To determine operational and analytical characteristics of respondent-driven sampling (RDS) in international settings and to explore factors that may affect recruitment of most-at-risk populations using RDS, we reviewed HIV biological and behavioral surveillance studies that used this method outside of the United States. We identified 123 eligible studies, 59 from Europe, 40 from Asia and the Pacific, 14 from Latin America, seven from Africa and three from Oceania. Studies collectively recruited 32,298 participants between 2003 and 2007; 53% of studies were conducted among injecting drug users, which generally had faster recruitment compared with studies among sex workers. All but 13 studies reached > or = 90% of their intended sample size, and six studies failed to reach equilibrium for key variables. This review has shown that RDS is an effective technique, when designed and implemented appropriately, to sample most-at-risk populations for HIV biological and behavioral surveys.

Using respondent-driven sampling (RDS), we gathered data from 128 HIV surveillance studies conducted outside the United States through October 1, 2007. We examined predictors of poor study outcomes, reviewed operational, design and analytical challenges associated with conducting RDS in international settings and offer recommendations to improve HIV surveillance. We explored factors for poor study outcomes using differences in mean sample size ratios (recruited/calculated sample size) as the outcome variable. Ninety-two percent of studies reported both calculated and recruited sample sizes. Studies of injecting drug users had a higher sample size ratio compared with other risk groups. Study challenges included appropriately defining eligibility criteria, structuring social network size questions, selecting design effects and conducting statistical analysis. As RDS is increasingly used for HIV surveillance, it is important to learn from past practical, theoretical and analytical challenges to maximize the utility of this method.

Obtaining samples of populations at risk for HIV challenges surveillance, prevention planning, and evaluation. Methods used include snowball sampling, time location sampling (TLS), and respondent-driven sampling (RDS). Few studies have made side-by-side comparisons to assess their relative advantages. We compared snowball, TLS, and RDS surveys of men who have sex with men (MSM) in Forteleza, Brazil, with a focus on the socio-economic status (SES) and risk behaviors of the samples to each other, to known AIDS cases and to the general population. RDS produced a sample with wider inclusion of lower SES than snowball sampling or TLS-a finding of health significance given the majority of AIDS cases reported among MSM in the state were low SES. RDS also achieved the sample size faster and at lower cost. For reasons of inclusion and cost-efficiency, RDS is the sampling methodology of choice for HIV surveillance of MSM in Fortaleza.

The AIDS epidemic in Brazil is disproportionately concentrated among MSM, as has been found in other countries. Renewed efforts to encourage testing, prevention and treatment are required.

ObjectivesRespondent-driven sampling (RDS) is a new data collection methodology used to estimate characteristics of hard-to-reach groups, such as the HIV prevalence in drug users. Many national public health systems and international organizations rely on RDS data. However, RDS reporting quality and available reporting guidelines are inadequate. We carried out a systematic review of RDS studies and present Strengthening the Reporting of Observational Studies in Epidemiology for RDS Studies (STROBE-RDS), a checklist of essential items to present in RDS publications, justified by an explanation and elaboration document.Study Design and SettingWe searched the MEDLINE (1970–2013), EMBASE (1974–2013), and Global Health (1910–2013) databases to assess the number and geographical distribution of published RDS studies. STROBE-RDS was developed based on STROBE guidelines, following Guidance for Developers of Health Research Reporting Guidelines.ResultsRDS has been used in over 460 studies from 69 countries, including the USA (151 studies), China (70), and India (32). STROBE-RDS includes modifications to 12 of the 22 items on the STROBE checklist. The two key areas that required modification concerned the selection of participants and statistical analysis of the sample.ConclusionSTROBE-RDS seeks to enhance the transparency and utility of research using RDS. If widely adopted, STROBE-RDS should improve global infectious diseases public health decision making.

Summaryobjectives Interventions that promote appropriate care-seeking for severely ill children have the potential to substantially reduce child mortality in developing countries, but little is known about the best approach to address the issue. This paper explores the relative importance of illness recognition as a barrier to care-seeking and the feasibility and potential impact of improving recognition.methods The study combined qualitative and quantitative methods including in-depth interviews exploring the local illness classification system, a Rapid Anthropological Assessment (RAA) recording narratives of recent episodes of child illness and a survey designed to test the hypotheses that emerged from the RAA.results Several danger symptoms were not recognized by caregivers. There were recognition problems which may not be feasibly addressed in an intervention. Other significant care-seeking barriers included classifying certain illnesses as Ônot-for-hospitalÕ and untreatable by modern medicine; problems of access; and frequent use of traditional medicines.conclusion The recognition component of any care-seeking intervention should identify the type of recognition problem present in the community. Many of the care-seeking barriers identified in the study revolved around the local illness classification system, which should be explored and built on as part of any care-seeking intervention.

SummaryLarge-scale trials of insecticide-treated nets (ITNs) throughout Sub-Saharan Africa demonstrated that they reduce child mortality in malaria endemic communities. These encouraging results have generated interest in ITNs as a viable malaria control strategy in many malaria endemic countries. However, regular use of ITNs under routine or non-project conditions has been beset with several problems. This paper explores how local community knowledge about malaria acts as a barrier to the use of ITNs in three settings. We employed structured formal observation and a range of interviewing techniques which included informal interviews, focus group discussions, semi-structured in-depth interviews, and structured survey interviewing. People recognize the term 'malaria' but have limited biomedical knowledge of the disease, including its aetiology, the role of the vector, and host response. Convulsions and anaemia are rarely linked to malaria. The people acknowledged a role for ITNs in nuisance reduction, but not for malaria prevention.

BackgroundOutpatient Therapeutic feeding Program (OTP) brings the services for management of Severe Acute Malnutrition (SAM) closer to the community by making services available at decentralized treatment points within the primary health care settings, through the use of ready-to-use therapeutic foods, community outreach and mobilization. Little is known about the program outcomes. This study revealed the levels of program outcome indictors and determinant factors to recovery rate.MethodsA retrospective cohort study was conducted on 628 children who had been managed for SAM under OTP from April/2008 to January/2012. The children were selected using systematic random sampling from 12 health posts and 4 health centers. The study relied on information of demographic characteristics, anthropometries, Plumpy'Nut, medical problems and routine medications intakes. The results were estimated using Kaplan-Meier survival curves, log-rank test and Cox-regression.ResultsThe recovery, defaulter, mortality and weight gain rates were 61.78%, 13.85%, 3.02% and 5.23 gm/kg/day, respectively. Routine medications were administered partially and children with medical problems were managed inappropriately under the program. As a child consumed one more sachet of Plumpy'Nut, the recovery rate from SAM increased by 4% (HR = 1.04, 95%-CI = 1.03, 1.05, P<0.001). The adjusted hazard ratios to recovery of children with diarrhea, appetite loss with Plumpy'Nut and failure to gain weight were 2.20 (HR = 2.20, 95%-CI = 1.31, 3.41, P = 0.001), 4.49 (HR = 1.74, 95%-CI = 1.07, 2.83, P = 0.046) and 3.88 (HR = 1.95, 95%-CI = 1.17, 3.23, P<0.001), respectively. Children who took amoxicillin and de-worming had 95% (HR = 1.95, 95%-CI = 1.17, 3.23) and 74% (HR = 1.74, 95%-CI = 1.07, 2.83) more probability to recover from SAM as compared to those who didn't take them.ConclusionsThe OTP was partially successful. Management of children with comorbidities under the program and partial administration of routine drugs were major threats for the program effectiveness. The stakeholders should focus on creating the capacity of the OTP providers on proper management of SAM to achieve fully effective program.