A5001624639- Global Maternal and Child Health
- HIV/AIDS Research and Interventions
- Maternal and Perinatal Health Interventions
- Child Nutrition and Water Access
- Adolescent Sexual and Reproductive Health
- HIV/AIDS Impact and Responses
- Poverty, Education, and Child Welfare
- Healthcare Policy and Management
- Counseling Practices and Supervision
- HIV, Drug Use, Sexual Risk
- Maternal Mental Health During Pregnancy and Postpartum
- HIV Research and Treatment
- COVID-19 Impact on Reproduction
- HIV-related health complications and treatments
- Global Health Workforce Issues
- Family and Patient Care in Intensive Care Units
- Health Systems, Economic Evaluations, Quality of Life
- Vaccine Coverage and Hesitancy
- Health Policy Implementation Science
- Infant Development and Preterm Care
- COVID-19 epidemiological studies
- Intimate Partner and Family Violence
- Community Development and Social Impact
- Breastfeeding Practices and Influences
- Intergenerational Family Dynamics and Caregiving
Boston University
2013-2025
Boston Medical Center
2019-2024
Cambridge Health Alliance
2024
Public Health Institute of Malawi
2023
Methodist Hospital
2022
Griffith University
2022
Johnson & Johnson (Brazil)
2022
Baxter (United States)
2022
Center for Global Health
2012-2021
Keele University
2020
In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt weaning at 4 months as compared standard practice has net benefit for HIV-free survival of children.We enrolled 958 HIV-infected and their infants in Lusaka, Zambia. All planned breast-feed exclusively months; 481 were randomly assigned counseling program encouraged months, 477 continued...
Background. Rates of perinatal human immunodeficiency virus (HIV) transmission are higher among HIV-infected mothers with more advanced disease, but effects maternal disease on HIV-uninfected offspring unclear. We investigated the hypothesis that severity HIV and immune dysfunction is associated increased morbidity mortality their uninfected infants. Methods. In a birth cohort 620 infants born to in Lusaka, Zambia, we associations between markers child mortality, hospital admissions, infant...
Sub-Saharan Africa contains over 60% of the world's HIV infections and Zambia is among most severely affected countries in region. As antiretroviral programs have been rapidly expanding, long-term success these depends on a good understanding behavioral determinants acceptance adherence to therapy (ART). The study used qualitative methods gain local insight into potentially important factors affecting HIV-infected women's decision accept or continue with ART. Some barriers identified by this...
Background Empirical data showing the clear benefits of exclusive breastfeeding (EBF) for HIV prevention are needed to encourage implementation lactation support programs HIV-infected women in low resource settings among whom replacement feeding is unsafe. We conducted a prospective, observational study Lusaka, Zambia, test hypothesis that EBF associated with lower risk postnatal transmission than non-EBF. Methods and Results As part randomized trial early weaning, 958 their infants were...
Background The WHO recommends maternity waiting homes (MWH) as one intervention to improve maternal and newborn health. However, persistent structural, cultural financial barriers in their design implementation have resulted mixed success both uptake utilization. Guidance is needed on how a MWH that acceptable sustainable. Using formative research guided by sustainability framework for health programs, we systematically collected data from key stakeholders potential users order Zambia could...
In wilted barley leaves, betaine accumulates at about 200 nanomoles per 10 centimeters leaf day. Results with (14)C-labeled precursors were qualitatively and quantitatively consistent de novo synthesis of this from serine via ethanolamine, choline, aldehyde indicated that water stress may increase the activities all steps in pathway except last.Doses (1 micromole) each precursor supplied as droplets to tips attached, 10-centimeter, second-leaf blades turgid plants, incorporation (14)C into...
Purpose: Access to skilled care and facilities with capacity provide emergency obstetric newborn is critical reducing maternal mortality. In rural areas of Zambia, 42% women deliver at home, suggesting persistent challenges for in seeking, reaching, receiving quality maternity care. This study assessed the determinants home delivery among remote Zambia. Methods: A household survey was administered a random selection recently delivered living 10 km or more from their catchment area health...
Residential accommodation for expectant mothers adjacent to health facilities, known as maternity waiting homes (MWH), is an intervention designed improve access skilled deliveries in low-income countries like Zambia where the maternal mortality ratio estimated at 398 deaths per 100,000 live births. Our study aimed assess relationship between MWH quality and likelihood of facility delivery Kalomo Choma Districts Southern Province, Zambia. We systematically assessed inventoried functional...
Introduction Maternity waiting homes (MWHs) aim to improve access facility delivery in rural areas. However, there is limited rigorous evidence of their effectiveness. Using formative research, we developed an MWH intervention model with three components: infrastructure, management and linkage services. This protocol describes a study measure the impact on among women living farthest (≥10 km) from designated health Zambia. will generate key new inform decision-making for policy Zambia...
Healthcare resources have been concentrated in urban areas, leaving rural regions vulnerable to poorer health outcomes. The Problem Solving for Better Health (PSBH) program was implemented enhance healthcare systems resource-limited by training personnel maximize existing problem-solving. This study evaluated the implementation effectiveness of PSBH-Nursing (PSBHN), a nationally led initiative train nurses PSBH Lesotho. A mixed-methods employing single-group pre-test post-test design...
Implementation fidelity measures are critical for understanding complex interventions. Though maternity waiting homes (MWHs) recommended by the WHO and have been used to help pregnant women access health facilities decades, a gap exists regarding studies on MWHs. To better understand intervention outcomes results, we assessed of implementation an improved Core MWH Model in 10 rural Zambia. We analysed indicators employing widely conceptual framework. compared performance from October 2016...
Abstract Disengagement from antiretroviral therapy (ART) is highest in the early treatment period (≤ 6 months after initiation/re-initiation), but low intensity models designed to increase retention generally exclude these clients. We describe client preferences for HIV service delivery period. From 9/2022 6/2023, we surveyed adult clients who were initiating or on ART ≤ at primary health facilities South Africa and Zambia. collected data experiences with treatment. enrolled 1,098...
Abstract Background Understanding factors affecting adoption of an innovation is critical to its long-term success. Maternity waiting homes (MWHs) increase access facility-based delivery in low-resourced settings; yet, quality issues deter utilization this innovative approach. We sought understand how attributes that are thought promote diffusion innovations (e.g., relative advantage, compatibility, observability, complexity, etc.) affected MWH use after implementation improved model rural...
Background HIV testing services (HTS) aim to increase status awareness and serve as the gateway prevention, care, treatment. Understanding clients' experiences accessing facility-based HTS is important ensure comprehensive service provision, improve linkage ultimately contribute better health outcomes. Methods We surveyed a convenience sample of adults presenting for at 42 facilities in Malawi, South Africa, Zambia between September 2022 April 2023. A structured questionnaire captured data...
Between June 2011 and December 2016, the Saving Mothers, Giving Life (SMGL) initiative in Uganda Zambia implemented a comprehensive approach targeting persistent barriers that impact woman's decision to seek care (first delay), ability reach (second receive adequate (third delay). This article addresses how SMGL partners strategies specifically second delay, including decreasing distance facilities capable of managing emergency obstetric newborn complications, ensuring sufficient numbers...
The COVID-19 pandemic has increased social and emotional stressors globally, increasing mental health concerns the risk of psychiatric illness worldwide. To date, relatively little is known about impact on vulnerable groups such as women children in low-resourced settings who generally have limited access to care. We explore two rounds data collected part an ongoing trial early childhood development assess distress among mothers under 5-years-old living rural areas Zambia during pandemic....
To reduce maternal mortality, countries must continue to seek ways increase access skilled care during pregnancy and delivery. In Zambia, while antenatal attendance is high, many barriers exist that prevent women from delivering with a health provider. This study explores how the individuals closest pregnant woman in rural Zambia can influence woman's decision her ability timely maternity care. At four centers, free listing (n = 167) exercise was conducted mothers, fathers, community elders....
Abstract Introduction In 2014, the South African government adopted a differentiated service delivery (DSD) model in its “National Adherence Guidelines for Chronic Diseases (HIV, TB and NCDs)” (AGL) to strengthen HIV care cascade. We describe barriers facilitators of AGL implementation as experienced by various stakeholders eight intervention control sites across four districts. Methods Embedded within cluster‐randomized evaluation AGL, we conducted 48 in‐depth interviews (IDIs) with...
Many countries in sub-Saharan Africa are rapidly scaling up "differentiated service delivery" (DSD) models for HIV treatment to improve the quality of care, increase access, reduce costs, and support continued expansion sustainability antiretroviral therapy (ART) programs. Although there is some published evidence about health outcomes patients DSD models, little known their impacts on healthcare providers' job satisfaction, patients' life, costs providers or patients, how affect resource...
BackgroundCotrimoxazole prophylaxis is recommended for subgroups of human immunodeficiency virus (HIV)–infected adults and children to reduce all-cause morbidity mortality. We investigated whether antenatal cotrimoxazole begun during pregnancy HIV-infected pregnant women with low CD4 cell counts would affect birth outcomes
Objective Maternity waiting homes (MWHs) have been identified as one solution to decrease maternal morbidity and mortality by bringing women living in hard-to-reach areas closer a hospital or health center that provides emergency obstetric care. The objective of this study was obtain data on current MWH characteristics the who use them well women's perceptions experiences with MWHs among seven Saving Mothers Giving Life (SMGL) supported districts Zambia. Methods A cross-sectional household...
Increased encounters with the healthcare system at multiple levels have potential to improve maternal and newborn outcomes. The literature is replete evidence on impact of antenatal care postnatal Additionally, maternity waiting homes (MWHs) been identified as a critical link in continuum for health yet there scant data associations among MWH use antenatal/postnatal attendance, family planning immunization rates newborns.A cross-sectional household survey was conducted collect from women who...
Single-dose nevirapine (SDNVP) for prevention of mother-to-child HIV transmission selects mutations conferring resistance to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. We investigated mortality and virologic clinical outcomes after introduction antiretroviral treatment (ART) among a cohort women given SDNVP.When ART programs were introduced in 2004 Lusaka, Zambia, we completing trial infant feeding, which involved following HIV-infected who received SDNVP between...
Sixteen million children in developing and middle-income countries have been orphaned by HIV/AIDS, at least another per year are rendered vulnerable parental HIV/AIDS-related illness. Since 2003 the US government has provided approximately $1.6 billion to give four of these care support through President's Emergency Plan for AIDS Relief (PEPFAR). We conducted five studies evaluate effectiveness PEPFAR's interventions such East Africa southern Africa. found evidence beneficial changes school...