth data involves a diverse set of potential models from which investigators can choose. However, the lack of a comprehensive framework for comparing non-nested models leads to difficulty in assessing model performance. This paper proposes a framework for comparing non-nested growth models using novel metrics of predictive accuracy based on modifications of the mean squared error criteria. Methods Three metrics were created: normalized, age-adjusted, and weighted mean squared error (MSE). Predictive performance metrics were used to compare linear mixed effects models and functional regression models. Prediction accuracy was assessed by partitioning the observed data into training and test datasets. This partitioning was constructed to assess prediction accuracy for backward (i.e., early growth), forward (i.e., late growth), in-range, and on new-individuals. Analyses were done with height measurements from 215 Peruvian children with data spanning from near birth to 2 years of age. Results Functional models outperformed linear mixed effects models in all scenarios tested. In particular, prediction errors for functional concurrent regression (FCR) and functional principal component analysis models were approximately 6% lower when compared to linear mixed effects models. When we weighted subject-specific MSEs according to subject-specific growth rates during infancy, we found that FCR was the best performer in all scenarios. Conclusion With this novel approach, we can quantitatively compare non-nested models and weight subgroups of interest to select the best performing growth model for a particular application or problem at hand.
- Published
- 2018
- Full Text
- View/download PDF
41. Modelling stunting in LiST: the effect of applying smoothing to linear growth data
- Author
-
Simon Cousens, Jamie Perin, Parul Christian, Lee Shu-Fune Wu, Sajid Soofi, Zulfiqar Bhutta, Claudio Lanata, Richard L. Guerrant, Aldo A. M. Lima, Kåre Mølbak, Palle Valentiner-Branth, William Checkley, Robert H. Gilman, R. Bradley Sack, Robert E. Black, Jean Humphrey, and Neff Walker
- Subjects
Lives saved tool ,Mixed effects modelling ,Nutritional interventions ,Stunting ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The Lives Saved Tool (LiST) is a widely used resource for evidence-based decision-making regarding health program scale-up in low- and middle-income countries. LiST estimates the impact of specified changes in intervention coverage on mortality and stunting among children under 5 years of age. We aimed to improve the estimates of the parameters in LiST that determine the rate at which the effects of interventions to prevent stunting attenuate as children get older. Methods We identified datasets with serial measurements of children’s lengths or heights and used random effects models and restricted cubic splines to model the growth trajectories of children with at least six serial length/height measurements. We applied WHO growth standards to both measured and modelled (smoothed) lengths/heights to determine children’s stunting status at multiple ages (1, 6, 12, 24 months). We then calculated the odds ratios for the association of stunting at one age point with stunting at the next (“stunting-to-stunting ORs”) using both measured and smoothed data points. We ran analyses in LiST to compare the impact on intervention effect attenuation of using smoothed rather than measured stunting-to-stunting ORs. Results A total of 21,786 children with 178,786 length/height measurements between them contributed to our analysis. The odds of stunting at a given age were strongly related to whether a child is stunted at an earlier age, using both measured and smoothed lengths/heights, although the relationship was stronger for smoothed than measured lengths/heights. Using smoothed lengths/heights, we estimated that children stunted at 1 month have 45 times the odds of being stunted at 6 months, with corresponding odds ratios of 362 for the period 6 to 12 months and 175 for the period 12 to 24 months. Using the odds ratios derived from the smoothed data in LiST resulted in a somewhat slower attenuation of intervention effects over time, but substantial attenuation was still observed in the LiST outputs. For example, in Mali the effect of effectively eliminating SGA births reduced prevalence of stunting at age 59 months from 44.4% to 43.7% when using odds ratios derived from measured lengths/heights and from 44.4% to 41.9% when using odds ratios derived from smoothed lengths/heights. Conclusions Smoothing of children’s measured lengths/heights increased the strength of the association between stunting at a given age and stunting at an earlier age. Using odds ratios based on smoothed lengths/heights in LiST resulted in a small reduction in the attenuation of intervention effects with age and thus some increase in the estimated benefits, and may better reflect the true benefits of early nutritional interventions.
- Published
- 2017
- Full Text
- View/download PDF
42. Effects of a liquefied petroleum gas stove intervention on pollutant exposure and adult cardiopulmonary outcomes (CHAP): study protocol for a randomized controlled trial
- Author
-
Magdalena Fandiño-Del-Rio, Dina Goodman, Josiah L. Kephart, Catherine H. Miele, Kendra N. Williams, Mitra Moazzami, Elizabeth C. Fung, Kirsten Koehler, Victor G. Davila-Roman, Kathryn A. Lee, Saachi Nangia, Steven A. Harvey, Kyle Steenland, Gustavo F. Gonzales, William Checkley, and Cardiopulmonary outcomes and Household Air Pollution trial (CHAP) Trial Investigators
- Subjects
Cookstove ,LPG ,Indoor air pollution ,Household air pollution ,Personal exposure ,Biomass fuel ,Medicine (General) ,R5-920 - Abstract
Abstract Background Biomass fuel smoke is a leading risk factor for the burden of disease worldwide. International campaigns are promoting the widespread adoption of liquefied petroleum gas (LPG) in resource-limited settings. However, it is unclear if the introduction and use of LPG stoves, in settings where biomass fuels are used daily, reduces pollution concentration exposure, improves health outcomes, or how cultural and social barriers influence the exclusive adoption of LPG stoves. Methods We will conduct a randomized controlled, field intervention trial of LPG stoves and fuel distribution in rural Puno, Peru, in which we will enroll 180 female participants aged 25–64 years and follow them for 2 years. After enrollment, we will collect information on sociodemographic characteristics, household characteristics, and cooking practices. During the first year of the study, LPG stoves and fuel tanks will be delivered to the homes of 90 intervention participants. During the second year, participants in the intervention arm will keep their LPG stoves, but the gas supply will stop. Control participants will receive LPG stoves and vouchers to obtain free fuel from distributors at the beginning of the second year, but gas will not be delivered. Starting at baseline, we will collect longitudinal measurements of respiratory symptoms, pulmonary function, blood pressure, endothelial function, carotid artery intima-media thickness, 24-h dietary recalls, exhaled carbon monoxide, quality-of-life indicators, and stove-use behaviors. Environmental exposure assessments will occur six times over the 2-year follow-up period, consisting of 48-h personal exposure and kitchen concentration measurements of fine particulate matter and carbon monoxide, and 48-h kitchen concentrations of nitrogen dioxide for a subset of 100 participants. Discussion Findings from this study will allow us to better understand behavioral patterns, environmental exposures, and cardiovascular and pulmonary outcomes resulting from the adoption of LPG stoves. If this trial indicates that LPG stoves are a feasible and effective way to reduce household air pollution and improve health, it will provide important information to support widespread adoption of LPG fuel as a strategy to reduce the global burden of disease. Trial registration ClinicalTrials.gov, ID: NCT02994680 , Cardiopulmonary Outcomes and Household Air Pollution (CHAP) Trial. Registered on 28 November 2016.
- Published
- 2017
- Full Text
- View/download PDF
43. Risk score for first-screening of prevalent undiagnosed chronic kidney disease in Peru: the CRONICAS-CKD risk score
- Author
-
Rodrigo M. Carrillo-Larco, J. Jaime Miranda, Robert H. Gilman, Josefina Medina-Lezama, Julio A. Chirinos-Pacheco, Paola V. Muñoz-Retamozo, Liam Smeeth, William Checkley, Antonio Bernabe-Ortiz, and CRONICAS Cohort Study Group
- Subjects
Risk assessment ,Kidney ,Chronic kidney disease ,Latin America ,Diseases of the genitourinary system. Urology ,RC870-923 - Abstract
Abstract Background Chronic Kidney Disease (CKD) represents a great burden for the patient and the health system, particularly if diagnosed at late stages. Consequently, tools to identify patients at high risk of having CKD are needed, particularly in limited-resources settings where laboratory facilities are scarce. This study aimed to develop a risk score for prevalent undiagnosed CKD using data from four settings in Peru: a complete risk score including all associated risk factors and another excluding laboratory-based variables. Methods Cross-sectional study. We used two population-based studies: one for developing and internal validation (CRONICAS), and another (PREVENCION) for external validation. Risk factors included clinical- and laboratory-based variables, among others: sex, age, hypertension and obesity; and lipid profile, anemia and glucose metabolism. The outcome was undiagnosed CKD: eGFR
- Published
- 2017
- Full Text
- View/download PDF
44. Disparities in dietary intake and physical activity patterns across the urbanization divide in the Peruvian Andes
- Author
-
Morgan L. McCloskey, Carla E. Tarazona-Meza, Jessica C. Jones-Smith, Catherine H. Miele, Robert H. Gilman, Antonio Bernabe-Ortiz, J. Jaime Miranda, and William Checkley
- Subjects
Nutrition transition ,24-h recall ,Urbanization ,Overweight ,Low- and middle income countries ,Chronic diseases ,Nutritional diseases. Deficiency diseases ,RC620-627 ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Diet and activity are thought to worsen with urbanization, thereby increasing risk of obesity and chronic diseases. A better understanding of dietary and activity patterns across the urbanization divide may help identify pathways, and therefore intervention targets, leading to the epidemic of overweight seen in low- and middle-income populations. Therefore, we sought to characterize diet and activity in a population-based study of urban and rural residents in Puno, Peru. Methods We compared diet and activity in 1005 (503 urban, 502 rural) participants via a lifestyle questionnaire. We then recruited an age- and sex-stratified random sample of 50 (25 urban, 25 rural) participants to further characterize diet and activity. Among these participants, diet composition and macronutrient intake was assessed by three non-consecutive 24-h dietary recalls and physical activity was assessed using Omron JH-720itc pedometers. Results Among 1005 participants, we found that urban residents consumed protein-rich foods, refined grains, sugary items, and fresh produce more frequently than rural residents. Among the 50 subsample participants, urban dwellers consumed more protein (47 vs. 39 g; p = 0.05), more carbohydrates (280 vs. 220 g; p = 0.03), more sugary foods (98 vs. 48 g, p = 0.02) and had greater dietary diversity (6.4 vs 5.8; p = 0.04). Rural subsample participants consumed more added salt (3.1 vs 1.7 g, p = 0.006) and tended to consume more vegetable oil. As estimated by pedometers, urban subsample participants burned fewer calories per day (191 vs 270 kcal, p = 0.03). Conclusions Although urbanization is typically thought to increase consumption of fat, sugar and salt, our 24-h recall results were mixed and showed lower levels of obesity in rural Puno were not necessarily indicative of nutritionally-balanced diets. All subsample participants had relatively traditional lifestyles (low fat intake, limited consumption of processed foods and frequent walking) that may play a role in chronic disease outcomes in this region.
- Published
- 2017
- Full Text
- View/download PDF
45. Associations between serum 25(OH)D concentrations and prevalent asthma among children living in communities with differing levels of urbanization: a cross-sectional study
- Author
-
Suzanne L. Pollard, John J. Lima, Karina Romero, Carla Tarazona-Meza, Edward Mougey, Katherine Tomaino, Gary Malpartida-Guzmán, Nadia N. Hansel, William Checkley, and GASP Study Investigators
- Subjects
Asthma ,Pediatric asthma ,Vitamin D ,25(OH)D ,Nutrition ,Urbanization ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background Prior evidence suggests that vitamin D deficiency may increase the risk of asthma and atopy and impair pulmonary function in children. Methods In this cross-sectional analysis nested in a case-control study, we analyzed serum 25(OH)D concentrations in 413 children with asthma and 471 children without asthma living in two geographically adjacent study communities (Pampas and Villa El Salvador). We measured total and antigen-specific IgE levels, pulmonary function, asthma control, and exhaled nitric oxide. Results Mean 25(OH)D concentrations were 25.2 ng/mL (SD 10.1) in children with asthma and 26.1 ng/mL (SD 13.7) in children without asthma (p = 0.28). Vitamin D deficiency (25(OH)D
- Published
- 2017
- Full Text
- View/download PDF
46. Causal Pathways from Enteropathogens to Environmental Enteropathy: Findings from the MAL-ED Birth Cohort Study
- Author
-
Margaret N. Kosek, Tahmeed Ahmed, Zulfiquar Bhutta, Laura Caulfield, Richard Guerrant, Eric Houpt, Gagandeep Kang, Margaret Kosek, Gwenyth Lee, Aldo Lima, Benjamin J.J. McCormick, James Platts-Mills, Jessica Seidman, Rebecca R. Blank, Michael Gottlieb, Stacey L. Knobler, Dennis R. Lang, Mark A. Miller, Karen H. Tountas, Zulfiqar A. Bhutta, William Checkley, Richard L. Guerrant, Carl J. Mason, Laura E. Murray-Kolb, William A. Petri, Jr., Jessica C. Seidman, Pascal Bessong, Rashidul Haque, Sushil John, Aldo A.M. Lima, Estomih R. Mduma, Reinaldo B. Oriá, Prakash Sunder Shrestha, Sanjaya Kumar Shrestha, Erling Svensen, Anita K.M. Zaidi, Cláudia B. Abreu, Angel Mendez Acosta, Imran Ahmed, A.M. Shamsir Ahmed, Asad Ali, Ramya Ambikapathi, Leah Barrett, Aubrey Bauck, Eliwaza Bayyo, Ladaporn Bodhidatta, Anuradha Bose, J. Daniel Carreon, Ram Krishna Chandyo, Vivek Charu, Hilda Costa, Rebecca Dillingham, Alessandra Di Moura, Viyada Doan, Jose Quirino Filho, Jhanelle Graham, Christel Hoest, Iqbal Hossain, Munirul Islam, M. Steffi Jennifer, Shiny Kaki, Beena Koshy, Álvaro M. Leite, Noélia L. Lima, Bruna L.L. Maciel, Mustafa Mahfuz, Cloupas Mahopo, Angelina Maphula, Monica McGrath, Archana Mohale, Milena Moraes, Francisco S. Mota, Jayaprakash Muliyil, Regisiana Mvungi, Gaurvika Nayyar, Emanuel Nyathi, Maribel Paredes Olortegui, Reinaldo Oria, Angel Orbe Vasquez, William K. Pan, John Pascal, Crystal L. Patil, Laura Pendergast, Silvia Rengifo Pinedo, Stephanie Psaki, Mohan Venkata Raghava, Karthikeyan Ramanujam, Muneera Rasheed, Zeba A. Rasmussen, Stephanie A. Richard, Anuradha Rose, Reeba Roshan, Barbara Schaefer, Rebecca Scharf, Srujan L. Sharma, Binob Shrestha, Rita Shrestha, Suzanne Simons, Alberto M. Soares, Rosa M.S. Mota, Sajid Soofi, Tor Strand, Fahmida Tofail, Rahul J. Thomas, Ali Turab, Manjeswori Ulak, Vivian Wang, Ladislaus Yarrot, Pablo Peñataro Yori, Didar Alam, Caroline Amour, Cesar Banda Chavez, Sudhir Babji, Rosa Rios de Burga, Julian Torres Flores, Jean Gratz, Ajila T. George, Dinesh Hariraju, Alexandre Havt, Priyadarshani Karunakaran, Robin P. Lazarus, Ila F. Lima, Dinesh Mondal, Pedro H.Q.S. Medeiros, Rosemary Nshama, Josiane Quetz, Shahida Qureshi, Sophy Raju, Anup Ramachandran, Rakhi Ramadas, A. Catharine Ross, Mery Siguas Salas, Amidou Samie, Kerry Schulze, E. Shanmuga Sundaram, Buliga Mujaga Swema, and Dixner Rengifo Trigoso
- Subjects
Enteropathy ,Undernutrition ,Stunting ,Enteropathogen ,Child growth ,Child health ,Medicine ,Medicine (General) ,R5-920 - Abstract
Background: Environmental enteropathy (EE), the adverse impact of frequent and numerous enteric infections on the gut resulting in a state of persistent immune activation and altered permeability, has been proposed as a key determinant of growth failure in children in low- and middle-income populations. A theory-driven systems model to critically evaluate pathways through which enteropathogens, gut permeability, and intestinal and systemic inflammation affect child growth was conducted within the framework of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) birth cohort study that included children from eight countries. Methods: Non-diarrheal stool samples (N = 22,846) from 1253 children from multiple sites were evaluated for a panel of 40 enteropathogens and fecal concentrations of myeloperoxidase, alpha-1-antitrypsin, and neopterin. Among these same children, urinary lactulose:mannitol (L:M) (N = 6363) and plasma alpha-1-acid glycoprotein (AGP) (N = 2797) were also measured. The temporal sampling design was used to create a directed acyclic graph of proposed mechanistic pathways between enteropathogen detection in non-diarrheal stools, biomarkers of intestinal permeability and inflammation, systemic inflammation and change in length- and weight- for age in children 0–2 years of age. Findings: Children in these populations had frequent enteric infections and high levels of both intestinal and systemic inflammation. Higher burdens of enteropathogens, especially those categorized as being enteroinvasive or causing mucosal disruption, were associated with elevated biomarker concentrations of gut and systemic inflammation and, via these associations, indirectly associated with both reduced linear and ponderal growth. Evidence for the association with reduced linear growth was stronger for systemic inflammation than for gut inflammation; the opposite was true of reduced ponderal growth. Although Giardia was associated with reduced growth, the association was not mediated by any of the biomarkers evaluated. Interpretation: The large quantity of empirical evidence contributing to this analysis supports the conceptual model of EE. The effects of EE on growth faltering in young children were small, but multiple mechanistic pathways underlying the attribution of growth failure to asymptomatic enteric infections had statistical support in the analysis. The strongest evidence for EE was the association between enteropathogens and linear growth mediated through systemic inflammation. Funding: Bill & Melinda Gates Foundation.
- Published
- 2017
- Full Text
- View/download PDF
47. Correction: Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD.
- Author
-
Akshay N Gupte, Mandar Paradkar, Sriram Selvaraju, Kannan Thiruvengadam, Shri Vijay Bala Yogendra Shivakumar, Krithikaa Sekar, Srinivasa Marinaik, Ayesha Momin, Archana Gaikwad, Premkumar Natrajan, Munivardhan Prithivi, Gomathy Shivaramakrishnan, Neeta Pradhan, Rewa Kohli, Swapnil Raskar, Divyashri Jain, Rani Velu, Bharath Karthavarayan, Rahul Lokhande, Nishi Suryavanshi, Nikhil Gupte, Lakshmi Murali, Sundeep Salvi, William Checkley, Jonathan Golub, Robert Bollinger, Vidya Mave, Chandrasekaran Padmapriyadarasini, and Amita Gupta
- Subjects
Medicine ,Science - Abstract
[This corrects the article DOI: 10.1371/journal.pone.0217289.].
- Published
- 2019
- Full Text
- View/download PDF
48. Assessment of lung function in successfully treated tuberculosis reveals high burden of ventilatory defects and COPD.
- Author
-
Akshay N Gupte, Mandar Paradkar, Sriram Selvaraju, Kannan Thiruvengadam, Shri Vijay Bala Yogendra Shivakumar, Krithikaa Sekar, Srinivasa Marinaik, Ayesha Momin, Archana Gaikwad, Premkumar Natrajan, Munivardhan Prithivi, Gomathy Shivaramakrishnan, Neeta Pradhan, Rewa Kohli, Swapnil Raskar, Divyashri Jain, Rani Velu, Bharath Karthavarayan, Rahul Lokhande, Nishi Suryavanshi, Nikhil Gupte, Lakshmi Murali, Sundeep Salvi, William Checkley, Jonathan Golub, Robert Bollinger, Vidya Mave, Chandrasekaran Padmapriyadarasini, and Amita Gupta
- Subjects
Medicine ,Science - Abstract
BackgroundBurden, phenotype and risk-factors of lung function defects in successfully treated tuberculosis cases are unclear.MethodsWe performed spirometry with bronchodilators in new drug-sensitive adult (≥18 years) pulmonary tuberculosis cases during the 12 months following successful treatment in India. Airflow obstruction was defined as pre-bronchodilator FEV1/FVCResultsOf the 172 participants included in the analysis, 82 (48%) were female, 22 (13%) had diabetes and 34 (20%) ever-smoked with a median (IQR) exposure of 3.5 (0.2-9.9) pack-years. Median (IQR) age and body-mass index (BMI) at enrollment was 32 (23-39) years and 18.1 (16.0-20.5) kg/m2 respectively. Airflow obstruction was detected in 42 (24%) participants; of whom 9 (21%) responded to short-acting bronchodilators and 25 (56%) had COPD; and was associated with duration of illness prior to treatment (aOR = 1.32 per 30-days, 95%CI 1.04-1.68, p = 0.02). A restrictive spirometry pattern was detected in 89 (52%) participants and was associated with female sex (aOR = 3.73, 95%CI 1.51-9.17, p = 0.004) and diabetes (aOR = 4.06, 95%CI 1.14-14.42, p = 0.03). Higher HbA1c at treatment initiation was associated with greater odds of a restrictive spirometry pattern (aOR = 1.29 per unit higher HbA1c, 95%CI 1.04 to 1.60, p = 0.02).ConclusionWe found a high burden of lung function defects and COPD in tuberculosis cases who successfully completed treatment. Screening for chronic lung diseases following treatment and linkage to respiratory health clinics should be included in the routine management plan of all tuberculosis cases in India, regardless of conventional COPD risk-factors such as older age and smoking.
- Published
- 2019
- Full Text
- View/download PDF
49. Use of quantitative molecular diagnostic methods to assess the aetiology, burden, and clinical characteristics of diarrhoea in children in low-resource settings: a reanalysis of the MAL-ED cohort study
- Author
-
James A Platts-Mills, MD, Jie Liu, PhD, Elizabeth T Rogawski, PhD, Furqan Kabir, MSc, Paphavee Lertsethtakarn, PhD, Mery Siguas, BSc, Shaila S Khan, MSc, Ira Praharaj, MD, Arinao Murei, BSc, Rosemary Nshama, BSc, Buliga Mujaga, BSc, Alexandre Havt, PhD, Irene A Maciel, PhD, Timothy L McMurry, PhD, Darwin J Operario, PhD, Mami Taniuchi, PhD, Jean Gratz, MS, Suzanne E Stroup, MS, James H Roberts, Adil Kalam, MSc, Fatima Aziz, MSc, Shahida Qureshi, MSc, M Ohedul Islam, MSc, Pimmada Sakpaisal, MSc, Sasikorn Silapong, B BSc, Pablo P Yori, MPH, Revathi Rajendiran, MSc, Blossom Benny, MSc, Monica McGrath, ScD, Benjamin J J McCormick, DPhil, Jessica C Seidman, PhD, Dennis Lang, PhD, Michael Gottlieb, PhD, Richard L Guerrant, MD, Aldo A M Lima, ProfPhD, Jose Paulo Leite, PhD, Amidou Samie, PhD, Pascal O Bessong, ProfPhD, Nicola Page, PhD, Ladaporn Bodhidatta, MD, Carl Mason, MD, Sanjaya Shrestha, MD, Ireen Kiwelu, PhD, Estomih R Mduma, MPH, Najeeha T Iqbal, PhD, Zulfiqar A Bhutta, ProfPhD, Tahmeed Ahmed, ProfMBBS, Rashidul Haque, PhD, Gagandeep Kang, ProfMD, Margaret N Kosek, MD, Eric R Houpt, ProfMD, Angel Mendez Acosta, Rosa Rios de Burga, Cesar Banda Chavez, Julian Torres Flores, Maribel Paredes Olotegui, Silvia Rengifo Pinedo, Dixner Rengifo Trigoso, Angel Orbe Vasquez, Imran Ahmed, Didar Alam, Asad Ali, Muneera Rasheed, Sajid Soofi, Ali Turab, Aisha Yousafzai, Anita KM Zaidi, Binob Shrestha, Bishnu Bahadur Rayamajhi, Tor Strand, Geetha Ammu, Sudhir Babji, Anuradha Bose, Ajila T George, Dinesh Hariraju, M. Steffi Jennifer, Sushil John, Shiny Kaki, Priyadarshani Karunakaran, Beena Koshy, Robin P Lazarus, Jayaprakash Muliyil, Preethi Ragasudha, Mohan Venkata Raghava, Sophy Raju, Anup Ramachandran, Rakhi Ramadas, Karthikeyan Ramanujam, Anuradha Rose, Reeba Roshan, Srujan L Sharma, Shanmuga Sundaram, Rahul J Thomas, William K Pan, Ramya Ambikapathi, J Daniel Carreon, Viyada Doan, Christel Hoest, Stacey Knobler, Mark A Miller, Stephanie Psaki, Zeba Rasmussen, Stephanie A Richard, Karen H Tountas, Erling Svensen, Caroline Amour, Eliwaza Bayyo, Regisiana Mvungi, John Pascal, Ladislaus Yarrot, Leah Barrett, Rebecca Dillingham, William A Petri, Rebecca Scharf, AM Shamsir Ahmed, Md Ashraful Alam, Umma Haque, Md Iqbal Hossain, Munirul Islam, Mustafa Mahfuz, Dinesh Mondal, Baitun Nahar, Fahmida Tofail, Ram Krishna Chandyo, Prakash Sunder Shrestha, Rita Shrestha, Manjeswori Ulak, Aubrey Bauck, Robert Black, Laura Caulfield, William Checkley, Gwenyth Lee, Kerry Schulze, Samuel Scott, Laura E Murray-Kolb, A Catharine Ross, Barbara Schaefer, Suzanne Simons, Laura Pendergast, Cláudia B Abreu, Hilda Costa, Alessandra Di Moura, José Quirino Filho, Álvaro M Leite, Noélia L Lima, Ila F Lima, Bruna LL Maciel, Pedro HQS Medeiros, Milena Moraes, Francisco S Mota, Reinaldo B Oriá, Josiane Quetz, Alberto M Soares, Rosa MS Mota, Crystal L Patil, Cloupas Mahopo, Angelina Maphula, and Emanuel Nyathi
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Optimum management of childhood diarrhoea in low-resource settings has been hampered by insufficient data on aetiology, burden, and associated clinical characteristics. We used quantitative diagnostic methods to reassess and refine estimates of diarrhoea aetiology from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) cohort study. Methods: We re-analysed stool specimens from the multisite MAL-ED cohort study of children aged 0–2 years done at eight locations (Dhaka, Bangladesh; Vellore, India; Bhaktapur, Nepal; Naushero Feroze, Pakistan; Venda, South Africa; Haydom, Tanzania; Fortaleza, Brazil; and Loreto, Peru), which included active surveillance for diarrhoea and routine non-diarrhoeal stool collection. We used quantitative PCR to test for 29 enteropathogens, calculated population-level pathogen-specific attributable burdens, derived stringent quantitative cutoffs to identify aetiology for individual episodes, and created aetiology prediction scores using clinical characteristics. Findings: We analysed 6625 diarrhoeal and 30 968 non-diarrhoeal surveillance stools from 1715 children. Overall, 64·9% of diarrhoea episodes (95% CI 62·6–71·2) could be attributed to an aetiology by quantitative PCR compared with 32·8% (30·8–38·7) using the original study microbiology. Viral diarrhoea (36·4% of overall incidence, 95% CI 33·6–39·5) was more common than bacterial (25·0%, 23·4–28·4) and parasitic diarrhoea (3·5%, 3·0–5·2). Ten pathogens accounted for 95·7% of attributable diarrhoea: Shigella (26·1 attributable episodes per 100 child-years, 95% CI 23·8–29·9), sapovirus (22·8, 18·9–27·5), rotavirus (20·7, 18·8–23·0), adenovirus 40/41 (19·0, 16·8–23·0), enterotoxigenic Escherichia coli (18·8, 16·5–23·8), norovirus (15·4, 13·5–20·1), astrovirus (15·0, 12·0–19·5), Campylobacter jejuni or C coli (12·1, 8·5–17·2), Cryptosporidium (5·8, 4·3–8·3), and typical enteropathogenic E coli (5·4, 2·8–9·3). 86·2% of the attributable incidence for Shigella was non-dysenteric. A prediction score for shigellosis was more accurate (sensitivity 50·4% [95% CI 46·7–54·1], specificity 84·0% [83·0–84·9]) than current guidelines, which recommend treatment only of bloody diarrhoea to cover Shigella (sensitivity 14·5% [95% CI 12·1–17·3], specificity 96·5% [96·0–97·0]). Interpretation: Quantitative molecular diagnostics improved estimates of pathogen-specific burdens of childhood diarrhoea in the community setting. Viral causes predominated, including a substantial burden of sapovirus; however, Shigella had the highest overall burden with a high incidence in the second year of life. These data could improve the management of diarrhoea in these low-resource settings. Funding: Bill & Melinda Gates Foundation.
- Published
- 2018
- Full Text
- View/download PDF
50. Use of quantitative molecular diagnostic methods to investigate the effect of enteropathogen infections on linear growth in children in low-resource settings: longitudinal analysis of results from the MAL-ED cohort study
- Author
-
Elizabeth T Rogawski, PhD, Jie Liu, PhD, James A Platts-Mills, MD, Furqan Kabir, MSc, Paphavee Lertsethtakarn, PhD, Mery Siguas, BSc, Shaila S Khan, MSc, Ira Praharaj, MD, Arinao Murei, BSc, Rosemary Nshama, BSc, Buliga Mujaga, BSc, Alexandre Havt, PhD, Irene A Maciel, PhD, Darwin J Operario, PhD, Mami Taniuchi, PhD, Jean Gratz, MS, Suzanne E Stroup, MS, James H Roberts, Adil Kalam, MSc, Fatima Aziz, MSc, Shahida Qureshi, MSc, M Ohedul Islam, MSc, Pimmada Sakpaisal, MSc, Sasikorn Silapong, MSc, Pablo P Yori, MPH, Revathi Rajendiran, MSc, Blossom Benny, MSc, Monica McGrath, ScD, Jessica C Seidman, PhD, Dennis Lang, PhD, Michael Gottlieb, PhD, Richard L Guerrant, MD, Aldo A M Lima, ProfPhD, Jose Paulo Leite, PhD, Amidou Samie, PhD, Pascal O Bessong, ProfPhD, Nicola Page, PhD, Ladaporn Bodhidatta, MD, Carl Mason, MD, Sanjaya Shrestha, MD, Ireen Kiwelu, PhD, Estomih R Mduma, MPH, Najeeha T Iqbal, PhD, Zulfiqar A Bhutta, ProfPhD, Tahmeed Ahmed, ProfMBBS, Rashidul Haque, PhD, Gagandeep Kang, ProfMD, Margaret N Kosek, MD, Eric R Houpt, ProfMD, Angel Mendez Acosta, Rosa Rios de Burga, Cesar Banda Chavez, Julian Torres Flores, Maribel Paredes Olotegui, Silvia Rengifo Pinedo, Dixner Rengifo Trigoso, Angel Orbe Vasquez, Imran Ahmed, Didar Alam, Asad Ali, Muneera Rasheed, Sajid Soofi, Ali Turab, Aisha Yousafzai, Anita KM Zaidi, Binob Shrestha, Bishnu Bahadur Rayamajhi, Tor Strand, Geetha Ammu, Sudhir Babji, Anuradha Bose, Ajila T George, Dinesh Hariraju, M. Steffi Jennifer, Sushil John, Shiny Kaki, Priyadarshani Karunakaran, Beena Koshy, Robin P Lazarus, Jayaprakash Muliyil, Preethi Ragasudha, Mohan Venkata Raghava, Sophy Raju, Anup Ramachandran, Rakhi Ramadas, Karthikeyan Ramanujam, Anuradha Rose, Reeba Roshan, Srujan L Sharma, Shanmuga Sundaram, Rahul J Thomas, William K Pan, Ramya Ambikapathi, J Daniel Carreon, Viyada Doan, Christel Hoest, Stacey Knobler, Mark A Miller, Stephanie Psaki, Zeba Rasmussen, Stephanie A Richard, Karen H Tountas, Erling Svensen, Caroline Amour, Eliwaza Bayyo, Regisiana Mvungi, John Pascal, Ladislaus Yarrot, Leah Barrett, Rebecca Dillingham, William A Petri, Rebecca Scharf, AM Shamsir Ahmed, Md Ashraful Alam, Umma Haque, Md Iqbal Hossain, Munirul Islam, Mustafa Mahfuz, Dinesh Mondal, Baitun Nahar, Fahmida Tofail, Ram Krishna Chandyo, Prakash Sunder Shrestha, Rita Shrestha, Manjeswori Ulak, Aubrey Bauck, Robert Black, Laura Caulfield, William Checkley, Gwenyth Lee, Kerry Schulze, Samuel Scott, Laura E Murray-Kolb, A Catharine Ross, Barbara Schaefer, Suzanne Simons, Laura Pendergast, Cláudia B Abreu, Hilda Costa, Alessandra Di Moura, José Quirino Filho, Álvaro M Leite, Noélia L Lima, Ila F Lima, Bruna LL Maciel, Pedro HQS Medeiros, Milena Moraes, Francisco S Mota, Reinaldo B Oriá, Josiane Quetz, Alberto M Soares, Rosa MS Mota, Crystal L Patil, Cloupas Mahopo, Angelina Maphula, and Emanuel Nyathi
- Subjects
Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: Enteropathogen infections in early childhood not only cause diarrhoea but contribute to poor growth. We used molecular diagnostics to assess whether particular enteropathogens were associated with linear growth across seven low-resource settings. Methods: We used quantitative PCR to detect 29 enteropathogens in diarrhoeal and non-diarrhoeal stools collected from children in the first 2 years of life obtained during the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite cohort study. Length was measured monthly. We estimated associations between aetiology-specific diarrhoea and subclinical enteropathogen infection and quantity and attained length in 3 month intervals, at age 2 and 5 years, and used a longitudinal model to account for temporality and time-dependent confounding. Findings: Among 1469 children who completed 2 year follow-up, 35 622 stool samples were tested and yielded valid results. Diarrhoeal episodes attributed to bacteria and parasites, but not viruses, were associated with small decreases in length after 3 months and at age 2 years. Substantial decrements in length at 2 years were associated with subclinical, non-diarrhoeal, infection with Shigella (length-for-age Z score [LAZ] reduction −0·14, 95% CI −0·27 to −0·01), enteroaggregative Escherichia coli (−0·21, −0·37 to −0·05), Campylobacter (−0·17, −0·32 to −0·01), and Giardia (−0·17, −0·30 to −0·05). Norovirus, Cryptosporidium, typical enteropathogenic E coli, and Enterocytozoon bieneusi were also associated with small decrements in LAZ. Shigella and E bieneusi were associated with the largest decreases in LAZ per log increase in quantity per g of stool (−0·13 LAZ, 95% CI −0·22 to −0·03 for Shigella; −0·14, −0·26 to −0·02 for E bieneusi). Based on these models, interventions that successfully decrease exposure to Shigella, enteroaggregative E coli, Campylobacter, and Giardia could increase mean length of children by 0·12–0·37 LAZ (0·4–1·2 cm) at the MAL-ED sites. Interpretation: Subclinical infection and quantity of pathogens, particularly Shigella, enteroaggregative E coli, Campylobacter, and Giardia, had a substantial negative association with linear growth, which was sustained during the first 2 years of life, and in some cases, to 5 years. Successfully reducing exposure to certain pathogens might reduce global stunting. Funding: Bill & Melinda Gates Foundation.
- Published
- 2018
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.