ISSN (Print): 2327-669X

ISSN (Online): 2327-6703

Editor-in-Chief: Jing Sun




The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety

1Internal Medicine Conemaugh Health System, Johnstown, PA

American Journal of Public Health Research. 2016, 4(4), 149-153
doi: 10.12691/ajphr-4-4-5
Copyright © 2016 Science and Education Publishing

Cite this paper:
Mohammad U. Malik, Amibahen Gandhi, Hassan Tahir, Jhanavi Sagi, Sandhya Narukonda, Thomas Simunich, Saba Waseem, Medha Joshi. The Impact of Inpatient Electronic Sign-out on Quality and Patient Safety. American Journal of Public Health Research. 2016; 4(4):149-153. doi: 10.12691/ajphr-4-4-5.

Correspondence to: Mohammad  U. Malik, Internal Medicine Conemaugh Health System, Johnstown, PA. Email:


Introduction: The transition of patient care to the resident on call during the sign-out/hand off is an integral part of residency training and is a time vulnerable to medical errors. Methods: Authors conducted the study from July 28th to December 14th 2014. Residents (n=26) were required to sign-out via the electronically via the SBAR (Situation-Background-Assessment-Recommendation) based electronic template. The quality of sign-out was assessed by night float questionnaire. The quality of the sign-out (scale 1 to 5), preventable morbidities, LOS, mortalities and readmissions were compared pre and post intervention for the admitted patients (pre= 184, post=172). Results: Improvement in the mean quality (Likert scale 1-5) of both the written sign-out, 3.0 to 3.8 (p<0.001), and verbal sign-out, 3.0 to 3.6 (p=0.002) (n=22 pre and post), was found. The preventable morbidities decreased from 10% to 5% (p=0.047). No statistically significant difference was noted for lethal morbidities, length of stay or readmissions. Conclusion: Implementation of electronic sign-out in addition to verbal sign-out improved the quality of sign-out with trend towards reduction in morbidities. The electronic sign-out may provide key information and help the on call team to make better decisions regarding the patient care.



[1]  Wohlauer MV, Arora VM, Horwitz LI, Bass EJ, Mahar SE, Philibert I. The patient handoff: a comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med 2012;87:411-418.
[2] The ACGME Duty Hours.
[3]  Horwitz LI, Krumholz HM, Green ML, Huot SJ. Transfers of patient care between house staff on internal medicine wards: a national survey. Arch Intern Med 2006;166:1173-1177.
[4]  McCrory MC, Aboumatar H, Custer JW, Yang CP, Hunt EA. “ABC-SBAR” training improves simulated critical patient hand-off by pediatric interns. Pediatr Emerg Care 2012;28:538-543.
[5]  Vawdrey DK, Stein DM, Fred MR, Bostwick SB, Stetson PD. Implementation of a computerized patient handoff application. AMIA Annu Symp Proc 2013;2013:1395-1400.
Show More References
[6]  Starmer AJ, Spector ND, Srivastava R, Allen AD, Landrigan CP, Sectish TC. I-pass, a mnemonic to standardize verbal handoffs. Pediatrics 2012;129: 201-204.
[7]  Starmer AJ, Sectish TC, Simon DW et al. Rates of medical errors and preventable adverse events among hospitalized children following implementation of a resident handoff bundle. JAMA 2013;310: 2262-2270.
[8]  Starmer AJ, Spector ND, Srivastava R et al. Changes in medical errors after implementation of a handoff program. N Engl J Med 2014; 371:1803-1812.
[9]  Haig KM, Sutton S, Whittington J. SBAR: a shared mental model for improving communication between clinicians. Jt Comm J Qual Patient Saf 2006;32:167-175.
[10] ACGME Common Program Requirements 2016.
[11]  Dekosky AS, Gangopadhyaya A, Chan B, Arora VM. Improving Written Sign-Outs Through Education and Structured Audit: The UPDATED Approach. J Grad Med Educ 2013;5:335-336.
[12]  Lee JC, Horst M, Rogers A et al. Checklist-styled daily sign-out rounds improve hospital throughput in a major trauma center. Am Surg 2014;80:434-440.
[13]  Oak SN, Dave NM, Garasia MB, Parelkar SV. Surgical checklist application and its impact on patient safety in pediatric surgery. J Postgrad Med 2015;61:92-94.
[14]  Agarwal HS, Saville BR, Slayton JM et al. Standardized postoperative handover process improves outcomes in the intensive care unit: a model for operational sustainability and improved team performance*. Crit Care Med 2012;40:2109-2115.
[15]  Graham KL, Marcantonio ER, Huang GC, Yang J, Davis RB, Smith CC. Effect of a systems intervention on the quality and safety of patient handoffs in an internal medicine residency program. J Gen Intern Med 2013;28:986-993.
[16]  Gonzalo JD, Yang JJ, Stuckey HL, Fischer CM, Sanchez LD, Herzig SJ. Patient care transitions from the emergency department to the medicine ward: evaluation of a standardized electronic signout tool. Int J Qual Health Care 2014;26:337-347.
[17]  Inaba K, Recinos G, Teixeira PG et al. Complications and death at the start of the new academic year: is there a July phenomenon? J Trauma 2010;68:19-22.
[18]  Shulkin DJ. The July phenomenon revisited: are hospital complications associated with new house staff? Am J Med Qual 1995;10:14-17.
[19]  Levy K, Voit J, Gupta A, Petrilli CM, Chopra V. Examining the July Effect: A National Survey of Academic Leaders in Medicine. Am J Med 2016;129:754-755.
[20]  Petrilli CM, Del VJ, Chopra V. Why July Matters. Acad Med 2016;91:910-912.
[21]  Lied TR, Kazandjian VA. A Hawthorne strategy: implications for performance measurement and improvement. Clin Perform Qual Health Care 1998;6:201-204.
Show Less References


Early Mobilization and Physical Activity Improve Stroke Recovery: A Cohort Study of Stroke Inpatients in Kisumu County Referral Hospitals, Kenya

1Faculty of Health Sciences, Great Lakes University of Kisumu, Kisumu, Kenya

2Department of Physiotherapy, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya

3Faculty of Health Science, Kibabii University, Bungoma, Kenya

4School of Public Health, Capital Medical University, Beijing, PR China

American Journal of Public Health Research. 2016, 4(4), 154-158
doi: 10.12691/ajphr-4-4-6
Copyright © 2016 Science and Education Publishing

Cite this paper:
Maurice Mike Ogolla, Damian Otieno Opemo, Collins Otieno Asweto. Early Mobilization and Physical Activity Improve Stroke Recovery: A Cohort Study of Stroke Inpatients in Kisumu County Referral Hospitals, Kenya. American Journal of Public Health Research. 2016; 4(4):154-158. doi: 10.12691/ajphr-4-4-6.

Correspondence to: Collins  Otieno Asweto, School of Public Health, Capital Medical University, Beijing, PR China. Email:


Early mobilization in acute stroke care is highly recommended in a range of developed countries policy; however, in developing countries like Kenya, lack of evidence seems to hinder formulation and implementation of policy guideline on early mobilization in acute stroke care. Therefore, to estimate the safe optimal time for early mobilization of stroke patients in Kenya, we conducted a prospective cohort study in two purposively selected health facilities in Kisumu County, Kenya. About 100 stroke patients admitted in medical wards (mean age 59.1±2.3 years, females 61%) were recruited. Barthel Index’ tool was used to assess recovery and physical activity levels. It comprised of scoring scale ranging from 0-100. The participants were categorized as follows: Patients who score between 0 – 30 were considered as mildly recovered, 31 - 60 as moderately recovered and patients who score from 61 – 100 were regarded as fully recovered. Multiple logistic regression model was used to compute adjusted ORs (AOR) of early mobilization and Barthel Index variable, adjusting for age, gender and type of stroke. Early mobilization improves patient recovery. Participants in early mobilization group were more like to independently feed, groom, dress, use toilet, use wheel chair and climb stairs with help compared to late mobilization (p <0.05). Most (76%) participants who were exposed to high physical activity had full recovery than the (5%) bones in low physical activity (p< 0.001). This study provides evidence that early mobilization and high physical activity improves stroke patient recovery.



[1]  WHO . The Atlas of Heart Disease and Stroke. WHO, Geneva, 2004.
[2]  Mukherjee D, Patil CG. Epidemiology and the Global Burden of Stroke. World Neurosurg, 2011;76(6):85-90.
[3]  Kim AS, Johnston SC. (2011). Global Variation in the Relative Burden of Stroke and Ischaemic Heart Disease. Circulation, 2011;124:314-323.
[4]  Connor MD, Walker R, Modi G, Warlow CP. Burden of stroke in black populations in sub-Saharan Africa. Lancet Neurology, 2007; 6: 269-278.
[5]  O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin S, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet, 2010; 376: 112-123.
Show More References
[6]  Rosamond W, Flegal K, Furie K, Go A, Greenlund K, Haase N, et al. Heart disease and stroke statistics-2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Circulation, 2008;117(4):25-146.
[7]  Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev, 2007; 4: CD000197.
[8]  Indredavik B, Bakke F, Slørdahl SA, Rokseth R, Hamheim LL. Treatment in a combined acute and rehabilitation stroke unit: Which aspects are most important? Stroke, 1999;30:917-923.
[9]  Langhorne P, Pollock A, Stroke Unit Trialists’ Collaboration. What are the components of effective stroke unit care? Age Ageing, 2002;31:365-371.
[10]  Mutin-Carnino M, Carnino A, Rofino S, Chopard A. Effects of Muscle Unloading, Reloading and Exercises on Inflammation During a Head Down Bed Rest. Int J Sports Med, 2013;35:28-34.
[11]  Bamford J, Dennis M, Sandercock P, Burn J,Warlow CP. The Frequency, Causes and Timing of Death within 30 days of a First Stroke; The Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry, 1990;35:824-829.
[12]  Langhorne P, Stott DJ, Robertson LS, Macdonald J, Jones LR. Medical Complications after Stroke: A Multicentre Study. Stroke, 2000;31:1223-1229.
[13]  Benhardt J, Dewey HM, Thrift AG, Donnan GA. Inactive and Alone:Physical Activity within the First 14 Days of Acute Stroke Unit Care. Stroke, 2004;35:1005-1009.
[14]  West T, Bernhardt J. Physical Activities in Hospitalized Stroke Patients. Stroke Res Treat, 2011;
[15]  Murphy TH, Corbett D. Plasticity During Stroke Recovery; From Synapse to Behaviour. Nat Rev Neurosci, 2009;10:861-872.
[16]  Johansson B. Brain Spasticity and Stroke Rehabilitation: The Willis Lecture. Stroke , 2000; 31(1):223-230.
[17]  Krakauer JW, Carmichael ST, Corbett D, Wittenberg G. Getting Neurorehabilitation Right: What can be Learned from Animal Model? Neurorehabil Neural Repair, 2012;26:923-931.
[18]  Pekna M, Pekny M, Nilsson M. Modulation of Neural Plasticity as a Basis for Stroke Rehabilitation. Stroke, 2012;4:2819-2828.
[19]  Bernhardt J, Dewey H, Thift A, Collier J, Donna G. A Very Early Rehabilitation Trial for Stroke (AVERT): Phase II Safety and Feasibility. Stroke, 2008;39(2):390-396.
[20]  Langhorne P, Stott D, Knight A, Bernhardt J, Barer D, Watkins C. Very early rehabilitation or intensive telemetry after stroke: A pilot randomized trial. Cerebrovasc Dis, 2010;29(4):352-360.
[21]  Craig LE, Bernhardt J, Langhorne P, et al. Early mobilization after stroke: An example of an individual patient data meta-analysis of a complex intervention. Stroke, 2010;41:2632-2636.
[22]  Arias M & Smith L. Early mobilization of acute stroke patients. Journal of Clinical Nursing, 2007; 16: 282-288
[23]  Maulden SA, Gassaway J, Horn SD, et al., Timing of initiation of rehabilitation after stroke, Arch Phys Med Rehabi, 2005; 86(12): 34-40.
[24]  Mahoney FI, Barthel D. “Functional evaluation: the Barthel Index.” Maryland State Med Journal 1965;14:56-61.
[25]  Tomoko O, Tatsuro I, Takahiro H, Kentaro K, Rika I, Kosuke N, Surya S, Takeo N. Reliability and validity tests of an evaluation tool based on the modified Barthel Index International. Journal of Therapy & Rehabilitation, 2011;18(8):422.
[26]  Bernhardt J, Thuy MNT, Collier JM, Legg LA. Very early versus delayed mobilisation after stroke (Review). The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. 2009.
[27]  Intercollegiate Stroke Working Party. National Clinical Guidelines for Stroke. London: Royal College of Physicians, 2008.
[28]  National Stroke Foundation. Clinical Guideliens for Stroke Management. Melbourne, Australia:2010.
[29]  Scottish Intercollegiate Guidelines Network. Management of Patients with stroke: Rehabilitation, Prevetion and Management of Complications and Discharge Planning. A National Clinical Guideline. Edinburgh, Scortland: 2010.
Show Less References


Health and Socio-economic Impacts of Livelihoods Programs among People Living with HIV in Cambodia: A Case-Control Study

1KHANA Center for Population Health Research, Cambodia

2Royal University of Phnom Penh, Cambodia

3Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Japan

4KHANA Social Enterprise, Cambodia

5Center for Global Health Research, Public Health Program, Touro University California, USA

American Journal of Public Health Research. 2016, 4(5), 159-169
doi: 10.12691/ajphr-4-5-1
Copyright © 2016 Science and Education Publishing

Cite this paper:
Sovannary Tuot, Kouland Thin, Mayumi Shimizu, Samedy Suong, Samrithea Sron, Pheak Chhoun, Khuondyla Pal, Chanrith Ngin, Siyan Yi. Health and Socio-economic Impacts of Livelihoods Programs among People Living with HIV in Cambodia: A Case-Control Study. American Journal of Public Health Research. 2016; 4(5):159-169. doi: 10.12691/ajphr-4-5-1.

Correspondence to: Siyan  Yi, KHANA Center for Population Health Research, Cambodia. Email:


Background: In Cambodia, the circumstances surrounding people living with HIV (PLHIV) remain serious conditions. To ameliorate these situations, KHANA has implemented livelihoods programs since 2010, including village saving and loans (VSL), skill trainings, and cash grants with on-going technical support. This study aims to evaluate the impacts of the programs in improving socio-economic conditions, health, and psychological well-being of PLHIV in Cambodia. Methods: In August 2014, a case-control study was conducted in six selected provinces. The cases were defined as PLHIV who lived in the selected operational districts where KHANA has implemented the livelihoods programs, and have participated in the programs for at least one year. Several indicators in socio-economic situations, food security, health conditions, and psychological well-being of the cases (n= 358) and the controls (n= 329) were compared. Results: The mean of monthly income of the cases who attended the programs for three years or more was 13.6% higher than that of the controls. A significantly higher proportion of the cases reported having three meals per day, while a significantly lower proportion of them received food assistance in the past 12 months. The mean total score for frequency of occurrence also indicated less severity of food insecurity among the cases. Regarding child education, the cases reported a significantly lower rate of out-of-school children. The proportion of the cases who rated their quality of life as good was significantly higher, and they were significantly less likely to report that they felt guilty being HIV-positive persons. Regarding psychological well-being, the mean total score of depressive symptoms for the cases was significantly lower than that for the controls, and the proportion of the cases with a cut-off score smaller than 1.75, which indicated less depressive symptoms, was also significantly higher than that of the controls. Conclusions: Findings from this study portray the positive impacts of KHANA’s livelihoods programs in maintaining and upgrading the livelihoods and quality of life of PLHIV in Cambodia. With these noticeable impacts, the programs should be scaled up to support PLHIV and vulnerable households across the country.



[1]  UNAIDS, Global Report. UNAIDS report on the global AIDS epidemic 2013. UNAIDS: Geneva, Switzerland, 2013.
[2]  Samji, H., Cescon, A., Hogg, R.S., Modur, S.P., Althoff, K.N., Buchacz, K., et al. “Closing the gap: increases in life expectancy among treated HIV-positive individuals in the United States and Canada.” PLOS One, 8(12). e81355. 2013.
[3]  Slaymaker, E., Todd, J., Marston, M., Calvert, C., Michael, D., Nakiyingi-Miiro, J., et al. “How have ART treatment programmes changed the patterns of excess mortality in people living with HIV? Estimates from four countries in East and Southern Africa.” Global Health Action, 7. 22789. 2014.
[4]  Sherr, L., Clucas, C., Harding, R., Sibley, E., Catalan, J. “HIV and depression – a systematic review of interventions.” Psychological Health Medicine, 16(5). 493-527. 2011.
[5]  Lowther, K., Selman, L., Harding, R., Higginson, I.J. Experience of persistent psychological symptoms and perceived stigma among people with HIV on antiretroviral therapy (ART): A systematic review. International Journal of Nursing Studies, 51(8). 1171-89. 2014.
Show More References
[6]  Musumari, P.M., Wouters, E., Kayembe, P.K., Kiumbu Nzita, M., Mbikayi, S.M., Suguimoto, S.P., et al. “Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study.” PLoS One, 9(1). e85327. 2014.
[7]  Weiser, S.D., Palar, K., Frongillo, E.A., Tsai, A.C., Kumbakumba, E., Depee, S., et al. “Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda.” AIDS, 28(1). 115-20. 2014.
[8]  Kalichman, S.C., Hernandez, D., Cherry, C., Kalichman, M.O., Washington, C., Grebler, T. “Food Insecurity and Other Poverty Indicators Among People Living with HIV/AIDS: Effects on Treatment and Health Outcomes.” Journal of Community Health, 39(6). 1133-9. 2014.
[9]  Young, S., Wheeler, A.C., McCoy, S.I., Weiser, S.D. “A Review of the Role of Food Insecurity in Adherence to Care and Treatment Among Adult and Pediatric Populations Living with HIV and AIDS.” AIDS and Behavior, 18 Suppl 5. S505-15. 2013.
[10]  Franke, M.F., Murray, M.B., Muñoz, M., Hernández-Díaz, S., Sebastián, J.L., Atwood, S., et al. “Food insufficiency is a risk factor for suboptimal antiretroviral therapy adherence among HIV-infected adults in urban Peru.” AIDS and Behavior, 15(7). 1483-9. 2011.
[11]  Tiyou, A., Belachew, T., Alemseged, F., Biadgilign, S. “Food insecurity and associated factors among HIV-infected individuals receiving highly active antiretroviral therapy in Jimma zone Southwest Ethiopia.” Nutrition Journal, 11: 51. 2012.
[12]  Berhe, N., Tegabu, D., Alemayehu, M. “Effect of nutritional factors on adherence to antiretroviral therapy among HIV-infected adults: a case control study in Northern Ethiopia.” BMC Infectious Diseases, 13. 233. 2013.
[13]  Weiser, S.D., Yuan, C., Guzman, D., Frongillo, E.A., Riley, E.D., Bangsberg, D.R., et al. “Food insecurity and HIV clinical outcomes in a longitudinal study of homeless and marginally housed HIV-infected individuals in San Francisco.” AIDS, 27(18). 2953-8. 2013.
[14]  Foof and Agriculture Organization of the United Nations (FAO). The State of Food Insecurity in the World - Meeting the 2015 international hunger targets: taking stock of uneven progress. FAO: Rome, Italy, 2015.
[15]  Nagata, J.M., Magerenge, R.O., Young, S.L., Oguta, J.O., Weiser, S.D., et al. “Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/AIDS on the shore of Lake Victoria, Kenya.” AIDS Care, 24(6). 728-36. 2012.
[16]  Weiser, S.D., Gupta, R., Tsai, A.C., Frongillo, E.A., Grede, N., Kumbakumba, E., et al. “Changes in food insecurity, nutritional status, and physical health status after antiretroviral therapy initiation in rural Uganda.” Journal of Acquired Immune Deficiency Syndromes, 61(2). 179-86. 2012.
[17]  Anema, A., Kerr, T., Milloy, M.J., Feng, C., Montaner, J.S., Wood, E. “Relationship between hunger, adherence to antiretroviral therapy and plasma HIV RNA suppression among HIV-positive illicit drug users in a Canadian setting.” AIDS Care, 26(4). 459-65. 2014.
[18]  Cole, S.M., Tembo, G. “The effect of food insecurity on mental health: panel evidence from rural Zambia.” Social Science & Medicine, 73(7). 1071-9. 2011.
[19]  Weiser, S.D., Young, S.L., Cohen, C.R., Kushel, M.B., Tsai, A.C., Tien, P.C., et al. “Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS.” American Journal of Clinical Nutrition, 94(6). 1729s-1739s. 2011.
[20]  Hosegood, V., Preston-Whyte, E., Busza, J., Moitse, S., Timaeus, I.M. “Revealing the full extent of households' experiences of HIV and AIDS in rural South Africa. Social Science & Medicine, 65(6). 1249-59. 2007.
[21]  Gillespie, S., Kadiyala, S. HIVAIDS and food and nutrition secuirity. Food Policy Review 7. International Food Policy Research Institute: Washington DC, the Uinited States, 2005.
[22]  World Food Program (WFP), World Health Organization (WHO), UNAIDS. HIV, food security, and nutrition. Policy Brief. WFP/WHO/UNAIDS: Geneva, Switzerland, 2008.
[23]  Weiser, S.D., Fernandes, K.A., Brandson, E.K., Lima, V.D., Anema, A., Bangsberg, D.R., et al. “The association between food insecurity and mortality among HIV-infected individuals on HAART.” Journal of Acquired Immune Deficiency Syndromes, 52(3). 342-9. 2009.
[24]  Miller, C.L., Bangsberg, D.R., Tuller, D.M., Senkungu, J., Kawuma, A., Frongillo, E.A., et al. “Food insecurity and sexual risk in an HIV endemic community in Uganda.” AIDS and Behavior, 15(7). 1512-9. 2011.
[25]  Weiser, S.D., Leiter, K., Bangsberg, D.R., Butler, L.M., Percy-de Korte, F., Hlanze, Z., et al. “Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland.” PLoS Medicine, 4(10). 1589-97. 2007.
[26]  Normén, L., Chan, K., Braitstein, P., Anema, A., Bondy, G., Montaner, J.S., et al. “Food insecurity and hunger are prevalent among HIV-positive individuals in British Columbia, Canada.” Journal of Nutrition, 135(4). 820-5. 2005.
[27]  Weiser, S.D., Tsai, A.C., Gupta, R., Frongillo, E.A., Kawuma, A., Senkungu, J., et al. “Food insecurity is associated with morbidity and patterns of healthcare utilization among HIV-infected individuals in a resource-poor setting.” AIDS, 26(1). 67-75. 2012.
[28]  Tsai, A.C., Bangsberg, D.R., Frongillo, E.A., Hunt, P.W., Muzoora, C., Martin, J.N., et al. “Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda.” Social Science & Medicine, 74(12). 2012-9. 2012.
[29]  Birbeck, G.L., Kvalsund, M.P., Byers, P.A., Bradbury, R., Mang'ombe, C., Organek, N., et al. “Neuropsychiatric and socioeconomic status impact antiretroviral adherence and mortality in rural Zambia.” American Journal Tropical Medicine and Hygiene, 85(4). 782-9. 2011.
[30]  UNAIDS. Administrative Committee on Coordination/Sub-Committee on Nutrition, Nutrition and HIV/AIDS. UNAIDS: Geneva, Switzerland, 2001.
[31]  Yager, J.E., Kadiyala, S., Weiser, S.D. “HIV/AIDS, food supplementation and livelihood programs in Uganda: a way forward?” PLOS One, 6(10). e26117. 2011.
[32]  Manary, M., Ndekhat, M., van Oosterhout, J.J. “Supplementary feeding in the care of the wasted HIV infected patient.” Malawi Medical Journal, 22(2). 46-8. 2010.
[33]  van Oosterhout, J.J., Ndekha, M., Moore, E., Kumwenda, J.J., Zijlstra, E.E., Manary, M. “The benefit of supplementary feeding for wasted Malawian adults initiating ART.” AIDS Care, 22(6). 737-42. 2010.
[34]  Rawat, R., Faust, E., Maluccio, J.A., Kadiyala, S. “The impact of a food assistance program on nutritional status, disease progression, and food security among people living with HIV in Uganda.” Journal of Acquired Immune Deficiency Syndromes, 66(1). e15-22. 2014.
[35]  Cantrell, R.A., Sinkala, M., Megazinni, K., Lawson-Marriott, S., Washington, S., Chi, B.H., et al. “A pilot study of food supplementation to improve adherence to antiretroviral therapy among food-insecure adults in Lusaka, Zambia.” Journal of Acquired Immune Deficiency Syndromes, 49(2). 190-5. 2008.
[36]  Tirivayi, N., Koethe, J.R., Groot, W. “Clinic-Based Food Assistance is Associated with Increased Medication Adherence among HIV-Infected Adults on Long-Term Antiretroviral Therapy in Zambia.” Journal of AIDS Clinical Research, 3(7). 171. 2012.
[37]  Kadiyala, S., Rawat, R., Roopnaraine, T., Babirye, F., Ochai, R. “Applying a programme theory framework to improve livelihood interventions integrated with HIV care and treatment programmes. Journal of Development Effect, 1(4). 470-91. 2009.
[38]  Datta, D., Njuguna, J. “Microcredit for people affected by HIV and AIDS: Insights from Kenya.” SAHARA Journal, 5(2). 94-102. 2008.
[39]  Viravaidya, M., Wolf, R.C., Guest, P. “An assessment of the positive partnership project in Thailand: key considerations for scaling-up microcredit loans for HIV-positive and negative pairs in other settings.” Global Public Health, 3(2). 115-36. 2008.
[40]  Wagner, G., Rana, Y., Linnemayr, S., Balya, J., Buzaalirwa, L. “A Qualitative Exploration of the Economic and Social Effects of Microcredit among People Living with HIV/AIDS in Uganda.” AIDS Research and Treatment, 2012. 318957. 2012.
[41]  Holmes, K., Winskell, K., Hennink, M., Chidiac, S. “Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: emerging lessons from Cote d'Ivoire.” Global Public Health, 6(4). 447-61. 2011.
[42]  KHANA. KHANA network household economic livelihood 2010 survey analysis. KHANA: Phnom Penh, Cambodia, 2010.
[43]  Alkenbrack Batteh, S.E., Forsythe, S., Martin, G., Chettra, T. “Confirming the impact of HIV/AIDS epidemics on household vulnerability in Asia: the case of Cambodia.” AIDS, 22 Suppl 1. S103-11. 2008.
[44]  KHANA. KHANA economic livelihood program strategic plan for sustainability. KHANA: Phnom Penh, Cambodia, 2012.
[45]  Thin, K., Suong, S., Kuma, K., Tuot, S., Yi, S. KHANA Livelihoods Programs for Improving Health and Quality of Life of People Infected and Affected by HIV: A qualitative Program Review. KHANA: Phnom Penh, Cambodia, 2014.
[46]  Shimizu, M., Yi, S., Tuot, S., Suong, S., Sron, S., Shibanuma, A., Jimba, M. The impact of a livelihood program on depression symptoms among people living with HIV in Cambodia. Global Health Action. 2016. (In press).
[47]  Coates, J., Swindale, A., Bilinsky, P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access. Food and Nutrition Technical Assistance Project. Academy for Educational Development: Washington DC, the United States, 2007.
[48]  Coates, J., Swindale, A., Bilinsky, P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v. 3). FHI 360/FANTA: Washington DC, the United States, 2007.
[49]  Martinez, P., Andia, I., Emenyonu, N., Hahn, J.A., Hauff, E., Pepper, L., et al. “Alcohol use, depressive symptoms and the receipt of antiretroviral therapy in southwest Uganda.” AIDS and Behavior, 12(4). 605-12. 2008.
[50]  Kalichman, S.C., Simbayi, L.C., Jooste, S., Toefy, Y., Cain, D., Cherry, C., et al. “Development of a brief scale to measure AIDS-related stigma in South Africa.” AIDS and Behavior, 9(2). 135-43. 2005.
[51]  Kalichman, S.C., Simbayi, L.C., Cloete, A., Mthembu, P.P., Mkhonta, R.N., Ginindza, T. “Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale.” AIDS Care, 21(1). 87-93. 2009.
[52]  Rao, D., Chen, W.T., Pearson, C.R., Simoni, J.M., Fredriksen-Goldsen, K., Nelson, K., et al. “Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China.” International Journal of STD and AIDS, 23(7). 481-4. 2012.
[53]  Bagley, C., Bolitho, F., Bertrand, L. “Norms and construct validity of the Rosenberg Self-Esteem Scale in Canadian high school populations: Implications for counselling.” Canadian Journal of Counseling Psychotherapy, 31(1). 82-92. 2007.
[54]  Rosenberg, M. Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ, the United States, 1965.
[55]  Helen Keller International. Homestead food production improved access to quality food, consumption and livelihood and reduced stigma among households of People Living with HIV/AIDS in Battambang Province of Cambodia. Helen Keller International: Phnom Penh, Cambodia, 2012.
[56]  Holmes, K., Winskell, K., Hennink, M., Chidiac, S. “Microfinance and HIV mitigation among people living with HIV in the era of anti-retroviral therapy: Emerging lessons from Côte d'Ivoire.” Global Public Health, 6(4). 447-61. 2011.
[57]  Rao, D., Chen, W.T., Pearson, C.R., Simoni, J.M., Fredriksen-Goldsen, K., Nelson, K., et al. “Social support mediates the relationship between HIV stigma and depression/quality of life among people living with HIV in Beijing, China.” International Journal of STD & AIDS, 23(7). 481-4. 2012.
[58]  Yadav, S. “Perceived social support, hope, and quality of life of persons living with HIV/AIDS: a case study from Nepal.” Quality of Life Research, 19(2). 157-66. 2010.
[59]  Joint United Nations Programme on HIV/AIDS (UNAIDS). People Living with HIV Stigma Index: Asia Pacific Regional Analysis. UNAIDS: Geneva, Switzerland, 2011.
[60]  Gordillo, V., Fekete, E., Platteau, T., Antoni, M.H., Schneiderman, N., Nöstlinger, C., et al. “Emotional support and gender in people living with HIV: effects on psychological well-being.” Journal of Behavioral Medicine, 32(6). 523-31. 2009.
Show Less References