Browsing Research Articles (SOPH) by Author "Jackson, Debra"
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Goga, Ameena; Dinh, Thu-Ha; Jackson, Debra (South African Medical Research Council, National Department of Health South Africa and PEPFAR/US Centers for Disease Control & Prevention, 2012)[more][less]
Abstract: Aims and Objectives: The overall aim of this evaluation was to conduct a national facility-based survey to monitor the effectiveness of the South African National PMTCT programme. The primary objective was to measure rates of early MTCT of HIV at six weeks postpartum. The secondary objective was to periodically estimate coverage of key PMTCT interventions and services (e.g., HIV testing, CD4 cell count testing, infant antiretroviral (ARV) prophylaxis, infant feeding counselling). URI: http://hdl.handle.net/10566/462 Files in this item: 1
GogaPMTCT2012.pdf (5.124Mb) -
Tylleskar, Thorkild; Jackson, Debra; Meda, Nicolas; Ingrebetsen, Ingunn Marie S; Chopra, Mickey; Diallo, Abdoulaye Hama; Doherty, Tanya; Ekström, Eva-Charlotte; Fadnes, Lars T; Goga, Ameena; Kankasa, Chipepo; Klungsøyr, Jørn I; Lombard, Carl; Nankabirwa, Victoria; Nankunda, Jolly K; Van de Perre, Philippe; Sanders, David; Shanmugam, Rebecca; Sommerfelt, Halvor; Wamani, Henry; Tumwine, James K; PROMISE-EBF Study Group (Elsevier, 2011)[more][less]
Abstract: Background: Exclusive breastfeeding (EBF) is reported to be a life-saving intervention in low-income settings. The effect of breastfeeding counselling by peer counsellors was assessed in Africa. Methods:24 communities in Burkina Faso, 24 in Uganda, and 34 in South Africa were assigned in a 1:1 ratio, by use of a computer-generated randomisation sequence, to the control or intervention clusters. In the intervention group, we scheduled one antenatal breastfeeding peer counselling visit and four post-delivery visits by trained peers. The data gathering team were masked to the intervention allocation. The primary outcomes were prevalance of EBF and diarrhoea reported by mothers for infants aged 12 weeks and 24 weeks. Country-specific prevalence ratios were adjusted for cluster effects and sites. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00397150. Findings 2579 mother–infant pairs were assigned to the intervention or control clusters in Burkina Faso (n=392 and n=402, respectively), Uganda (n=396 and n=369, respectively), and South Africa (n=535 and 485, respectively). The EBF prevalences based on 24-h recall at 12 weeks in the intervention and control clusters were 310 (79%) of 392 and 139 (35%) of 402, respectively, in Burkina Faso (prevalence ratio 2·29, 95% CI 1·33–3·92); 323 (82%) of 396 and 161 (44%) of 369, respectively, in Uganda (1·89, 1·70–2·11); and 56 (10%) of 535 and 30 (6%) of 485, respectively, in South Africa (1·72, 1·12–2·63). The EBF prevalences based on 7-day recall in the intervention and control clusters were 300 (77%) and 94 (23%), respectively, in Burkina Faso (3·27, 2·13–5·03); 305 (77%) and 125 (34%), respectively, in Uganda (2·30, 2·00–2·65); and 41 (8%) and 19 (4%), respectively, in South Africa (1·98, 1·30–3·02). At 24 weeks, the prevalences based on 24-h recall were 286 (73%) in the intervention cluster and 88 (22%) in the control cluster in Burkina Faso (3·33, 1·74–6·38); 232 (59%) and 57 (15%), respectively, in Uganda (3·83, 2·97–4·95); and 12 (2%) and two (<1%), respectively, in South Africa (5·70, 1·33–24·26). The prevalences based on 7-day recall were 279 (71%) in the intervention cluster and 38 (9%) in the control cluster in Burkina Faso (7·53, 4·42–12·82); 203 (51%) and 41 (11%), respectively, in Uganda (4·66, 3·35–6·49); and ten (2%) and one (<1%), respectively, in South Africa (9·83, 1·40–69·14). Diarrhoea prevalence at age 12 weeks in the intervention and control clusters was 20 (5%) and 36 (9%), respectively, in Burkina Faso (0·57, 0·27–1·22); 39 (10%) and 32 (9%), respectively, in Uganda (1·13, 0·81–1·59); and 45 (8%) and 33 (7%), respectively, in South Africa (1·16, 0·78–1·75). The prevalence at age 24 weeks in the intervention and control clusters was 26 (7%) and 32 (8%), respectively, in Burkina Faso (0·83, 0·45–1·54); 52 (13%) and 59 (16%), respectively, in Uganda (0·82, 0·58–1·15); and 54 (10%) and 33 (7%), respectively, in South Africa (1·31, 0·89–1·93). Interpretation: Low-intensity individual breastfeeding peer counselling is achievable and, although it does not affect the diarrhoea prevalence, can be used to effectively increase EBF prevalence in many sub-Saharan African settings. URI: http://hdl.handle.net/10566/516 Files in this item: 2
TylleskarExclusiveBreastfeeding2011.pdf (1.030Mb) -
Uwimana, Jeannine; Jackson, Debra; Hausler, Harry; Zarowsky, Christina (Wiley-Blackwell, 2012)[more][less]
Abstract: In South Africa, the control of TB and HIV co-infection remains a major challenge despite the availability of international and national guidelines for integration of TB and HIV services. This study was undertaken in KwaZulu-Natal, one of the provinces most affected by both TB and HIV, to identify and understand managers’ and community care workers’ (CCWs) perceptions of health systems barriers related to the implementation of collaborative TB⁄ HIV activities, including prevention of mother to child transmission of HIV (PMTCT). We conducted 29 in-depth interviews with health managers at provincial, district and facility level and with managers of NGOs involved in TB and HIV care, as well as six focus group discussions with CCWs. Thematic analysis of transcripts revealed a convergence of perspectives on the process and the level of the implementation of policy directives on collaborative TB and HIV activities across all categories of respondents (i.e. province-, district-, facility- and communitybased organizations). The majority of participants felt that the implementation of the policy was insufficiently consultative and that leadership and political will were lacking. The predominant themes related to health systems barriers include challenges related to structure and organisational culture; management, planning and power issues; unequal financing; and human resource capacity and regulatory problems notably relating to scope of practice of nurses and CCWs. Accelerated implementation of collaborative TB⁄ HIV activities including PMTCT will require political will and leadership to address these health systems barriers. URI: http://hdl.handle.net/10566/457 Files in this item: 1
UwimanaHealthSystemBarriers2012.pdf (205.7Kb)
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