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Yeremey Grishin
Yeremey Grishin

Michael Mccollum Epub To Pdf


We know of only one randomized controlled trial that has assessed the effectiveness of task-shifting for HAART delivery in sub-Saharan Africa. That study found that nurse-managed ART was non-inferior to doctor-managed ART in urban clinics in Johannesburg and Cape Town, South Africa: both treatment arms had similar outcomes of viral suppression, adherence, toxicity and death [45]. A study done in the Democratic Republic of Congo looked at concordance between doctor and nurse decisions to initiate ART and found 95% agreement on ART initiation [46]. Similarly in Rwanda, nurses accurately determined ART eligibility for more than 99% of patients [47]. In Mozambique, patients seen by mid-level workers (with 2.5 years training) were almost 30% more likely to have CD4 counts done at 6 months post ART initiation than those seen by doctors, and were 44% less likely to be lost to follow-up. There were no significant differences in mortality, CD4 counts done at 12 months, or adherence rates [48]. Finally, a study from Malawi found that the training of lay workers as pharmacy assistants reduced prescribing errors by 25% by unburdening the system [49].




michael mccollum epub to pdf


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The data from two studies were each reported using different standards (study from Senegal in datasets 18 & 19 [39, 40] and from Democratic Republic of Congo in datasets 20 & 21 [40, 41]). Each of the duplicate datasets were included in an initial analysis by subgroup comparing the effect of using different diagnostic cut-off points to analyse the data and demonstrate the effect of using different references on the derived outcomes. The duplicated data (18 to 21) were not used in the other analyses as report 7 had incorporated the same two datasets, combined with a study from Nepal, into their analysis. As report 7 used WHO criteria, separated children with both criteria (S-both) and as far as possible excluded oedematous children the data in this report was considered to be most reliable.


Relative Risk of mortality in children diagnosed by WHZ relative to MUAC by mode of treatment. Legend: IPF In-patient Facility (Hospital. Therapeutic Feeding Center); OTP Out-patient treatment program (Home treatment); Com community study; IND India; NER Niger; SDN South Sudan; UGA Uganda; SEN Senegal; CMR Cameroun; KEN Kenya; COD Democratic Republic of the Congo; ETH Ethiopia; MWI Malawi; BFA Burkina Faso; RR relative risk; CI confidence intervals


Relative Risk of mortality in children diagnosed by WHZ relative to MUAC omitting the duplicate data. Legend: S-whz WHZ below cut off point with MUAC above cut-off point as defined in the paper; S-muac MUAC below cut off point with WHZ above cut-off point as defined in the paper; All-whz WHZ below the cut-off point, with MUAC either above or below the cut-off point as defined in the paper; All-muac MUAC below the cut-off point, WHZ either above or below the cut-off as defined in the paper; IND India; NER Niger; SDN South Sudan; UGA Uganda; SEN Senegal; CMR Cameroun; KEN Kenya; COD Democratic Republic of the Congo; ETH Ethiopia; MWI Malawi; BFA Burkina Faso; RR relative risk; CI confidence intervals


When focusing upon SAM, the whole community is not relevant. What is relevant is the extent to which the children in the study represent the children with SAM in the community. The least biased sample of such children should come from those children with SAM in a large random sample of the community. Although with demographic, social and nutritional change, historical cohorts may not represent SAM in present day circumstances or in other countries, apart from Senegal and the Democratic Republic of Congo, as the diagnosis of SAM by the two criteria differs markedly from place to place [21].


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