PLOS Global Public Health

Journal Information
EISSN: 27673375
Total articles ≅ 1,060

Latest articles in this journal

, , Lice González Angulo, Matteo Chiacchiaretta, , , Camilla Rodrigues, , , , et al.
Published: 31 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001754

Abstract:
There were approximately 10 million tuberculosis (TB) cases in 2020, of which 500,000 were drug-resistant. Only one third of drug-resistant TB cases were diagnosed and enrolled on appropriate treatment, an issue partly driven by a lack of rapid, accurate drug-susceptibility testing (DST) tools deployable in peripheral settings. In 2014, World Health Organization (WHO) published target product profiles (TPPs) which detailed minimal and optimal criteria to address high-priority TB diagnostic needs, including DST. Since then, the TB community’s needs have evolved; new treatment regimens, changes in TB definitions, further emergence of drug resistance, technological advances, and changing end-users requirements have necessitated an update. The DST TPP’s revision was therefore undertaken by WHO with the Stop TB Partnership New Diagnostics Working Group. We describe the process of updating the TPP for next-generation TB DST for use at peripheral centres, highlight key updates, and discuss guidance regarding technical and operational specifications.
Published: 31 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001768

Abstract:
Overweight and obesity increase the risk of cardiovascular disease, type 2 diabetes mellitus, hypertension, stroke, and some type of cancers, and maternal health globally. In Cambodia, the prevalence of overweight and obesity among women aged 15–49 years increased from 6% in 2000 to 18% in 2014, becoming a public health burden. We examined socio-demographic and behavioral factors associated with overweight and/or obesity among women of reproductive age (WRA) in Cambodia. We analyzed data from the 2014 Cambodia Demographic and Health Survey (CDHS) that used a two-stage stratified cluster sampling design. Data analysis was restricted to non-pregnant women, resulting in an analytic sample of 10,818 women. Multivariable logistic regressions were performed using STATA V16 to examine factors associated with overweight and obesity. Prevalence of overweight and obesity among non-pregnant women of reproductive age were 15.2% and 2.8% respectively. Factors independently associated with increased odds of overweight and/or obesity including women aged 20–29 years with adjusted odds ratio [AOR = 2.4; 95% CI: 1.6–3.6], 30–39 years [AOR = 4.6; 95% CI: 3.0–6.9], and 40–49 years [AOR = 6.6; 95% CI: 4.3–10.1], married women [AOR = 1.8; 95% CI: 1.3–2.7], urban residence [AOR = 1.3; 95% CI: 1.1–1.5], and women having at least 4 children [AOR = 1.7; 95% CI: 1.2–2.5]. The factors were associated with decreased odds of overweight and obesity: completed at least secondary education [AOR = 0.7; 95% CI: 0.6–0.8], agricultural work [AOR = 0.7; 95% CI: 0.5–0.8], and manual labor work [AOR = 0.7; 95% CI: 0.6–0.9]. Increased age, married women, living in urban residence, and having at least four children were the main risk factors associated with overweight and/or obesity. Conversely, higher education, working in agriculture, and working in manual labor were negatively associated with overweight and/or obesity. Cambodia’s non-communicable disease (NCD) public health programs should consider these characteristic for targeting interventions to further reduce overweight and/or obesity in the coming years.
, , , Florian Marx, Kennedy Otwombe, Eustasius Musenge, Salome Charalambous
Published: 31 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001728

Abstract:
Globally, high viral load (VL) suppression rates are indicators of successful HIV treatment programs. Evaluation of these programmes at lower levels is likely to highlight variations that are masked at the provincial or national levels. This ecological study used routinely collected clinical and surveillance data on the HIV programme from 88 sampled Ekurhuleni wards. Between January 2012 and December 2016, 26 222 HIV VL tests for 2817 patients were conducted. We conducted a secondary analysis to determine the predictors of high VL suppression accounting for space and time random effects and estimate the impact of the national universal test-and-treat roll-out in 2016 and forecast VL suppression rates for five years post-2016.The proportion of VL suppression increased over the years: 2012 (47.8%: 95% confidence interval (CI): 36.7%-67.4%); 2013 (58.2%: 95%CI: 41.4%-79.6%); 2014 (62.7%: 95%CI: 45.2%-84.7%); 2015 (67.2%: 95%CI: 49.0%-89.9%) and 2016 (61.2%: 95%CI: 43.9%-83.0%). For every percentage increase in ART initiation, high VL suppression rates increased by 35% (RR: 1.345; 95% credible interval (Crl) 1.221–1.492) and for every percentage increase in women in the ward, high VL suppression increased by 44% (RR: 1.442; 95%CrI: 1.056–1.962). There was evidence of high and low clusters of viral load suppression observed at ward-level. The VL suppression rates in Ekurhuleni were lower than the 90% UNAIDS target. There was heterogeneity of high VL suppression across wards and study period. Targeted interventions strengthening ART initiation and retention in care are critical to achieving optimal VL suppression in Ekurhuleni and districts with similar profiles.
Sarah Castle, Fiacre Bazie, Amelia Maytan-Joneydi, Kindo Boukary, Lisa M. Calhoun, Yentema Onadja, Georges Guiella,
Published: 31 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001780

Abstract:
This qualitative study from Burkina Faso explores community-level perceptions of family planning (FP) service quality among FP users and non-users. It examines how perspectives on service quality may influence women’s motivation to seek modern methods from health facilities. For this study, twenty focus group discussions were undertaken with non-users and current users of modern FP including unmarried, sexually active women ages 15–19 and 20–24 and ever married women ages 15–24 and 25+ in Bobo Dioulasso and Banfora, Burkina Faso. The findings demonstrate that respondents prioritized a welcoming environment, positive provider-client exchanges, the full provision of information (especially about side-effects), a pain-free experience, a short waiting time, and privacy and confidentiality. Poor service quality did not, in general, reduce women’s demand or need to use a FP method. Some women who were reluctant to use formal health services used a non-facility-based method (calendar method, withdrawal, condoms or abstinence). Importantly, many unmarried, younger women and adolescents, who were more likely to be stigmatized by providers, exhibited agency by proactively seeking a method despite the potential for a negative experience. They prioritized their health and wellbeing over and above any interpersonal barriers they were likely to encounter. Incorporating strategies to improve the quality of FP services based on locally defined elements of quality should be a specific programmatic goal. These strategies can be identified through quality assessments employing a woman-centered lens. Women who visit facilities can be encouraged to share their positive experiences with their networks to improve community-level perspectives of facility quality. Improving service quality can attract new users, especially adolescents, and retain those who have already adopted a FP method. Through these multi-pronged actions, women’s (and community) expectations and experience of quality can improve. This, in turn, may lead to greater client satisfaction and associated higher FP prevalence.
, Patience Mushamiri, Paula Beeri, , Sarah Jenner, Simone Proebstl, Sarah H Kehoe, Kate A Ward, Mary Barker, Wendy Lawrence, et al.
Published: 30 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0000401

Abstract:
Evidence that nutrition-specific and nutrition-sensitive interventions can improve maternal and child nutrition status in sub-Saharan Africa is inconclusive. Using behaviour change theory and techniques in intervention design may increase effectiveness and make outcomes more predictable. This systematic review aimed to determine whether interventions that included behaviour change functions were effective. Six databases were searched systematically, using MeSH and free-text terms, for articles describing nutrition-specific and nutrition-sensitive behaviour change interventions published in English until January 2022. Titles, abstracts and full-text papers were double-screened. Data extraction and quality assessments followed Centre for Reviews and Dissemination guidelines. Behaviour change functions of interventions were mapped onto the COM-B model and Behaviour Change Wheel. PROSPERO registered (135054). The search yielded 1193 articles: 79 articles met inclusion criteria, ranging from low (n = 30) to high (n = 11) risk of bias. Many that applied behaviour change theory, communication or counselling resulted in significant improvements in infant stunting and wasting, household dietary intake and maternal psychosocial measures. Interventions with >2 behaviour change functions (including persuasion, incentivisation, environmental restructuring) were the most effective. We recommend incorporating behaviour change functions in nutrition interventions to improve maternal and child outcomes, specifically drawing on the Behaviour Change Wheel, COM-B model (SORT B recommendation). To enhance the designs of these interventions, and ultimately improve the nutritional and psychosocial outcomes for mothers and infants in sub-Saharan Africa, collaborations are recommended between behaviour change and nutrition experts, intervention designers, policy makers and commissioners to fund and roll-out multicomponent behaviour change interventions.
, Valerie Mueller, Nicole Wu, Atonu Rabbani
Published: 30 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001086

Abstract:
High levels of compliance with public health measures are critical to ensure a successful response to the COVID-19 pandemic and other public health emergencies. However, most data on compliance are self-reported and the tendency to overreport due to social desirability could yield biased estimates of actual compliance. A list experiment is a widely used method to estimate social desirability bias in self-reported estimates of sensitive behaviours. We estimate rates of compliance with facemask mandates in Kenya, Nigeria, and Bangladesh using data from phone surveys conducted in March-April 2021. Data on compliance were collected from two different survey modules: a self-reported compliance module (stated) and a list experiment (elicited). We find large gaps between stated and elicited rates of facemask wearing for different groups depending on specific country contexts and high levels of overreporting of facemask compliance in self-reported surveys: there was an almost 40 percentage point gap in Kenya, 30 percentage points in Nigeria, and 20 percentage points in Bangladesh. We also observe differences in rates of self-reported facemask wearing among key groups but not using the elicited responses from the list experiment, which suggest that social desirability bias may vary by demographics. Data collected from self-reported surveys may not be reliable to monitor ongoing compliance with public health measures. Moreover, elicited compliance rates indicate levels of mask wearing are likely much lower than those estimated using self-reported data.
, Caroline Mavere, Emmanuel Bahemana, Anange Lwilla, , Seth Bwigane, Adela Peter, Joy Makando, Benjamin Peter, Patricia Agaba, et al.
Published: 30 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0000929

Abstract:
The World Health Organization early warning indicators (EWIs) permit surveillance of factors associated with the emergence of HIV drug resistance (HIVDR). We examined cross- and within-region performance on HIVDR EWIs for selected HIV care and treatment clinics (CTCs) in five regions of southern Tanzania. We retrospectively abstracted EWI data from 50 CTCs for the January to December 2013 period. EWIs included the following: on time ART pick-up, retention on ART, ARV stockouts, and pharmacy prescribing and dispensing practices. Data for pediatric and adult people living with HIV were abstracted from source files, and frequencies and proportions were calculated for each EWI overall, as well as stratified by region, facility, and age group. Across and within all regions, on average, on-time pick-up of pills (63.0%), retention on ART (76.0%), and pharmacy stockouts (69.0%) were consistently poor for the pediatric population. Similarly, on-time pill pick up (66.0%), retention on ART (72.0%) and pharmacy stockouts (53.0%) for adults were also poor. By contrast, performance on pharmacy prescribing and dispensing practices were as desired for both pediatric and adult populations with few facility-level exceptions. In this study, regions and facilities in the southern highlands of Tanzania reported widespread presence of HIVDR risk factors, including sub-optimal timeliness of pill pickup, retention on ART, and drug stockouts. There is an urgent need to implement the WHO EWIs monitoring to minimize the emergence of preventable HIV drug resistance and to maintain the effectiveness of first and second-line ART regimens. This is particularly critical in the context of new ART drug roll-out such as dolutegravir during the COVID-19 pandemic when resultant HIV service disruptions require careful monitoring, and for virologic suppression as countries move closer to epidemic control.
Katrin Jaradeh, Tyler Van Fleet Kingery, Jackline Cheruiyot, Francesca Odhiambo, Elizabeth A. Bukusi, Craig R. Cohen,
Published: 29 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0000817

Abstract:
Voluntary male medical circumcision (VMMC) reduces HIV acquisition by up to 60%. Kenya has successfully scaled up VMMC to an estimated 91% of eligible men and boys in certain regions in combination due to VMMC and cultural circumcisions. VMMC as a program is implemented regionally in traditionally non-circumcising counties where the prevalence is still below 91%, ranging from 56.4% to 66.7%. Given that funding toward VMMC is expected to decline in the coming years, it is important to identify what models of service delivery are most appropriate and efficient to sustainably meet the VMMC needs of new cohorts’ eligible men. To this end, we compared the costs of facility-based VMMC and one within a rapid results initiative (RRI), a public health service scheduled during school holidays to perform many procedures over a short period. We employed activity-based micro-costing to estimate the costs, from the implementer perspective, of facility-based VMMC and RRI-based VMMC conducted between October 2017 and September 2018 at 41 sites in Kisumu County, Kenya supported by the Family AIDS care & Education Services (FACES). We conducted site visits and reviewed financial ledger and programmatic data to identify and quantify resources consumed and the number of VMMC procedures performed during routine care and RRIs. Ledger data were used to estimate fixed costs, recurring costs, and cost per circumcision (CPC) in United States dollar (USD). A sensitivity analysis was done to estimate CPC where we allocated 6 months of the ledger to facility-based and 6 months to RRI. Overall, FACES spent $3,092,891 toward VMMC services and performed 42,139 procedures during the funding year. This included $2,644,910 in stable programmatic costs, $139,786 procedure costs, and $308,195 for RRI-specific activities. Over the year, 49% (n = 20,625) of procedures were performed as part of routine care and 51% (n = 21,514) were performed during the RRIs. Procedures conducted during facility-based cost $99.35 per circumcision, those conducted during the RRIs cost $48.51 per circumcision, and according to our sensitivity analysis, CPC for facility-based ranges from $99.35 to $287.24 and for RRI costs ranged from $29.81 to $48.51. The cost of VMMC during the RRI was substantially lower than unit costs reported in previous costing studies. We conclude that circumcision campaigns, such as the RRI, offer an efficient and sustainable approach to VMMC.
Alicia Dunajcik, Kambria Haire, Jennifer D. Thomas, Leah F. Moriarty, Yuri Springer, Julie M. Villanueva, Adam MacNeil, Benjamin Silk, Jeffrey B. Nemhauser, Ramona Byrkit, et al.
Published: 29 March 2023
PLOS Global Public Health, Volume 3; https://doi.org/10.1371/journal.pgph.0001252

Abstract:
The first three SARS-CoV-2 phylogenetic lineages classified as variants of concern (VOCs) in the United States (U.S.) from December 15, 2020 to February 28, 2021, Alpha (B.1.1.7), Beta (B.1.351), and Gamma (P.1) lineages, were initially detected internationally. This investigation examined available travel history of coronavirus disease 2019 (COVID-19) cases reported in the U.S. in whom laboratory testing showed one of these initial VOCs. Travel history, demographics, and health outcomes for a convenience sample of persons infected with a SARS-CoV-2 VOC from December 15, 2020 through February 28, 2021 were provided by 35 state and city health departments, and proportion reporting travel was calculated. Of 1,761 confirmed VOC cases analyzed, 1,368 had available data on travel history. Of those with data on travel history, 1,168 (85%) reported no travel preceding laboratory confirmation of SARS-CoV-2 and only 105 (8%) reported international travel during the 30 days preceding a positive SARS-CoV-2 test or symptom onset. International travel was reported by 92/1,304 (7%) of persons infected with the Alpha variant, 7/55 (22%) with Beta, and 5/9 (56%) with Gamma. Of the first three SARS-CoV-2 lineages designated as VOCs in the U.S., international travel was common only among the few Gamma cases. Most persons infected with Alpha and Beta variant reported no travel history, therefore, community transmission of these VOCs was likely common in the U.S. by March 2021. These findings underscore the importance of global surveillance using whole genome sequencing to detect and inform mitigation strategies for emerging SARS-CoV-2 VOCs.
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