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Article ; Online: Development of a neonatal curriculum for medical students in Zimbabwe - a cross sectional survey.

Chimhuya, Simbarashe / Mbuwayesango, Bothwell / Aagaard, Eva M / Nathoo, Kusum J

2018 Volume 18, Issue 1, Page(s) 90

Abstract: Background: Calls have been made to reassess the curricula of medical schools throughout the world to adopt competence-based programs that address the healthcare needs of society. Zimbabwe is a country characterized by a high neonatal mortality rate of ... ...

Abstract	Background: Calls have been made to reassess the curricula of medical schools throughout the world to adopt competence-based programs that address the healthcare needs of society. Zimbabwe is a country characterized by a high neonatal mortality rate of 24 per 1000 live births. The current research sought to determine the content and appropriate teaching strategies needed to guide the development of an undergraduate neonatal curriculum map for medical students at the University of Zimbabwe College of Health Sciences. Methods: We surveyed faculty (n = 8) and non-faculty pediatricians (n = 5), senior resident medical officers (N = 26) using a self-administered questionnaire, and completed one focus group discussion with midwives (n = 11). We asked respondents their expectations regarding knowledge, psychomotor skills, competencies, and teaching strategies in a basic newborn curriculum for medical students. Relevant policy and curricula documents were reviewed to assess newborn health needs and the current training. A group of faculty educationists (n = 11) collated and finalized the findings from the document review, survey, and focus group using descriptive statistics and thematic analysis. Results: The document review revealed three key neonatal health objectives according to the current national maternal and neonatal health road map. These objectives are to be met using a four tier approach comprising (i) family planning (ii) focused antenatal care (iii) clean and safe delivery and (iv) basic and comprehensive emergency obstetric & neonatal care. Existing curriculum has 15 newborn topics taught in lecture style during the pediatric rotations, and five newborn care skills to be learned through observation. The existing curriculum is silent on desired competencies. In the current study 19 cognitive areas, 17 psychomotor skills and six competency domains were identified for an ideal neonatal curriculum for undergraduate students. A combination of teaching strategies including classroom, simulation and a clinical rotation were recommended. Conclusion: This study revealed a significant gap between the existing neonatal curriculum and the ideal curriculum as recommended by broad stakeholders in the context of national health care needs. Next steps are to complete the development and implementation of the proposed curriculum map to better align with the ideal state.
MeSH term(s)	Clinical Competence ; Cross-Sectional Studies ; Curriculum ; Delivery, Obstetric/education ; Delivery, Obstetric/standards ; Education, Medical, Undergraduate/organization & administration ; Emergency Treatment/methods ; Family Planning Services/education ; Focus Groups ; Health Care Surveys/methods ; Humans ; Infant ; Infant Mortality ; Infant, Newborn ; Needs Assessment ; Neonatology/education ; Prenatal Care ; Program Development ; Students, Medical ; Zimbabwe
Language	English
Publishing date	2018-05-02
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-018-1194-2
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Article ; Online: Inflammation and epithelial repair predict mortality, hospital readmission, and growth recovery in complicated severe acute malnutrition.

Science translational medicine

2024 Volume 16, Issue 736, Page(s) eadh0673

Abstract: Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in ... ...

Abstract	Severe acute malnutrition (SAM) is the most high-risk form of undernutrition, particularly when children require hospitalization for complications. Complicated SAM is a multisystem disease with high inpatient and postdischarge mortality, especially in children with comorbidities such as HIV; however, the underlying pathogenesis of complicated SAM is poorly understood. Targeted multiplex biomarker analysis in children hospitalized with SAM (
MeSH term(s)	Child ; Humans ; Infant ; Patient Readmission ; Patient Discharge ; HIV Infections/complications ; Aftercare ; Vascular Endothelial Growth Factor A ; Severe Acute Malnutrition/complications ; Inflammation/complications ; Intercellular Signaling Peptides and Proteins ; Malnutrition/complications
Chemical Substances	Vascular Endothelial Growth Factor A ; Intercellular Signaling Peptides and Proteins
Language	English
Publishing date	2024-02-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	2518854-9
ISSN	1946-6242 ; 1946-6234
ISSN (online)	1946-6242
ISSN	1946-6234
DOI	10.1126/scitranslmed.adh0673
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Article ; Online: Brief Report: Suboptimal Lopinavir Exposure in Infants on Rifampicin Treatment Receiving Double-dosed or Semisuperboosted Lopinavir/Ritonavir: Time for a Change.

Jacobs, Tom G / Mumbiro, Vivian / Chitsamatanga, Moses / Namuziya, Natasha / Passanduca, Alfeu / Domínguez-Rodríguez, Sara / Tagarro, Alfredo / Nathoo, Kusum J / Nduna, Bwendo / Ballesteros, Alvaro / Madrid, Lola / Mujuru, Hilda A / Chabala, Chishala / Buck, W Chris / Rojo, Pablo / Burger, David M / Moraleda, Cinta / Colbers, Angela

Journal of acquired immune deficiency syndromes (1999)

2023 Volume 93, Issue 1, Page(s) 42–46

Abstract: Background: Although super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice, many different LPV/r dosing strategies are applied due to ... ...

Abstract	Background: Although super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice, many different LPV/r dosing strategies are applied due to poor availability of pediatric separate ritonavir formulations needed to superboost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB) treatment. Methods: This was a 2-arm pharmacokinetic substudy nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB treatment; during rifampicin cotreatment, they received double-dosed (ratio 8:2) or semisuperboosted LPV/r (adding a ritonavir 100 mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r. Results: In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin cotreatment (5 received double-dosed and 4 semisuperboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0 kg (5.2-6.8), and 10/14 were male. Of those receiving rifampicin, 6/9 infants (67%) had LPV Ctrough <1.0 mg/L compared with 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin. Conclusion: Double-dosed or semisuperboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB coinfection, including twice-daily dolutegravir.
MeSH term(s)	Male ; Infant ; Humans ; Child ; Female ; Lopinavir/therapeutic use ; Ritonavir/therapeutic use ; Rifampin/therapeutic use ; HIV Infections/drug therapy ; Anti-HIV Agents/therapeutic use ; HIV Protease Inhibitors/therapeutic use
Chemical Substances	Lopinavir (2494G1JF75) ; Ritonavir (O3J8G9O825) ; Rifampin (VJT6J7R4TR) ; Anti-HIV Agents ; HIV Protease Inhibitors
Language	English
Publishing date	2023-04-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000003168
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Article ; Online: Risk factors for inpatient mortality among children with severe acute malnutrition in Zimbabwe and Zambia.

Sturgeon, Jonathan P / Mufukari, Wadzanai / Tome, Joice / Dumbura, Cherlynn / Majo, Florence D / Ngosa, Deophine / Chandwe, Kanta / Kapoma, Chanda / Mutasa, Kuda / Nathoo, Kusum J / Bourke, Claire D / Ntozini, Robert / Bwakura-Dangarembizi, Mutsa / Amadi, Beatrice / Kelly, Paul / Prendergast, Andrew J

European journal of clinical nutrition

2023 Volume 77, Issue 9, Page(s) 895–904

Abstract: Background/objectives: Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital ... ...

Abstract	Background/objectives: Malnutrition underlies 45% of deaths in children under-5 years annually. Children hospitalised with complicated severe acute malnutrition (SAM) have unacceptably high mortality. We aimed to identify variables from early hospital admission (baseline factors) independently associated with inpatient mortality in this cohort to identify those most at risk. Subjects/methods: Observational study of 745 children aged 0-59 months admitted with complicated SAM at three hospitals in Zimbabwe/Zambia. Children underwent anthropometry and clinical assessment by a study physician within 72 h of enrolment, and caregivers provided sociodemographic data. Children were followed-up daily until discharge/death. A multivariable survival analysis identified the baseline factors independently associated with mortality. Results: 70/745 (9.4%) children died in hospital. Age between 6-23 months [aHR 6.53, 95%CI 2.24-19.02], higher mid-upper arm circumference [aHR 0.73, 95%CI 0.59-0.89], presence of oedema [aHR 2.22, 95%CI 1.23-4.05], shock [aHR 8.18, 95%CI 3.79-17.65], sepsis [aHR 3.13, 95%CI 1.44-6.80], persistent diarrhoea [aHR 2.27, 95%CI 1.18-4.37], lack of a toilet at home [aHR 4.35, 95%CI 1.65-11.47], and recruitment at one Harare site [aHR 0.38, 95%CI 0.18-0.83] were all independently associated with inpatient mortality. Oedematous children had a significantly higher birthweight [2987 g vs 2757 g, p < 0.001] than those without oedema; higher birthweight was weakly associated with mortality [aHR 1.50 95%CI 0.97-2.31]. Conclusions: Children with oedema, low MUAC, baseline infections, shock and lack of home sanitation had a significantly increased risk of inpatient mortality following hospitalisation for complicated SAM. Children with high-risk features may require additional care. A better understanding of the pathophysiology of SAM is needed to identify adjunctive interventions.
MeSH term(s)	Humans ; Child ; Infant ; Child, Preschool ; Zambia/epidemiology ; Zimbabwe/epidemiology ; Birth Weight ; Inpatients ; Severe Acute Malnutrition/complications ; Malnutrition/complications ; Risk Factors ; Edema/complications
Language	English
Publishing date	2023-08-08
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	639358-5
ISSN	1476-5640 ; 0954-3007
ISSN (online)	1476-5640
ISSN	0954-3007
DOI	10.1038/s41430-023-01320-9
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Article ; Online: Fat and lean mass predict time to hospital readmission or mortality in children treated for complicated severe acute malnutrition in Zimbabwe and Zambia.

Bwakura-Dangarembizi, Mutsa / Dumbura, Cherlynn / Ngosa, Deophine / Majo, Florence D / Piper, Joe D / Sturgeon, Jonathan P / Nathoo, Kusum J / Amadi, Beatrice / Norris, Shane / Chasekwa, Bernard / Ntozini, Robert / Wells, Jonathan C / Kelly, Paul / Prendergast, Andrew J

The British journal of nutrition

2022 Volume 130, Issue 6, Page(s) 1024–1033

Abstract: HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, ... ...

Abstract	HIV and severe wasting are associated with post-discharge mortality and hospital readmission among children with complicated severe acute malnutrition (SAM); however, the reasons remain unclear. We assessed body composition at hospital discharge, stratified by HIV and oedema status, in a cohort of children with complicated SAM in three hospitals in Zambia and Zimbabwe. We measured skinfold thicknesses and bioelectrical impedance analysis (BIA) to investigate whether fat and lean mass were independent predictors of time to death or readmission. Cox proportional hazards models were used to estimate the association between death/readmission and discharge body composition. Mixed effects models were fitted to compare longitudinal changes in body composition over 1 year. At discharge, 284 and 546 children had complete BIA and skinfold measurements, respectively. Low discharge lean and peripheral fat mass were independently associated with death/hospital readmission. Each unit
MeSH term(s)	Humans ; Male ; Female ; Child ; Adolescent ; Young Adult ; Adipose Tissue ; Patient Readmission ; Zimbabwe/epidemiology ; HIV Infections/complications ; HIV Infections/epidemiology ; Zambia/epidemiology ; Body Composition ; Thinness ; Severe Acute Malnutrition/epidemiology ; Severe Acute Malnutrition/therapy ; Patient Discharge ; Follow-Up Studies
Language	English
Publishing date	2022-12-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	280396-3
ISSN	1475-2662 ; 0007-1145
ISSN (online)	1475-2662
ISSN	0007-1145
DOI	10.1017/S0007114522004056
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Article ; Online: Risk factors for postdischarge mortality following hospitalization for severe acute malnutrition in Zimbabwe and Zambia.

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

The American journal of clinical nutrition

2021 Volume 113, Issue 3, Page(s) 665–674

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) ... ...

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.
MeSH term(s)	Aftercare ; Anti-HIV Agents/therapeutic use ; Cohort Studies ; Female ; HIV Infections/complications ; HIV Infections/drug therapy ; HIV Infections/mortality ; Humans ; Infant ; Male ; Patient Discharge ; Prospective Studies ; Risk Factors ; Severe Acute Malnutrition/mortality ; Zambia/epidemiology ; Zimbabwe/epidemiology
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2021-01-20
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	280048-2
ISSN	1938-3207 ; 0002-9165
ISSN (online)	1938-3207
ISSN	0002-9165
DOI	10.1093/ajcn/nqaa346
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Article: Cost estimates of diarrhea hospitalizations among children <5 years old in Zimbabwe

Mujuru, Hilda A / Burnett, Eleanor / Nathoo, Kusum J / Ticklay, Ismail / Gonah, Nhamo A / Mukaratirwa, Arnold / Berejena, Chipo / Manangazira, Portia / Rupfutse, Maxwell / Chavers, Tyler / Weldegebriel, Goitom G / Mwenda, Jason M / Parashar, Umesh D / Tate, Jacqueline E

Vaccine. 2020 Oct. 07, v. 38, no. 43

2020

Abstract: Diarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017.Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and indirect costs ... ...

Abstract	Diarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017.Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and indirect costs attributable to a diarrhea hospitalization in Zimbabwe after rotavirus vaccine introduction.Children <5 years old admitted to Harare Central Hospital from June 2018 to April 2019 with acute watery diarrhea were eligible for this evaluation. A 3-part structured questionnaire was used to collect data by interview from the child’s family and by review of the medical record. A stool specimen was also collected and tested for rotavirus. Direct medical costs were the sum of medications, consumables, diagnostic tests, and service delivery costs. Direct non-medical costs were the sum of transportation, meals and lodging for caregivers. Indirect costs are the lost income for household members.A total of 202 children were enrolled with a median age of 12 months (IQR: 7–21) and 48 (24%) had malnutrition. Children were sick for a median of 2 days and most had received outpatient medical care prior to admission. The median monthly household income was higher for well-nourished children compared to malnourished children (p < 0.001). The median total cost of a diarrhea illness resulting in hospitalization was $293.74 (IQR: 188.42, 427.89). Direct medical costs, with a median of $251.74 (IQR: 155.42, 390.96), comprised the majority of the total cost. Among children who tested positive for rotavirus, the median total illness cost was $243.78 (IQR: 160.92, 323.84). The median direct medical costs were higher for malnourished than well-nourished children (p < 0.001).Direct medical costs are the primary determinant of diarrhea illness costs in Zimbabwe. The descriptive findings from this evaluation are an important first step in calculating the cost effectiveness of rotavirus vaccine.
Keywords	caregivers ; children ; cost effectiveness ; diarrhea ; feces ; hospitals ; household income ; malnutrition ; medical records ; questionnaires ; transportation ; vaccination ; vaccines ; Zimbabwe
Language	English
Dates of publication	2020-1007
Size	p. 6735-6740.
Publishing place	Elsevier Ltd
Document type	Article
Note	NAL-AP-2-clean
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2020.08.049
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Article ; Online: Brief Report: Cessation of Long-Term Cotrimoxazole Prophylaxis in HIV-Infected Children Does Not Alter the Carriage of Antimicrobial Resistance Genes.

Francis, Freddy / Gough, Ethan K / Edens, Thaddeus J / Berejena, Chipo / Bwakura-Dangarembizi, Mutsawashe / Shonhai, Annie / Nathoo, Kusum J / Glass, Magdalena / Gibb, Diana M / Prendergast, Andrew J / Manges, Amee R

Journal of acquired immune deficiency syndromes (1999)

2020 Volume 85, Issue 5, Page(s) 601–605

Abstract: Background: Cotrimoxazole (CTX) is a broad-spectrum antimicrobial, combining trimethoprim and sulfamethoxazole. CTX prophylaxis reduces mortality and morbidity among people living with HIV in regions with high prevalence of bacterial infections and ... ...

Abstract	Background: Cotrimoxazole (CTX) is a broad-spectrum antimicrobial, combining trimethoprim and sulfamethoxazole. CTX prophylaxis reduces mortality and morbidity among people living with HIV in regions with high prevalence of bacterial infections and malaria. The Antiretroviral research for Watoto trial evaluated the effect of stopping versus continuing CTX prophylaxis in sub-Saharan Africa. Methods: In this study, 72 HIV-infected Zimbabwean children, on antiretroviral therapy, provided fecal samples at 84 and 96 weeks after randomization to continue or stop CTX. DNA was extracted for whole metagenome shotgun sequencing, with sequencing reads mapped to the Comprehensive Antibiotic Resistance Database to identify CTX and other antimicrobial resistance genes. Results: There were minimal differences in the carriage of CTX resistance genes between groups. The dfrA1 gene, conferring trimethoprim resistance, was significantly higher in the continue group (P = 0.039) and the tetA(P) gene conferring resistance to tetracycline was significantly higher in the stop group (P = 0.013). CTX prophylaxis has a role in shaping the resistome; however, stopping prophylaxis does not decrease resistance gene abundance. Conclusions: No differences were observed in resistance gene carriage between the stop and continue groups. The previously shown multi-faceted protective effects of CTX in antiretroviral research for Watoto trial clinical outcomes are not outweighed by the risk of multi-drug resistance gene selection due to prophylaxis. These findings are reassuring, given current recommendations for long-term CTX prophylaxis among children living with HIV in sub-Saharan Africa to decrease mortality and morbidity.
MeSH term(s)	Anti-Bacterial Agents/pharmacology ; Anti-Infective Agents/administration & dosage ; Anti-Infective Agents/therapeutic use ; Child ; Child, Preschool ; Drug Resistance, Microbial/drug effects ; Drug Resistance, Microbial/genetics ; Female ; Gastrointestinal Microbiome/drug effects ; Gastrointestinal Microbiome/genetics ; HIV Infections/complications ; Humans ; Male ; Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Zimbabwe
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
Language	English
Publishing date	2020-08-27
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
ZDB-ID	645053-2
ISSN	1944-7884 ; 1077-9450 ; 0897-5965 ; 0894-9255 ; 1525-4135
ISSN (online)	1944-7884 ; 1077-9450
ISSN	0897-5965 ; 0894-9255 ; 1525-4135
DOI	10.1097/QAI.0000000000002489
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Article ; Online: Cost estimates of diarrhea hospitalizations among children <5 years old in Zimbabwe.

Vaccine

2020 Volume 38, Issue 43, Page(s) 6735–6740

Abstract: Introduction: Diarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017. Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and ... ...

Abstract	Introduction: Diarrhoea is a leading killer of children <5 years old, accounting for 480,000 deaths in 2017. Zimbabwe introduced Rotarix into its vaccination program in 2014. In this evaluation, we estimate direct medical, direct non-medical, and indirect costs attributable to a diarrhea hospitalization in Zimbabwe after rotavirus vaccine introduction. Methods: Children <5 years old admitted to Harare Central Hospital from June 2018 to April 2019 with acute watery diarrhea were eligible for this evaluation. A 3-part structured questionnaire was used to collect data by interview from the child's family and by review of the medical record. A stool specimen was also collected and tested for rotavirus. Direct medical costs were the sum of medications, consumables, diagnostic tests, and service delivery costs. Direct non-medical costs were the sum of transportation, meals and lodging for caregivers. Indirect costs are the lost income for household members. Results: A total of 202 children were enrolled with a median age of 12 months (IQR: 7-21) and 48 (24%) had malnutrition. Children were sick for a median of 2 days and most had received outpatient medical care prior to admission. The median monthly household income was higher for well-nourished children compared to malnourished children (p < 0.001). The median total cost of a diarrhea illness resulting in hospitalization was $293.74 (IQR: 188.42, 427.89). Direct medical costs, with a median of $251.74 (IQR: 155.42, 390.96), comprised the majority of the total cost. Among children who tested positive for rotavirus, the median total illness cost was $243.78 (IQR: 160.92, 323.84). The median direct medical costs were higher for malnourished than well-nourished children (p < 0.001). Conclusion: Direct medical costs are the primary determinant of diarrhea illness costs in Zimbabwe. The descriptive findings from this evaluation are an important first step in calculating the cost effectiveness of rotavirus vaccine.
MeSH term(s)	Child ; Child, Preschool ; Cost of Illness ; Diarrhea/epidemiology ; Hospitalization ; Humans ; Infant ; Rotavirus ; Rotavirus Infections/epidemiology ; Rotavirus Vaccines ; Zimbabwe/epidemiology
Chemical Substances	Rotavirus Vaccines
Language	English
Publishing date	2020-08-29
Publishing country	Netherlands
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	605674-x
ISSN	1873-2518 ; 0264-410X
ISSN (online)	1873-2518
ISSN	0264-410X
DOI	10.1016/j.vaccine.2020.08.049
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Article ; Online: Recovery of children following hospitalisation for complicated severe acute malnutrition.

Bwakura-Dangarembizi, Mutsa / Dumbura, Cherlynn / Amadi, Beatrice / Chasekwa, Bernard / Ngosa, Deophine / Majo, Florence D / Sturgeon, Jonathan P / Chandwe, Kanta / Kapoma, Chanda / Bourke, Claire D / Robertson, Ruairi C / Nathoo, Kusum J / Ntozini, Robert / Norris, Shane A / Kelly, Paul / Prendergast, Andrew J

Maternal & child nutrition

2021 Volume 18, Issue 2, Page(s) e13302

Abstract: Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery ... ...

Abstract	Nutritional recovery and hospital readmission following inpatient management of complicated severe acute malnutrition (SAM) are poorly characterised. We aimed to ascertain patterns and factors associated with hospital readmission, nutritional recovery and morbidity, in children discharged from hospital following management of complicated SAM in Zambia and Zimbabwe over 52-weeks posthospitalization. Multivariable Fine-Gray subdistribution hazard models, with death and loss to follow-up as competing risks, were used to identify factors associated with hospital readmission; negative binomial regression to assess time to hospitalisation and ordinal logistic regression to model factors associated with nutritional recovery. A total of 649 children (53% male, median age 18.2 months) were discharged to continue community nutritional rehabilitation. All-cause hospital readmission was 15.4% (95% CI 12.7, 18.6) over 52 weeks. Independent risk factors for time to readmission were cerebral palsy (adjusted subhazard ratio (aSHR): 2.96, 95% CI 1.56, 5.61) and nonoedematous SAM (aSHR: 1.64, 95%CI 1.03, 2.64). Unit increases in height-for-age Z-score (HAZ) (aSHR: 0.82, 95% CI 0.71, 0.95) and enrolment in Zambia (aSHR: 0.52, 95% CI 0.28, 0.97) were associated with reduced subhazard of time to readmission. Young age, SAM at discharge, nonoedematous SAM and cerebral palsy were associated with poor nutritional recovery throughout follow-up. Collectively, nonoedematous SAM, ongoing SAM at discharge, cerebral palsy and low HAZ are independent risk factors for readmission and poor nutritional recovery following complicated SAM. Children with these high-risk features should be prioritised for additional convalescent care to improve long-term outcomes.
MeSH term(s)	Cerebral Palsy/therapy ; Child ; Female ; Hospitalization ; Humans ; Infant ; Male ; Malnutrition ; Patient Discharge ; Patient Readmission ; Severe Acute Malnutrition/therapy
Language	English
Publishing date	2021-12-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2175105-5
ISSN	1740-8709 ; 1740-8695
ISSN (online)	1740-8709
ISSN	1740-8695
DOI	10.1111/mcn.13302
Database	MEDical Literature Analysis and Retrieval System OnLINE

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