10 results on '"Chasekwa, Bernard"'
Search Results
2. The Impact of Improved Water, Sanitation, and Hygiene on Oral Rotavirus Vaccine Immunogenicity in Zimbabwean Infants: Substudy of a Cluster-randomized Trial
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Church, James A, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P, Chasekwa, Bernard, Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M, Majo, Florence D, Tavengwa, Naume V, Moulton, Lawrence H, Humphrey, Jean H, Kirkpatrick, Beth D, and Prendergast, Andrew J
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Male ,Rotavirus ,Zimbabwe ,infants ,Vaccination ,Rotavirus Vaccines ,Hygiene ,Rotavirus Infections ,WASH ,Immunogenicity, Vaccine ,Pregnancy ,Water Quality ,Africa ,Humans ,Female ,Sanitation ,oral vaccine ,Articles and Commentaries - Abstract
Background Oral vaccines have lower efficacy in developing compared to developed countries. Poor water, sanitation, and hygiene (WASH) may contribute to reduced oral vaccine immunogenicity. Methods We conducted a cluster-randomized 2 × 2 factorial trial in rural Zimbabwe. Pregnant women and their infants were eligible if they lived in clusters randomized to (1) standard of care (52 clusters); (2) improved infant feeding (53 clusters); (3) WASH: ventilated improved pit latrine, 2 hand-washing stations, liquid soap, chlorine, infant play space, and hygiene counseling (53 clusters); or (4) feeding plus WASH (53 clusters). This substudy compared oral rotavirus vaccine (RVV) seroconversion (primary outcome), and seropositivity and geometric mean titer (GMT) (secondary outcomes), in WASH vs non-WASH infants by intention-to-treat analysis. Results We included 801 infants with documented RVV receipt and postvaccine titer measurements (329 from 84 WASH clusters; 472 from 102 non-WASH clusters); 328 infants with prevaccination titers were included in the primary outcome. Thirty-three of 109 (30.3%) infants in the WASH group seroconverted following rotavirus vaccination, compared to 43 of 219 (19.6%) in the non-WASH group (absolute difference, 10.6% [95% confidence interval {CI}, .54%–20.7%]; P = .031). In the WASH vs non-WASH groups, 90 of 329 (27.4%) vs 107 of 472 (22.7%) were seropositive postvaccination (absolute difference, 4.7% [95% CI, –1.4% to 10.8%]; P = .130), and antirotavirus GMT was 18.4 (95% CI, 15.6–21.7) U/mL vs 14.9 (95% CI, 13.2–16.8) U/mL (P = .072). Conclusions Improvements in household WASH led to modest but significant increases in seroconversion to RVV in rural Zimbabwean infants. Clinical Trials Registration NCT01824940., Oral vaccines have lower efficacy in developing compared to developed countries. In a substudy of a cluster-randomized trial, improvements in household water, sanitation, and hygiene led to modest increases in seroconversion to oral rotavirus vaccine among rural Zimbabwean infants.
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- 2019
3. Head circumferences of children born to HIV-infected and HIV-uninfected mothers in Zimbabwe during the preantiretroviral therapy era
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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Male ,Zimbabwe ,Anthropometry ,Infant, Newborn ,HIV ,Infant ,HIV Infections ,Clinical Science: Concise Communication ,Child Development ,children ,Pregnancy ,Child, Preschool ,Africa ,head circumference ,Microcephaly ,Humans ,Female ,Longitudinal Studies ,Pregnancy Complications, Infectious ,Head ,Maternal-Fetal Exchange - Abstract
Objectives: To describe the head growth of children according to maternal and child HIV infection status. Design: Longitudinal analysis of head circumference data from 13 647 children followed from birth in the ZVITAMBO trial, undertaken in Harare, Zimbabwe, between 1997 and 2001, prior to availability of antiretroviral therapy (ART) or cotrimoxazole prophylaxis. Methods: Head circumference was measured at birth, then at regular intervals through 24 months of age. Mean head circumference-for-age Z-scores (HCZ) and prevalence of microcephaly (HCZ
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- 2016
4. Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia.
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Bwakura-Dangarembizi, Mutsa, Dumbura, Cherlynn, Amadi, Beatrice, Ngosa, Deophine, Majo, Florence D, Nathoo, Kusum J, Mwakamui, Simutanyi, Mutasa, Kuda, Chasekwa, Bernard, Ntozini, Robert, Kelly, Paul, Prendergast, Andrew J, and the HOPE-SAM study team
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MALNUTRITION treatment ,HOSPITALS ,STATISTICS ,CONFIDENCE intervals ,TIME ,MULTIVARIATE analysis ,HIV seroconversion ,ANTIRETROVIRAL agents ,SEVERITY of illness index ,RISK assessment ,DESCRIPTIVE statistics ,CEREBRAL palsy ,ACUTE diseases ,HOSPITAL care of children ,DISCHARGE planning ,CHILD mortality ,LONGITUDINAL method ,PROPORTIONAL hazards models ,EDEMA ,CHILDREN - Abstract
Background Children discharged from hospital following management of complicated severe acute malnutrition (SAM) have a high risk of mortality, especially HIV-positive children. Few studies have examined mortality in the antiretroviral therapy (ART) era. Objectives Our objectives were to ascertain 52-wk mortality in children discharged from hospital for management of complicated SAM, and to identify independent predictors of mortality. Methods A prospective cohort study was conducted in children enrolled from 3 hospitals in Zambia and Zimbabwe between July 2016 and March 2018. The primary outcome was mortality at 52 wk. Univariable and multivariable Cox regression models were used to identify independent risk factors for death, and to investigate whether HIV modifies these associations. Results Of 745 children, median age at enrolment was 17.4 mo (IQR: 12.8, 22.1 mo), 21.7% were HIV-positive, and 64.4% had edema. Seventy children (9.4%; 95% CI: 7.4, 11.7%) died and 26 exited during hospitalization; 649 were followed postdischarge. At discharge, 43.9% had ongoing SAM and only 50.8% of HIV-positive children were receiving ART. Vital status was ascertained for 604 (93.1%), of whom 55 (9.1%; 95% CI: 6.9, 11.7%) died at median 16.6 wk (IQR: 9.4, 21.9 wk). Overall, 20.0% (95% CI: 13.5, 27.9%) and 5.6% (95% CI: 3.8, 7.9%) of HIV-positive and HIV-negative children, respectively, died [adjusted hazard ratio (aHR): 3.83; 95% CI: 2.15, 6.82]. Additional independent risk factors for mortality were ongoing SAM (aHR: 2.28; 95% CI: 1.22, 4.25), cerebral palsy (aHR: 5.60; 95% CI: 2.72, 11.50) and nonedematous SAM (aHR: 2.23; 95% CI: 1.24, 4.01), with no evidence of interaction with HIV status. Conclusions HIV-positive children have an almost 4-fold higher mortality than HIV-negative children in the year following hospitalization for complicated SAM. A better understanding of causes of death, an improved continuum of care for HIV and SAM, and targeted interventions to improve convalescence are needed. [ABSTRACT FROM AUTHOR]
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- 2021
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5. Mortality, Human Immunodeficiency Virus (HIV) Transmission, and Growth in Children Exposed to HIV in Rural Zimbabwe.
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Evans, Ceri, Chasekwa, Bernard, Ntozini, Robert, Majo, Florence D, Mutasa, Kuda, Tavengwa, Naume, Mutasa, Batsirai, Mbuya, Mduduzi N N, Smith, Laura E, Stoltzfus, Rebecca J, Moulton, Lawrence H, Humphrey, Jean H, Prendergast, Andrew J, and Team, for the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial
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HIV prevention , *HIV infection transmission , *ANTHROPOMETRY , *COMPARATIVE studies , *CONFIDENCE intervals , *GROWTH disorders , *HIV , *HIV infections , *HIV-positive persons , *HUMAN growth , *INFANT mortality , *MEDICAL screening , *MOTHERS , *RURAL conditions , *ANTIRETROVIRAL agents , *VERTICAL transmission (Communicable diseases) , *DESCRIPTIVE statistics , *CHILDREN , *FETUS - Abstract
Background Clinical outcomes of children who are human immunodeficiency virus (HIV)–exposed in sub-Saharan Africa remain uncertain. Methods The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial evaluated improved infant and young child feeding (IYCF) and/or improved water, sanitation, and hygiene in 2 rural Zimbabwean districts with 15% antenatal HIV prevalence and > 80% prevention of mother-to-child transmission (PMTCT) coverage. Children born between February 2013 and December 2015 had longitudinal HIV testing and anthropometry. We compared mortality and growth between children who were HIV-exposed and HIV-unexposed through 18 months. Children receiving IYCF were excluded from growth analyses. Results Fifty-one of 738 (7%) children who were HIV-exposed and 198 of 3989 (5%) children who were HIV-unexposed (CHU) died (hazard ratio, 1.41 [95% confidence interval {CI}, 1.02–1.93]). Twenty-five (3%) children who were HIV-exposed tested HIV positive, 596 (81%) were HIV-exposed uninfected (CHEU), and 117 (16%) had unknown HIV status by 18 months; overall transmission estimates were 4.3%–7.7%. Mean length-for-age z score at 18 months was 0.38 (95% CI,.24–.51) standard deviations lower among CHEU compared to CHU. Among 367 children exposed to HIV in non-IYCF arms, 147 (40%) were alive, HIV-free, and nonstunted at 18 months, compared to 1169 of 1956 (60%) CHU (absolute difference, 20% [95% CI, 15%–26%]). Conclusions In rural Zimbabwe, mortality remains 40% higher among children exposed to HIV, vertical transmission exceeds elimination targets, and half of CHEU are stunted. We propose the composite outcome of "alive, HIV free, and thriving" as the long-term goal of PMTCT programs. Clinical Trials Registration NCT01824940. [ABSTRACT FROM AUTHOR]
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- 2021
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6. The Friendship Bench as a brief psychological intervention with peer support in rural Zimbabwean women: a mixed methods pilot evaluation.
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Fernando, Shamiso, Brown, Tim, Datta, Kavita, Chidhanguro, Dzivaidzo, Tavengwa, Naume V., Chandna, Jaya, Munetsi, Epiphania, Dzapasi, Lloyd, Nyachowe, Chandiwana, Mutasa, Batsirai, Chasekwa, Bernard, Ntozini, Robert, Chibanda, Dixon, and Prendergast, Andrew J.
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PSYCHOTHERAPY ,RURAL women ,PROBLEM-solving therapy ,EDINBURGH Postnatal Depression Scale ,COMMUNITY health workers - Abstract
Background: There is a large treatment gap for common mental disorders in rural areas of low-income countries. We tested the Friendship Bench as a brief psychological intervention delivered by village health workers (VHWs) in rural Zimbabwe. Methods: Rural women identified with depression in a previous trial received weekly home-based problem-solving therapy from VHWs for 6 weeks, and joined a peer-support group. Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and Shona Symptom Questionnaire (SSQ). Acceptability was explored through in-depth interviews and focus group discussions. The proportion of women with depression pre- and post-intervention was compared using McNemar's test. Results: Ten VHWs delivered problem-solving therapy to 27 women of mean age 33 years; 25 completed six sessions. Women valued an established and trustful relationship with their VHW, which ensured confidentiality and prevented gossip, and reported finding individual problem-solving therapy beneficial. Peer-support meetings provided space to share problems, solutions and skills. The proportion of women with depression or suicidal ideation on the EPDS declined from 68% to 12% [difference 56% (95% confidence interval (CI) 27.0–85.0); p = 0.001], and the proportion scoring high (>7) on the SSQ declined from 52% to 4% [difference 48% (95% CI 24.4–71.6); p < 0.001] after the 6-week intervention. Conclusion: VHW-delivered problem-solving therapy and peer-support was acceptable and showed promising results in this pilot evaluation, leading to quantitative and qualitative improvements in mental health among rural Zimbabwean women. Scale-up of the Friendship Bench in rural areas would help close the treatment gap for common mental disorders. [ABSTRACT FROM AUTHOR]
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- 2021
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7. Predictors of oral rotavirus vaccine immunogenicity in rural Zimbabwean infants.
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Church, James A., Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Lee, Benjamin, Carmolli, Marya P., Ntozini, Robert, Mutasa, Kuda, McNeal, Monica M., Majo, Florence D., Tavengwa, Naume V., Kirkpatrick, Beth D., Moulton, Lawrence H., Humphrey, Jean H., and Prendergast, Andrew J.
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ROTAVIRUSES , *ORAL vaccines , *ROTAVIRUS vaccines , *INFANTS , *INFANT nutrition , *LOW-income countries - Abstract
Oral rotavirus vaccines (RVV) have poor immunogenicity in low-income countries, for reasons that remain unclear. This study identified the determinants of RVV immunogenicity among infants in rural Zimbabwe. Anti-rotavirus IgA titres were measured among a sub-group of infants enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial (NCT01824940). SHINE was a cluster-randomized trial of improved infant and young child feeding, and improved water, sanitation and hygiene (WASH) in two rural Zimbabwean districts. Infants received RVV as part of the national immunisation programme. Among HIV-unexposed infants in the non-WASH trial arms, we evaluated associations between potential risk factors (vaccine schedule and dose, maternal and infant nutritional status, infant diarrhoea, and household environment) and RVV immunogenicity (seroconversion, seropositivity and geometric mean titres) using multivariable regression. Among 219 infants with seroconversion data, 43 (20%) successfully seroconverted and 176 (80%) failed to seroconvert to RVV. Seroconversion was positively associated with a higher length-for-age Z-score (LAZ) around the time of vaccination (adjusted RR 1.27 (95% CI 1.04, 1.55), P = 0.021), and negatively associated with concurrent OPV and RVV administration (adjusted RR 0.36 (0.19, 0.71), P = 0.003). Among 472 infants with post-vaccination titres, a higher LAZ score was associated with increased seropositivity (aRR 1.21 (95% CI 1.06, 1.38), P = 0.004), and higher birthweight was associated with increased IgA titres (0.45 (95%CI 0.18, 1.09) U/mL greater per 100 g gain in birthweight; P = 0.001). Infant ponderal and linear growth were positively associated with RVV immunogenicity, while concurrent administration of OPV was negatively associated with RVV immunogenicity. Together, these findings suggest that improving foetal growth and separating RVV and OPV administration are plausible approaches to increasing RVV immunogenicity. [ABSTRACT FROM AUTHOR]
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- 2020
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8. Neonatal vitamin A supplementation and immune responses to oral polio vaccine in Zimbabwean infants.
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Church, James A, Rukobo, Sandra, Govha, Margaret, Carmolli, Marya P, Diehl, Sean A, Chasekwa, Bernard, Ntozini, Robert, Mutasa, Kuda, Humphrey, Jean H, Kirkpatrick, Beth D, and Prendergast, Andrew J
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ORAL vaccines ,POLIOMYELITIS vaccines ,INFANTS ,IMMUNE response ,VITAMIN A - Abstract
Background Micronutrient deficiencies may contribute to reduced oral vaccine immunogenicity in developing countries. We hypothesised that neonatal vitamin A supplementation (NVAS) would improve oral vaccine responses. Methods We performed a cross-sectional study of infants recruited at birth to the Zimbabwe Vitamin A for Mothers and Babies (ZVITAMBO) trial, a randomised controlled trial of single, high-dose NVAS vs placebo conducted in Zimbabwe between 1997–2001. We measured poliovirus-specific IgA to type 1–3 polio strains by semiquantitative capture ELISA in cryopreserved plasma samples collected at 6 months of age. Results A total of 181 infants fulfilled inclusion criteria, of whom 80 were randomised to NVAS and 101 to placebo. There were no significant differences in baseline characteristics between groups. At 6 months of age, median (IQR) vaccine titres for infants randomised to NVAS vs placebo were 932 (421–3001) vs 1774 (711–5431) for Sabin-1 (p=0.04); 1361 (705–3402) vs 2309 (1081–4283) for Sabin-2 (p=0.15); and 1584 (796–4216) vs 2260 (996–5723) for Sabin-3 (p=0.14), respectively. After adjusting for breast feeding status, birth weight, season and infant sex in a linear regression model, there was only weak evidence of difference in log mean titres between vitamin A and placebo groups for Sabin-1 (p=0.08) and no evidence of difference in log mean titres for Sabin-2 and Sabin-3. Conclusions NVAS did not augment oral polio vaccine responses in Zimbabwean infants. Further research is required to understand the impact of NVAS on responses to other oral vaccines. The trial is registered with clinicaltrials.gov identifier: NCT00198718. [ABSTRACT FROM AUTHOR]
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- 2019
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9. Measuring wealth in rural communities: Lessons from the Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial.
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Chasekwa, Bernard, Maluccio, John A., Ntozini, Robert, Moulton, Lawrence H., Wu, Fan, Smith, Laura E., Matare, Cynthia R., Stoltzfus, Rebecca J., Mbuya, Mduduzi N. N., Tielsch, James M., Martin, Stephanie L., Jones, Andrew D., Humphrey, Jean H., Fielding, Katherine, and null, null
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POVERTY , *HUMAN capital , *QUALITY of life , *SUBJECTIVE well-being (Psychology) , *SOCIOECONOMIC factors - Abstract
Background: Poverty and human capital development are inextricably linked and therefore research on human capital typically incorporates measures of economic well-being. In the context of randomized trials of health interventions, for example, such measures are used to: 1) assess baseline balance; 2) estimate covariate-adjusted analyses; and 3) conduct subgroup analyses. Many factors characterize economic well-being, however, and analysts often generate summary measures such as indices of household socio-economic status or wealth. In this paper, a household wealth index is developed and tested for participants in the cluster-randomized Sanitation, Hygiene, Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe. Methods: Building on the approach used in the Zimbabwe Demographic and Health Survey (ZDHS), we combined a set of housing characteristics, ownership of assets and agricultural resources into a wealth index using principal component analysis (PCA) on binary variables. The index was assessed for internal and external validity. Its sensitivity was examined considering an expanded set of variables and an alternative statistical approach of polychoric PCA. Correlation between indices was determined using the Spearman’s rank correlation coefficient and agreement between quintiles using a linear weighted Kappa statistic. Using the 2015 ZDHS data, we constructed a separate index and applied the loadings resulting from that analysis to the SHINE study population, to compare the wealth distribution in the SHINE study with rural Zimbabwe. Results: The derived indices using the different methods were highly correlated (r>0.9), and the wealth quintiles derived from the different indices had substantial to near perfect agreement (linear weighted Kappa>0.7). The indices were strongly associated with a range of assets and other wealth measures, indicating both internal and external validity. Households in SHINE were modestly wealthier than the overall population of households in rural Zimbabwe. Conclusion: The SHINE wealth index developed here is a valid and robust measure of wealth in the sample. [ABSTRACT FROM AUTHOR]
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- 2018
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10. Cytomegalovirus Acquisition and Inflammation in Human Immunodeficiency Virus-Exposed Uninfected Zimbabwean Infants.
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Evans, Ceri, Chasekwa, Bernard, Rukobo, Sandra, Govha, Margaret, Mutasa, Kuda, Ntozini, Robert, Humphrey, Jean H., and Prendergast, Andrew J.
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CYTOMEGALOVIRUSES , *HIV , *INFANT disease prevention , *C-reactive protein , *PUBLIC health - Abstract
Cytomegalovirus (CMV) acquisition and inflammation were evaluated in 231 human immunodeficiency virus (HIV)-exposed uninfected (HEU) and 100 HIV-unexposed Zimbabwean infants aged 6 weeks. The HEU and HIV-unexposed infants had a similarly high prevalence of CMV (81.4% vs 74.0%, respectively; P = .14), but HEU infants had higher CMV loads (P = .005) and >2-fold higher C-reactive protein (CRP) concentrations (P < .0001). The CMV-positive HEU infants had higher CRP than the CMV-negative HEU infants; this association disappeared after adjusting for maternal HIV load. Overall, CMV acquisition is high in early life, but HEU infants have higher CMV loads and a proinflammatory milieu, which may be driven partly by maternal HIV viremia. [ABSTRACT FROM AUTHOR]
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- 2017
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