This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted... more
This article presents a systematic review and analysis of grey literature to identify and address gaps in knowledge regarding the role and influence of bystander activation on pre-hospital emergency care (PEC) response time. We conducted a systematic search for full-text articles published since 2000 in Web of Science, PubMed, Science Direct, and Google Scholar databases. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, using “pre-hospital emergency care response time” and “bystanders” as search keywords. The risk of bias was assessed using the ROBINS-I tool. Our analysis included forty-six relevant studies meeting the inclusion criteria. However, we observed that many studies were poorly reported, posing risks of selection and detection biases. Additionally, we identified methodological and study design weaknesses in five studies. Given the critical role of PEC services in saving lives and preventing medical complications, the ...
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Research Interests: Dentistry, Health Promotion, Methodology, Global Health, Developing Countries, and 15 moreHealth Services Research, Medicine, Inequalities, India, Humans, Needs Assessment, Biomedical Research, Oral health, Needs, Hiv Aids, Information Dissemination, Oral Diseases, Health Services Accessibility, healthcare disparities, and HIV infections
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Vulvovaginal candidiasis (VVC), a common cause of vaginitis, affects 75% of women in their lifetime. In Kenya, vaginitis/VVC is managed using the vaginal discharge syndrome guidelines. We assessed how frequently healthcare workers... more
Vulvovaginal candidiasis (VVC), a common cause of vaginitis, affects 75% of women in their lifetime. In Kenya, vaginitis/VVC is managed using the vaginal discharge syndrome guidelines. We assessed how frequently healthcare workers consider the diagnosis of vaginitis/VVC in symptomatic women, and adherence to the syndromic guidelines, outpatient records at Nairobi City County health facilities, of non-pregnant symptomatic females aged ≥15 years were abstracted. Descriptive statistics were applied, and analysis of determinants of practice determined using multivariable logistic regression models. Of 6,516 patients, 4,236 (65%) (inter-facility range 11–92%) had vaginitis of which 1,554 (37%) were considered VVC (inter-facility range 0–99%). Vaginitis was associated with facility, adjusted odds ratio (aOR) 2.80 (95% confidence interval (CI) 1.64–4.76) and aOR 0.03 (95% CI 0.02–0.04); and month, aOR 0.33 (95% CI 0.25–0.43). Vaginal examination was in 53% (inter-facility range 0–98%). Adherence to syndromic treatment was 56% (inter-facility range 0–83%), better with older patients (aOR 7.73, 95% CI 3.31–18.07). Vaginitis and VVC are commonly diagnosed in symptomatic patients in Nairobi; adherence to the syndromic guidelines is low and differs across the health facilities. Interventions to improve adherence are needed.
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1<p>intervention group (I): n = 32; control group(C): n = 27.</p>2<p>intervention group (I): n = 27; control group(C): n = 15.</p><p>HROL – HIV related orofacial lesions.</p
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Clinical data from outpatient registers related to: outpatient records examined, consultations which included oral examination, diagnosis made on dental decay, diagnosis made on gum diseases and diagnosis made on suspected oral HIV lesions by PHWs in the intervention and control divisions, expres...more
<p><i>I</i> = intervention division.</p><p><i>C</i> = Control division.</p>1<p>pre-training data for PHWs.</p>2<p>post-training data for... more
<p><i>I</i> = intervention division.</p><p><i>C</i> = Control division.</p>1<p>pre-training data for PHWs.</p>2<p>post-training data for PHWs.</p>3<p>pre-trainig data for CHWs.</p>4<p>post- training data for CHWs.</p><p>OPD = outpatient department.</p
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Clinical data drawn from laboratory registers to compare pre-training (March to December 2009) and post-training (March to December in 2010) performance of professional health workers in the intervention and control divisions, regarding a)number of patients with HIV-related oral lesions(including...more
1<p>group one HIV-related oral lesions according European Economic Community (EEC) Clearinghouse on oral problems related to HIV infection (1993) criteria.</p><p>HROLs = HIV-related oral... more
1<p>group one HIV-related oral lesions according European Economic Community (EEC) Clearinghouse on oral problems related to HIV infection (1993) criteria.</p><p>HROLs = HIV-related oral lesions.</p><p>OPC = oropharyngeal candidiasis.</p><p>OPD = Outpatients department.</p
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Vulvovaginal candidiasis (VVC), a common cause of vaginitis, affects 75% of women in their lifetime. In Kenya, vaginitis/VVC is managed using the vaginal discharge syndrome guidelines. We assessed how frequently healthcare workers... more
Vulvovaginal candidiasis (VVC), a common cause of vaginitis, affects 75% of women in their lifetime. In Kenya, vaginitis/VVC is managed using the vaginal discharge syndrome guidelines. We assessed how frequently healthcare workers consider the diagnosis of vaginitis/VVC in symptomatic women, and adherence to the syndromic guidelines, outpatient records at Nairobi City County health facilities, of non-pregnant symptomatic females aged ≥15 years were abstracted. Descriptive statistics were applied, and analysis of determinants of practice determined using multivariable logistic regression models. Of 6,516 patients, 4,236 (65%) (inter-facility range 11–92%) had vaginitis of which 1,554 (37%) were considered VVC (inter-facility range 0–99%). Vaginitis was associated with facility, adjusted odds ratio (aOR) 2.80 (95% confidence interval (CI) 1.64–4.76) and aOR 0.03 (95% CI 0.02–0.04); and month, aOR 0.33 (95% CI 0.25–0.43). Vaginal examination was in 53% (inter-facility range 0–98%). Adh...
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ObjectivesReview the meaning of ‘health need’, consider oral health inequalities and oral health promotion among people with HIV and outline methods to enhance coordination, standardization and dissemination of research... more
ObjectivesReview the meaning of ‘health need’, consider oral health inequalities and oral health promotion among people with HIV and outline methods to enhance coordination, standardization and dissemination of research efforts.MethodsThis workshop involved a brief introduction of each topic by an invited speaker followed by participant discussion. Participants were dentists and dental students attending the 7th World Workshop on Oral Health & Disease in AIDSResultsA health need was regarded as a population's ability to benefit from care. Oral health inequalities called for both downstream and upstream health promotion. A community health programme to reach people with HIV infection in the community was described. Despite deploying community health workers to reduce costs, the programme required additional resources for comprehensive implementation. The Indian National AIDS Control Program exemplified coordinated efforts. Knowledge transfer can be achieved via educational, linka...
Research Interests: Dentistry, Health Promotion, Methodology, Global Health, Developing Countries, and 15 moreHealth Services Research, Medicine, Inequalities, India, Humans, Needs Assessment, Biomedical Research, Oral health, Needs, Hiv Aids, Information Dissemination, Oral Diseases, Health Services Accessibility, healthcare disparities, and HIV infections
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An estimated 90% of HIV-infected people are likely to develop oral lesions in the course of HIV infection. Oro-pharyngeal candidiasis (OPC), an early marker for HIV-infection, can be diagnosed during an oral examination (OE). Primary... more
An estimated 90% of HIV-infected people are likely to develop oral lesions in the course of HIV infection. Oro-pharyngeal candidiasis (OPC), an early marker for HIV-infection, can be diagnosed during an oral examination (OE). Primary healthcare (PHC) providers in Kenya are neither trained nor sufficiently equipped to perform this simple, cheap and non-invasive examination. The PHC system in Kenya offers an opportunity to integrate early recognition and management of oral lesions into general health care. This study aims to estimate the effect of a multifaceted intervention for PHC providers in training them to perform an OE. Specifically, our primary objective is to establish whether the intervention is effective in increasing: i) the frequency of early detection of HIV-related oral lesions; and ii) referral rates for HIV-testing. THE STUDY HAS BEEN DESIGNED IN TWO PARTS: a retrospective clinical data record study and a prospective cohort study with pre-post control group design, carried out in 2 administrative divisions in Nairobi East district. The intervention group will receive one day of training on recognition of HIV-related oral lesions and other common oral conditions. Reminder sessions will be held at individual health facilities. Routine tally sheets will be used to record all patients with HIV-related oral lesions, dental caries and periodontal disease. A convenience sample of all the PHC in a division will be used. It will not be possible to blind investigators or assessors. Expected impact of the study for Public Health. Early recognition and treatment of HIV infection influences long-term survival rates and will reduce healthcare expenditure. The project is funded by the Netherlands organisation for international cooperation in higher education (NUFFIC). We would like to thank all participating health facilities and health care workers for their willingness to take part in this study. LNK also thanks the Kenya Ministry of Public Health and Sanitation for permission to carry out this study. We also thank Mr. J Mulder from Radboud University Nijmegen Medical Centre, Department of Methodology, Information Management and Statistics, Nijmegen, The Netherlands for statistical advice. THIS STUDY IS FUNDED BY A RESEARCH GRANT FROM THE NETHERLANDS ORGANIZATION FOR INTERNATIONAL COOPERATION IN HIGHER EDUCATION (NUFFIC, GRANT NR: C&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;B-NFP-PHD.10/110), The Hague, The Netherlands. Netherlands Trial Register NTR2627 (date registered 22(nd) November 2010). Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (approval number KNH-ERC/A/474), and The Ministry of Public Health and Sanitation (Ref. N. MPHS/IB/1/14 Vol. III).
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Human immunodeficiency virus (HIV) related orofacial lesions (HROLs) impact negatively on the health of patients and could be managed at primary healthcare (PHC) level. Community health workers (CHWs) are crucial in optimal patient... more
Human immunodeficiency virus (HIV) related orofacial lesions (HROLs) impact negatively on the health of patients and could be managed at primary healthcare (PHC) level. Community health workers (CHWs) are crucial in optimal patient management through patient identification, education and early referral for professional care. The study objective was to assess knowledge of Nairobi East district CHWs regarding HROLs and other common oral diseases. Of the total population of CHWs, 815 [94.5%] completed a 56-item questionnaire covering 5 topics: general dental knowledge, knowledge about HROLs, past encounters with HROLs, current care at community level, opinions regarding oral health problems; and items concerning background characteristics and past training activities. Confirmatory factor analysis revealed Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha coefficient values of 0.45, 0.59, 0.79, 0.50 and 0.09 respectively. The first four topics were confirmed as domains. Mean minimum score was 0 and mean maximum score was 1 for each variable. However, for &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;past encounters with HROLs, the minimum score was 0 and maximum score was 5. CHWs had moderate knowledge about general oral health (mean = 0.47) and HROLs (mean = 0.43). None had been formally trained in oral health aspects. Although they had high opinions regarding their role in identifying, educating and referring patients with HROLs (mean = 0.80) to the health facilities, they actually rarely referred such patients. CHWs need training for building competence in promoting oral health among general and HIV patients in their communities and in early identification and management of non-HIV oral lesions.
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Better knowledge and skills for diagnosis and management of human immunodeficiency virus (HIV) related oral lesions by primary healthcare workers (PHWs) may increase recognition of HIV-related oral lesions (HROLs) and may improve... more
Better knowledge and skills for diagnosis and management of human immunodeficiency virus (HIV) related oral lesions by primary healthcare workers (PHWs) may increase recognition of HIV-related oral lesions (HROLs) and may improve implementation of HIV testing in Kenya. For this purpose training programs at health facility and community level were evaluated. A pre-post control-test group design in two administrative divisions of Nairobi East District was used. Clinical competencies of PHWs (n = 32 intervention, and n = 27 control) at health facility level were assessed 9 months after training, and after 6 months for community health workers, (CHWs) (n = 411 intervention and n = 404 control) using written questionnaires, clinical data and patient interviews. Effects on referral for HIV testing and actual HIV testing were assessed by comparing laboratory registries pre- and post training. PHWs in intervention (n = 27; 84%) and control (n = 15; 60%) divisions, and CHWs in intervention (n = 330; 80%) and control (189; 47%) divisions, completed all questionnaires. Trained PHWs significantly increased their knowledge of HROLs (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.02), frequency of oral examinations, diagnosis of HROLs and referral of patients with HROLs for HIV testing. Trained CHWs significantly gained knowledge about HROLs (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.02) and referred more patients with HROLs to health facilities. Overall percentage of HIV-positive test results was three-fold for HROLs compared to non-HROLs. Specifically, 70% of patients with oro pharyngeal candidiasis (OPC), the most commonly diagnosed HROL, were confirmed as being HIV-positive. Increase in overall HIV testing rates (1.6% pre-, 1.2% post training) and overall percentage of HIV-positive results (13% pre-, 16% post-intervention) was not significant. Training programs significantly increased PHW and CHW knowledge, recognition and management of HROLs but increased neither overall HIV testing rates nor overall percentage of positive tests. Speculation is that the health system and patient-related barriers seriously limit HIV testing. Netherlands Trial Register NTR2627 (date registered 22nd November 2010), and NTR2697 (date registered 13th January 2011).