School-based interventions for preventing Hiv, sexually transmitted infections, and pregnancy in adolescents
Identifieur interne : 003B18 ( Ncbi/Merge ); précédent : 003B17; suivant : 003B19School-based interventions for preventing Hiv, sexually transmitted infections, and pregnancy in adolescents
Auteurs : Amanda J. Mason-Jones [Royaume-Uni, Afrique du Sud] ; David Sinclair [Royaume-Uni] ; Catherine Mathews [Afrique du Sud] ; Ashraf Kagee [Afrique du Sud] ; Alex Hillman [Royaume-Uni] ; Carl Lombard [Afrique du Sud]Source :
- The Cochrane Database of Systematic Reviews [ 1469-493X ] ; 2016.
Abstract
School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs).
To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents.
We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers.
We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents.
Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.
We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland).
Six trials evaluated school-based educational interventions.
In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants;
Two trials evaluated incentive-based programmes to promote school attendance.
In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants;
The single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants;
There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.
Cochrane researchers conducted a review of the effects of school-based interventions for reducing HIV, sexually transmitted infections (STIs), and pregnancy in adolescents. After searching for relevant trials up to 7 April 2016, they included eight trials that had enrolled 55,157 adolescents.
Sexually active adolescents, particularly young women, are at high risk in many countries of contracting HIV and other STIs. Early unintended pregnancy can also have a detrimental impact on young people's lives.
The school environment plays an important role in the development of children and young people, and curriculum-based sexuality education programmes have become popular in many regions of the world. While there is some evidence that these programmes improve knowledge and reduce self-reported risk taking, this review evaluated whether they have any impact on the number of young people that contracted STIs or on the number of adolescent pregnancies.
Sexual and reproductive health education programmes
As they are currently configured, educational programmes alone probably have no effect on the number of young people infected with HIV during adolescence (
Material or monetary incentive-based programmes to promote school attendance
Giving monthly cash, or free school uniforms, to encourage students to stay in school may have no effect on the number of young people infected with HIV during adolescence (
Combined educational and incentive-based programmes
Based on a single included trial, giving an incentive such as a free school uniform combined with a programme of sexual and reproductive health education may reduce STIs (herpes simplex virus;
There is currently little evidence that educational programmes alone are effective at reducing STIs or adolescent pregnancy. Incentive-based interventions that focus on keeping young people, especially girls, in secondary school may reduce adolescent pregnancy but further high quality trials are needed to confirm this.
Url:
DOI: 10.1002/14651858.CD006417.pub3
PubMed: 27824221
PubMed Central: 5461872
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<series><title level="j">The Cochrane Database of Systematic Reviews</title>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs).</p>
</sec>
<sec><title>Objectives</title>
<p>To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents.</p>
</sec>
<sec><title>Search methods</title>
<p>We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers.</p>
</sec>
<sec><title>Selection criteria</title>
<p>We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents.</p>
</sec>
<sec><title>Data collection and analysis</title>
<p>Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.</p>
</sec>
<sec><title>Main results</title>
<p>We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland).</p>
<p><bold>Sexual and reproductive health educational programmes</bold>
</p>
<p>Six trials evaluated school-based educational interventions.</p>
<p>In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; <italic>low certainty evidence</italic>
), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; <italic>moderate certainty evidence</italic>
; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; <italic>low certainty evidence</italic>
). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; <italic>moderate certainty evidence</italic>
).</p>
<p><bold>Material or monetary incentive-based programmes to promote school attendance</bold>
</p>
<p>Two trials evaluated incentive-based programmes to promote school attendance.</p>
<p>In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; <italic>low certainty evidence</italic>
). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; <italic>very low certainty evidence</italic>
). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; <italic>very low certainty evidence</italic>
). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; <italic>low certainty evidence</italic>
).</p>
<p><bold>Combined educational and incentive-based programmes</bold>
</p>
<p>The single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; <italic>low certainty evidence</italic>
), predominantly in young women, but no effect was detected for HIV or pregnancy (<italic>low certainty evidence</italic>
).</p>
</sec>
<sec><title>Authors' conclusions</title>
<p>There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.</p>
</sec>
<sec><title>School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents</title>
<p>Cochrane researchers conducted a review of the effects of school-based interventions for reducing HIV, sexually transmitted infections (STIs), and pregnancy in adolescents. After searching for relevant trials up to 7 April 2016, they included eight trials that had enrolled 55,157 adolescents.</p>
<p><bold>Why is this important and how might school-based programmes work?</bold>
</p>
<p>Sexually active adolescents, particularly young women, are at high risk in many countries of contracting HIV and other STIs. Early unintended pregnancy can also have a detrimental impact on young people's lives.</p>
<p>The school environment plays an important role in the development of children and young people, and curriculum-based sexuality education programmes have become popular in many regions of the world. While there is some evidence that these programmes improve knowledge and reduce self-reported risk taking, this review evaluated whether they have any impact on the number of young people that contracted STIs or on the number of adolescent pregnancies.</p>
<p><bold>What the research says</bold>
</p>
<p>Sexual and reproductive health education programmes</p>
<p>As they are currently configured, educational programmes alone probably have no effect on the number of young people infected with HIV during adolescence (<italic>low certainty evidence</italic>
). They also probably have no effect on the number of young people infected with other STIs (herpes simplex virus: <italic>moderate certainty evidence</italic>
; syphilis: <italic>low certainty evidence</italic>
), or the number of adolescent pregnancies (<italic>moderate certainty evidence</italic>
).</p>
<p>Material or monetary incentive-based programmes to promote school attendance</p>
<p>Giving monthly cash, or free school uniforms, to encourage students to stay in school may have no effect on the number of young people infected with HIV during adolescence (<italic>low certainty evidence</italic>
). We do not currently know whether monthly cash or free school uniforms will reduce the number of young people infected with other STIs (<italic>very low certainty evidence</italic>
). However, incentives to promote school attendance may reduce the number of adolescent pregnancies (<italic>low certainty evidence</italic>
).</p>
<p>Combined educational and incentive-based programmes</p>
<p>Based on a single included trial, giving an incentive such as a free school uniform combined with a programme of sexual and reproductive health education may reduce STIs (herpes simplex virus; <italic>low certainty evidence</italic>
) in young women, but no effect was detected for HIV or pregnancy (<italic>low certainty evidence</italic>
).</p>
<p><bold>Authors' conclusions</bold>
</p>
<p>There is currently little evidence that educational programmes alone are effective at reducing STIs or adolescent pregnancy. Incentive-based interventions that focus on keeping young people, especially girls, in secondary school may reduce adolescent pregnancy but further high quality trials are needed to confirm this.</p>
</sec>
</div>
</front>
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<pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Cochrane Database Syst Rev</journal-id>
<journal-id journal-id-type="iso-abbrev">Cochrane Database Syst Rev</journal-id>
<journal-id journal-id-type="publisher-id">cd</journal-id>
<journal-title-group><journal-title>The Cochrane Database of Systematic Reviews</journal-title>
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<issn pub-type="epub">1469-493X</issn>
<publisher><publisher-name>John Wiley & Sons, Ltd</publisher-name>
<publisher-loc>Chichester, UK</publisher-loc>
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<article-meta><article-id pub-id-type="pmid">27824221</article-id>
<article-id pub-id-type="pmc">5461872</article-id>
<article-id pub-id-type="doi">10.1002/14651858.CD006417.pub3</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Review</subject>
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<title-group><article-title>School-based interventions for preventing Hiv, sexually transmitted infections, and pregnancy in adolescents</article-title>
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<institution>Department of Health Sciences, University of York</institution>
<addr-line>York, UK</addr-line>
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<aff id="au2"><label>2</label>
<institution>Department of Psychiatry and Mental Health, University of Cape Town</institution>
<addr-line>Cape Town, South Africa</addr-line>
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<aff id="au3"><label>3</label>
<institution>Interdisciplinary Health Sciences, University of Stellenbosch</institution>
<addr-line>Cape Town, South Africa</addr-line>
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<aff id="au4"><label>4</label>
<institution>Department of Clinical Sciences, Liverpool School of Tropical Medicine</institution>
<addr-line>Liverpool, UK</addr-line>
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<aff id="au5"><label>5</label>
<institution>Health Systems Research Unit, South African Medical Research Council</institution>
<addr-line>Tygerberg, South Africa</addr-line>
</aff>
<aff id="au6"><label>6</label>
<institution>School of Public Health and Family Medicine, University of Cape Town</institution>
<addr-line>Cape Town, South Africa</addr-line>
</aff>
<aff id="au7"><label>7</label>
<institution>Department of Psychology, Stellenbosch University</institution>
<addr-line>Matieland, South Africa</addr-line>
</aff>
<aff id="au8"><label>8</label>
<institution>Biostatistics Unit, South African Medical Research Council</institution>
<addr-line>Cape Town, South Africa</addr-line>
</aff>
</contrib-group>
<author-notes><corresp id="cor1"><institution>Department of Health Sciences, University of York</institution>
, <addr-line>Seebohm Rowntree Building, Heslington, York, YO10 5DD, UK</addr-line>
. <email>amanda.mason-jones@york.ac.uk</email>
<email>amandajmasonjones@gmail.com</email>
.</corresp>
</author-notes>
<pub-date pub-type="epub"><day>08</day>
<month>11</month>
<year>2016</year>
</pub-date>
<issue>11</issue>
<elocation-id>CD006417</elocation-id>
<permissions><copyright-statement>Copyright © 2016 The Authors. Cochrane Database of Systematic Reviews published by John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration.</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0"><license-p>This is an open access article under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0">Creative Commons Attribution-Non-Commercial</ext-link>
Licence, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>School-based sexual and reproductive health programmes are widely accepted as an approach to reducing high-risk sexual behaviour among adolescents. Many studies and systematic reviews have concentrated on measuring effects on knowledge or self-reported behaviour rather than biological outcomes, such as pregnancy or prevalence of sexually transmitted infections (STIs).</p>
</sec>
<sec><title>Objectives</title>
<p>To evaluate the effects of school-based sexual and reproductive health programmes on sexually transmitted infections (such as HIV, herpes simplex virus, and syphilis), and pregnancy among adolescents.</p>
</sec>
<sec><title>Search methods</title>
<p>We searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) for published peer-reviewed journal articles; and ClinicalTrials.gov and the World Health Organization's (WHO) International Clinical Trials Registry Platform for prospective trials; AIDS Educaton and Global Information System (AEGIS) and National Library of Medicine (NLM) gateway for conference presentations; and the Centers for Disease Control and Prevention (CDC), UNAIDS, the WHO and the National Health Service (NHS) centre for Reviews and Dissemination (CRD) websites from 1990 to 7 April 2016. We handsearched the reference lists of all relevant papers.</p>
</sec>
<sec><title>Selection criteria</title>
<p>We included randomized controlled trials (RCTs), both individually randomized and cluster-randomized, that evaluated school-based programmes aimed at improving the sexual and reproductive health of adolescents.</p>
</sec>
<sec><title>Data collection and analysis</title>
<p>Two review authors independently assessed trials for inclusion, evaluated risk of bias, and extracted data. When appropriate, we obtained summary measures of treatment effect through a random-effects meta-analysis and we reported them using risk ratios (RR) with 95% confidence intervals (CIs). We assessed the certainty of the evidence using the GRADE approach.</p>
</sec>
<sec><title>Main results</title>
<p>We included eight cluster-RCTs that enrolled 55,157 participants. Five trials were conducted in sub-Saharan Africa (Malawi, South Africa, Tanzania, Zimbabwe, and Kenya), one in Latin America (Chile), and two in Europe (England and Scotland).</p>
<p><bold>Sexual and reproductive health educational programmes</bold>
</p>
<p>Six trials evaluated school-based educational interventions.</p>
<p>In these trials, the educational programmes evaluated had no demonstrable effect on the prevalence of HIV (RR 1.03, 95% CI 0.80 to 1.32, three trials; 14,163 participants; <italic>low certainty evidence</italic>
), or other STIs (herpes simplex virus prevalence: RR 1.04, 95% CI 0.94 to 1.15; three trials, 17,445 participants; <italic>moderate certainty evidence</italic>
; syphilis prevalence: RR 0.81, 95% CI 0.47 to 1.39; one trial, 6977 participants; <italic>low certainty evidence</italic>
). There was also no apparent effect on the number of young women who were pregnant at the end of the trial (RR 0.99, 95% CI 0.84 to 1.16; three trials, 8280 participants; <italic>moderate certainty evidence</italic>
).</p>
<p><bold>Material or monetary incentive-based programmes to promote school attendance</bold>
</p>
<p>Two trials evaluated incentive-based programmes to promote school attendance.</p>
<p>In these two trials, the incentives used had no demonstrable effect on HIV prevalence (RR 1.23, 95% CI 0.51 to 2.96; two trials, 3805 participants; <italic>low certainty evidence</italic>
). Compared to controls, the prevalence of herpes simplex virus infection was lower in young women receiving a monthly cash incentive to stay in school (RR 0.30, 95% CI 0.11 to 0.85), but not in young people given free school uniforms (Data not pooled, two trials, 7229 participants; <italic>very low certainty evidence</italic>
). One trial evaluated the effects on syphilis and the prevalence was too low to detect or exclude effects confidently (RR 0.41, 95% CI 0.05 to 3.27; one trial, 1291 participants; <italic>very low certainty evidence</italic>
). However, the number of young women who were pregnant at the end of the trial was lower among those who received incentives (RR 0.76, 95% CI 0.58 to 0.99; two trials, 4200 participants; <italic>low certainty evidence</italic>
).</p>
<p><bold>Combined educational and incentive-based programmes</bold>
</p>
<p>The single trial that evaluated free school uniforms also included a trial arm in which participants received both uniforms and a programme of sexual and reproductive education. In this trial arm herpes simplex virus infection was reduced (RR 0.82, 95% CI 0.68 to 0.99; one trial, 5899 participants; <italic>low certainty evidence</italic>
), predominantly in young women, but no effect was detected for HIV or pregnancy (<italic>low certainty evidence</italic>
).</p>
</sec>
<sec><title>Authors' conclusions</title>
<p>There is a continued need to provide health services to adolescents that include contraceptive choices and condoms and that involve them in the design of services. Schools may be a good place in which to provide these services. There is little evidence that educational curriculum-based programmes alone are effective in improving sexual and reproductive health outcomes for adolescents. Incentive-based interventions that focus on keeping young people in secondary school may reduce adolescent pregnancy but further trials are needed to confirm this.</p>
</sec>
<sec><title>School-based interventions for preventing HIV, sexually transmitted infections, and pregnancy in adolescents</title>
<p>Cochrane researchers conducted a review of the effects of school-based interventions for reducing HIV, sexually transmitted infections (STIs), and pregnancy in adolescents. After searching for relevant trials up to 7 April 2016, they included eight trials that had enrolled 55,157 adolescents.</p>
<p><bold>Why is this important and how might school-based programmes work?</bold>
</p>
<p>Sexually active adolescents, particularly young women, are at high risk in many countries of contracting HIV and other STIs. Early unintended pregnancy can also have a detrimental impact on young people's lives.</p>
<p>The school environment plays an important role in the development of children and young people, and curriculum-based sexuality education programmes have become popular in many regions of the world. While there is some evidence that these programmes improve knowledge and reduce self-reported risk taking, this review evaluated whether they have any impact on the number of young people that contracted STIs or on the number of adolescent pregnancies.</p>
<p><bold>What the research says</bold>
</p>
<p>Sexual and reproductive health education programmes</p>
<p>As they are currently configured, educational programmes alone probably have no effect on the number of young people infected with HIV during adolescence (<italic>low certainty evidence</italic>
). They also probably have no effect on the number of young people infected with other STIs (herpes simplex virus: <italic>moderate certainty evidence</italic>
; syphilis: <italic>low certainty evidence</italic>
), or the number of adolescent pregnancies (<italic>moderate certainty evidence</italic>
).</p>
<p>Material or monetary incentive-based programmes to promote school attendance</p>
<p>Giving monthly cash, or free school uniforms, to encourage students to stay in school may have no effect on the number of young people infected with HIV during adolescence (<italic>low certainty evidence</italic>
). We do not currently know whether monthly cash or free school uniforms will reduce the number of young people infected with other STIs (<italic>very low certainty evidence</italic>
). However, incentives to promote school attendance may reduce the number of adolescent pregnancies (<italic>low certainty evidence</italic>
).</p>
<p>Combined educational and incentive-based programmes</p>
<p>Based on a single included trial, giving an incentive such as a free school uniform combined with a programme of sexual and reproductive health education may reduce STIs (herpes simplex virus; <italic>low certainty evidence</italic>
) in young women, but no effect was detected for HIV or pregnancy (<italic>low certainty evidence</italic>
).</p>
<p><bold>Authors' conclusions</bold>
</p>
<p>There is currently little evidence that educational programmes alone are effective at reducing STIs or adolescent pregnancy. Incentive-based interventions that focus on keeping young people, especially girls, in secondary school may reduce adolescent pregnancy but further high quality trials are needed to confirm this.</p>
</sec>
</abstract>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Afrique du Sud</li>
<li>Royaume-Uni</li>
</country>
</list>
<tree><country name="Royaume-Uni"><noRegion><name sortKey="Mason Jones, Amanda J" sort="Mason Jones, Amanda J" uniqKey="Mason Jones A" first="Amanda J" last="Mason-Jones">Amanda J. Mason-Jones</name>
</noRegion>
<name sortKey="Hillman, Alex" sort="Hillman, Alex" uniqKey="Hillman A" first="Alex" last="Hillman">Alex Hillman</name>
<name sortKey="Sinclair, David" sort="Sinclair, David" uniqKey="Sinclair D" first="David" last="Sinclair">David Sinclair</name>
</country>
<country name="Afrique du Sud"><noRegion><name sortKey="Mason Jones, Amanda J" sort="Mason Jones, Amanda J" uniqKey="Mason Jones A" first="Amanda J" last="Mason-Jones">Amanda J. Mason-Jones</name>
</noRegion>
<name sortKey="Kagee, Ashraf" sort="Kagee, Ashraf" uniqKey="Kagee A" first="Ashraf" last="Kagee">Ashraf Kagee</name>
<name sortKey="Lombard, Carl" sort="Lombard, Carl" uniqKey="Lombard C" first="Carl" last="Lombard">Carl Lombard</name>
<name sortKey="Mason Jones, Amanda J" sort="Mason Jones, Amanda J" uniqKey="Mason Jones A" first="Amanda J" last="Mason-Jones">Amanda J. Mason-Jones</name>
<name sortKey="Mathews, Catherine" sort="Mathews, Catherine" uniqKey="Mathews C" first="Catherine" last="Mathews">Catherine Mathews</name>
<name sortKey="Mathews, Catherine" sort="Mathews, Catherine" uniqKey="Mathews C" first="Catherine" last="Mathews">Catherine Mathews</name>
</country>
</tree>
</affiliations>
</record>
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