Models of integration of TB and HIV services and factors associated with perceived quality of TB-HIV integrated service delivery in O.R Tambo District, South Africa
- Dlatu, Ntandazo, Longo-Mbenza, Benjamin, Apalata, Teke
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Apalata, Teke
- Date: 2023/07
- Subjects: Tuberculosis , HIV , HIV/TB integration , Healthcare services
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13560 , vital:78954 , DOI: https://doi.org/10.1186/s12913-023-09748-2
- Description: Background Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Methods This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. Results Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y=3.72–0.06X (adjusted R2=23%, p-value=0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions’ coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk’s Lambda=0.750, p=0.043).
- Full Text:
- Date Issued: 2023/07
- Authors: Dlatu, Ntandazo , Longo-Mbenza, Benjamin , Apalata, Teke
- Date: 2023/07
- Subjects: Tuberculosis , HIV , HIV/TB integration , Healthcare services
- Language: English
- Type: Article
- Identifier: http://hdl.handle.net/11260/13560 , vital:78954 , DOI: https://doi.org/10.1186/s12913-023-09748-2
- Description: Background Tuberculosis is the leading infectious cause of death among people living with HIV. Reducing morbidity and mortality from HIV-associated TB requires strong collaboration between TB and HIV services at all levels with fully integrated, people-centered models of care. Methods This is a qualitative study design using principles of ethnography and the application of aggregate complexity theory. A total of 54 individual interviews with healthcare workers and patients took place in five primary healthcare facilities in the O.R. Tambo district. The participants were purposively selected until the data reached saturation point, and all interviews were tape-recorded. Quantitative analysis of qualitative data was used after coding ethnographic data, looking for emerging patterns, and counting the number of times a qualitative code occurred. A Likert scale was used to assess the perceived quality of TB/HIV integration. Regression models and canonical discriminant analyses were used to explore the associations between the perceived quality of TB and HIV integrated service delivery and independent predictors of interest using SPSS® version 23.0 (Chicago, IL) considering a type I error of 0.05. Results Of the 54 participants, 39 (72.2%) reported that TB and HIV services were partially integrated while 15 (27.8%) participants reported that TB/HIV services were fully integrated. Using the Likert scale gradient, 23 (42.6%) participants perceived the quality of integrated TB/HIV services as poor while 13 (24.1%) and 18 (33.3%) perceived the quality of TB/HIV integrated services as moderate and excellent, respectively. Multiple linear regression analysis showed that access to healthcare services was significantly and independently associated with the perceived quality of integrated TB/HIV services following the equation: Y=3.72–0.06X (adjusted R2=23%, p-value=0.001). Canonical discriminant analysis (CDA) showed that in all 5 municipal facilities, long distances to healthcare facilities leading to reduced access to services were significantly more likely to be the most impeding factor, which is negatively influencing the perceived quality of integrated TB/HIV services, with functions’ coefficients ranging from 9.175 in Mhlontlo to 16.514 in KSD (Wilk’s Lambda=0.750, p=0.043).
- Full Text:
- Date Issued: 2023/07
Mildly elevated thyroid-stimulating hormone is associated with endothelial dysfunction and severe preeclampsia among pregnant women with insufficient iodine intake in Eastern Cape province, South Africa
- Businge, Charles Bitamazire, Longo-Mbenza, Benjamin, Kengne, Andre Pascal
- Authors: Businge, Charles Bitamazire , Longo-Mbenza, Benjamin , Kengne, Andre Pascal
- Date: 2021
- Subjects: Preeclampsia Iodine deficiency diseases Endothelial cells Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6908 , vital:52565 , xlink:href="https://10.1080/07853890.2021.1947520"
- Description: Background Preeclampsia and hypothyroidism are associated with endothelial dysfunction. Iodine deficiency is a risk factor for subclinical hypothyroidism in pregnancy. However, there is a paucity of data on the relationship between iodine nutrition state in pregnancy, the degree of endothelial dysfunction, and the risk of preeclampsia. Methods Ninety-five normotensive pregnant women, 50 women with preeclampsia with no severe features, and 50 women with severe preeclampsia were enrolled into the current study from the maternity units of Nelson Mandela Academic Hospital and Mthatha Regional Hospitals in Eastern Cape Province, South Africa. Urinary iodine concentration (UIC), serum markers of thyroid function, aortic augmentation index, and pulse wave velocity (PWV) were compared. Results Median UIC was 167.5, 127.7, and 88.5 µg/L, respectively for normotensive pregnant women, those with preeclampsia and severe preeclampsia (p = .150). Participants with severe preeclampsia had significantly higher median thyroid-stimulating hormone (TSH) and oxidized LDL than normotensive and preeclamptic women without severe features (respectively 3.0, 2.3, and 2.3 IU/L; 1.2, 1.0, and 1.0 IU/L, p less .05). The median Aortic augmentation index was 7.5, 19.0, and 21.0 (p less .001), and the pulse wave velocity 5.1, 5.7, and 6.3, respectively for normotensive, preeclampsia, and severe preeclampsia participants (both p less .001). In linear regressions, TSH, age, and hypertensive disease were independent predictors of elevated PWV. Conclusion Upper normal-range TSH levels in women with severe preeclampsia were associated with markers of endothelial dysfunction. The low UIC and trend towards the elevation of thyroglobulin suggest that inadequate iodine intake may have increased TSH levels and indirectly caused endothelial dysfunction. Keywords: Preeclampsia, Iodine deficiency, Elevated thyroid-stimulating hormone, Pulse wave velocity, Endothelial dysfunction
- Full Text:
- Date Issued: 2021
- Authors: Businge, Charles Bitamazire , Longo-Mbenza, Benjamin , Kengne, Andre Pascal
- Date: 2021
- Subjects: Preeclampsia Iodine deficiency diseases Endothelial cells Article
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/6908 , vital:52565 , xlink:href="https://10.1080/07853890.2021.1947520"
- Description: Background Preeclampsia and hypothyroidism are associated with endothelial dysfunction. Iodine deficiency is a risk factor for subclinical hypothyroidism in pregnancy. However, there is a paucity of data on the relationship between iodine nutrition state in pregnancy, the degree of endothelial dysfunction, and the risk of preeclampsia. Methods Ninety-five normotensive pregnant women, 50 women with preeclampsia with no severe features, and 50 women with severe preeclampsia were enrolled into the current study from the maternity units of Nelson Mandela Academic Hospital and Mthatha Regional Hospitals in Eastern Cape Province, South Africa. Urinary iodine concentration (UIC), serum markers of thyroid function, aortic augmentation index, and pulse wave velocity (PWV) were compared. Results Median UIC was 167.5, 127.7, and 88.5 µg/L, respectively for normotensive pregnant women, those with preeclampsia and severe preeclampsia (p = .150). Participants with severe preeclampsia had significantly higher median thyroid-stimulating hormone (TSH) and oxidized LDL than normotensive and preeclamptic women without severe features (respectively 3.0, 2.3, and 2.3 IU/L; 1.2, 1.0, and 1.0 IU/L, p less .05). The median Aortic augmentation index was 7.5, 19.0, and 21.0 (p less .001), and the pulse wave velocity 5.1, 5.7, and 6.3, respectively for normotensive, preeclampsia, and severe preeclampsia participants (both p less .001). In linear regressions, TSH, age, and hypertensive disease were independent predictors of elevated PWV. Conclusion Upper normal-range TSH levels in women with severe preeclampsia were associated with markers of endothelial dysfunction. The low UIC and trend towards the elevation of thyroglobulin suggest that inadequate iodine intake may have increased TSH levels and indirectly caused endothelial dysfunction. Keywords: Preeclampsia, Iodine deficiency, Elevated thyroid-stimulating hormone, Pulse wave velocity, Endothelial dysfunction
- Full Text:
- Date Issued: 2021
Sociodemographic inequities associated with participation in leisure-time physical activity in sub-Saharan Africa: an individual participant data meta-analysis
- Longo-Mbenza, Benjamin, Barr, Anna Louise, Partap, Uttara, Young, Elizabeth H, Agoudavi, Kokou, Balde, Naby, Kagaruki, Gibson B, Mayige, Mary T, Mutungi, Gerald, Mwalim, Omar, Wesseh, Chea S, Bahendeka, Silver K, Guwatudde, David, Jørgensen, Jutta M Adelin, Bovet, Pascal, Motala, Ayesha A, Sandhu, Manjinder S
- Authors: Longo-Mbenza, Benjamin , Barr, Anna Louise , Partap, Uttara , Young, Elizabeth H , Agoudavi, Kokou , Balde, Naby , Kagaruki, Gibson B , Mayige, Mary T , Mutungi, Gerald , Mwalim, Omar , Wesseh, Chea S , Bahendeka, Silver K , Guwatudde, David , Jørgensen, Jutta M Adelin , Bovet, Pascal , Motala, Ayesha A , Sandhu, Manjinder S
- Date: 2020-06-15
- Subjects: Recreation. Use of leisure time , Occupational therapy , Health surveys
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3378 , vital:43337 , https://doi.org/10.1186/s12889-020-08987-w
- Description: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in subSaharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P less than 0.001; I2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.
- Full Text:
- Date Issued: 2020-06-15
- Authors: Longo-Mbenza, Benjamin , Barr, Anna Louise , Partap, Uttara , Young, Elizabeth H , Agoudavi, Kokou , Balde, Naby , Kagaruki, Gibson B , Mayige, Mary T , Mutungi, Gerald , Mwalim, Omar , Wesseh, Chea S , Bahendeka, Silver K , Guwatudde, David , Jørgensen, Jutta M Adelin , Bovet, Pascal , Motala, Ayesha A , Sandhu, Manjinder S
- Date: 2020-06-15
- Subjects: Recreation. Use of leisure time , Occupational therapy , Health surveys
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/3378 , vital:43337 , https://doi.org/10.1186/s12889-020-08987-w
- Description: Leisure-time physical activity (LTPA) is an important contributor to total physical activity and the focus of many interventions promoting activity in high-income populations. Little is known about LTPA in subSaharan Africa (SSA), and with expected declines in physical activity due to rapid urbanisation and lifestyle changes we aimed to assess the sociodemographic differences in the prevalence of LTPA in the adult populations of this region to identify potential barriers for equitable participation. A two-step individual participant data meta-analysis was conducted using data collected in SSA through 10 population health surveys that included the Global Physical Activity Questionnaire. For each sociodemographic characteristic, the pooled adjusted prevalence and risk ratios (RRs) for participation in LTPA were calculated using the random effects method. Between-study heterogeneity was explored through meta-regression analyses and tests for interaction. Across the 10 populations (N = 26,022), 18.9% (95%CI: 14.3, 24.1; I2 = 99.0%) of adults (≥ 18 years) participated in LTPA. Men were more likely to participate in LTPA compared with women (RR for women: 0.43; 95%CI: 0.32, 0.60; P less than 0.001; I2 = 97.5%), while age was inversely associated with participation. Higher levels of education were associated with increased LTPA participation (RR: 1.30; 95%CI: 1.09, 1.55; P = 0.004; I2 = 98.1%), with those living in rural areas or self-employed less likely to participate in LTPA. These associations remained after adjusting for time spent physically active at work or through active travel. In these populations, participation in LTPA was low, and strongly associated with sex, age, education, self-employment and urban residence. Identifying the potential barriers that reduce participation in these groups is necessary to enable equitable access to the health and social benefits associated with LTPA.
- Full Text:
- Date Issued: 2020-06-15
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