Papers by Amynah Janmohamed
International journal of gynaecology and obstetrics, Oct 1, 2010
Objective: To compare temperatures reached by 4 different cryotherapy devices commonly used to tr... more Objective: To compare temperatures reached by 4 different cryotherapy devices commonly used to treat precancerous cervical lesions in low-resource countries using nitrous oxide (N 2 O) and carbon dioxide (CO 2) as well as with and without a gas conditioner. Methods: Bench testing was conducted using 4 different cryotherapy devices and locally obtained N 2 O and medical-and industrial-grade CO 2 refrigerant with and without a gas conditioner. A thermocouple was used to continuously measure the temperature of the cryotherapy tip. Comparison across the cryotherapy devices was based on the mean and lowest temperatures. Results: Without the gas conditioner, all of the devices tested reached mean temperatures colder than-50°C with N 2 O, although 2 devices reached warmer temperatures in a proportion of N 2 O tests. Only 2 of the devices reached mean temperatures colder than-50°C with CO 2. One-way analysis of variance identified the device as the dominant factor for the temperature differences, while the gas was not a determinant of temperature variation. The gas conditioner hindered the performance of 2 of the devices, and only improved the performance of 1 device. Conclusion: Both N 2 O and CO 2 reach appropriate freezing temperatures with some cryotherapy devices. Performance of some cryotherapy devices is suboptimal.
European journal of nutrition & food safety, Jan 10, 2015
Public Health Nutrition, Jul 3, 2023
Objective: To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore ... more Objective: To assess child vitamin A supplementation (VAS) coverage in 2019 and 2020 and explore key factors, including COVID-19 concerns, that influenced VAS status in four sub-Saharan African countries. Design: Data from eight representative household surveys were used to assess VAS coverage. Multivariable logistic regression models examined the effect of rural/ urban residence, child sex and age, caregiver education, COVID-19 concern and household wealth on VAS status.
Maternal and Child Nutrition, Jun 30, 2020
Thailand is now faced with a double burden of malnutrition. Using nationally representative data ... more Thailand is now faced with a double burden of malnutrition. Using nationally representative data from the 2015-2016 Multiple Indicator Cluster Survey, we utilized multinomial logistic regression models to examine factors associated with stunting only, wasting only, overweight only, concurrent stunting and overweight, and concurrent stunting and wasting among children 0-59 months of age (n = 11,068). The prevalences of <5 stunting only (height-forage Z score < −2 SD) and wasting only (WHZ < −2 SD) were 8.5% and 4.7%, respectively. The prevalence of <5 overweight only (WHZ > +2 SD) was 7.8%. Children 12-23 months (risk ratio [RR], 95% confidence interval [CI]: 1.47 [1.18, 1.83]; p < .01) and 24-35 months (RR, 95% CI: 1.56 [1.26, 1.94]; p < .001) were at increased risk for stunting only, compared with children 48-59 months. The strongest risk factor for stunting only was low birth weight (RR, 95% CI: 3.42 [2.86, 4.10]; p < .001). Children 0-5 months were at highest risk for wasting only, compared with children 48-59 months (RR, 95% CI: 2.91 [2.16, 3.92]; p < .001). Children 48-59 months and male children were more likely to be overweight only. Higher household wealth and smaller household size were also significant predictors of overweight only. A small proportion of children were concurrently stunted and overweight (1.3%) and concurrently stunted and wasted (0.6%). A multipronged approach focused on adequate prenatal care, improving breastfeeding and complementary feeding practices, and mitigating the growing burden of overweight is needed to address the double burden of malnutrition in Thailand.
Tropical Medicine & International Health, May 26, 2017
objective To compare administrative coverage data with results from household coverage surveys fo... more objective To compare administrative coverage data with results from household coverage surveys for vitamin A supplementation (VAS) and deworming campaigns conducted during 2010-2015 in 12 African countries. methods Paired t-tests examined differences between administrative and survey coverage for 52 VAS and 34 deworming dyads. Independent t-tests measured VAS and deworming coverage differences between data sources for door-to-door and fixed-site delivery strategies and VAS coverage differences between 6-to 11-month and 12-to 59-month age group. results For VAS, administrative coverage was higher than survey estimates in 47 of 52 (90%) campaign rounds, with a mean difference of 16.1% (95% CI: 9.5-22.7; P < 0.001). For deworming, administrative coverage exceeded survey estimates in 31 of 34 (91%) comparisons, with a mean difference of 29.8% (95% CI: 16.9-42.6; P < 0.001). Mean AE SD differences in coverage between administrative and survey data were 12.2% AE 22.5% for the door-to-door delivery strategy and 25.9% AE 24.7% for the fixed-site model (P = 0.06). For deworming, mean AE SD differences in coverage between data sources were 28.1% AE 43.5% and 33.1% AE 17.9% for door-to-door and fixed-site distribution, respectively (P = 0.64). VAS administrative coverage was higher than survey estimates in 37 of 49 (76%) comparisons for the 6-to 11-month age group and 45 of 48 (94%) comparisons for the 12-to 59-month age group. conclusion Reliance on health facility data alone for calculating VAS and deworming coverage may mask low coverage and prevent measures to improve programmes. Countries should periodically validate administrative coverage estimates with population-based methods.
Nutrients, Feb 10, 2020
Weak delivery systems reduce the potential of evidence-supported interventions to improve nutriti... more Weak delivery systems reduce the potential of evidence-supported interventions to improve nutrition. We synthesized the evidence for the effectiveness of nutrition-specific intervention delivery platforms for improving nutrition outcomes in low and middle-income countries (LMIC). A systematic literature search for studies published from 1997 to June 2018 resulted in the inclusion of 83 randomized controlled trials (RCTs), quasi-randomized, and controlled before-after studies across a variety of delivery platforms. In this paper, we report on meta-analysed outcomes for community health worker (CHW) home visits and mother/peer group delivery platforms. Compared to care as usual, CHW home visits increased early initiation of breastfeeding (EIBF) (
American Journal of Tropical Medicine and Hygiene, Nov 2, 2016
Multiple factors contribute to undernutrition in Cambodian women. Our aim was to determine if typ... more Multiple factors contribute to undernutrition in Cambodian women. Our aim was to determine if type of household sanitation facility was associated with body mass index (BMI) and hemoglobin (Hb) concentration among pregnant women. Women (N = 544) from 75 villages in Kampong Chhnang Province had their height, weight, and Hb measured (HemoCue Hb 201 +) in the first trimester. Sociodemographic and household characteristics were collected. Multivariable linear and logistic regression models were used for analyses. Approximately 40% (N = 221) of women reported primarily using an 'improved' sanitation facility (closed pit latrine) and ∼60% (N = 323) used 'non-improved' facilities (open defecation). Mean ± standard deviation (SD) BMI was higher among women with improved versus non-improved facilities (19.9 ± 3.0 kg/m 2 versus 19.4 ± 2.3 kg/m 2 ; P = 0.01). Mean ± SD Hb concentration was also higher among women with improved versus non-improved facilities (118 ± 12 g/L versus 114 ± 14 g/L; P = 0.001). Anemia prevalence (Hb < 110 g/L) was higher among women with non-improved facilities (34% versus 25%; P = 0.04). An improved sanitation facility was a positive predictor of BMI (β = 0.57 kg/m 2 ; 95% confidence interval [CI] = 0.10, 1.04) and Hb concentration (β = 2.94 g/L; 95% CI = 0.53, 5.35), adjusting for age, parity, household size, village, gestation week, source of drinking water, and iron folic acid supplementation. Poor sanitation was associated with lower BMI and Hb concentration among pregnant Cambodian women. This warrants multisectoral approaches involving the health, nutrition, water, and sanitation sectors to effectively improve maternal health in Cambodia.
Public Health Nutrition, May 23, 2017
Objective: Vitamin A supplementation (VAS) for children aged 6-59 months occurs regularly in most... more Objective: Vitamin A supplementation (VAS) for children aged 6-59 months occurs regularly in most sub-Saharan African countries. The present study aimed to explore child, household and delivery platform factors associated with VAS coverage and identify barriers to compliance in thirteen African countries. Design: We pooled data (n~60 000) from forty-four household coverage surveys and used bivariate and multivariable regression analyses to assess the effects of supplementation strategy, rural v. urban residence, child sex, child age, caregiver education and campaign awareness on child VAS status. Setting/Subjects: Primary caregivers of children aged 6-59 months in thirteen countries. Results: Door-to-door distribution resulted in higher VAS coverage than fixed-site plus outreach approaches (91 v. 63 %) and was a significant predictor of supplementation in the adjusted model (OR = 19•0; 95 % CI 17•2, 21•1; P < 0•001). Having been informed about the campaign was the main predictor of VAS in the door-to-door (OR = 6•8; 95 % CI 5•8, 7•9; P < 0•001) and fixed-site plus outreach (OR = 72•5; 95 % CI 66•6, 78•8; P < 0•001) groups. Conclusions: Door-to-door provision of VAS may achieve higher coverage than fixed-site models in the African context. However, the phase-out of door-to-door polio immunization campaigns in most sub-Saharan African countries threatens the main distribution vehicle for VAS. Our findings suggest well-informed communities are key to attaining higher coverage using fixed-site delivery alternatives.
Journal of Public Health in Africa, May 3, 2019
We conducted a randomized controlled trial to assess the effect of providing mothers with mobile ... more We conducted a randomized controlled trial to assess the effect of providing mothers with mobile voice or text (SMS) reminder messages on health facility attendance at five infant immunization and vitamin A supplementation (VAS) visits. The study was conducted at 29 health facilities in Korhogo district. Mothers were randomized to receive a voice or text reminder message two days prior to each scheduled visit and two additional reminders for missed doses (n=798; intervention group), or no phone reminder messages (n=798; control group). Infants in the intervention group were 2.85 (95% CI: 1.85-4.37), 2.80 (95% CI: 1.88-4.17), 2.68 (95% CI: 1.84-3.91), and 4.52 (95% CI: 2.84-7.20) times more likely to receive pentavalent 1-3 and MMR/yellow fever doses, respectively, and 5.67 (95% CI: 3.48-9.23) times more likely to receive VAS, as compared to the control group. In the reminder group, 58.3% of infants completed all five visits, compared to 35.7% in the control group (P<0.001). Providing mothers mobile phone message reminders is a potentially effective strategy for improving immunization and VAS coverage in Côte d'Ivoire.
Background: Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered an... more Background: Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule. There are no known studies on the accuracy of Hb measurement among individuals with Hb E or other Hb variants. Methods: This method-comparison study evaluates two methods to measure Hb concentration in capillary blood using a hemoglobinometer (HemoCueÒ) and in venous blood using an automated hematology analyzer (Sysmex XT-1800i). We determined the bias and concordance between the two methods among 420 non-pregnant women (18-45 y) in Cambodia using secondary data from a separate trial. Results: Bias and concordance appeared similar between methods among women with no Hb disorders (n=195, bias=2.5, rc=0.68), women with Hb E variants (n=133, bias=2.5, rc=0.78), and women with other Hb variants (n=92, bias=2.7, rc=0.73). Overall, agreement was poor between methods. The overall bias was 2.6 g/L (difference in Hb means between methods), resulting in a difference in anem...
Bulletin of The World Health Organization, 2011
Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects ... more Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
Vaccine, 2011
Operational research using a mixed method, cross-sectional, case-study approach assessed the feas... more Operational research using a mixed method, cross-sectional, case-study approach assessed the feasibility and health system impact of large-scale implementation of human papillomavirus (HPV) vaccination into routine vaccine delivery by the Ministry of Health in Peru. The strategy was school-based vaccination of fifth grade girls in 527 primary schools in Piura region. Our evaluation showed that school-based HPV vaccination is feasible without major changes in existing health systems. This was reflected in the opinions of health personnel, the lack of impact on other vaccine coverage, and the high HPV vaccine coverage documented in routine records and by an independent community-based survey.
Psychiatric Bulletin, 2004
Aims and MethodWe surveyed all our senior house officers (SHOs) in 1998 to ascertain the nature a... more Aims and MethodWe surveyed all our senior house officers (SHOs) in 1998 to ascertain the nature and quality of their psychotherapy training. Following the introduction of a structured psychotherapy training programme, we wished to see what difference this had made to their training experience. The same questionnaire was used to survey all SHOs currently training in our trust, and compared their responses with those of the earlier cohort.ResultsThere was a statistically significant increase in the number of trainees seeing patients, in the number of psychotherapy patients being seen, and in the expectations of trainees of being able to fulfil College requirements.Clinical ImplicationsOur results demonstrate the value of a formal psychotherapy training programme for the quality of psychotherapy training at SHO level. In particular, the introduction of protected time may have been crucial in allowing the SHOs to gain the necessary experience.
JAMA, 2011
ERVICAL CANCER IS AN IMPORtant cause of morbidity and mortality among women throughout the world.... more ERVICAL CANCER IS AN IMPORtant cause of morbidity and mortality among women throughout the world. Each year, new cases of cervical cancer occur in approximately 529 000 women and 275 000 women die. 1 An estimated 88% of deaths due to cervical cancer occur among women residing in developing countries. 1,2 In Vietnam, cervical cancer is the fourth leading cause of cancer deaths among women, with significant disparities between regions. 3-5 Inadequate access to cervical cancer screening and early intervention is the main cause of this health burden inequity. Human papillomaviruses (HPVs) are the primary cause of cervical cancer. Of the more than 100 identified HPV types, HPV-16 and HPV-18 account for 70% of cervical cancer cases; however, regional variations do exist. 6,7 HPV-16 and HPV-18 are included in 2 of the HPV vaccine formulations currently licensed and prequalified by the World Health Organization. These vaccines are highly efficacious in preventing cervical precancers related to HPV-16 and HPV-18 when administered to women naive to these HPV types. 8-11 Combined with continued strengthening of simple evidence-based screening and treatment approaches, effective HPV vaccine programs could reduce cervical cancer rates in developing coun-Author Affiliations are listed at the end of this article.
International Journal of Gynecology & Obstetrics, 2010
Objective: To compare temperatures reached by 4 different cryotherapy devices commonly used to tr... more Objective: To compare temperatures reached by 4 different cryotherapy devices commonly used to treat precancerous cervical lesions in low-resource countries using nitrous oxide (N 2 O) and carbon dioxide (CO 2) as well as with and without a gas conditioner. Methods: Bench testing was conducted using 4 different cryotherapy devices and locally obtained N 2 O and medical-and industrial-grade CO 2 refrigerant with and without a gas conditioner. A thermocouple was used to continuously measure the temperature of the cryotherapy tip. Comparison across the cryotherapy devices was based on the mean and lowest temperatures. Results: Without the gas conditioner, all of the devices tested reached mean temperatures colder than-50°C with N 2 O, although 2 devices reached warmer temperatures in a proportion of N 2 O tests. Only 2 of the devices reached mean temperatures colder than-50°C with CO 2. One-way analysis of variance identified the device as the dominant factor for the temperature differences, while the gas was not a determinant of temperature variation. The gas conditioner hindered the performance of 2 of the devices, and only improved the performance of 1 device. Conclusion: Both N 2 O and CO 2 reach appropriate freezing temperatures with some cryotherapy devices. Performance of some cryotherapy devices is suboptimal.
International Journal of Gynecology & Obstetrics, 2009
Objective: To assess the impact of the cough technique on the tip temperature reached in a cryoth... more Objective: To assess the impact of the cough technique on the tip temperature reached in a cryotherapy device commonly used to treat precancerous cervical lesions. Methods: During February to March 2009, bench testing was conducted in Peru on 3 Wallach LL100 cryotherapy units using locally obtained carbon dioxide as the refrigerant. The temperature at the cryo tip was measured continuously with a thermocouple. Mean temperatures recorded with and without the cough technique were compared across the 3 cryotherapy devices. Results: Higher mean temperatures were observed with the cough technique (-21.7°C [95% CI,-23.0 to-20.4];-22.0°C [95% CI,-24.2 to-19.7];-29.4°C [95% CI,-30.3 to-28.6]) compared with mean temperatures observed with the standard procedure (-38.6°C [95% CI,-44.8 to-32.4];-36.0°C [95% CI,-43.5 to-28.5];-41.4°C [95% CI,-49.8 to-33.0]). No test performed with the cough technique reached a temperature below-33°C. Conclusion: Higher temperatures were observed when the cough technique was used. Caution should be exercised by practitioners who use this procedure when performing cryotherapy because the temperatures obtained may not be sufficient to destroy precancerous tissue.
Bulletin of the World Health Organization, 2011
Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects ... more Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3-85.6) in Peru, 88.9% (95% CI: 84.7-92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0-97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4-81.6) to 87.8% (95% CI: 84.3-91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4-73.4) to 83.3% (95% CI: 79.3-87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
The Open Vaccine Journal, 2009
Introduction: Formative research can inform country-level HPV vaccine delivery strategies, commun... more Introduction: Formative research can inform country-level HPV vaccine delivery strategies, communication messages, and advocacy plans. This paper describes our formative research's conceptual framework; details our applied methodology; summarizes our field experience and challenges; and outlines best practices for formative research in vaccine introduction. Methods: From 2006-2008, literature reviews, stakeholder mapping, sociocultural studies, health system assessments, and policy reviews were conducted. Data collection at individual, interpersonal, community, institutional, and policy levels included in-depth interviews, focus groups, surveys, observations, secondary data, and facility audits. Data were analyzed thematically using an iterative process. Discussion: Integrated formative research can be implemented in low-resource settings, but may require overcoming operational challenges. Best practices in applied formative research include a conceptual framework, multidisciplinary approach, and rapid dissemination of results. Conclusions: Formative research informs effective health program planning by examining complex and interrelated factors surrounding vaccination. Methodologically sound formative research provides valid and reliable evidence for country-level vaccine introduction.
International Journal of Laboratory Hematology, 2020
This report is part of the "Cervical Cancer Prevention: Practical Experience Series" on... more This report is part of the "Cervical Cancer Prevention: Practical Experience Series" on the RHO Cervical Cancer website summarizing lessons learned to guide cervical cancer prevention program planning in low-resource settings. It demonstrates that formative research is a necessary component of overall planning discusses formative research issues specific to cervical cancer and explains how research results may be used for strategic planning within the cervical cancer context.
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Papers by Amynah Janmohamed