Showing papers by "Deborah Watson-Jones published in 2023"

Associations between age of menarche, early sexual debut and high‐risk sexual behaviour among urban Tanzanian schoolgirls: A cross‐sectional study

Abstract: This cross‐sectional survey aimed to explore associations between age of menarche, early sexual debut and high‐risk sexual behaviour among urban Tanzanian schoolgirls.

Protection, health seeking, or a laissez-passer: Participants' decision-making in an EVD vaccine trial in the eastern Democratic Republic of the Congo.

Abstract: During the 10th Ebola virus disease (EVD) epidemic in the eastern Democratic Republic of the Congo (DRC) (2018-2020), two experimental EVD vaccines were deployed in North Kivu. This province has been at the centre of conflict in the region for the last 25 years. Amidst ambivalence towards protracted foreign intervention and controversy about introducing two experimental vaccines, the existing literature has focused on mistrust and 'resistance' towards the Ebola response and vaccines. In this article, we examine why people in the eastern DRC did decide to volunteer for a trial of a second EVD vaccine in North Kivu, despite the controversy. Drawing on ethnographic observation, interviews, and focus groups with trial participants conducted between September 2020 and April 2021, we analyse three motivations for participating: protection, health seeking, and expectations surrounding travel requirements. We make three points. First, participation in vaccine trials may be understood locally to have advantages which have not been considered by the trial, because they go beyond medical considerations and are specific to a particular social setting. Second, despite much of the literature focusing on a causal relationship between rumours and 'vaccine hesitancy', some rumours may in fact encourage participation. Third, material objects associated with trial participation - such as participant vaccine cards - can hold social and political meaning beyond the confines of the vaccine clinic, and influence decisions surrounding participation. Empirical investigation of how medical interventions become entangled in political economies is essential to understanding the perceived functions of participation, and thus the reasons why people volunteer in clinical trials. Participants' narratives about their decision-making provide an insight into how international bioethical debates interact with, but may also stand apart from, the situated social and economic realities driving decision-making around clinical trials on the ground. This highlights the need for ethical approaches that foreground the political, social, and economic context.

Piloting a pragmatic clinical audit tool for quality improvement in rural paediatric care in northern Sierra Leone

Abstract: Hospital admissions and their clinical outcome can reflect the disease burden in a population and can be utilised as effective surveillance and impact monitoring tools. Inadequate documentation of admissions and their outcomes have contributed to the poor quality of paediatric care in many health care settings in sub-Saharan Africa. We have developed and piloted a simple tool for documentation of basic, standardised patient-level information on causes of admissions, diagnoses, treatments and outcomes in patients admitted to the paediatric ward of a district hospital in a rural community in Sierra Leone. From 1 August 2019 to 31 July 2021, we used this tool to document the admissions, treatments and clinical outcomes of 1,663 children admitted to this hospital. The majority of the children (1015, 62%) were aged between 12-59 months, were boys (942, 57%), were wasted (516, 31%), stunted (238 14%) or underweight (537, 32%). More than half of the children lived more than 1 km distance from the hospital (876/1410, 62%). Most were admitted before 4pm (1171/1626, 72%) and during weekdays (1231/1662, 74%). The highest number of paediatric admissions occurred in November 2019 and the lowest in April 2020. Severe malaria was the leading cause of admission. More than 80% of the children were successfully treated and discharged home (1356/1663, 81.5%) while 122/1663 (7.3%) died. Children aged under-five years who were underweight, and those who presented with danger signs (e.g. signs of breathing difficulty, dehydration, head injury or severe infections) had a higher risk of death than children without these features (p<0.01; p=0.03; p=0.011 and p= 0.009, respectively). Lack of systematic documentation of medical histories and poor record keeping of hospital admissions and outcomes can be overcome by using a simple tool. Continuous use of the tool with regular audits could improve delivery of paediatric care in resource-limited settings.