African Health Sciences 2021-09-29T08:59:26+00:00 Dr James Tumwine Open Journal Systems <p>African Health Sciences is an open access, free online, internationally refereed journal publishing original articles on research, clinical practice, public health, policy, planning, implementation and evaluation, in the health and related sciences relevant to Africa and the tropics. African Health Sciences acknowledges support provided by the African Health Journals Partnership Project that is funded by the US National Institutes of Health (through the National Library of Medicine and the Fogarty International Center) and facilitated by the Council of Science Editors.</p> <p>Indexed on MEDLINE/PUBMED; PUBMED CENTRAL; African Index Medicus; HINARI; Bioline; AJOL; Science Citation Index - Clarivate (Thompson Reuters)&nbsp;<strong>Impact factor (2018):</strong> <strong>0.842. CiteScore (2018): 0.99.</strong></p> <p>Other websites related to this journal include:&nbsp; <a title="" href="" target="_blank" rel="noopener"></a></p> <p>African Health Sciences encourages authors to now submit their papers online to the following website: <a title="" href="" target="_blank" rel="noopener"></a></p> Editorial: TB on the rise: but researchers are not sleeping 2021-09-27T07:58:48+00:00 James K Tumwine <p>Nil.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Early detection of Pre-XDR TB with line probe assay in a high TB burden country 2021-09-27T08:16:17+00:00 Laura Madukaji Isaac Okohu Saheed Usman Uche Oyedum Abdullah Enagi Abubakar Usman AS Adedeji Femi Owolagba Eke Ofuche Jay Osi Samuels Toyin Jolayemi Prosper Okonkwo <p><strong>Background</strong>: Worldwide, tuberculosis (TB) is one of the top 10 causes of death. Drug resistant tuberculosis has lately become a major public health problem that threatens progress made in Tuberculosis (TB) care and control worldwide. The aim of this study was to determine the prevalence of Pre-extensive drug resistant TB among MDR TB in North Central of Nigeria.</p> <p><strong>Methods</strong>: This study was conducted from October, 2018 to August, 2019 with 150 samples. In Nigeria, guidelines for DR-TB as recommended by WHO is followed. All the samples from the patients who gave their consent were transported to a zonal reference TB laboratory (ZRL).</p> <p><strong>Results</strong>: Mean age was 38.6 ± 13.4 years with peak age at 35-44. Out of these 103 samples processed with LPA, 101(98%) were rifampicin resistant and 2 were rifampicin sensitive, 99(96%) were INH resistant and 4 (4%) were INH sensitive, 5(5%) were fluoroquinolone resistant, 98(95%) were fluoroquinolone sensitive, 12 (12%) were Aminoglycoside + Capreomycin resistant, 91(83%) were Aminoglycoside + Capreomycin sensitive.</p> <p><strong>Conclusion</strong>: Multidrug resistant TB and its severe forms (Pre-extensive &amp; extensively drug resistant TB) can be detected early with rapid tool- Line Probe Assay rapid and prevented timely by early initiation on treatment.</p> <p><strong>Keywords:</strong> Pre-XDR TB; line probe assay in a high TB burden country.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study 2021-09-27T08:34:39+00:00 Andrew Kazibwe Fred Twinomugisha Joseph Musaazi Florence Nakaggwa Disan Lukanga Phillip Aleu Timothy Kiyemba Abel Nkolo Nicholas Sebuliba Kirirabwa Debora B Freitas Lopez Estella Birabwa Seyoum Dejene Stella Zawedde-Muyanja <p><strong>Introduction:</strong> Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda.</p> <p><strong>Methods:</strong> We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers.</p> <p><strong>Results:</strong> From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p&lt;0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p&lt;0.01) and highest among children 0-14 (4.8% vs 3.2% p&lt;0.01).</p> <p><strong>Conclusion:</strong> Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years.</p> <p><strong>Keywords:</strong> Tuberculosis; screening; community; Uganda.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Evaluation of PCR pncA-restriction fragment length polymorphism and PCR amplification of genomic regions of difference for the identification of M. bovis strains in lymph nodes cultures 2021-09-27T08:47:15+00:00 Imen Bouzouita Henda Draoui Samia Mahdhi Leila Essalah Leila Slim Saidi <p><strong>Background:</strong> A rapid accurate identification of <em>Mycobacterium bovis</em> is essential for surveillance purposes.</p> <p><strong>Objectives:</strong> A PCR <em>pncA</em>-Restriction Fragment Length Polymorphism (RFLP) and a multiplex PCR based on the detection of 3 regions of difference (RD-PCR): RD9, RD4 and RD1 were evaluated for the identification of <em>M. bovis</em> in lymph nodes cultures, in Tunisia, during 2013-2015.</p> <p><strong>Methods:</strong> Eighty-two <em>M. tuberculosis</em> complex strains were identified using the biochemical tests, GenoType MTBC assay, PCR <em>pncA</em>-RFLP and RD-PCR.</p> <p><strong>Results:</strong> The PCR <em>pncA</em>-RFLP showed that 54 M. bovis strains, identified by GenoType MTBC, had a mutation at position 169 of pncA gene. Twenty-eight strains did not show any mutation at this position 27 <em>M. tuberculosis</em> isolates and one <em>M. caprae</em>. The PCR <em>pncA</em>-RFLP had a sensitivity of 100.0% (95%CI: 93.3 -100.0) and a specificity of 100.0% (95%CI: 87.9- 100.0) for identifying M. bovis. The RD-PCR showed that all <em>M. bovis</em> strains had the RD9 and RD4 deleted but presented RD1. RD-PCR also presented high sensitivity and specificity in detecting <em>M. bovis</em> strains (100.0%).</p> <p><strong>Conclusions:</strong> PCR <em>pncA</em>-RFLP and RD-PCR represent very accurate and rapid tools to identify <em>M. bovis</em>. They can be easily implemented in each laboratory due to their low cost and easy use.</p> <p><strong>Keywords:</strong> GenoType MTBC; lymph nodes; <em>Mycobacterium bovis</em>; PCR pncA-RFLP; RD-PCR.</p> 2021-09-27T00:00:00+00:00 Copyright (c) It is not always Tuberculosis! A case of pulmonary cryptococcosis in an immunocompetent child in Uganda 2021-09-27T08:53:33+00:00 Irene Nakatudde Phillip Kasirye Sarah Kiguli Philippa Musoke <p>Pulmonary cryptococcosis is rare in immunocompetent individuals. Limited data exist regarding its occurrence in children, especially in developing countries. This case report describes an 8-year-old HIV-negative child with pulmonary cryptococco- sis, previously diagnosed and treated for tuberculosis twice without improvement. Fine needle aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis and serum cryptococcal antigen test was positive. The child improved on am- photericin and fluconazole treatment. Despite the limited diagnostic capacity in many resource-constrained settings like Uganda, this case report highlights the need to investigate other causes of pneumonia in immunocompetent children that are not improving on conventional antimicrobial treatments.</p> <p><strong>Keywords:</strong> Pulmonary cryptococcosis; immunocompetent; children; Uganda.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Predictors for tuberculosis co-infection in people living with HIV/AIDS 2021-09-27T09:00:36+00:00 Esra Zerdali İnci Yılmaz Nakir Serkan Sürme Uğurcan Sayılı Mustafa Yıldırım <p><strong>Background/aim:</strong> Tuberculosis (TB) is one of the most common chronic infectious conditions causing mortality and se- vere outcomes, particularly in people living with HIV/AIDS (PLWHA). In this study, we aimed to determine the prevalence and predictors of TB among PLWHA.</p> <p><strong>Materials and methods:</strong> We conducted a retrospective and single-center study of adults (≥18 years) PLWHA registered at our tertiary teaching and research hospital between 2000 and 2016.</p> <p><strong>Results:</strong> A total of 711 PLWHA were included. Of whom, 633 (89.0%) were male. Mean age was 36.53 ±11.55 years (range, 17-79). Thirty-eight (5.3%) patients were diagnosed with active TB. TB development was associated with low CD4+ lymphocyte count (p&lt;0.001), high viral load (p=0.040) and alcohol consumption (p=0.004) but no association with age (p=0.392), gender (p=0.928) and duration since anti-retroviral therapy initiation (p=0.788) was found. Also, a receiver operating characteristic analysis showed that the area under the curves of CD4+ lymphocyte count as a predictor for TB development in PLWHA was 0.717 (p&lt;0.001).</p> <p><strong>Conclusion:</strong> There are still clinical challenges to predict TB diagnosis. However, CD4+ lymphocyte count and viral load may be considered as valuable predictors for TB development. Also, community strategies to reduce harmful effect of alco- hol use should be developed.</p> <p><strong>Keywords:</strong> Tuberculosis; HIV viral load; CD4 cell counts.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Prevalence and associated factors of HIV-TB co-infection among HIV patients: a retrospective Study 2021-09-27T09:04:57+00:00 Melkamu A Zeru <p><strong>Background:</strong> TB/HIV co-infection is a major public health problem in many parts of the world. But the prevalence of co-infection was varies among countries. This study was designed to assess prevalence of TB/HIV co-infection and to determine its factors.</p> <p><strong>Methods:</strong> A retrospective study was done among HIV-positive patients at Hiwot Fana hospital from December, 2014 to 2018. The study participants were selected by simple random sampling. Patients with incomplete chart reviews were exclud- ed and demographic, clinical and laboratory information were analyzed using SPSS and STATA. Uni-vitiate and bivariate logistic regressions were applied.</p> <p><strong>Results:</strong> Five hundred fourteen patients were enrolled in this study. Of these, 187(37.4%) had TB. Bivariate logistic analysis showed that HIV patients with regards to marital status[AOR = 2.6; 95%CI = 1.19- 2.89] , education status [AOR = 3.74; 95%CI = 2.47–5.66], weight less than 50kg [AOR = 2.54; 95% CI = 1.35 – 4.81], CD4 level &lt; 200cells/mm3 [AOR = 4.57; 95%CI = 2.38– 6.86] and patient who were at WHO clinical stage III [AOR = 7.8; 95%CI = 5.15 – 8.55] were significantly associated with TB/HIV co-infection.</p> <p><strong>Conclusion:</strong> The prevalence of TB among HIV patients was high and predicted by marital, education status, weight, CD4 cell count and WHO clinical stage III.</p> <p><strong>Keywords:</strong> Prevalence; TB; HIV; co-infection; Harari Region.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Detection of hepatitis C virus among HIV patients in Port Harcourt, Rivers State 2021-09-27T09:49:27+00:00 Glory Barinuaka Baeka Julius Kola Oloke Oluyinka Oladele Opaleye <p><strong>Background:</strong> Hepatitis C virus (HCV) a major human pathogen infecting millions of individuals worldwide, thereby in- creasing the risks for chronic liver diseases and has been discovered that HIV/HCV co-infected patients have a greater risk.</p> <p><strong>Objective:</strong> To determine the prevalence of HCV infection among HIV infected people in Port Harcourt, Rivers State.</p> <p><strong>Methodology:</strong> The patients were from the ages of 18 and above attending the antiretroviral clinic for over 6 months. The mean age of the participants was 36.91±8.38. Data were gotten from the 550 patients using a modified questionnaire and 5mls of blood samples were collected through venepuncture into EDTA bottles and spun at 3000rpm for 10 minutes sepa- rating the plasma from the whole blood. The CD4+ count was gotten from the patients’ file and the samples kept at -700C till analized. HCV antibody was detected using a commercially available third generation kit manufactured by Melsin Medical Co and statistical analysis was done using a Stata version 16. P value was determined using ANOVA.</p> <p><strong>Result:</strong> Total number positive to the HCV antibody was 24(4.4%) of which 8(33.3%) were males, while 16(66.7%) were females. Prevalence (29.2%) was among patients in the 31–35 age range. The CD4+ count ranged from 22-864 cells/µl with a mean value of 303.08±194.</p> <p><strong>Conclusion:</strong> From this study HIV/HCV co-infection occurs among HIV infected people in Port Harcourt. The CD4+ count was discovered to be low and was not age, nor gender dependent. HIV infected people should therefore be routinely screened for HCV.</p> <p><strong>Keywords:</strong> Serology; HCV; HIV; CD4+ Count.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Social support as a correlate of depression among people living with HIV and AIDS in Nigeria 2021-09-27T09:56:38+00:00 Dorothy Ebere Adimora Francisca Ngozi Ogba Monica Obiageli Omeje Fidelis Eze Amaeze Friday Mamudu Adene <p><strong>Background:</strong> Depression is a highly prevalent mental disorder among PLHIV, whilst social support is important in disease prevention, health promotion, therapeutic measure especially for PLHIV.</p> <p><strong>Objectives:</strong> To ascertain the different types and sources of social support and their association with depression among PLHIV in Nigeria.</p> <p><strong>Materials and Methods:</strong> The study was a correlation with 2515 PLHIV in three teaching hospitals in South-Eastern Nige- ria. Data were collected between January to June, 2019 through interviews, using socio-demographic and Clinical Form and a Social Support Scale for PLHIV. SPSS-20 used for data analysis.</p> <p><strong>Results:</strong> It was shown that average scores of instrumental and emotional social supports (IESS) were satisfactory and not influenced by sex (p = 0.894; p = 0.496), education (p = 0.805; p = 0.182), marital status (p = 0.076; p = 0.446) and length of antiretroviral therapy (p = 0.510; p = 0.136). People diagnosed for less than three years had more instrumental support (p = 0.05) than those diagnosed over three years. The regression score also revealed a high predictive power of IESS on depression of PLHIV.</p> <p><strong>Conclusion:</strong> PLHIV have satisfactory social support, especially from family not residing in the same household and emo- tional social support from friends. Analyses identified knowledge gaps in the community regarding the social support re- ceived by PLHIV and their depression symptoms.</p> <p><strong>Keywords:</strong> Depression; instrumental support; emotional support; HIV; AIDS.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Comparative incidence of adverse drug reaction during the first and subsequent year of antiretroviral therapy in a Nigerian HIV infected cohort 2021-09-27T10:13:20+00:00 Isaac O Abah Wetkos D Dayom Dauda A Dangiwa Roseline Aderemi-Williams Joseph Anejo-Okopi Oche O Agbaji Phyllis Kanki John C Aguiyi <p><strong>Background:</strong> Despite close to two decades of antiretroviral therapy (ART) in Nigeria, data on late on-onset ART-associated adverse drug reactions (ADRs) are sparse.</p> <p><strong>Objectives:</strong> To describe early and late-onset ADRs and compare their incidence in an outpatient HIV positive Cohort on ART.</p> <p><strong>Method:</strong> We described the incidence of clinical ADRs identified and documented in an outpatient clinic cohort of HIV-pos- itive patients treated between June 2004 and December 2015 at a tertiary health facility in Nigeria. Incidence rates of ADRs during the first and subsequent years of ART were compared.</p> <p><strong>Results:</strong> of the 13,983 patients’ data analyzed, 9317 were females (66%), and those in the age bracket of 25 to 45 years made up 78% of the studied population. During 52,411 person-years (py) of ART, 1485 incident ADRs were recorded; Incidence rate (IR) 28.3 (95% confidence interval [CI] 26.9:29.8) ADRs per 1000 person-years (py) of ART. The IR of ADRs was about two times higher in the first year of ART compared to subsequent years of treatment; crude incidence rate ratio (IRR) 1.77 (95% CI 1.59:1.97). Anemia, hypersensitivity reactions, and nervous system disorders had 7, 23, and 5 times higher incidence, respectively, in the first year of therapy, compared to subsequent years.</p> <p><strong>Conclusion:</strong> The first year of ART is the period of highest risk of ADRs. Individual and programmatic treatment success in resource-limited settings requires strategies for early identification and management of ADR during the period of greatest risk of ADRs.</p> <p><strong>Keywords:</strong> Adverse drug events; antiretroviral therapy; drug toxicity; sub- Saharan Africa.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Interface between biomedical and traditional systems of treatment and care among HIV positive fisher folk in two fishing communities on Lake Victoria, Uganda 2021-09-27T10:20:06+00:00 Christopher Tumwine Peter Aggleton Stephen Bell <p><strong>Background:</strong> Fisherfolk have been identified as a key population in the HIV response in Uganda due to high HIV preva- lence and low engagement in HIV services. While studies have examined lifestyles and risk, much remains to be understood about help and health seeking experiences, including the combined use of biomedical and traditional health care.</p> <p><strong>Objective:</strong> To examine the use of biomedical and traditional health care in two fishing communities around Lake Victoria in Uganda.</p> <p><strong>Methods:</strong> Exploratory, in-depth qualitative study involving semi-structured interviews with 42 HIV positive fisherfolk.</p> <p><strong>Results:</strong> Prior to HIV diagnosis, participants who described becoming ill sought different forms of help including biomedical treatment prescribed by health workers or self-prescribed; biomedical and herbal medicines together; herbal medicines only; or no form of treatment. Following HIV diagnosis, the majority of participants used ART exclusively, while a smaller number used both ART and traditional care strategies, or reported times when they used alternative therapies instead of ART. Prior to HIV diagnosis, fisherfolk’s health care seeking practices inhibited engagement with HIV testing and access to biomedical HIV treatment and care. After HIV diagnosis, most resorted only to using ART.</p> <p><strong>Conclusion:</strong> Study findings provide insight into how fisherfolk’s use of biomedical and traditional care prior to diagnosis influences subsequent engagement with HIV treatment. Efforts are needed to reach fisherfolk through everyday health seeking networks to ensure HIV is diagnosed and treated as early as possible.</p> <p><strong>Keywords:</strong> HIV care; fisherfolk; HIV; Uganda; traditional healers; anti-retroviral therapy.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Adherence to oral HIV pre-exposure prophylaxis among female sex workers in Kampala, Uganda 2021-09-27T10:29:27+00:00 Grace Kakoola Nalukwago John Bosco Isunju Timothy Muwonge Thomas Katairo Nelson Bunani Fred Semitala Peter Kyambadde Flavia Matovu <p><strong>Introduction:</strong> In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were inter- viewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done.</p> <p><strong>Results:</strong> Using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) were negatively associated with high PrEP adherence.</p> <p><strong>Conclusion:</strong> Barriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks.</p> <p><strong>Keywords:</strong> Oral PrEP; adherence; female sex workers.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Adolescent girls’ perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya 2021-09-27T11:07:22+00:00 Gift-Noelle Wango Kawango Agot Henry Ogolla Marylyn Ochillo Spala Ohaga Harsha Thirumurthy <p><strong>Background:</strong> Adolescent girls (AG) in sub-Saharan Africa are at elevated risk of acquiring HIV, yet few know the HIV status of their sexual partners. Interventions to promote testing among partners are urgently needed.</p> <p><strong>Objectives:</strong> To explore AG’s perceived ability to safely distribute HIV self-tests to their partners, if partners would self-test, and how to minimize partner violence.</p> <p><strong>Methods:</strong> We recruited HIV-negative AG ages 15-19 years with a partner of unknown HIV status or who tested negative &gt;6 months previously. Using mixed-methods for data collection and regression and inductive thematic analysis for quantitative and qualitative analysis, respectively, we determined factors associated with the study objectives.</p> <p><strong>Results:</strong> We enrolled 101 AG, median age 17.3 years, sexual debut 15-16 years, and 54.5% reported ≥2 lifetime partners. Most participants (95.0%) would offer self-tests to their partners and 95.1% reported high-to-moderate chance their part- ner would self-test. No participant attribute was associated with perceived ability to offer self-test or likelihood of partner testing. To avoid violence, AG recommended politeness, indirect approach, voluntariness, and highlighting advantages of self-testing.</p> <p><strong>Conclusions:</strong> AG believe they can safely distribute self-tests to their partners, and most partners would self-test, expanding utility of HIV self-tests to include partners of AG.</p> <p><strong>Keywords:</strong> HIV self-testing; partner testing; couples testing; adolescent girls; Kenya.&nbsp;</p> 2021-09-27T00:00:00+00:00 Copyright (c) Knowledge, attitude, and preferred strategies towards HIV/AIDS prevention among adolescents attending secondary schools in South Western Uganda 2021-09-27T11:23:18+00:00 Esther Beebwa Conrad Muzoora Scholastic Ashaba Sara Groves Fortunate Atwine <p><strong>Background:</strong> Globally, HIV/AIDS continues to rise among adolescents. Ugandan studies have examined knowledge and attitudes regarding HIV/AIDS among adult populations. This study specifically paid attention to this particular age group of adolescents 12-19 years.</p> <p><strong>Aim:</strong> To explore HIV knowledge and attitudes among adolescents attending secondary schools Mbarara Uganda.</p> <p><strong>Methods:</strong> A qualitative descriptive study was conducted in three secondary schools in South Western Uganda. Forty eight (48) adolescents with age range between 12-19 years were purposively recruited in the study. Data were collected from six focus groups and analyzed thematically. Ethical approval received from MUST (#05/10-17) and UNSCT (#SS4535) review committees.</p> <p><strong>Results:</strong> Four themes emerged: Knowledge about HIV, sources of information, attitudes towards persons with HIV and prevention strategies. Most adolescents had the basic knowledge of HIV from multiple sources like social media, health workers, peers, and parents. Their attitudes toward individuals with HIV included compassion, shock, and uneasiness. Par- ticipants suggested prevention programs to be implemented in the schools emphasizing HIV education, life skills, sex edu- cation and the formation of peer groups.</p> <p><strong>Conclusions:</strong> The findings showed that most participants had knowledge about HIV and how it can be prevented however few had knowledge gap thinking that HIV does not exist.</p> <p><strong>Keywords:</strong> Adolescents; attitudes; knowledge; HIV/AIDS; prevention.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at a regional hospital in the north east of Namibia 2021-09-29T08:59:26+00:00 Daniel Opotamutale Ashipala Getruida Shikukumwa Medusalem Hangula Joel <p><strong>Background:</strong> In sub-Saharan Africa, over 1,000 newborns are infected with HIV every day, despite available medical in- terventions. Mother-to-child transmission (MTCT) remains one of the primary sources of HIV infection in children and without interventions 40% of babies born from HIV-positive mothers would be infected with the virus. It is estimated that 300 000 children become infected with HIV worldwide, whilst 1.5 million children die when their mothers opt for other choices instead of breastfeeding.</p> <p><strong>Objective:</strong> The purpose of the study was to assess and describe the knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at Rundu Intermediate Hospital, Kavango East Region in Namibia.</p> <p><strong>Method:</strong> The study was a descriptive cross-sectional survey that used convenience sampling, as the researcher sought to use subjects available during the time of study to select 79 HIV positive mothers.</p> <p><strong>Results:</strong> Participants in this study (94%; n=51) had good knowledge of the benefit of exclusive breastfeeding and that the benefits of breastfeeding outweigh the risk of HIV transmission from mother to child. The results confirmed that (77.2%; n=42) of the mothers opted to take ART with the babies until they stop breastfeeding.</p> <p><strong>Conclusion:</strong> HIV positive mothers had good knowledge, attitudes and practices regarding the benefits of exclusive breast- feeding. A significant number of mothers were, however, not sure about breastfeeding exclusively for 6 months as they would stop if offered free formula milk for the baby. Support by the fathers and others in the community is vital.</p> <p><strong>Keywords:</strong> Knowledge; HIV; breastfeeding; attitudes; practices; HIV-positive mothers; Namibia.</p> 2021-09-27T00:00:00+00:00 Copyright (c) A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method 2021-09-27T11:41:07+00:00 Sevinç Dağıstanlı Süleyman Sönmez Murat Ünsel Emre Bozdağ Ali Kocataş Merve Boşat Eray Yurtseven Zeynep Çalışkan Mehmet Güven Günver <p><strong>Background/aim:</strong> The present study aimed to create a decision tree for the identification of clinical, laboratory and radio- logical data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul.</p> <p><strong>Materials and methods:</strong> The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was per- formed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree.</p> <p><strong>Results:</strong> A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%.</p> <p><strong>Conclusions:</strong> There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived.</p> <p><strong>Keywords:</strong> Survival algorithm; COVID-19 intensive care patients; CRT method.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Covid-19 pandemic: chronicle of responses and experiences of the infection prevention and control committee at a tertiary hospital in southwest Nigeria 2021-09-27T11:50:07+00:00 Akinwumi Ayodeji Akinbodewa Michael Simidele Odimayo Olorunfemi Akinbode Ogundele Tosin Oluwapelumi Ogunleye Olanrewaju Olayinka Johnson Oluwakemi Abiola Lamidi Mathew Akinmurele Oluwabunmi Motunrayo Oyebade <p>Since the advent of 2019-Corona virus Disease (COVID-19) in Nigeria in February 2020, the number of confirmed cases has risen astronomically to over 61,307 cases within 8 months with more than 812 healthcare workers infected and some recorded deaths within their ranks. Infection prevention and control is a key component in ensuring safety of healthcare workers in the hospital as health- care-associated infection is one of the most common complications of healthcare management. Unbridled transmission of infection can lead to shortage of healthcare personnel, reduced system efficiency, increased morbidity and mortality among patients and in some instances, total collapse of healthcare delivery services. The Infection Prevention and Control Committee is a recognised group by the Centre for Disease Control and Prevention with their core programmes including drawing up activities, procedures and policies designed to achieve above-stated objectives before, during and after any disease outbreak, especially emerging and re-emerging ones such as the 2019 Coronavirus Disease. In this report, we highlight the roles played by the Infection Prevention and Control Committee of the University of Medical Sciences Teaching Hospital to prevent the spread of COVID-19 within and outside the hospital community and the lessons learned to date.</p> <p><strong>Keywords:</strong>&nbsp;COVID-19; infection prevention; infection control; Nigeria.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Diabetes and COVID-19 in Congolese patients 2021-09-27T12:13:09+00:00 Henriette Poaty Guy Emergence Poaty Gilbert NDziessi Emile Godefroy Ngakeni Tatiana Doukaga Makouka René Soussa Gadoua Regis Ondzé Lambert Kitembo Presley Jeanel Msengui Jethro Massala Peya Michel Gbala Sapoulou Pascal Ibata Henri Germain Monabeka Alexis Elira Dokekias <p><strong>Background:</strong> The global pandemic Coronavirus Disease 2019 (COVID-19) due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is reported to be potentially severe in patients with morbid conditions. One common reported comorbidities is diabetes. We aimed in this study to precise the clinical characteristics and outcomes in a series of congolese diabetic patients affected by COVID-19 infection.</p> <p><strong>Patients and methods:</strong> We retrospectely studied from 256 COVID-19 patients, a cohort of 30 persons with previously known diabetes. The glycaemia controls have been obtained by plasma glucose assay. All patients have been tested positive to SARS-CoV-2 by RT-PCR method.</p> <p><strong>Results:</strong> The COVID-19 diabetic patients represented 11,7% of all COVID-19 patients with confidence interval of 95% [7,77-15,65]. Older individuals and male sex were predominent. Dyspnea and sauration of oxygen &lt; 90 were significatives and added risk factors were noted in 63.3% of patients, particulary hyperglycaemia with hypertension or obesity. The mortality rate at the percentage of 36.7% was more prevalent in patients with added comorbidities (30%) versus without comorbidities (6.7%).</p> <p><strong>Conclusion:</strong> Congolese COVID-19 diabetic patients of male sex and older age exhibiting arterial hypertension and obesity are the most exposed to severe COVID-19 and increasead mortality rate.</p> <p><strong>Keywords:</strong> COVID-19, SARS-CoV-2, diabetes, Congolese patients.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Evaluating the Novel Coronavirus infection outbreak surveillance results in a state hospital: a retrospective study 2021-09-27T12:25:04+00:00 Ezgi Dirgar Betül Tosun Soner Berşe Nuran Tosun <p><strong>Background:</strong> Coronavirus disease (COVID-19) has raised the global public health concern and has been declared a pan- demic by the World Health Organization.</p> <p><strong>Objectives:</strong> This study was aimed to examine the clinical course and outcomes of the patients with COVID-19 in the south- eastern part of Turkey.</p> <p><strong>Methods:</strong> This retrospective study was conducted on the files of 173 patients who were diagnosed with COVID-19. The “COVID-19 Case Information Form” in the patients’ medical records was used.</p> <p><strong>Results:</strong> Of the patients with COVID-19, 64.2% were male and 16.2% had a chronic disease. Their mean age was 34.76±25.75 years. Cough and fatigue were the most common clinical symptoms at admission with 38.7%. The patients at the age of 65 and over were treated mostly in the intensive care unit, and the symptoms associated with the cardiovascular and nausea and vomiting were observed more often (p&lt;0.05).</p> <p><strong>Conclusions:</strong> It was found that the majority of the patients were male and there were differences between the age groups in terms of transmission route, the clinic where they were being followed-up, some symptoms, and clinical status outcome. It is recommended that multi-center, prospective, experimental, or observational studies with larger samples should be and the patients should be followed-up for longer periods.</p> <p><strong>Keywords:</strong> COVID-19; coronavirus; surveillance; retrospective study.</p> 2021-09-27T00:00:00+00:00 Copyright (c) A comparative study of serological diagnosis of Dengue outbreak 2019 2021-09-27T12:40:02+00:00 Muhammad Bilal Habib Noreen Sher Akbar Anber Saleem <p><strong>Purpose:</strong> The interpretation &amp; correlation of the different laboratory parameters in positive dengue cases in order to eval- uate that which laboratory test is more significant for diagnosis of Dengue.</p> <p><strong>Methods:</strong> Prospective examination of samples (patients’ serum) for dengue virus of different genotype by using multiplex anti-dengue IgM, IgG. We have done NS-1 test by (ICT) immunochromatographic devices, and complete blood picture (CBC) by Sysmex XP-100.</p> <p><strong>Result:</strong> Detection of Viral RNA in 100 patients showed effects in the total of 73 (73.0%) samples. This graphical compar- ison shows the whole positive cases including dengue NS-I antigen, dengue serology (IgM &amp; IgG), total 62 positive cases of NS-I are detected, 10 positive cases of dengue IgM and 9 positive cases of IgG detected, in which Complete Blood Test (CBC) shows remarkable reduction in Platelets (32 cases) and Leucopenia in (24 positive cases).</p> <p><strong>Conclusion:</strong> In this research, it is concluded that the diagnosis of dengue cases is preliminary limited to initial stages i.e. CBC or sometimes dengue NS-I, as dengue IgM severity is more effective than that of Dengue NS-I &amp; IgG. Many patients who had negative results in CBC and NS-1 testing, became positive when IgM and IgG serology testing has been done.</p> <p><strong>Keywords:</strong> Dengue; NS-1; IgG; IgM; Immunochrometographic test.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Insecticide resistance of Dengue vectors in South East Asia: a systematic review 2021-09-27T12:50:50+00:00 Mohd Rohaizat Hassan Noor Atika Azit Suhaiza Mohd Fadzil Siti Rasidah Abd Ghani Norfazilah Ahmad Azmawati Mohammed Nawi <p><strong>Background:</strong> The insecticides used widely has led to resistance in the vector and impose a challenge to vector control op- eration.</p> <p><strong>Objectives:</strong> This review aims to analyse the distribution of insecticide resistance of dengue vectors in South East Asia and to describe the mechanism of insecticide resistance.</p> <p><strong>Methods:</strong> Literature search for articles published on 2015 to 2019 from PubMed, Scopus and ProQuest was performed. Total of 37 studies included in the final review from the initial 420 studies.</p> <p><strong>Results:</strong> Pyrethroid resistance was concentrated on the west coast of Peninsular Malaysia and Northern Thailand and scat- tered at Java Island, Indonesia while organophosphate resistance was seen across the Java Island (Indonesia), West Sumatera and North Peninsular Malaysia. Organochlorine resistance was seen in Sabah, Malaysia and scattered distribution in Nusa Tenggara, Indonesia. V1016G, S989P, F1269C gene mutation in Aedes Aegypti were associated with Pyrethroid resistance in Singapore and Indonesia. In Malaysia, over-expressed with monooxygenase P450 genes (CYP9J27, CYP6CB1, CYP9J26 and CYP9M4) Glutathione S-transferases, carboxylesterases commonly associated with pyrethroids resistance in Aedes Aegypti and CYP612 overexpressed in Aedes Albopictus. The genetic mutation in A302S in Aedes Albopictus was associated with organochlorine resistance in Malaysia.</p> <p><strong>Conclusions:</strong> Rotation of insecticide, integration with synergist and routine assessment of resistance profile are recom- mended strategies in insecticide resistance management.</p> <p><strong>Keywords:</strong> Insecticide resistance; vector management; Aedes; pyrethroid; mortality.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Assessment of hepatitis B surface antigen negative blood units for HBV DNA among replacement blood donors in a hospital based blood bank in Nigeria 2021-09-27T14:11:55+00:00 Foluke Atinuke Fasola Adeola Fowotade Adedayo Faneye <p><strong>Background:</strong> Hepatitis B virus infection is one of the greatest threats to blood safety all over the world. The laboratory algorithm based on only the detection of hepatitis B surface antigen (HBsAg) leaves a gap for infected HBsAg negative donors to donate blood during the “window period” (WP) and late stages of infection.</p> <p><strong>Objective:</strong> To estimate the frequency of the presence of HBV deoxyribonucleic acid (DNA) in HBsAg negative blood units screened using two different assays for HBsAg in a high endemic region.</p> <p><strong>Methods:</strong> Frozen serum aliquot of 100 replacement blood donors who donated blood units that were HBsAg negative were retrieved and tested for HBV DNA. Sample positive for HBV DNA was sequenced by Sanger’s method, genotyped and the viral load was determined.</p> <p><strong>Results:</strong> One sample (1%) was positive for HBV DNA. The HBV viral load of the sample was 768,000 IU/ml. The partial S-gene of the Hepatitis B virus isolated was genotype E using the NCBI viral genotyping tool.</p> <p><strong>Conclusions:</strong> There is still a risk of HBV infected blood unit escaping detection when donor testing is limited to HBsAg screening. The use of NAT which can substantially reduce HBV infected blood donors from the donor pool should be considered.</p> <p><strong>Keywords:</strong> Hepatitis B surface Antigen; Hepatitis B Virus; DNA; blood donors; blood safety.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Diphtheria serology in adults in Central Java and East Java, Indonesia: the importance of continuous diphtheria vaccination 2021-09-27T15:00:25+00:00 Sunarno Febriyani Asri Subangkit Mursinah Herna Susanti Nike Sariadji Kambang Widoretno Febriyana Dwi Febrianti Tati Saraswati Ratih Dian Puspandari Nelly <p><strong>Background:</strong> Vaccination increase immunity against diphtheria, yet will decrease by aging. Therefore, boosters are needed to be done regularly.</p> <p><strong>Objectives:</strong> This study aims to determine the immunity to diphtheria for the population of 16 years old and above.</p> <p><strong>Methods:</strong> The sample of study were 295 collected blood serums by Riskesdas project in 2013, the criteria was above 15 years of age and originating from the Provinces of Central Java or East Java inclusively. Immunity assessment was based on antibody titer (IgG) against diphtheria using Vero Cell cytotoxicity test. Statistical analysis was performed using the X2 test.</p> <p><strong>Results:</strong> The full protective IgG titer (&gt;0.1 IU/ml) at the age of 16-20 years included 75% sample with a geometric mean titer (GMT) of 0.19 IU/ml. Yet, at the age of 21-60 years and &gt; 60 years, full protective IgG titers only cover 45.5% and 33.3% sample with GMT respectively 0.06 IU / ml. Statistical analysis showed the relationship between age and immune status with p-value 0.003. Otherwise, no relationship between the status of immunity with sex and residency with p-values of 0.16 and 0.43.</p> <p><strong>Conclusions:</strong> The immune status against diphtheria at the age of above 15 years decreases with aging.</p> <p><strong>Keywords:</strong> Adult; diphtheria; Indonesia; serology.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Anatomical variations of the renal artery: a computerized tomographic angiogram study in living kidney donors at a Nigerian Kidney Transplant Center 2021-09-27T15:08:51+00:00 Abayomi Aremu Martin Igbokwe Olalekan Olatise Ahmad Lawal Kester Maduadi <p><strong>Background:</strong> Understanding of the renal vascular anatomy is key to a safe and successful donor nephrectomy, which ulti- mately impacts on the renal graft function and survival in kidney transplant recipients.</p> <p><strong>Objective:</strong> To report the various anatomical configurations of the renal artery identified in living kidney donors in a Nige- rian kidney transplant institution .</p> <p><strong>Materials and Methods:</strong> The computerized tomography angiograms of 100 consecutive living kidney donors were pro- spectively reviewed over an 18-month period. Anatomical variations of the renal arteries including accessory arteries and early divisions were noted. Duration of surgery and ischemic time were recorded intra-operatively. Data analysis was carried out using IBM SPSS version 20.</p> <p><strong>Results:</strong> There were variations in renal artery configuration in 50 (50%) cases, 32% were accessory renal arteries while 18% were early branches of the renal artery. The classical bilateral solitary renal arteries were found in 50 (50%) of potential do- nors. There was statistically significant longer operating and ischemic time in donors with multiple renal arteries as compared with solitary arteries (p&lt;0.05).</p> <p><strong>Conclusion:</strong> There are a wide variety of renal artery configurations seen in potential kidney donors. The classical solitary renal artery remains the commonest and most favourable configuration for donor nephrectomy and transplantation.</p> <p><strong>Keywords:</strong> Renal artery; variations; living kidney donors.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Association of eNOS (G894T, rs1799983) and KCNJ11 (E23K, rs5219) gene polymorphism with coronary artery disease in North Indian population 2021-09-27T15:19:24+00:00 Syed Tasleem Raza Sachendra P Singh Saliha Rizvi Alina Zaidi Sanchita Srivastava Arif Hussain Farzana Mahdi <p><strong>Background:</strong> Endothelial nitric oxide synthase (eNOS) and potassium voltage-gated channel subfamily J member 11 (KCNJ11) could be the candidate genes for coronary artery disease (CAD). This study investigated the relationship of the eNOS (rs1799983) and KCNJ11 (rs5219) polymorphisms with the presence and severity of CAD in the North Indian pop- ulation.</p> <p><strong>Methods:</strong> This study included 300 subjects, 150 CAD cases and 150 healthy controls. Single nucleotide polymorphism was evaluated by Polymerase chain reaction and Restriction fragment length polymorphism (PCR-RFLP). Analysis was performed by SPSS (version 21.0).</p> <p><strong>Results:</strong> We observed that KK genotype of KCNJ11E23K (rs5219) polymorphism (P=0.0001) genotypes and K allele (P=0.0001) was found to be a positive risk factor and strongly associated with CAD. In the case of eNOSG894T (rs1799983) there was no association found with CAD.</p> <p><strong>Conclusion:</strong> These results illustrate the probability of associations between SNPs and CAD although specific genetic pol- ymorphisms affecting ion channel function and expression have still to be clarified by further investigations involving larger cohorts.</p> <p><strong>Keywords:</strong> Coronary Artery Disease (CAD); endothelial nitric oxide synthase (eNOS); potassium voltage-gated channel subfamily J member 11 (KCNJ11); gene polymorphism.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Gut permeability is associated with hypertension and measures of obesity but not with Endothelial Dysfunction in South African youth 2021-09-27T15:38:06+00:00 Ezona E Ntlahla Mvuyisi MO Mfengu Godwill A Engwa Benedicta N Nkeh-Chungag Constance R Sewani-Rusike <p><strong>Background:</strong> Though gut permeability has shown to be associated with measures of obesity and hypertension, its relation- ship with endothelial dysfunction, an early predictor for cardiovascular diseases remains unknown.</p> <p><strong>Objective:</strong> This study assessed the relationship between hypertension, measures of obesity, gut permeability and endothelial dysfunction.</p> <p><strong>Methods:</strong> A cross-sectional quantitative study which enrolled 151 South African youths was conducted. Anthropometric and blood pressure measurements were performed. Zonulin, a marker for gut permeability; adiponectin, an anti-inflamma- tory molecule, as well as asymmetric dimethylarginine (ADMA) and Nitric oxide (NO) which are markers for endothelial- function were assayed.</p> <p><strong>Results:</strong> Approximately eighteen percent (17.88%) of the participants were hypertensive while 40.4% were pre-hyperten- sive. Adiponectin significantly increased in hypertensive subjects and negatively correlated (p&lt;0.05) with measures of obesity but was not associated with gut permeability and endothelial dysfunction. Increased body mass index (BMI) and visceral fat (VF) predicted reduced adiponectin (inflammation). Zonulin was significantly higher (p&lt;0.05) in hypertensive subjects and positively associated (p&lt;0.05) with systolic blood pressure (SBP) in females. A positive relationship (p&lt;0.05) was observed between zonulin and measurements of obesity. Moreover, zonulin negatively associated (p&lt;0.05) with ADMA but positively associated (p&lt;0.05) with NO in males. Increased VF and waist circumference predicted gut permeability.</p> <p><strong>Conclusion:</strong> Gut permeability was associated with hypertension and measures of obesity but not with markers of endothe- lial dysfunction in a South African youth population.</p> <p><strong>Keywords:</strong> Gut permeability; hypertension; obesity; endothelial dysfunction; inflammation.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Increased ambulatory arterial stiffness index and blood pressure load in normotensive obese patients 2021-09-27T15:45:55+00:00 Fatma Kaplan Efe Mujgan Tek Tobb Etu Hastanesi̇ <p><strong>Objectives:</strong> It has been shown that blood pressure (BP) values measured in obese subjects are higher than the individuals with normal weight, even in normotensive limits. However, data concerning the Ambulatory Arterial Stiffness Index (AASI) and blood pressure load in normotensive obese subjects is lacking. This study was aimed to compare the ambulatory arterial stiffness index and blood pressure load in normotensive obese and healthy controls.</p> <p><strong>Methods:</strong> One hundred normotensive obese and one hundred normal weight subjects were included in this study. All sub- jects underwent 24-hour ambulatory blood pressure monitoring. Ambulatory arterial stiffness index was calculated from 24-hour ambulatory blood pressure monitoring records. Ambulatory arterial stiffness index was defined as one minus the regression slope of unedited 24-h diastolic on systolic blood pressures. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) load values were calculated from 24-hour ambulatory blood pressure monitoring analysis.</p> <p><strong>Results:</strong> Ambulatory arterial stiffness index of the obese subjects was significantly higher than the healthy controls (0.48±0.2 vs. 0.33±0.11, p&lt;0.001). 24-hours systolic blood pressure and diastolic blood pressure loads were significantly higher in obese subjects. Logistic regression analysis revealed that body mass index (BMI) was an independent predictor for an abnor- mal ambulatory arterial stiffness ındex (≥0.50) (OR: 1.137, 95% CI: 0.915-1.001, p=0.004).</p> <p><strong>Conclusion:</strong> Blood pressure load and ambulatory arterial stiffness index are increased in normotensive obese patients. Moreover, body mass index is an independent predictor for an abnormal ambulatory arterial stiffness index. Our results indicate that obese subjects are at higher risk for future cardiovascular events despite normal office BP levels.</p> <p><strong>Keywords:</strong> Ambulatory arterial stiffness index; blood pressure load; obesity; blood pressure.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Reported self-management of hypertension among adult hypertensive patients in a developing country: a cross-sectional study in a Nigerian tertiary hospital 2021-09-27T15:53:21+00:00 Ogban E Omoronyia Idowu Okesiji Chiamaka H Uwalaka Enagu A Mpama <p><strong>Background:</strong> Sustained control of blood pressure, is dependent on degree of self-management, which includes self-inte- gration, self-regulation, self-monitoring and adherence to regimen. We assessed the pattern of self-management of hyper- tension among adult hypertensive patients in a developing country.</p> <p><strong>Methods:</strong> Cross-sectional study design and convenience sampling, was used to recruit adult hypertensive patients, attending Lagos State University Teaching Hospital, Lagos, Nigeria. Interviewer-administered questionnaire was used to obtain data on self-management components. SPSS version 21.0 was used to analyze data, with p-value set at 0.05.</p> <p><strong>Result:</strong> One hundred and seven (107) respondents, had mean age of 49.0 ± 12.0 years. Mean value for self-management was 3.15 ± 0.55, comprising self-integration (3.06 ± 0.36), self-regulation (3.32 ± 0.63), self-monitoring (3.29 ± 0.84) and adherence to regimen (3.15 ± 0.55). Most components of self-management, had high levels of mean score. Respondents that were less than 40 years, compared with those that were more than 40 years, had greater mean values for self-integration (3.37 vs 3.05), but significantly lesser values for all other components (p &lt; 0.05).</p> <p><strong>Conclusion:</strong> Young hypertensives had poor levels of most components of self-management. There is urgent need for health educational programs on self-management of hypertension among young people in sub-Saharan Africa.</p> <p><strong>Keywords:</strong> Hypertension; self-management; self-integration; self-regulation; adherence; Nigeria.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Comparison of survival models and assessment of risk factors for survival of cardiovascular patients at Addis Ababa Cardiac Center, Ethiopia: a retrospective study 2021-09-27T16:02:20+00:00 Belaynesh Yeniew Enyew Zeytu Gashaw Asfaw <p><strong>Background:</strong> Cardiovascular diseases (CVDs) is disorders of heart and blood vessels. It is a major health problem across the world,and 82% of CVD deaths is contributed by countries with low and middle income. The aim of this study was to choose appropriate model for the survival of cardiovascular patients data and identify the factors that affect the survival of cardiovascular patients at Addis Ababa Cardiac Center.</p> <p><strong>Method:</strong> A Retrospective study was conducted on patients under follow-up at Addis Ababa Cardiac Center between Sep- tember 2010 to December 2018. The patients included have made either post operation or pre-operation. Out of 1042 car- diac patients, a sample of 332 were selected for the current study using simple random sampling technique. Non-parametric, semi-parametric and parametric survival models were used and comparisons were made to select the appropriate predicting model.</p> <p><strong>Results:</strong> Among the sample of 332 cardiac patients, only 67(20.2%) experienced CVD and the remaining 265(79.8%) were censored. The median and the maximum survival time of cardiac patients was 1925 and 1403 days respectively.The estimated hazard ratio of male patients to female patients is 1.926214 (95%CI: 1.111917-3.336847; p = 0.019) implying that the risk of death of male patients is 1.926214 times higher than female cardiac patients keeping the other covariates constant in the model. Even if, all semi parametric and parametric survival models fitted to the current data well, various model comparison criteria showed that parametric/weibull AFT survival model is better than the other.</p> <p><strong>Conclusions:</strong> The governmental and non-governmental stakeholders should pay attention to give training on the risk fac- tors identified on the current study to optimize individual’s knowledge and awareness so that death due to CVDs can be minimized.</p> <p><strong>Keywords:</strong> Cardiovascular patient; survival analysis; non-parametric; semi-parametric; parametric.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Aerobic versus resistance exercises on systemic inflammation and sleep parameters in obese subjects with chronic insomnia syndrome 2021-09-27T16:26:18+00:00 Osama H Al-Jiffri Shehab M Abd El-Kader <p><strong>Background:</strong> Chronic primary insomnia is a prevalent sleep disorder that is associated with adverse effects on health out- comes. Exercise is often considered a non-pharmacological approach that could have beneficial effects on sleep.</p> <p><strong>Objective:</strong> The aim of the study was to compare the impact of aerobic and resistance exercise training on quality of sleep and inflammatory markers among subjects with chronic primary insomnia.</p> <p><strong>Material and Methods:</strong> Sixty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 31-52 years. All participants were randomly assigned to aerobic exercise intervention group (group A, n=35) or resistance exercise intervention group (group B, n=35). Polysomnographic recordings for sleep quality assessment, IL-6, IL-10 and TNF-α were measured before and at the end of the study after six months.</p> <p><strong>Results:</strong> There was a significant increase in the total sleep duration, sleep efficiency, sleep onset latency and IL-10 in group(A) and group (B) in addition to significant reduction in awake time after sleep onset, REM latency, IL-6 and TNF-α after 6 months of aerbic and resistance exercise training. However, there were significant differences between both groups at the end of the study.</p> <p><strong>Conclusion:</strong> Aerobic exercise training is more appropriately than resistance exercise training in modulation of inflammatory and sleep quality among subjects with chronic primary insomnia.</p> <p><strong>Keywords:</strong> Aerobic exercise; chronic primary insomnia; inflammatory cytokines; resistance exercise; sleep quality.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Inflammatory cytokines and sleep parameters response to life style intervention in subjects with obese chronic insomnia syndrome 2021-09-27T16:36:35+00:00 Fadwah M Al-Sharif Shehab M Abd El-Kader <p><strong>Background:</strong> Chronic primary insomnia is a prevalent sleep disorder that is associated with adverse effects on health out- comes. Sleep disturbance is usually associated with abnormal level of systemic inflammation biomarkers.</p> <p><strong>Objective:</strong> The aim of this study was to detect changes in sleep quality and inflammatory markers following weight loss among subjects with chronic primary insomnia.</p> <p><strong>Material and Methods:</strong> Eighty previously sedentary subjects with chronic primary insomnia subjects enrolled in this study, their age ranged from 32-51 year were randomly assigned to life style intervention group (group A, n=40) or control group (group B, n=40). Polysomnographic recordings for sleep quality assessment, IL-6, IL-10 and TNF-α were measured before and at the end of the study after six months.</p> <p><strong>Results:</strong> There was a significant increase in the total sleep duration, sleep efficiency, sleep onset latency and IL-10 in addi- tion to significant reduction in awake time after sleep onset, REM latency, IL-6 and TNF-α after 6 months of in group(A) as a result of weight loss program; while the results of the control group (group B) were not significant. Also, there were significant differences between both groups at the end of the study.</p> <p><strong>Conclusion:</strong> Life style intervention modulates systemic inflammatory parameters and sleep quality among subjects with chronic primary insomnia.</p> <p><strong>Keywords:</strong> Chronic primary insomnia; inflammatory cytokines; life style intervention; sleep quality.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Knowledge and practices of physicians on blood component therapy: a cross-sectional study from two tertiary hospitals in Nigeria 2021-09-27T16:56:24+00:00 Esther Obi Claudius Diette-spiff Hannah Omunakwe <p><strong>Introduction:</strong> Comprehension of blood component therapy (BCT) has profound impact on transfusion outcomes. Varia- tions from the standards in practices of BCT may jeopardize patient care.</p> <p><strong>Aim:</strong> To assess the understanding and implementation of BCT by physicians.</p> <p><strong>Methods:</strong> The study was carried out at two tertiary health care centres. It was a descriptive cross- sectional study using a self-administered, questionnaire comprising of 30 questions.</p> <p><strong>Result:</strong> A total of 265 physicians responded from various clinical specialties. Physicians studied showed remarkable knowl- edge (98%) of BCT. Nevertheless, 92.8% of the respondents' were inclined to prescribing whole blood and the common- est reason given was ready availability at the blood bank. More than half of the respondents' have prescribed BCT with sedimented red cells and platelet concentrates being the most frequently prescribed blood components. Non-availability of blood components and cost implications were some of the identified limitations to the use of BCT.</p> <p><strong>Conclusion:</strong> Majority of the physicians have a good knowledge concerning BCT. Nonetheless, there was a knowledge-prac- tice mismatch attributable to the unavailability of the various blood components limiting optimal practice of BCT. Strategies should be formulated to overcome these identified challenges to ensure quality transfusion services in our healthcare facil- ities.</p> <p><strong>Keywords:</strong> Physicians; blood component therapy; blood transfusion; blood components; knowledge.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at university of medical sciences teaching hospital, Ondo, Nigeria 2021-09-27T17:16:08+00:00 Akinwumi Ayodeji Akinbodewa Adeyemi Ogunleye Oluseyi Ademola Adejumo <p><strong>Introduction:</strong> Prospective blood donors are routinely screened for blood borne infections but medical illnesses and haemo- globin genotype are overlooked despite a high prevalence of haemoglobin AS among Nigerian donors.</p> <p><strong>Objective:</strong> To determine the prevalence of haemoglobin AS and its association to renal function, if any.</p> <p><strong>Method:</strong> Apparently healthy donors were studied between February and December 2018. Their haemoglobin genotype and, estimated glomerular filtration rates were determined.</p> <p><strong>Results:</strong> There were 96 males (94.1%) and 6 (5.9%) females with mean age of 26.7±4.5 years (range 19-44 years) and mean eGFR of 103.97±19.00ml/min/1.73m2. Eighty one (79.4%) and 21 (20.6%) subjects had haemoglobin AA and AS geno- types respectively. The mean eGFR for subjects with haemoglobin AA and AS were 105.2±18.6ml/min/1.73m2 and 99.9 ± 21.2ml/min/1.73m2 respectively (p value = 0.270). Eighty one (79.4%), 20 (19.6%) and 1 (1.0%) subjects had renal function at &gt;90ml/min/1.73m2, 60-89ml/min/1.73m2 and 30-59ml/min/m2 respectively. There was no significant difference in the mean eGFR between subjects with haemoglobin AA and AS (mean difference 5.3, p = 0.265, 95%CI = -4.07 to 14.60).</p> <p><strong>Conclusion:</strong> The prevalence of sickle cell trait among Nigerian blood donors is high. There is no significant difference in the renal function status of blood donors with SCT and normal haemoglobin genotype.</p> <p><strong>Keywords:</strong> Haemoglobin genotype; sickle cell trait; renal function; blood donor; Nigeria.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Polymorphism in the TP63 gene imparts a potential risk for leukemia in the North Indian population 2021-09-28T12:41:34+00:00 Amrita Bhat Gh. Rasool Bhat Sonali Verma Ruchi Shah Ashna Nagpal Bhanu Sharma Divya Bakshi Jyotsna Suri Supinder Singh Mukesh Tanwar Samantha Vaishnavi Audesh Bhat Rakesh Kumar <p><strong>Background:</strong> The role of single nucleotide polymorphism rs10937405 (C&gt;T) of the TP63 gene in cancer including leu- kemia has previously been studied in different world populations; however, the role of this variant in leukemia in the North Indian population of Jammu and Kashmir is still unknown.</p> <p><strong>Objectives:</strong> In the present study, we investigated the association of genetic variant rs10937405 with leukemic in the Jammu and Kashmir population.</p> <p><strong>Methods:</strong> A total of 588 subjects, (188 cases and 400 controls) were recruited for the study. The rs10937405 variant was genotyped by using the real-time based TaqMan assay.</p> <p><strong>Results:</strong> A statistically significant association was observed between the rs10937405 and leukemia [OR of 1.94 (95% CI 1.51-2.48), p=1.2x10-6].</p> <p><strong>Conclusion:</strong> The current study concludes that the rs10937405 variant is a risk factor for the development of leukemia in the population of Jammu and Kashmir, North India. However, it would be interesting to explore the contribution of this variant in other cancers as well. Our findings will help in the development of diagnostic markers for leukemia in the studied population and potentially for other North Indian populations.</p> <p><strong>Keywords:</strong> Single Nucleotide Polymorphism (SNPs); Leukemia; North Indian population; Tumour suppressor (TP63); Linkage Disequilibrium (LD); Genome wide association studies (GWAS); Jammu and Kashmir (J &amp;K).</p> 2021-09-27T00:00:00+00:00 Copyright (c) Prognostic significance of the preoperative neutrophil-to-lymphocyte ratio patients with giant cell tumor of bone 2021-09-28T13:11:25+00:00 Aliekber Yapar Ismail Burak Atalay Mehmet Ali Tokgoz Coskun Ulucakoy Bedii Safak Gungor <p><strong>Objective:</strong> To evaluate the prognostic significance of neutrophil-to-lymphocyte ratio (NLR) in giant cell tumor of bone (GCT).</p> <p><strong>Methods:</strong> The patients with GCT were identified in the hospital records and pre-treatment complete blood count results were acquired retrospectively. Whether preoperative NLR lymphocyte-to-monocyte ratio (LMR) and platelet-to-lymphocyte ratio (PLR) values had prognostic significance in predicting recurrence was evaluated by Receiver operating curve (ROC) analysis. Furthermore, the prognostic value of NLR was evaluated by Multivariable Cox Regression analysis.</p> <p><strong>Results:</strong> There were 96 patients with GCT. It was found that only NLR values had prognostic significance for predicting recurrence (AUC:0.647; 95% CI:0.533-0.762; P=0.021). The statistically significant cut-off value of NLR for predicting re- currence was ≥2.25.NLR was ≥2.25 in 51% (n = 49) of patients. Multivariable analysis showed that NLR ≥2.25 (HR=2.9, 95% CI:1.3-6.6; p=0.009) and lung metastasis (HR=7.9, 95% CI:2.2-28.2; p=0.001) were independent factors of recurrence. In patients with lung metastasis and patients with NLR ≥2.25, recurrence was observed in a sooner period (Log rank test; p=0.001; p=0.009, respectively).</p> <p><strong>Conclusion:</strong> Our findings showed that NLR is a new and promising inflammation-based prognostic factor in GCT patients.</p> <p><strong>Keywords:</strong> Giant cell tumor of bone; neutrophil-to-lymphocyte ratio; prognostic significance.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Factors associated with delayed uptake of cataract surgery among adult patients at Mulago National Referral Hospital, Uganda 2021-09-28T13:50:41+00:00 Francis O Sebabi Walter O Okello Faith Nakubulwa Rogers Sempindu Catherine Driciru Caroline Nalukenge Ben Mulinde Lydia Nakiyingi Damalie Nakanjako Grace N Ssali Anne A Musika <p><strong>Background:</strong> Cataract is the leading cause of blindness globally. Many patients with cataract in developing countries delay to come for cataract surgery.</p> <p><strong>Objectives:</strong> This study aimed to determine the factors associated with delayed uptake of cataract surgery among adult pa- tients seen at Mulago National Referral Hospital eye clinic in Uganda.</p> <p><strong>Methods:</strong> Employing a hospital based cross-sectional study, adult patients with cataract and having moderate visual impair- ment or blindness were recruited. Patient-related factors for delayed surgery were assessed using a predetermined question- naire. Data was analyzed using stata version 14.2. Logistic regressions were used to determine the factors associated with delayed uptake of cataract surgery among these patients.</p> <p><strong>Results:</strong> Eighty two participants with operable cataract were evaluated. Females were 44 (54%) and the mean age of partic- ipants was 67 years. Fifty three (65%) had delayed uptake of cataract surgery. The factors associated with delayed uptake of cataract surgery among patients with cataract were financial constraint, felt no need for surgery and good unilateral vision.</p> <p><strong>Conclusions:</strong> Financial constraints, no felt need for cataract surgery and having good unilateral vision are the factors asso- ciated with delayed uptake of cataract surgery among cataract patients. We recommend cataract surgical outreach to remote areas and health education.</p> <p><strong>Keywords:</strong> Risk factors; operable cataract; cataract; surgery; Uganda; sub-Saharan Africa.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Presentation, etiology and treatment outcome of neovascular glaucoma in Ekiti state, South Western Nigeria 2021-09-28T14:02:32+00:00 Iyiade Ajayi Olusola Omotoye Kayode Ajite Emmanuel Abah <p><strong>Background:</strong> Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical loca- tions.</p> <p><strong>Objective:</strong> The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital.</p> <p><strong>Method:</strong> A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25.</p> <p><strong>Results:</strong> 29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up.</p> <p><strong>Conclusion:</strong> NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices.</p> <p><strong>Keywords:</strong> Neovascular glaucoma; retinal ischemia; rubeosis iridis; secondary glaucoma.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Effect of different cold application materials on pain during chest tube removal: three-arm randomized controlled clinical trial 2021-09-28T14:27:54+00:00 Dilara Soydan Gülay Altun Uğraş <p><strong>Background:</strong> Chest tube causes severe pain during removal because it attaches to the endothelium in the chest cavity.</p> <p><strong>Objectives:</strong> This study aimed to determine the effectiveness of cold application with ice pack and gel pad in the control of pain experienced during chest tube removal.</p> <p><strong>Methods:</strong> The sample of prospective, parallel three-arm (1:1:1), randomized controlled clinical trial consisted of 180 patients in two experimental groups (ice pack/gel pad) and one control group. The primary outcome was effect of cold application materi- als on severity of pain during chest removal. Secondary outcomes were duration of cold application and analgesic requirements of the patients.</p> <p><strong>Results:</strong> The study found that the cold application using either of the materials reduced the severity of pain and the need for analgesics after the removal of chest tube compared to the control group (p&lt;0.05). But cold application with ice pack allowed the skin to drop to the temperature effective in pain control in a shorter time than gel pad application (p&lt;0.05).</p> <p><strong>Conclusions:</strong> Despite entirely covering the area around the chest tube, the gel pad was more disadvantageous than ice pack in pain control due to the longer duration of cold application.</p> <p><strong>Keywords:</strong> Chest tube removal; cold application; pain; nurse.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Challenges that healthcare practitioners experience in the comprehensive assessment of patients with non-communicable diseases: a preliminary investigation 2021-09-28T14:44:04+00:00 Lynn Smith Heather Morris-Eyton Habib Noorbhai Yoga Coopoo <p><strong>Background:</strong> Resource allocation and access to comprehensive treatment in the public healthcare sector are always under pressure. This pressure takes the form of staff shortages, treatment models and the holistic care of patients, compromising basic healthcare in South Africa.</p> <p><strong>Objectives:</strong> The study’s aim was to determine the challenges that healthcare practitioners experience while assessing patients with non-communicable diseases, in private and public healthcare sectors in the Gauteng Province of South Africa.</p> <p><strong>Methods:</strong> The research design was exploratory and contextual. Qualitative data were collected through focus groups and semi-structured interviews among healthcare practitioners (n = 12). Data analysis took place using Atlas.ti 8.4 Windows (2020). Inter-rater reliability (r = 93.68%) was calculated to ensure the rigour and validity of the results.</p> <p><strong>Results:</strong> From the discussion, four themes emerged: 1) limited consultation time; 2) overwhelming economic impact and healthcare cost for facilities and patients; 3) holistic patient care encompassing physical, mental and socioeconomic compo- nents; and 4) lack of patient education due to time constraints experienced by healthcare practitioners.</p> <p><strong>Conclusion:</strong> Consultation times are reduced due to a shortage of medical staff, patient numbers, equipment, and poor working conditions. By improving these conditions, patients across all socioeconomic groups will be better assisted, treated, and educated, benefiting from equal access and quality healthcare.</p> <p><strong>Keywords:</strong> Healthcare practitioners; non-communicable diseases; qualitative research.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Relationships of depression and anxiety to readmission rates among patients with diabetes from Harare and Parirenyatwa referral hospitals in Zimbabwe 2021-09-28T14:59:46+00:00 Prosper Chopera Sineke Glorious Mbambo Tonderayi Matthew Matsungo <p><strong>Background:</strong> The knowledge of determinants of readmission among individuals with diabetes minimises relapse and de- creases diabetes associated morbidity and mortality.</p> <p><strong>Objectives:</strong> To explore the prevalence of depression and anxiety as well as determinants of readmission in individuals with diabetes from Harare, Zimbabwe.</p> <p><strong>Methods:</strong> A cross sectional study was carried out at Parirenyatwa and Harare group of hospitals. Participants were recruited through purposive sampling and interviewed at the diabetic clinics. Depression and anxiety were measured using the Hospi- tal Anxiety and Depression Scale. Binary logistic regression was used to determine predictors of readmission.</p> <p><strong>Results:</strong> In total 65 participants took part, 36.9% were males. The mean age ±SD was 44.89±14.2 years. Anxiety affected 40% and 20% were at risk of anxiety, while depression was reported in 27.7% and 30.8% were at risk of depression. De- pression [OR=0.64, 95%CI: 0.42-0.97 (p=0.037)] and checking of blood glucose [OR=0.06, 95%CI: 0.01-0.71 (p=0.025)] were significant negative predictors of readmission among diabetic patients while anxiety was a significant positive predictor OR=1.55, 95%CI: 1.09-2.21 (p=0.015).</p> <p><strong>Conclusions:</strong> Mental health conditions in people living with diabetes are factors contributing to increased re admissions and are more prevalent with aging. Psychotherapy and education interventions are recommended for the elderly diabetic population.</p> <p><strong>Keywords:</strong> Diabetes; hospital readmission; anxiety; depression.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Prevalence of pre-diabetes and risk factors among secondary school adolescents in Osogbo Local Government Area, Osun State, Nigeria 2021-09-28T15:16:26+00:00 Nafisat O Akintayo-Usman Funmilayo A Okanlawon Saheed O Usman <p><strong>Background:</strong> Pre-diabetes is an emerging public health challenge in sub-Saharan Africa.</p> <p><strong>Objectives:</strong> To estimate prevalence of pre-diabetes and assess its associated factors among adolescents. The risk factors were divided into individual, interpersonal and community factors, adapting socio-ecological model.</p> <p><strong>Methods:</strong> This study utilised a cross-sectional descriptive survey. The target population was secondary school adolescents of Osogbo Local Government. Questionnaire was used to interview 405 participants through multi-stage sampling. Predia- betes was measure through fasting blood glucose.</p> <p><strong>Results:</strong> Findings revealed prevalence rate of 9.4%. Individual factors identified to be significant include age, religion and family history. Further analysis showed adolescents with normal BMI and high BP are likely to develop pre-diabetes when compared to those with underweight and normal BP respectively. Among interpersonal factors, parents’ dietary habit was significant. Also, adolescents with employed parents were likely to develop pre-diabetes compared to those with unemployed parents. Lastly, availability of healthy food in school was the only statistically significant community factor. Hence, the more availability of food, fruits and vegetables in schools, the less likelihood of developing prediabetes.</p> <p><strong>Conclusion:</strong> These findings affirmed that prediabetes is becoming common problem among Nigerian adolescents. There is therefore need for stakeholders to face this challenge before it becomes endemic.</p> <p><strong>Keywords:</strong> Pre-diabetes; adolescents; individual factors; interpersonal factors; community factors.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Correlation of perinatal outcomes with amniotic fluid assessment techniques in high-risk pregnancies in a Tertiary Hospital in Southern Nigeria 2021-09-28T15:35:50+00:00 Ovoke Egagifo Lawrence O Omo-Aghoja Ayotunde T Adeyinka <p><strong>Background:</strong> Oligohydramnios is a predictor of fetal compromise and a useful tool in pregnancy management. It has been assessed using various techniques, including two-diameter pocket (2-DP) and amniotic fluid index (AFI).</p> <p><strong>Objectives:</strong> To determine which of these two techniques best diagnose oligohydramnios and predicts adverse perinatal outcomes.</p> <p><strong>Methods:</strong> This was a comparative cross-sectional study conducted at Delta State University Teaching Hospital, Oghara in southern region of Nigeria over eight months period. One hundred high-risk pregnant women were recruited and ultra- sound determination of amniotic fluid was performed using AFI and 2-DP. The women were followed up till delivery to determine adverse perinatal outcomes.</p> <p><strong>Results:</strong> The indices of validity of AFI and the 2-DP were calculated and compared. The 2-DP had a higher sensitivity than AFI for adverse outcomes in high-risk pregnancies complicated by oligohydramnios.</p> <p><strong>Conclusion:</strong> The 2-DP technique should preferably be used for the assessment of oligohydramnios in high-risk pregnancies.</p> <p><strong>Keywords:</strong> Two-diameter pocket; amniotic fluid index; oligohydramnios; high-risk pregnancies; adverse perinatal outcomes.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Preterm birth and its associated factors in Ethiopia: a systematic review and meta- analysis 2021-09-28T15:45:45+00:00 Fikadu Waltengus Sendeku Fentahun Yenealem Beyene Azimeraw Arega Tesfu Simachew Animen Bante Getnet Gedefaw Azeze <p><strong>Background:</strong> Preterm birth is a public health concern globally. In low- and middle-income countries, like Ethiopia, preterm birth is under reported and underestimated. Therefore, this systematic review and meta-analysis assessed the pooled preva- lence and associated risk factors for preterm birth in Ethiopia.</p> <p><strong>Methods:</strong> In this review the databases used were PubMed, Google scholar, EMBASE, HINARI and African journal online. Publication bias was checked using a funnel plot and Eggers test.</p> <p><strong>Results:</strong> A total of 30 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of preterm birth in Ethiopia was 11.4% (95% CI; 9.04, 13.76). On pooled analysis, preterm birth was associated with pregnan- cy-induced hypertension being HIV-positive, premature rupture of membrane, rural residence, the mother having a history of abortion, multiple pregnancies, and anemia during pregnancy.</p> <p><strong>Conclusion:</strong> The national prevalence of preterm birth in Ethiopia was low. Early identifying those pregnant women who are at risk of the above determinants and proving quality healthcare and counsel them how to prevent preterm births, which decrease the rate of preterm birth and its consequences. So, both governmental and non-governmental health sectors work on the minimization of these risk factors.</p> <p><strong>Keywords:</strong> Prevalence; pre-term birth; determinants; systematic review; meta-analysis; Ethiopia.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Effect of massage therapy on preterm neonate's body temperature 2021-09-28T15:53:41+00:00 Emily Nyaga Fabian Esamai O'Brien Kyololo <p><strong>Background:</strong> Low-cost care strategies can be implemented to avert the morbidity and mortality associated with hypother- mia in preterm neonates.</p> <p><strong>Objective:</strong> To determine the effect of massage therapy on body temperature of preterm neonates.</p> <p><strong>Methods:</strong> A quasi-experimental design was conducted among 72 preterm neonates at a level II special care nursery in Western Kenya. Neonates were recruited on the third day of life and followed up for 10 days. Neonates in the intervention group were massaged three times a day for 15 minutes. Body temperature was monitored and recorded before, during and after each therapy session. Neonates in the control group received routine care: temperature monitoring three times a day, feeding and diaper change.</p> <p><strong>Results:</strong> Neonates who received massage had higher mean body temperature than the control group during therapy on day 6 (p = .019) and after therapy on day 6 (p = .017) and day 8 (p = .005). A comparison within massage group (before/during, during/after, before/after) showed an increase in mean body temperature during therapy compared to before therapy (p &lt;.001) and after therapy compared to before therapy (p &lt;.001).</p> <p><strong>Conclusion:</strong> Massage therapy increases body temperature in preterm neonates. Keywords: Body temperature; massage therapy; preterm neonates.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Pitfalls and technical errors in the first approach to neonates with anorectal malformations in a non-specialist context: can we do any better? A review from three Eastern African Centres 2021-09-28T16:11:45+00:00 Alessandro Calisti Faisal Abdelgalil Nugud Kibreab Belay Agnes Mlawa Pierluigi Lelli Chiesa <p><strong>Introduction:</strong> In sub-Saharan Africa, Anorectal malformations (ARM) are the most frequent cause of neonatal obstruc- tion. Referral to a Pediatric Surgeon is frequently delayed. The first treatment is often delivered at not specialist level and mismanagement may result.</p> <p><strong>Aim:</strong> To study ARM patients referred beyond neonatal period and managed at a non-specialist level.</p> <p><strong>Materials and Methods:</strong> One hundred and thirty patients were included (M/F ratio 63/67) among 144 admitted to three Eastern African Hospitals with Pediatric Surgical facilities. Demographics, type of anomaly, delay on referral, previous man- agement, most commonly observed errors are reported.</p> <p><strong>Results:</strong> The Mean age at referral was 23 months (range five weeks – 23 years). Colostomy was the most frequent surgery (92 cases). Stomas often did not follow the recommended criteria. Ten per cent were not on the sigmoid, and 35% were not divided. "Loop" or "double-barrel" colostomies did not exclude the distal loop. Inverted (10,5%), prolapsed stomas (7,5%), short distal loop (16%) were observed. Twenty-four cases (26%) needed redo. Primary perineal exploration in eight patients resulted in incontinence.</p> <p><strong>Conclusions:</strong> Investments on training practitioners, acting at District/Rural level, and closer links with tertiary centres are recommended to avoid ARM mismanagement and delayed referral to a Specialist.</p> <p><strong>Keywords:</strong> Ano rectal malformations; neonate; low resources context.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Ingestion of supplements and fortified food with iodine on the breast milk iodine concentration in deficiency areas: a systematic review 2021-09-28T17:03:22+00:00 Almeida Abudo Leite Machamba Silvia Eloiza Priore Mariana de Souza Macedo Sylvia do Carmo Castro Franceschini <p><strong>Introduction:</strong> The level of iodine in breast milk may be inadequate and compromise the health of this, both due to excess and lack, some population groups remain deficient because of the low consumption of iodate salt, because there is an in- crease in consumption of other sources of iodine, such as supplements and fortified foods.</p> <p><strong>Objective:</strong> To evaluate the effect of the consumption of fortified foods and nutritional supplements with iodine on mater- nal milk levels.</p> <p><strong>Methodology:</strong> Systematic review based on the Prism method, using the descriptors provided by DeCS. The reading, selec- tion and analysis of the methodological quality of the articles was done by two researchers independently.</p> <p><strong>Results:</strong> From 346 abstracts, 6 were eligible. The median iodination range between the studies ranged from 75 to 600 μg in supplements and 150 and 225 μg in fortified foods with effect on increased iodine concentration of breastmilk (BMIC), achieving the adequacy of the median BMIC in 4 of the 6 studies.</p> <p><strong>Conclusion:</strong> Iodine ingestion through supplements or fortified foods results in improved iodine levels in breast milk.</p> <p><strong>Keywords:</strong> Iodine; supplements; fortified foods; breastmilk; iodine concentration.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Perspectives of skilled birth attendants and pregnant women regarding episiotomy: a quantitative approach 2021-09-28T17:16:42+00:00 Dokuba Tex-Jack Chinemerem Eleke <p><strong>Background:</strong> The World Health Organization recommended less than 10% episiotomy rate for Skilled Birth Attendants (SBAs) and hospitals in 1996. More than two decades afterwards, some health facilities are still grappling with meeting the set target.</p> <p><strong>Objectives:</strong> This study assessed the perspectives of SBAs and pregnant women regarding episiotomy in a Nigerian univer- sity teaching hospital.</p> <p><strong>Methods:</strong> A cross-sectional design was employed. Census sampling was used to select 19 SBAS and 973 vaginal birth re- cords from 2019, while consecutive sampling technique was used to enrol 134 consenting pregnant women obtaining ante- natal services in the facility. Data was collected using a three part instrument involving a data extraction sheet, episiotomy practice questionnaire for SBAs, and feelings about episiotomy questionnaire for pregnant women. Assembled data were summarised with descriptive statistics.</p> <p><strong>Results:</strong> The episiotomy rate was 345(35.5%). About 266 (77.1%) of first time mothers (primips) and 79(22.9%) of non- first time mothers (multips) received episiotomy. Ten (52.6%) of the SBAs were unsure of any evidence supporting routine episiotomy. All the 19(100%) SBAs reported that there was no existing facility-based policy regarding routine episiotomy. Seventy five (56%) of the pregnant women reported feeling generally bad about episiotomy. One hundred and one (82.3%) of them hinted that they will not feel satisfied if they were given episiotomy with the reason that it ensures quick vaginal birth.</p> <p><strong>Conclusion:</strong> The rate of episiotomy was higher than global recommended standards and primips are disproportionately af- fected. If organised by professional societies, more scientific conferences on limiting episiotomy might remedy this situation.</p> <p><strong>Keywords:</strong> Episiotomy; birth; pregnant women; vagina; Nigeria.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Systematic review and meta-analysis assessing the knowledge and use of the female condom among Nigerians 2021-09-28T18:10:41+00:00 Philemon Dauda Shallie Firoza Haffejee <p><strong>Background:</strong> The female condom (FC) is a critical component in a comprehensive and sustainable approach to prevent HIV, other sexually transmitted infections and unintended pregnancies.</p> <p><strong>Objectives:</strong> This review provides comprehensive information about Nigerian’s knowledge and use of FC.</p> <p><strong>Methods:</strong> We screened search output, evaluated study eligibility, and extracted data in duplicate. Data from similar studies were combined in a meta-analysis.</p> <p><strong>Results:</strong> There was a significantly (p &lt; 0.0001) high-level of awareness amongst the respondents. However, the use of the FC was very low at 5.5% among female respondents. There was a significant (p &lt; 0.0001) difference between FC awareness and use. The main reasons for FC use were prevention of unintended pregnancy (55%) and STIs/HIV (31%). We observed a significant difference between reasons of non-use of the FC [F (5, 13) = 5.195, P = 0.0077]. Furthermore, there were significant differences between the sources of information on FC [F (3, 8) = 32.89, P &lt; 0.0001].</p> <p><strong>Conclusion:</strong> Despite the high levels of awareness, especially among the female respondents, the use of the FC has remained extremely low even among the young, educated undergraduate students. There is aneed for robust and consistent advocacy to make the FC available and affordable.</p> <p><strong>Keywords:</strong> Female condom; women; men; awareness; use; Nigeria.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Predictors of intention to use modern contraceptives among female senior secondary school students in the Kpando Municipality, Ghana 2021-09-28T18:33:38+00:00 Amanda D Der Judith A Anaman-Torgbor Veronica O Charles-Unadike Elvis E Tarkang <p><strong>Background:</strong> Improving the reproductive health of young women in developing countries requires access to safe and effec- tive methods of fertility control. Volta Region records one of the highest prevalence of teenage pregnancy and adolescents aged 15-19 years are the least acceptors of contraceptives in the Region. Guided by the Theory of Planned Behaviour, this study determined predictors of intention to use modern contraceptives among female Senior Secondary School students in the Kpando Municipality, Ghana.</p> <p><strong>Method:</strong> A cross-sectional design was adopted, collecting data among a multistage sample of 270 participants, using a pre- tested self-administered questionnaire and analysing them using Stata software Version 16 at the 0.05 level of significance.</p> <p><strong>Results:</strong> The mean age of the respondents was 16.78 ± 1.31. About 40.2% of the sexually experienced participants used a modern contraceptive during ther first sexual encounter. However, the majority (69.3%) had the intention to use modern contraceptives. Regarding subjective norms, the majority of the significant others (63.0%) were not supportive of modern contraceptive use and more than half of the respondents (59.3%) had a positive attitude towards modern contraceptive use, while 54.1% perceived that they had control over modern contraceptive use. The majority (69.3%) had the intention to use modern contraceptives. Perceived behavioural control was the only significant predictor of the intention to use modern contraceptives [AOR= 9.80 (C.I: 5.11, 18.77); p&lt; 0.001].</p> <p><strong>Conclusion:</strong> Interventions to increase the perception of control over contraceptive use is of the essence. This will help increase their intention to use modern contraceptives.</p> <p><strong>Keywords:</strong> Modern contraceptive use; theory of planned behaviour; senior secondary school students; Ghana; Kpando Municipality.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Current fertility desire and its associated factors among currently married eligible couples in urban and rural area of Puducherry, south India 2021-09-28T18:49:42+00:00 Ganesh Kumar Saya Kariyarath Cheriyath Premarajan Gautam Roy Sonali Sarkar Sitanshu Sekhar Kar Revathi Ulaganeethi Jeby Jose Olickal <p><strong>Background:</strong> There are paucity of studies on current fertility desire at community level.</p> <p><strong>Objective:</strong> To assess current fertility desire and its associated factors among eligible couples of reproductive age group in Puducherry, India.</p> <p><strong>Methods:</strong> A community-based cross-sectional study from 2016 to 2017 among 2228 currently married eligible couples assessed socio-demographic and fertility-related factors associated with fertility desire. Data were collected based on the National Family Health Survey questionnaire. Association of fertility desire was assessed by univariate and generalised linear regression analysis.</p> <p><strong>Results:</strong> Out of 1979 respondents, current fertility desire within two years was 13.7% (95% CI, 12.3%-15.3%). Mean number of children (SD) currently living and preferred was 1.77(0.851) and 2.11 (0.528) respectively. After adjusting for confounders, the significant factors positively associated with fertility desire include woman's age of 18–24 (APR = 2.91), 25-29 years (APR=2.48), 30-34 (APR=2.47), 35-39(APR=2.06), high socioeconomic status (APR=2.02), those without child (APR=52.35) and those with one child (APR=35.60).</p> <p><strong>Conclusion:</strong> The fertility desire is comparatively lesser than other areas. Those without or with a single child and high so- cio-economic status group had comparatively more fertility desire.</p> <p><strong>Keywords:</strong> Fertility desire; eligible couples; India.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation 2021-09-28T19:13:22+00:00 Samuel J Pullen Augusta R Herman Brittany CL Lange Nicole Christian-Brathwaite Melissa Ulloa Michael P Kempeh Dyujay G Karnga Mosoka P Fallah Jeremiah Menyongai Benjamin Harris Yadira Alonso David C Henderson Christina PC Borba <p><strong>Background:</strong> A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war.</p> <p><strong>Methods:</strong> A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis.</p> <p><strong>Results:</strong> Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depres- sion and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern health- care.</p> <p><strong>Conclusion:</strong> Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Western- ized nosology and social factors. Traditional healer’s attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with ‘modern’ health care providers, but this will require reciprocal trust-building.</p> <p><strong>Keywords:&nbsp;</strong>Traditional healer; mental healthcare; Liberia; qualitative research.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Prevalence and socio-economic factors affecting the use of traditional medicine among adults of Katikekile Subcounty, Moroto District, Uganda 2021-09-28T19:26:31+00:00 Annie Logiel Erik Jørs Pardon Akugizibwe Peder Ahnfeldt-Mollerup <p><strong>Background:</strong> In Uganda generally and in rural areas in particular, use of traditional medicine is a common practice, yet there remains lack of evidence on the overall utilization of traditional medicine and there are many aspects that remain unclear.</p> <p><strong>Objective:</strong> To determine the use of traditional medicine and factors associated with this among the adults of Katikekile Subcounty in Moroto district.</p> <p><strong>Methods:</strong> A descriptive cross-sectional study using quantitative and qualitative methods. Interviews among 323 respond- ents, and focus group discussions were carried out among village traditional birth attendants, village health team members, and traditional health providers.</p> <p><strong>Results:</strong> Use of traditional medicine among the adults of Katikekile Subcounty was 68%. Usage was more prevalent among older people, and the majority of the adults used traditional medicine often as their first line-treatment for any illness. Herbs used for traditional medicines are usually locally available and free-of-charge. Long distance to health-facility based health care services, and medical fees contributed to the use of traditional medicine.</p> <p><strong>Conclusion:</strong> Use of traditional medicine among adults of Katikekile Subcounty in Moroto in the Karamoja region in Uganda was high, and majority of the adults often used traditional medicine as first line-treatment. Both socioeconomic and health sector factors were associated with use of traditional medicine.</p> <p><strong>Keywords:</strong> Intercultural medicine; indigenous; herbalists.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Suicidal tendencies and its association with psychoactive use predictors among university students in Uganda: a cross-sectional study 2021-09-28T19:38:38+00:00 Sheila Wesonga Charles Osingada Allen Nabisere Stanley Nkemijika Connie Olwit <p><strong>Background:</strong> Globally, suicide is one of the leading causes of death, and approximately 80% of all suicides occur in low- and middle-income countries. Younger people in Africa are at a higher risk of suicide than others.</p> <p><strong>Objective:</strong> To describe the prevalence and factors associated with suicidal tendencies among undergraduate university stu- dents using alcohol and other psychoactive substances.</p> <p><strong>Methods:</strong> Convenient sampling was used to identify 400 students who participated in the study. Socio-demographic and Mini-International Neuropsychiatric Interview tools were used to obtain information. Data were analyzed using SAS 9.4 and presented in descriptive and inferential statistics.</p> <p><strong>Results:</strong> Among the respondents, 80% were male, and 85% were using marijuana. 6.3% had suicidal tendencies. Respond- ents from the northern region had more suicidal tendencies than other regions, and unemployed students had more suicidal tendencies than those employed. After multivariate analysis, being abusive and dependent on other psychoactive substances was associated with suicidality. And having dependence on both alcohol and other psychoactive substances was associated with suicidality.</p> <p><strong>Conclusion:</strong> Suicidality screening and psychosocial support should be provided to this vulnerable population. Efforts There is a need to strengthen, implement more effective preventive strategies to reduce the use of alcohol and other psychoactive substances.</p> <p><strong>Keywords:</strong> Suicidal tendencies; psychoactive use; university students; Uganda.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Burnout and quality of life among nurses working in selected mental health institutions in South West Nigeria 2021-09-28T19:46:30+00:00 Morufat A Alabi Adeyinka G Ishola Adenike C Onibokun Victor O Lasebikan <p><strong>Background:</strong> Burnout remains a huge public health problem among nurses.</p> <p><strong>Methods:</strong> A cross-sectional descriptive study assessed 259 nurses from two Neuropsychiatric hospitals in Nigeria. Data was collected using a sociodemographic/ job related questionnaire, the Maslach Burnout Inventory (MBI), and the Short-Form health survey (SF-12). The associations between sociodemographic characteristic and burnout was anaysed using Chi square test, between burnout and quality of life using Spearman correlation statistics. Predictors of burnout were determined using binary regression analysis</p> <p><strong>Results:</strong> Prevalence of emotional exhaustion (EE) was 44.4%, depersonalization (DEP) 31.7% and reduced personal ac- complishment was 98.8%. Predictors of EE were: poor funding from management, OR = 0.38 (95% CI 0.15-0.95) and role conflict, OR = 2.44 (95% CI 1.03-5.78), while the predictors of DEP, were age group, 31-40 years, OR = 0.37 (95% CI 0.18-0.77), male gender, OR = 2.55 (95% CI 1.40-4.65), role conflict, OR = 6.53 (95% CI 0.88-7.81) and working at more urban city, OR = 3.07 (95% CI 1.54-6.16). The mean total Quality of life (QOL) scores were significantly higher among respondents who had no EE and DEP p &lt; 0.001.</p> <p><strong>Conclusion:</strong> Burnout is high among mental health nurses and is associated with poor quality of life.</p> <p><strong>Keywords:</strong> Nurses; burnout; quality of life; workplace; organizational factors; more-urban.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Disability management in a public-private health care facility in South Africa: an organisational perspective 2021-09-28T19:54:00+00:00 Rubendri Govender Pragashnie Govender Deshini Naidoo <p><strong>Background:</strong> Job retention, long-term absenteeism and medical boarding pay-outs are significant concerns for employers with- in the public health care sector of South Africa.</p> <p><strong>Objective:</strong> To describe disability management policies, procedures and programmes of employees following impairment and disability in a public-private healthcare facility in South Africa.</p> <p><strong>Methods:</strong> An exploratory qualitative study design was used with key informants in senior management and nursing managers (n=12) selected via purposive sampling. Audio-recorded data from semi-structured interviews and a focus group were themati- cally analysed using inductive reasoning.</p> <p><strong>Results:</strong> There is poor adherence to occupational health and disability management policies and the current referral process is informal with managers using discretion to manage employees with ill health and acquired disability. The procedures prescribed in the policy and procedure on incapacity and ill-health-retirement need to be followed, and an early return to work programme within the health care facility needs to be implemented.</p> <p><strong>Conclusions:</strong> Despite South Africa having many policies on recruitment and reasonable accommodations, there is a lack of implementation of these policies. An integrated disability management policy and programme encompassing health prevention, early return to work strategies, vocational rehabilitation and the implementation of reasonable accommodation is required to ensure that employees who have acquired disabilities or ill health are successful in the workplace.</p> <p><strong>Keywords:</strong> Disability management; vocational assessments; return to work.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Association of trace elements abnormalities with thyroid dysfunction 2021-09-28T20:04:08+00:00 Maha M Al-Bazi Taha A Kumosani Abdulrahman L Al-Malki Kurunthachalam Kannan Said S Moselhy <p><strong>Background:</strong> The metabolic pathways can be affected by dysregulation in thyroid hormone levels which in turn can arise from environmental chemical exposure. This study investigated the association of selected trace elements with thyroid dis- orders in a Saudi population.</p> <p><strong>Methods:</strong> Urine samples collected from 100 participants (50 thyroid disorder patients and 50 controls) were analyzed to determine trace elements using inductively coupled plasma-mass spectrometer. Non-parametric Mann-Whitney Test, were used to examine the association between socio-demographic as well as clinical characteristics of thyroid profile levels (T3,T4 and TSH) and urinary trace element concentrations.</p> <p><strong>Results:</strong> Urine from patients with thyroid disorders had significantly higher concentrations of Ni, Cu, and Cd (p-values &lt;0.0005). In contrast, urinary Cr and Zn (p-values &lt;0.013 and 0.005) were low in thyroid patients compared to the control.</p> <p><strong>Conclusion:</strong> First study to report urinary trace element levels showed a possible link between thyroid disorders and trace element exposure which reflect the environmental pollution.</p> <p><strong>Keywords:</strong> Trace metals; heavy elements; thyroid dysfunction.</p> 2021-09-27T00:00:00+00:00 Copyright (c) New trend of drugs abused by secondary school students in Nigeria 2021-09-28T20:10:09+00:00 Ochuko E Nabofa <p><strong>Background:</strong> It appears that there is a new trend in the types of drugs abused by secondary school students in Nigeria that makes it difficult to identify current drug abusers.</p> <p><strong>Objectives:</strong> This study was conducted to reveal the trends with regards to the types of drugs abused by these students in the country.</p> <p><strong>Methods:</strong> This is an online and desktop review of published articles about the types of drugs abused by secondary school students during the period that spanned from 2010–2020.</p> <p><strong>Results:</strong> In all, 17 research reports were identified as having data on the types of drugs abused by secondary students in the Nigeria. It was found that 18 different drugs were empirically identified as being abused by secondary school students in 9 different states of Nigeria. The observed trend is that alcohol, cannabis, tobacco and cigarettes are the most abused drugs, while drugs that were least abused were cocaine, caffeine, glue, heroine, energy drinks, miraa, rohypnol and tramadol.</p> <p><strong>Conclusion:</strong> It was concluded that studies of drug abuse by secondary school students in Nigeria are not yet robust enough to reveal the types of drugs that are currently being abused.</p> <p><strong>Keywords:</strong> Adolescent Health; Drug Abuse; Drug Effects; Drug Safety; Drug Utilisation.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Public health implication of solid waste generated by households in Bekwarra Local Government area 2021-09-28T20:17:48+00:00 Donald I kwun Omang Godwin Egbe John Simon Alain Inah Jude Owan Bisong <p><strong>Background:</strong> This study was conducted in Bekwarra Local Government Area of Cross River State, Nigeria, to determine the public health implication of solid waste generated by households.</p> <p><strong>Methods:</strong> A cross sectional descriptive design was employed, using a semi-structured questionnaire together with an obser- vation checklist to elicit information from the respondents. Proportionate sampling was used to select 400 respondents of 18 years and above for the study area. Data collected were analysed using the Microsoft Excel 2007 and Statistical Package for Social Sciences (SPSS) software version 20.</p> <p><strong>Results:</strong> Respondents knowledge concerning solid waste disposal was assessed and the results showed that majority of the respondents 193 (63.7%) had high level of knowledge of solid waste disposal, while 170 (42.5%) had average level of knowl- edge of solid waste disposal. Wastes produced by households in the study include vegetables (95.5%), ash (94%), clothing/ rag (94.2%), wood (95%), and animal waste (86.2%) had the highest abundance. Diseases associated with these wastes pro- duced by households include cholera (18.2%), malaria (47.2%), lassa fever (10.7%) and diarrhea (23.9%) with malaria been the most prevalence infection.</p> <p><strong>Conclusion:</strong> The result shows solid waste posed a serious health hazard and lead to the spread of infectious diseases. These issues can be addressed through health education and enlightenment of the people on waste disposal.</p> <p><strong>Keywords:</strong> Municipal waste; public health; infection; health hazard; environmental pollution.</p> 2021-09-27T00:00:00+00:00 Copyright (c) Summer temperature and all-cause mortality from 2006 to 2015 for Hyderabad, India 2021-09-28T20:25:31+00:00 Suresh K Rathi Prahlad R Sodani <p><strong>Background:</strong> Studies have documented a significant association between temperature and all-cause mortality for various cities but such data are unavailable for Hyderabad City.</p> <p><strong>Objective:</strong> The objective of this work was to assess the association between the extreme heat and all-cause mortality for summer months (March to June) from 2006 to 2015 for Hyderabad city population.</p> <p><strong>Methods:</strong> We obtained the data on temperature and all-cause mortality for at least ten years for summer months. Descriptive and Bivariate analysis were conducted. Pearson correlation coefficient was used to study the relationship between heat and all-cause mortality for lag time effect.</p> <p><strong>Results:</strong> A total of 122,117 deaths for 1,220 summer days (2006 to 2015) were analyzed with mean daily all-cause mortality was 100.1±21.5. There is an increase of 16% and 17% per day mean all-cause mortality at the maximum temperature of ≥40oC and for extreme danger days (Heat Index &gt;54oC) respectively. The mean daily all-cause mortality shows a significant association with maximum temperature (P &lt; 0.001) and Heat Index from caution to extreme danger risk days (P &lt; 0.0183). The lag effect of extreme heat on all-cause mortality for the study period (2006 to 2015) was at peak on same day of the maximum temperature (r = 0.273 at p&lt;0.01).</p> <p><strong>Conclusion:</strong> The study concludes that the impact of ambient heat in the rise of all-cause mortality is clearly evident (16% mean deaths/day). There was no lag effect from the effect of extreme heat on all-cause mortality as the peak period was the same as the maximum temperature. Hence heat action plans are needed. However, extreme heat-related mortality merits further analysis.</p> <p><strong>Keywords:</strong> Heat wave; all-cause mortality; urban; humidity; heat index; India.</p> 2021-09-27T00:00:00+00:00 Copyright (c) The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field 2021-09-28T20:38:20+00:00 Christina E Stiles Edward O’Neil Jr Kenneth Kabali James O’Donovan <p><strong>Background:</strong> Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs.</p> <p><strong>Objectives:</strong> This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach.</p> <p><strong>Methods:</strong> CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the interven- tion.</p> <p><strong>Results:</strong> Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an “any pace, any place” basis and using the tablets to conduct community teaching and outreach. Barriers included appro- priate consideration of the implementation timeline and avoiding a “one size fits all” approach to digital literacy training.</p> <p><strong>Conclusions:</strong> The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success.</p> <p><strong>Keywords:</strong> Low-cost ruggedized Android tablets; in-service training; community health workers; Mukono.</p> 2021-09-27T00:00:00+00:00 Copyright (c) SRY and NR5A1 gene mutation in Algerian children and adolescents with DSD and testicular dysgenesis 2021-09-28T20:50:20+00:00 Naouel Kherouatou-Chaoui Djalila Chellat-Rezgoune Mohamed Larbi Rezgoune Ken Mc Elreavey Laaldja Souhem Touabti Noreddine Abadi Dalila Satta <p><strong>Background:</strong> In humans, sex determination and differentiation is genetically controlled. Disorders of sex development (DSD) result in anomalies of the development of the external and internal genitalia. Variants in transcription factors such as SRY, NR5A1 and SOX9, can cause changes in gonadal development often associated with ambiguity of the external genitalia.</p> <p><strong>Objectives:</strong> This study has been conducted to determine the frequency, types and associated genetic alterations in patients with DSD in the Algerian population.</p> <p><strong>Methods:</strong> Thirty patients were included. Based on their clinical presentation, thirteen patients presented with ambiguous external genitalia, thirteen patients presented with hypospadias and four patients presented with bilateral undescended tes- tes. Karyotype analysis was performed on peripheral blood lymphocytes using standard R-banding. DNA was isolated from blood leukocytes for PCR reaction and mutational analysis of SRY and NR5A1 was done by direct sequencing.</p> <p><strong>Results:</strong> Most patients with ambiguous genitalia had a 46,XY karyotype. One patient had a deletion of SRY, otherwise no point mutations in SRY or NR5A1 genes were identified. However, a single NR5A1 polymorphism (p.Gly146Ala) in patient with 46,XX DSD has been detected.</p> <p><strong>Conclusions:</strong> The absence of mutations in these genes suggests that there are others genes playing an important role in sex development and differentiation.</p> <p><strong>Keywords:</strong> DSD; consanguinity; karyotyping; <em>SRY</em>; <em>NR5A1</em>; sequencing.</p> 2021-09-27T00:00:00+00:00 Copyright (c) State of pedestrian road safety in Uganda: a qualitative study of existing interventions 2021-09-28T21:01:48+00:00 Jimmy Osuret Stellah Namatovu Claire Biribawa Bonny Enock Balugaba Esther Bayiga Zziwa Kennedy Muni Albert Ningwa Frederick Oporia Milton Mutto Patrick Kyamanywa David Guwatudde Olive Kobusingye <p><strong>Background:</strong> Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions.</p> <p><strong>Methods:</strong> We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with par- ticipants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software.</p> <p><strong>Results:</strong> Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key program- matic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions.</p> <p><strong>Conclusion:</strong> The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda’s pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.</p> <p><strong>Keywords:</strong> Pedestrian; safety intervention; qualitative; Uganda.</p> 2021-09-27T00:00:00+00:00 Copyright (c)