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Article ; Online: When Potentially Lifesaving Drugs are Both Experimental and in Very Short Supply: A Clinician's Story from the Front Lines of the Battle Against Ebola.

Mobula, Linda M

The American journal of tropical medicine and hygiene

2015 Volume 93, Issue 2, Page(s) 210–211

MeSH term(s)	Antiviral Agents/supply & distribution ; Antiviral Agents/therapeutic use ; Hemorrhagic Fever, Ebola/drug therapy ; Humans ; Therapies, Investigational/ethics
Chemical Substances	Antiviral Agents
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	2942-7
ISSN	1476-1645 ; 0002-9637
ISSN (online)	1476-1645
ISSN	0002-9637
DOI	10.4269/ajtmh.15-0302
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Article ; Online: Protecting the vulnerable during COVID-19: Treating and preventing chronic disease disparities.

Mobula, Linda M / Heller, David J / Commodore-Mensah, Yvonne / Walker Harris, Vanessa / Cooper, Lisa A

Gates open research

2020 Volume 4, Page(s) 125

Abstract: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases - are key drivers of this ... ...

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases - are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself - but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions - task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering emerging universal primary care models.
Keywords	covid19
Language	English
Publishing date	2020-09-09
Publishing country	United States
Document type	Journal Article
ISSN	2572-4754
ISSN (online)	2572-4754
DOI	10.12688/gatesopenres.13181.1
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Article ; Online: Prioritizing the sexual and reproductive health and rights of adolescent girls and young women within HIV treatment and care services in emergency settings: a girl-centered agenda.

Roxo, Uchechi / Mobula, M Linda / Walker, Damilola / Ficht, Allison / Yeiser, Sarah

Reproductive health

2019 Volume 16, Issue Suppl 1, Page(s) 57

Abstract: Background: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research ... ...

Abstract	Background: Extensive documentation exists on a range of negative sexual and reproductive health outcomes and rights violations occurring during humanitarian emergencies. We explore two central questions: Do existing policies, services, and research adequately address the SRH rights, priorities and HIV risks of adolescent girls and young women in emergency settings? What are the missed opportunities for holistically addressing the vulnerabilities experienced by those living with HIV during rapid onset disasters and long term, protracted emergencies? Authors review considerations informing real-time decision making, and highlight missed opportunities to apply a gendered lens in the delivery of AGYW-centered SRHR/HIV services. Methods: A scoping review identified studies on HIV intervention and outcomes in emergency settings, published in the peer-reviewed literature (2002-2017). This exercise was complemented with a desk review of normative guidance, frameworks, and implementation guidelines on HIV and SRH in emergency responses, and by consultations with subject matter experts. Results: The existing frameworks and guidance pay scant attention to the sexual reproductive health and rights of young women living with HIV (WLHIV), focusing mainly on prevention of mother to child transmission (PMTCT), antiretroviral therapy (ART), HIV testing services, and linkage to treatment services. Applying a gendered sexual and reproductive health lens to the response offers opportunities to identify critical implementation questions, and highlight promising practices, to better tailor current services for AGYW. Conclusions: A plurality of competing needs crowds out dedicated time and space to effectively integrate HIV and sexual and reproductive health interventions in emergency settings. Political will is required to advance multi-sectoral cooperation, through joint planning, rights-informed learning and integrative responses, and to promote creative solutions for ART continuation, drug supply and HIV testing, treatment and care. Recent advancements in policy and practice would suggest that a more AGYW-centered response is feasible.
MeSH term(s)	Adolescent ; Adolescent Health Services/organization & administration ; Adult ; Female ; HIV/isolation & purification ; HIV Infections/prevention & control ; HIV Infections/virology ; Health Policy ; Health Services Needs and Demand ; Humans ; Meta-Analysis as Topic ; Pregnancy ; Reproductive Health Services/organization & administration ; Reproductive Rights/legislation & jurisprudence ; Reproductive Rights/standards ; Sexual Behavior ; Sexual Health ; Young Adult
Language	English
Publishing date	2019-05-29
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2149029-6
ISSN	1742-4755 ; 1742-4755
ISSN (online)	1742-4755
ISSN	1742-4755
DOI	10.1186/s12978-019-0710-0
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Article: The cost of public health interventions to respond to the 10th Ebola outbreak in the Democratic Republic of the Congo.

Zeng, Wu / Samaha, Hadia / Yao, Michel / Ahuka-Mundeke, Steve / Wilkinson, Thomas / Jombart, Thibaut / Baabo, Dominique / Lokonga, Jean-Pierre / Yuma, Sylvain / Mobula-Shufelt, Linda

BMJ global health

2023 Volume 8, Issue 10

Abstract: The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion in EVD control over two years (2018-2020). This is the ... ...

Abstract	The 10th Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) drew substantial attention from the international community, which in turn invested more than US$1 billion in EVD control over two years (2018-2020). This is the first EVD outbreak to take place in a conflict area, which led to a shift in strategy from a pure public health response (PHR) to a multisectoral humanitarian response. A wide range of disease control and mitigation activities were implemented and were outlined in the five budgeted Strategic Response Plans used throughout the 26 months. This study used the budget/expenditure and output indicators for disease control and mitigation interventions compiled by the government of DRC and development and humanitarian partners to estimate unit costs of key Ebola control interventions. Of all the investment in EVD control, 68% was spent on PHR. The remaining 32% covered security, community support interventions for the PHR. The disbursement for the public health pillar was distributed as follows: (1) coordination (18.8%), (2), clinical management of EVD cases (18.4%), (3) surveillance and vaccination (15.9%), (4) infection prevention and control/WASH (13.8%) and (5) risk communication (13.7%). The unit costs of key EVD control interventions were as follows: US$66 182 for maintaining a rapid response team per month, US$4435 for contact tracing and surveillance per identified EVD case, US$1464 for EVD treatment per case, US$59.4 per EVD laboratory test, US$120.7 per vaccinated individual against EVD and US$175.0 for mental health and psychosocial support per beneficiary. The estimated unit costs of key EVD disease control interventions provide crucial information for future infectious disease control planning and budgeting, as well as prioritisation of disease control interventions.
MeSH term(s)	Humans ; Hemorrhagic Fever, Ebola/epidemiology ; Hemorrhagic Fever, Ebola/prevention & control ; Democratic Republic of the Congo/epidemiology ; Public Health ; Disease Outbreaks/prevention & control ; Communication
Language	English
Publishing date	2023-10-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2023-012660
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Article ; Online: Incident stroke among Ghanaians with hypertension and diabetes: A multicenter, prospective cohort study.

Sarfo, Fred S / Mobula, Linda M / Plange-Rhule, Jacob / Ansong, Daniel / Ofori-Adjei, David

Journal of the neurological sciences

2018 Volume 395, Page(s) 17–24

Abstract: Background: The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups.: Methods: A prospective ... ...

Abstract	Background: The burden of stroke among hypertensive and diabetic population in sub-Saharan Africa remains high. We sought to identify the risk factors associated with stroke occurrence in these high-risk population groups. Methods: A prospective cohort study involving adults with hypertension and or type II diabetes mellitus at 5 public hospitals in Ghana who were stroke-free at enrollment. Patients were followed every 2 months at clinic for 18 months and assessed clinically for first ever stroke by physicians. We calculated crude incidence rates for stroke and assessed the factors associated with stroke occurrence using a multivariate Cox Proportional Hazards regression models. Results: Of 3220 eligible participants with 3805 person-years of follow-up, there were 54 clinically confirmed new strokes. Incidence rate of stroke was 14.19 events per 1000 person-years [95% CI: 10.77-18.38], with rates among diabetics with hypertension being 16.64 [10.58-25.00], hypertension of 13.77 [9.33-19.64] and diabetes was 9.81 [3.59-21.74]. Two factors independently associated with stroke occurrence were previous cigarette smoking with adjusted HR (95% CI) of 2.59 (1.18-5.67) and physical inactivity, 1.81 (1.06-3.10). In secondary analysis, stage II hypertension compared with optimal BP was associated with aHR of 3.04 (1.00-9.27), p = .05 for stroke occurrence. Conclusion: Incident stroke among Ghanaians with hypertension and diabetes is quite high. Stricter control of blood pressure and engaging in regular physical activities are strongly recommended to reduce the risk of strokes.
MeSH term(s)	Diabetes Mellitus, Type 2/epidemiology ; Female ; Follow-Up Studies ; Ghana/epidemiology ; Humans ; Hypertension/epidemiology ; Incidence ; Male ; Middle Aged ; Pilot Projects ; Prospective Studies ; Risk Factors ; Sedentary Behavior ; Smoking/epidemiology ; Stroke/epidemiology
Language	English
Publishing date	2018-09-13
Publishing country	Netherlands
Document type	Journal Article ; Multicenter Study
ZDB-ID	80160-4
ISSN	1878-5883 ; 0022-510X ; 0374-8642
ISSN (online)	1878-5883
ISSN	0022-510X ; 0374-8642
DOI	10.1016/j.jns.2018.09.018
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Article ; Online: Need for Reinforced Strategies to Support Delivery of HIV Clinical Services During the Ebola Outbreak in Guinea, Liberia, and Sierra Leone.

Mobula, M Linda / Brown, Charlene A / Burnham, Gilbert / Phelps, Benjamin R

Disaster medicine and public health preparedness

2015 Volume 9, Issue 5, Page(s) 522–526

Abstract: The Ebola Virus Disease (EVD) outbreak in West Africa has been declared a public health emergency of international concern by the World Health Organization. The Ebola outbreak has led to the disruption of already fragile but essential health services and ...

Abstract	The Ebola Virus Disease (EVD) outbreak in West Africa has been declared a public health emergency of international concern by the World Health Organization. The Ebola outbreak has led to the disruption of already fragile but essential health services and drug distribution systems; HIV clinical services in Liberia, Sierra Leone, and Guinea were particularly affected. Targeted approaches are necessary to protect the continuity of HIV treatment for people living with HIV and should be integrated within the broader Ebola response; this will save lives, prevent drug resistance, and decrease the likelihood of HIV transmission.
MeSH term(s)	Delivery of Health Care ; Disease Outbreaks ; Guinea ; HIV Infections/prevention & control ; HIV Infections/therapy ; Hemorrhagic Fever, Ebola ; Humans ; Liberia ; Public Health/methods ; Sierra Leone
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375268-3
ISSN	1938-744X ; 1935-7893
ISSN (online)	1938-744X
ISSN	1935-7893
DOI	10.1017/dmp.2015.35
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Article ; Online: Prevalence and predictors of chronic kidney disease among Ghanaian patients with hypertension and diabetes mellitus: A multicenter cross-sectional study.

Tannor, Elliot K / Sarfo, Fred Stephen / Mobula, Linda M / Sarfo-Kantanka, Osei / Adu-Gyamfi, Rexford / Plange-Rhule, Jacob

Journal of clinical hypertension (Greenwich, Conn.)

2019 Volume 21, Issue 10, Page(s) 1542–1550

Abstract: The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with ... ...

Abstract	The burden of chronic kidney disease (CKD) is rapidly rising in developing countries due to astronomical increases in key risk factors including hypertension and diabetes. We sought to assess the burden and predictors of CKD among Ghanaians with hypertension and/or diabetes mellitus in a multicenter hospital-based study. We conducted a cross-sectional study in the Ghana Access and Affordability Program (GAAP) involving adults with hypertension only (HPT), hypertension with diabetes mellitus (HPT + DM), and diabetes mellitus only (DM) in 5 health facilities in Ghana. A structured questionnaire was administered to collect data on demographic variables, medical history, and clinical examination. Serum creatinine and proteinuria were measured, and estimated glomerular filtration rate derived using the CKD-EPI formula. A multivariable logistic regression model was used to identify factors associated with CKD. A total of 2781 (84.4%) of 3294 participants had serum creatinine and proteinuria data available for analysis. The prevalence of CKD was 242 (28.5%) among participants with both DM and HPT, 417 (26.3%) among participants with HPT, and 56 (16.1%) among those with DM alone. Predictors of CKD were increasing age aOR 1.26 (1.17-1.36), low educational level aOR 1.7 (1.23-2.35), duration of HPT OR, 1.02 (1.01-1.04), and use of herbal medications aOR 1.39 (1.10-1.75). Female gender was protective of CKD aOR 0.75 (0.62-0.92). Among patients with DM, increasing age and systolic blood pressure were associated with CKD. There is high prevalence of CKD among DM and hypertension patients in Ghana. Optimizing blood pressure control and limiting the use of herbal preparations may mitigate CKD occurrence in high cardiovascular risk populations in developing countries.
MeSH term(s)	Adult ; Aged ; Blood Pressure/physiology ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/prevention & control ; Clinical Decision Rules ; Creatinine/blood ; Cross-Sectional Studies ; Diabetes Mellitus/epidemiology ; Female ; Ghana/epidemiology ; Global Burden of Disease/statistics & numerical data ; Herbal Medicine/statistics & numerical data ; Humans ; Hypertension/complications ; Hypertension/epidemiology ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Proteinuria/diagnosis ; Proteinuria/etiology ; Renal Insufficiency, Chronic/epidemiology ; Renal Insufficiency, Chronic/etiology ; Risk Factors ; Surveys and Questionnaires
Chemical Substances	Creatinine (AYI8EX34EU)
Language	English
Publishing date	2019-08-29
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2077222-1
ISSN	1751-7176 ; 1524-6175
ISSN (online)	1751-7176
ISSN	1524-6175
DOI	10.1111/jch.13672
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Article ; Online: Protecting the vulnerable during COVID-19

Linda M. Mobula / David J. Heller / Yvonne Commodore-Mensah / Vanessa Walker Harris / Lisa A. Cooper

Gates Open Research, Vol

Treating and preventing chronic disease disparities [version 1; peer review: 2 approved]

2020 Volume 4

Abstract	The coronavirus disease 2019 (COVID-19) pandemic has exacerbated health disparities across ethnic and socioeconomic groups. Non-communicable diseases (NCDs) - such as hypertension, diabetes, and obstructive lung diseases – are key drivers of this widening gap, because they disproportionately afflict vulnerable populations. Vulnerable populations with non-communicable diseases, in turn, are disproportionately affected by COVID-19 itself – but also at increased risk of poor outcomes from those underlying conditions. Proven strategies for NCD control must be adapted to help vulnerable patients react to these dual threats. We detail six key policy interventions – task shifting, workforce protection, telehealth and mobile services, insurance restructuring and increased funding for NCDs, prescription policies for NCDs and community partnerships - to bridge this care gap. Long-term integration of these care models post-COVID-19 may prevent care shocks during future pandemics, bolstering emerging universal primary care models.
Keywords	Medicine ; R
Subject code	360
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	F1000 Research Ltd
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A humanitarian response to the West African Ebola virus disease outbreak

Linda M. Mobula / Jolene H. Nakao / Sonia Walia / Justin Pendarvis / Peter Morris / David Townes

Journal of International Humanitarian Action, Vol 3, Iss 1, Pp 1-

2018 Volume 6

Abstract: Abstract The 2014–2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a total of 28,616 suspected, probable, and confirmed cases reported in Guinea, Liberia, and Sierra Leone. The international humanitarian ... ...

Abstract	Abstract The 2014–2016 Ebola virus disease (EVD) outbreak in West Africa was of unprecedented magnitude with a total of 28,616 suspected, probable, and confirmed cases reported in Guinea, Liberia, and Sierra Leone. The international humanitarian community utilized its expertise in rapid response and scale up in emergency situations to manage a threat different from the more common humanitarian emergencies resulting from conflict or natural disaster. Unique multisectoral partnerships forged between traditional public health actors and humanitarian actors facilitated mutual learning and opened the door to ongoing working relationships that will hasten efficient and effective response to future global public health emergencies.
Keywords	Ebola virus disease ; Humanitarian ; West Africa ; Anthropology ; GN1-890 ; International relations ; JZ2-6530
Language	English
Publishing date	2018-08-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Factors associated with uncontrolled blood pressure among Ghanaians: Evidence from a multicenter hospital-based study.

Sarfo, Fred Stephen / Mobula, Linda M / Burnham, Gilbert / Ansong, Daniel / Plange-Rhule, Jacob / Sarfo-Kantanka, Osei / Ofori-Adjei, David

PloS one

2018 Volume 13, Issue 3, Page(s) e0193494

Abstract: Background: The burden of uncontrolled hypertension in Low-and-Middle Income Countries (LMICs) is high, with an increased risk of cardiovascular diseases and chronic renal failure in these settings.: Objective: To assess the factors associated with ... ...

Abstract	Background: The burden of uncontrolled hypertension in Low-and-Middle Income Countries (LMICs) is high, with an increased risk of cardiovascular diseases and chronic renal failure in these settings. Objective: To assess the factors associated with uncontrolled blood pressure control in a cross-section of Ghanaian hypertensive subjects involved in an on-going multicenter epidemiological study aimed at improving access to hypertension treatment. Methods: A cross-sectional study involving 2,870 participants with hypertension with or without diabetes who were enrolled at 5 hospitals in Ghana (2 tertiary, 2 district and 1 rural hospital). Data on demographics, medical history, lifestyle factors, anti-hypertensive medications and treatment adherence were collected. The 14-item version of the Hill-Bone compliance to high blood pressure therapy scale was used to assess adherence to treatment in 3 domains namely adherence to medications, salt intake and clinic appointments. Questionnaires on knowledge, attitudes and practices on hypertension, sources of antihypertensive medications and challenges with accessing these medications were also administered. Blood pressure, weight and height were measured for each subject at enrollment. Factors associated with uncontrolled blood pressure (>140/90mmHg) were assessed using a multivariate logistic regression model. Results: The mean ± SD age of study participants was 58.9 ± 16.6 years, with a female preponderance (76.8%). Among study participants, 1,213 (42.3%) study participants had blood pressure measurements under control. Factors that remained significantly associated with uncontrolled blood pressure with adjusted OR (95% CI) included receiving therapy at a tertiary level of care: 2.47 (1.57-3.87), longer duration of hypertension diagnosis: 1.01 (1.00-1.03), poor adherence to therapy: 1.21 (1.09-1.35) for each 5 points higher score on the Hill-Bone scale, reported difficulties in obtaining antihypertensive medications: 1.24 (1.02-1.49) and number of antihypertensive medications prescribed: 1.32 (1.21-1.44). Conclusion: We have found high rates of uncontrolled blood pressure among Ghanaian patients with hypertension accessing healthcare in public institutions. The system-level and individual-level factors associated with poor blood pressure control should be addressed to improve hypertension management among Ghanaians.
MeSH term(s)	Adult ; Aged ; Blood Pressure/drug effects ; Cross-Sectional Studies ; Female ; Ghana/epidemiology ; Health Knowledge, Attitudes, Practice ; Health Services Accessibility/economics ; Health Services Accessibility/statistics & numerical data ; Hospitals/statistics & numerical data ; Humans ; Hypertension/drug therapy ; Hypertension/physiopathology ; Male ; Medication Adherence/statistics & numerical data ; Middle Aged
Language	English
Publishing date	2018
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ISSN	1932-6203
ISSN (online)	1932-6203
DOI	10.1371/journal.pone.0193494
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