Acceptability of IV iron treatment for iron deficiency anaemia in pregnancy in Nigeria: a qualitative study with pregnant women, domestic decision-makers, and health care providers.
Anaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria.
We purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis.
We identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA.
IV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability. Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021.
Akinajo OR
，Babah OA
，Banke-Thomas A
，Beňová L
，Sam-Agudu NA
，Balogun MR
，Adaramoye VO
，Galadanci HS
，Quao RA
，Afolabi BB
，Annerstedt KS
... -
《Reproductive Health》
Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021.
As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally.
We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load <1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period.
Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition remains highest in the sub-Saharan Africa super-region, where it declined from its 1995 peak of 21·8% (20·1-24·2) to 8·7% (7·5-10·7) in 2021. Four of the seven GBD super-regions had a lifetime probability of less than 1% in 2021. In 2021, sub-Saharan Africa had the highest PUV of 999·9 (857·4-1154·2) per 100 000 population, but this was a 64·5% (58·8-69·4) reduction in PUV from 2003 to 2021. In the same period, PUV increased in central Europe, eastern Europe, and central Asia by 116·1% (8·0-218·2). Our forecasts predict a continued global decline in HIV incidence and mortality, with the number of people living with HIV peaking at 44·4 million (40·7-49·8) by 2039, followed by a gradual decrease. In 2025, we projected 1·43 million (1·29-1·59) new HIV infections and 615 000 (567 000-680 000) HIV-related deaths, suggesting that the interim 2025 targets for reducing these figures are unlikely to be achieved. Furthermore, our forecasted results indicate that few countries will meet the 2030 target for reducing HIV incidence and HIV-related deaths by 90% from 2010 levels.
Our forecasts indicate that continuation of current levels of HIV control are not likely to attain ambitious incidence and mortality reduction targets by 2030, and more than 40 million people globally will continue to require lifelong ART for decades into the future. The global community will need to show sustained and substantive efforts to make the progress needed to reach and sustain the end of AIDS as a public threat.
The Bill & Melinda Gates Foundation and the National Institute of Allergy and Infectious Diseases.
GBD 2021 HIV Collaborators
《Lancet HIV》
The role of parent-adolescent communication interventions in improving sexual and reproductive health outcomes in sub-Saharan Africa: protocol for a systematic review and meta-analysis.
Across sub-Saharan Africa, adolescents face the triple tragedy: unintended pregnancies, unsafe abortion, and sexually transmitted infections including HIV due to various reasons, among them, poor parent-adolescent communication on sexual and reproductive health. Effective interventions such as improving parent‒adolescent communication has been recognized as a protective factor for adolescent sexual and reproductive health outcomes. Research shows that parent-adolescent communication is associated with reduced adolescent engagement in risky sexual behaviours, including early sexual initiation, lower rates of teenage pregnancy, sexually transmitted infections, and increased self-efficacy in decision making. Despite the potential role of parent-adolescent communication in promoting optimal adolescent sexual and reproductive health, limited research evidence exists on interventions to improve parent-adolescent communication on sexual and reproductive health in sub-Saharan African countries. The aim of this systematic review is to assess the role of parent-adolescent communication intervention programs in improving sexual and reproductive health outcomes.
We will pool evidence from published literature from January 1990 up to and including February 2024 from multiple databases: PubMed, Web of Science, Scopus, African Journals Online, JSTOR, Directory of Open Access Journals, and Google Scholar. Articles published in the English language will be included. Two reviewers will conduct screening for titles, abstracts, and full texts, while a third reviewer will arbitrate in cases of lack of concurrence. Experimental, quasi-experimental and observational study designs will be included.. A data extraction tool based on Microsoft Excel will be used to extract data items from different studies. We will focus on the following outcomes: initiation of sexual activity, use of condoms and contraceptives, reduced risky sexual behaviours such as unprotected sex, and lower rates of teenage pregnancy. When feasible, articles will be combined for statistical meta-analysis. Effect sizes, either reported as weighted mean differences for continuous data or as odds ratios for binary data, will be presented as proportions with 95% confidence intervals. We will use the random effects model to meta-analyse the include studies as we expect considerable variability across study designs. This will provide an average effect size that accounts for variability of results within studies. Sensitivity analysis will also be conducted to assess the robustness of the findings or conclusions of the meta-analysis. The review findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
This review provides insights into parent-based intervention programs that have been implemented in sub-Saharan African countries to improve adolescent sexual and reproductive health via promotion of parent-adolescent sexuality communication. The findings will guide further research on this issue as well as inform policy makers on which interventions have a potential effect in improving adolescent sexual and reproductive health. Protocol Registration Number: CRD42024525191 (PROSPERO), Date of registration: 27/03/2024.
Gatheru PM
，Wao H
，Alamdo A
，Kwarteng PG
，Kwashie M
，Kabiru CW
，Ogum D
，Torpey K
，Manu A
... -
《Reproductive Health》
ResearchGate
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钛学术
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