Delivering early essential newborn care training in Rural Mongolia: an on-the-ground perspective

: 1.034_MDG A retrospective chart review of treatment initiation and outcomes following antiretroviral therapy (ART) delivery at the Komfo Anokye Teaching Hospital (KATH) HIV clinic in

Background: There is no doubt that global access to anti-retroviral medications has certainly helped to curb the HIV/AIDs epidemic , but what is still open to interpretation is how successful we are at the individual level in resource limited settings.
Methods: We reviewed the charts of patients who enrolled in care at the Komfo Anokye Teaching Hospital (KATH) HIV clinic in Kumasi, Ghana in 2004. We collected information on demographics, clinical statuses at presentation, and treatment histories over a 10 year period. We calculated descriptive statistics including means, standard deviations, and percentages to describe various characteristics and treatment outcomes (gaps in care, regimen changes, loss to follow up) of this cohort.
Interpretation: Over this 10 year period following the introduction of ARTs, there was a high percentage of patients experiencing regimen changes, gaps in care, and loss to follow up. This highlights the fact that simply providing ARTs is not enough to curb the HIV/ AIDs epidemic in resource limited settings. Background: The under-five mortality rate in Mongolia has fallen 74% over the past 20 years, yet the fall in neonatal mortality rate has lagged behind. Moreover, the country has seen a disparity in the reduction in neonatal deaths across socioeconomic lines. The WHO, UNICEF, UNFPA and the Mongolian Ministry of Health together have developed the Early Essential Newborn Care (EENC) program to train local physicians on neonatal resuscitation and routine newborn care. This program was implemented in 2014 with a goal of reducing the country's neonatal mortality rate by half by 2020. Objectives include sharing the perspective of two Mongolian physicians on the front lines of this nation-wide program and taking an in-depth look at the barriers in improving newborn mortality in Bayan-Ölgii, an area with one the highest neonatal mortality rates in the country.
Methods: This is a qualitative investigation by two physicians from the US who served as independent observers to a three-day EENC training program in Bayan-Ölgii. A neonatologist and an obstetrician who led the program were interviewed. Pre and post-test data was collected from 12 participants using a standardized set of 12 questions including questions about routine newborn care and neonatal asphyxia. Interpretation: The EENC course provided a structured training program in rural Mongolia, which in this setting may prove an effective method of teaching neonatal care and resuscitation to both medical and non-medical personnel. The effectiveness of the training program must be assessed continuously on a larger scale.
Funding: Research supported by the NIH award 5D43ES022862 and the Children's Hospital Los Angeles Global Health resident track. Methods: We used individual-level data from 99 Demographic and Health Surveys conducted in 36 countries in sub-Saharan Africa between 1996 and 2014 to assess the likelihood of mortality before 5 years of age. We conducted a separate analysis using annual countrylevel data on use of ITNs, IRS and ACTs between 2000-2014 from the Malaria Atlas Project. A difference-in-differences (DD) methodology was used to compare trends in PMI recipient vs. non-recipient countries and determine the impact of PMI. Models were adjusted for whether countries received support from the President's Emergency Plan for AIDS Relief (PEPFAR) and included country and year fixed effects. Standard errors were clustered at the country-level.
Findings: Our sample consisted of 7,945,703 person-year observations for children aged 5 years and 688 country-year observations of population's coverage of ITNs, IRS and ACTs. DD results showed that PMI led to a significantly lower risk of mortality among children aged 5 years (odds ratio, OR, 0.83, 95%CI 0.73-0.93). This result persisted in models that controlled for PEPFAR (OR 0.82, CI 0.73-0.92). Lastly, we found that populations in PMI-recipient countries had 10 percentage points higher coverage of ITNs (P<0.01) and 6 percentage points more child fever cases treated with ACTs (P<0.001) than populations in non-recipient countries.
Interpretation: PMI led to a large reduction in all-cause child mortality in analyses that compared trends in recipient and nonrecipient countries. This impact may have been due to increased use of malaria prevention strategies implemented with PMI support and was robust to controlling for PEPFAR. Our results should be interpreted with caution, as we did not fully account for all aid in the region; future research should address this limitation.

Results:
The study data is currently being analyzed using Stata version 12. Following research hypothesis will be presented: HIV patients with higher social capital and strong social networks 1) engage in HIV care with higher CD4 counts and lower WHO HIV/AIDS stages 2) stay in HIV care and less missed appointments. 3) have better quality of life (assessed by SF-12). Content analysis on HIV patients use of mobile phone and text messages revealed that PLWH's closest social networks were identified as immediate family members, followed by extended friends and relatives. Approximately 20% of the participants reported no use of SMS due to 'vision problems', 'prefer calling', or 'not accustomed to SMS'. Seventy-three percent of participants sent none to 10 SMS over one week. Affordability, accessibility, and privacy are the top three stated reasons for preferring SMS.
Implications: SMS is an affordable and well-accepted mode of communication among this sample of Tanzanians living with HIV. SMS can be used to improve PLWH's knowledge about the management of their chronic health status, retention and engagement to care.