African Health Sciences

Editorial: Non-communicable diseases; sexual reproductive issues; infectious diseases and health systems challenges

James K Tumwine — 2022-12-21

Nil.

A meta-analysis and experimental data for multidrug resistance genes in breast cancer

Shumaila Zaib — 2022-12-21

Background: Increasing trend of breast cancer incidence worldwide is a known fact. This curable disease may become fatal if drug resistance is developed leading to metastatic cancerous tissue.

Objective: This is a two parts study; a meta-analysis exploring association of drug resistance (mdr1 and ABCG2) genes with breast cancer and mutational association with molecular subtypes of cancer.

Methods: PCR-SSCP for genomic polymorphisms and RT-PCR for expression analysis were performed.

Results: C3435T polymorphism of mdr1 gene was most commonly studied mutation with contradictory results. Association of ABCG2 gene mutations with untreated breast cancer was reported only by one study so far. Regarding current genomic analysis of mdr1 gene, three novel mutations were found in exon 12 and 2 mutations were found in exon 26. In ABCG2 gene, addition of C and T were found in intron 8 at the intron-exon junction. A positive correlation was observed between these mutations and tumor grade. Levels of mRNA expression revealed that they were over expressed in cancerous tissues compared with controls.

Conclusion: These findings suggest that these genes are associated with breast cancer.

Keywords: Expression; mutations; mdr1; ABCG2; breast cancer.

Breast biomarkers profile of invasive lobular carcinoma in a cohort of arab women shows no significant differences from carcinoma of no special type

Areej Al Nemer — 2022-12-21

Objectives: Invasive lobular carcinoma (ILC) of the breast is known for its common presentation at an older age, and the frequent expression of favourable profile of estrogen and progesterone receptors (ER & PR) positivity, and human epidermal growth factor receptor 2 (HER2) negativity combined with low proliferation rate as measured by Ki67. This study aimed to test these clinicopathological features of ILC in an Arabic cohort.

Methods: All breast biopsies diagnosed as IDC or ILC were retrospectively reviewed over 2 years period (2017-2018) in an academic centre. Variables were compared using Fisher’s exact test for statistical significance.

Results: A total of 134 cases were recruited, 12.7% were ILC. The median age was 52 years for both types. Clustering of ILC cases was noticed in luminal A subtype (47.1%), but there was no statistically significant difference in subtyping between the 2 histologic groups. Ki67 was significantly lower in ILC than IDC category.

Conclusions: Our study showed that ILC in our cohort lacks the advantage of older age and the common high expression of ER positivity in comparison to IDC. There is, however, significant difference of the value of Ki67 proliferation marker. The prognosis of lobular morphology is questionable in our cohort.

Keywords: Biomarkers; breast carcinoma types; immunohistochemistry; invasive lobular carcinoma; Ki67.

Breast cancer knowledge and screening practices among undergraduates in a Nigerian tertiary institution, Southwest Region

Abayomi Yusuf — 2022-12-21

Introduction: Breast cancer is the most diagnosed female malignancy in Nigeria. This study aimed to assess the knowledge and practice of breast cancer screening among female undergraduates in a tertiary institution in Southwest Nigeria.

Methods: This cross-sectional study recruited 350 female undergraduates of a public university in southwest Nigeria using a multi-stage sampling method involving simple random sampling. A structured self-administered questionnaire was used for data collection. Epi info 7 was used for data analysis, level of significance was set at 5% (p<0.05).

Results: The majority, 316(90.3%) had poor knowledge of breast cancer and screening and 340(97.1%) had positive attitude towards screening. Only 185(52.9%) had done breast self-examination and 16(4.6%) had done clinical breast examination. The student’s year of study was significantly associated with knowledge of breast cancer (p = 0.002) Marital status (p=0.039) and attitude towards breast cancer screening (p<0.001) were significantly associated with breast self-examination. Students in their third year were 6 (2 – 16) times more likely to have good knowledge of breast cancer (Adjusted Odds Ratio 5.87, Confidence
Interval 2.17 – 15.86).

Conclusion: Overall knowledge and practice of breast cancer screening were poor, but students’ attitude towards screening was positive. Health education on breast cancer and screening is recommended.

Keywords: Knowledge; practice; breast cancer; screening; young people; Nigeria.

Histopathological characterization of lung tumours at the University Teaching Hospital, Lusaka, Zambia: a pilot study

Mizinga Jacqueline Tembo — 2022-12-21

Background: There are limited data on histological classification of primary lung cancer from sub-Saharan Africa. Furthermore, the time trends of age-truncated incidence rates of lung cancer by histological phenotype in Zambia are also unknown.

Objectives: The objective of this study was to determine histological types of lung tumours at the University Teaching Hospital (UTH) in Lusaka, Zambia.

Methods: This was a retrospective pilot study of lung tumour biopsies collected from the histopathology laboratory at the UTH over a period of one year. Tissue sections were stained and when seen, lung cancer was classified using standard histological methods. Data were analysed using IBM SSPS version 23.

Results: A total of 23 lung cancer tissues were retrieved. Histological types included eleven (47.8%) squamous cell carcinoma (SCC), six (26.1%) adenocarcinoma, two (8.7%) small cell carcinoma, two (8.7%) large cell carcinoma, 1 (4.3%) inflammatory myofibroblastic tumours and 1 (4.3%) pleural pulmonary blastoma. The results showed that the most affected age group was 60-69 years with most of the histological subtype in this age group being SCC. There was no statistically significant difference of histological subtypes across age groups, p=0.12.

Conclusion: This study has shown that the most commonly diagnosed type of primary lung cancer is squamous cell carcinoma.
More data are needed to further corroborate this observation.

Keywords: Lung cancer; histopathology; Zambia.

Investigation of the effects of mir-219-1 gene variants on the development of disease in non-small cell lung cancer patients

Sevgi Kalkanli Tas — 2022-12-21

Background: Various variants of the miR-219-1 gene are one of the first genes associated with NSCLC prognosis in the literature.

Objectives: We aimed to genotype two different variants of the miR-219-1 gene and to investigate to using of the result as a biomarker in the diagnosis and treatment of NSCLC.

Materials and Methods: The patients were chosen according to International NSCLC criteria and genomic DNA was isolated from blood (138 patients and 100 healthy individuals). Then qRT-PCR was applied to determine the rs213210 and rs421446 variants of miR-219-1 gene polymorphisms. Allele and genotype frequencies were compared using Pearson’s chi-square and Fisher’s exact tests test.

Results: We found that TT genotype (p=0,381) in rs213210 compared with CC genotype (p=0,165) and CC genotype (p=0,823) in rs421446 compared with TT genotype (p=0,537) did not show a significantly increased risk of NSCLC. There is no relationship between polymorphisms in miR-219-1 and the outcome of NSCLC.

Conclusion: miRNA single nucleotide polymorphisms can be used as genetic biomarkers to predict cancer susceptibility, early diagnosis, and prognosis. Our study has shown that two variants of miR-219-1 were not related to NSCLC in the Turkish population. The reason for this can be differences in ethnicity, regions, and background of population and these differences could lead to various outcomes.

Keywords: NSCLC; miR-219-1 gene; single-nucleotide polymorphisms.

Willingness-to-pay for a population-based-prostate-specific antigen screening for prostate cancer in Anambra State, Southeast, Nigeria: a contingent valuation study

Blessing Ifeoma Umeh — 2022-12-21

Background: Early diagnosis of cancer precursors improves treatment outcomes. Organized screening for prostate cancer is still uncommon in Nigeria, and if it is added to the national health budget, it may necessitate additional co-financing alternatives.

Objectives: The study aims to evaluate the maximum willingness- to- pay amount and acceptability of a Population-based screening for prostate cancer among a group of Nigerian men.

Methods: The study was a cross-sectional survey-based study conducted among men drawn from different districts of the state. The payment card elicitation format was used to estimate the average maximum WTP amount. Multivariate Logistic regression was used to evaluate the correlates of WTP.

Result: A total of 439(81.9%) participants were willing to pay for the screening while only 97(18.1%) of the participants rejected the screening. The average WTP amount was US$6.01(mean ± median ± SD 6.01±4.12±5.75). Residence and knowledge of the disease were the major predictors.

Conclusion: The findings showed that men in Anambra state Nigerian were willing to pay an average of US$6.01 for the Population-based screening. Even though the stated WTP amount seems low compared to the conventional cost of opportunistic screening (between USD 21), the majority of the participants 439(81.9%) willing to pay for the screening should be capitalized upon in finding alternative financing options for the program.

Keywords: Willingness to pay (WTP); prostate-specific antigen (PSA); Population-based screening; prostate cancer; contingent valuation study; Anambra state; Nigeria.

MicroRNA-186 suppresses cell proliferation and metastasis in bladder cancer

Jun Feng Liang — 2022-12-21

Purpose: Bladder cancer (BCa) is a common malignancy in the urinary system. This study aims to explore the role of miR-186 in BCa tumorigenesis.

Methods: The expression of miR-186 and ADAMTS12 in clinical BCa tissues and cell lines was detected. BCa cell lines T24, 5637 and EJ were used to transfect miR-186 mimics or inhibitors. Luciferase reporter gene detection confirmed the correlation between miR-
186 and ADAMTS12. MTT method and flow cytometry were used to detect cell viability and apoptosis. Cell migration and invasion ability was detected by transwell assay. The protein level of ADAMTS12, β-catenin, GSK-3β and p-GSK-3β was determined using western blot analysis.

Results: MiR-186 was negatively correlated with the expression of ADAMTS12 in BCa tissues. Further research confirmed that ADAMTS12 is the direct target of miR-186. In addition, overexpression of miR-186 down-regulated the expression of ADAMTS12,
inhibiting cell viability and apoptosis, while knockout of miR-186 led to the opposite result. miR-186 also inhibits the phosphorylation of GSK-3 β and β-catenin without changing the total GSK-3β level. Our study shows that miR-186 has a negative regulatory effect
on the expression of ADAMTS12 in clinical specimens and in vitro. miR-186 can inhibit the proliferation and invasion of BCa cells.

Conclusions: miR-186 has the potential to be used as a biomarker in the early detection of BCa.

Keywords: Purpose: Bladder cancer (BCa) is a common malignancy in the urinary system. This study aims to explore the role of miR-186 in BCa
tumorigenesis.
Methods: The expression of miR-186 and ADAMTS12 in clinical BCa tissues and cell lines was detected. BCa cell lines T24, 5637 and
EJ were used to transfect miR-186 mimics or inhibitors. Luciferase reporter gene detection confirmed the correlation between miR-
186 and ADAMTS12. MTT method and flow cytometry were used to detect cell viability and apoptosis. Cell migration and invasion
ability was detected by transwell assay. The protein level of ADAMTS12, β-catenin, GSK-3β and p-GSK-3β was determined using
western blot analysis.
Results: MiR-186 was negatively correlated with the expression of ADAMTS12 in BCa tissues. Further research confirmed that
ADAMTS12 is the direct target of miR-186. In addition, overexpression of miR-186 down-regulated the expression of ADAMTS12,
inhibiting cell viability and apoptosis, while knockout of miR-186 led to the opposite result. miR-186 also inhibits the phosphorylation
of GSK-3 β and β-catenin without changing the total GSK-3β level. Our study shows that miR-186 has a negative regulatory effect
on the expression of ADAMTS12 in clinical specimens and in vitro. miR-186 can inhibit the proliferation and invasion of BCa cells.
Conclusions: miR-186 has the potential to be used as a biomarker in the early detection of BCa.
Keywords: miR-186; ADAMTS12; bladder cancer; proliferation; metastasis biomarker.

Multiple myeloma with unexplained isolated anaemia in a 24year old man- a case report

Oladapo Wale Aworanti — 2022-12-21

Background: Multiple myeloma (MM) is a disease of the elderly with a median age at presentation of 70 years. It is rare to diagnose MM in individuals less than 40 years and even extremely rare in those less than 30 years of age. MM is usually suspected in those aged 50 years and above having a combination of hypercalcemia, renal insufficiency, anaemia and bone lesions. Although anaemia is a common clinical feature of MM, it is very rare that anaemia would be the only clinical presentation, hence the need to report this index case.

Case Presentation: We present a rare case of MM in a 24-year- old male who presented with only symptomatic anaemia.
Investigations for the cause of anaemia, including Bone marrow aspiration cytology revealed a diagnosis of MM ISS stage II.
Here, we highlighted the need to seek early haematologist consultation in investigating patients’ whose cause of anaemia is not
immediately obvious from the clinical presentation and routine laboratory investigations.

Conclusion: MM can present at a younger age with unexplained anaemia without bone pains or renal insufficiency. High level of suspicion for MM is required in young patients with unexplained anaemia

Keywords: Multiple myeloma; isolated anaemia; young patient.

Bloodstream infection in cancer patients; susceptibility profiles of the isolated pathogens, at Khartoum Oncology Hospital, Sudan

Omeima Mohammed Zain — 2022-12-21

Introduction: Bloodstream infection is one of the major causes of mortality in patients with malignancies. This study aimed to determine the local profile of blood culture isolates and their antibiotic sensitivities in febrile neutropenic cancer patients and to
decide if any modifications to antibiotics policies are necessary.

Methods: This is a cross-sectional study conducted between the first of October to the end of December 2018 at Khartoum
Oncology Hospital, Sudan. Blood samples from febrile neutropenic patients were collected for culture. Isolates were identified,
and their antimicrobial susceptibility was determined by standard laboratory procedures.

Results: Bloodstream infections were confirmed in 12 % (n = 69/569) of total blood cultures. Gram negative bacilli were the dominant causative agents (63.8%) while (36.2%) of infections were caused by gram positive cocci. Escherichia coli was the most common isolate (30.4%).
The proportions of resistance among gram negative bacilli were high for cefuroxime, amoxicillin/clavulanic acid, Ceftazidime,
and ceftriaxone. Extended-spectrum β-lactamase producing isolates were identified in 34.1% of the positive cultures. Gram
positive cocci showed high resistance to tetracycline, penicillin and erythromycin but were completely sensitive to vancomycin
and gentamicin. Most of Staphylococcus aureus isolates were methicillin resistant.
Conclusion: Gram negative bacilli were the predominant etiologic agents of bloodstream infections in our patients. Both Gram-positive and Gram-negative bacteria showed high levels of resistance for most of the common antibiotics used for empiric treatment. Regular surveillance to study bacterial resistance patterns must be conducted to modify antibiotics stewardship
in our institution.
Keywords: Blood stream infection; malignancy; antibiotics sensitivity; Sudan.

Therapeutic pluralism and the politics of disclosure: breast cancer patients’ experiences in public healthcare

Jennifer Nyawira Githaiga — 2022-12-21

Background: Despite the widespread utilisation of complementary and or alternative medicine (CAM) by breast cancer patients in low-and-middle-income countries, few disclose CAM use to their physicians.

Objective: This study examines disclosure CAM use among a small sample of women attending a breast cancer clinic in a public health hospital in the Western Cape, South Africa.

Methods: An Interpretative Phenomenological Analysis (IPA) approach was utilised in this study. Semi-structured in-depth interviews were conducted with a convenience sample of 17 women attending a breast clinic in a public hospital.

Results: Non-disclosure of CAM use was attributed to minimal time for patient-doctor interactions due to resource constraints in public health facilities and the superior status accorded to biomedical doctors’ superior knowledge, associated with paternalism, leading to patients’ fear of reproach for using CAM. Consequently, disclosure of CAM only occurred in instances where it was deemed an absolute necessity.

Conclusion: Considering the reality of an overstretched public healthcare system, what may be possible is an active attempt to communicate to patients that doctors are aware that patients may use a range of resources (such as CAM), which is their right, and further, recommend patient disclosure of CAM use to their doctors, because of the possibility of drug interactions and other potentially negative effects.

Keywords: Breast cancer; alternative medicine; South Africa.

Factors influencing quality of life among cancer survivors in Kenya

Mary Kung’u — 2022-12-22

Background: The number of cancer survivors is growing continuously due to advances in treatment of cancer patients. In developed countries, numerous studies on quality of life (QoL) of cancer survivors have been conducted. Little is known regarding the QoL of cancer survivors in Kenya. Therefore, the aim of this study was to explore the factors that contribute to QoL of cancer survivors in Kenya.

Methods: A descriptive cross-sectional design was used for the study. Participants were 108 adult cancer survivors. Self and interviewer administered QoL Patient/Cancer Survivor Questionnaire was used.

Results: Findings indicate a statistically significant relationship between QoL and age (rs =-.055 p<.05), marital status (rs=.490 p<.01), income (rs =.228 p<.05), stage of cancer diagnosis (rs =-.269. p<.01), year of cancer diagnosis (rs =-.295 p<.01), religious affiliation (rs =-.279, p<.01) and the religion one belonged to (rs =-.198 p<.05). Regression analysis showed that age, stage of cancer diagnosis, time off treatment, educational level, and religious affiliation are significant predictors of QoL in cancer survivors.

Conclusions: The findings highlight the importance of key factors associated to QoL in cancer survivors in Kenya. Interventions aimed at early cancer detection, treatment, and spiritual support among cancer survivors will improve QoL.

Keywords: Quality of Life (QoL); Kenya; cancer patients.

Sociodemographic and gynaecological factors that influence uptake of cervical cancer screening. A cross-sectional study in Calabar, Nigeria

Boniface U Ago — 2022-12-22

Background: Voluntary screening for cervical cancer has not been very effective in sub-Saharan Africa. Awareness and presence of risk factors may drive the need to screen.

Objective: To characterise sociodemographic and gynaecological factors as promoters of screening uptake.

Methodology: The setting was a women health rally in Calabar, Nigeria with women from different towns/ villages in Cross River State. An interviewer-administered questionnaire assessed sociodemographic and gynaecological risk factors for cervical cancer, previous Pap smear, and acceptance to screen. Data inputted in EpiInfo 7, and GraphPad Prism 7.04 statistical software’s, were analysed using descriptive and inferential statistics.

Results: One hundred and eighty (180) women gave consent for inclusion in the study. The age ranged from 21 to 65 with a mean of 39.8±10.3 years. With 52.22% of respondents accepting and 47.78% declining to screen, test of association showed that knowledge of cervical cancer, history of multiple sexual partners, and presence of offensive watery vaginal discharge significantly reduced the number of women who refused to screen. Previously screened women were not more likely to accept screening.
Conclusion: Screening for cervical cancer was still poor. Cervical cancer knowledge and recognition of risk factors improve screening uptake.

Keywords: Cervical cancer screening uptake; risk factors.

A preliminary study to evaluate the impact of pharmaceutical care services on clinical outcome and medication adherence in type 2 diabetes mellitus patients from Ethiopian perspective

Bruke Berhanu Billoro — 2022-12-22

Background: The role of clinical pharmacist in hospital settings of Ethiopia is still new and infant.

Objective: To evaluate the impact of pharmaceutical care on clinical outcome and medication adherence in type 2 diabetes mellitus (T2DM) patients.

Methods: A single cantered, pre-post interventional study design was carried out by enrolling 100 uncontrolled T2DM patients from March 1-August 30, 2020. The intervention package included assessment of pharmacological and non-pharmacological needs, counselling patients in person at the clinic, and providing educational materials.

Results: Of the 100 patients initially enrolled, 87(87%) completed the follow-up and included in the final data analysis. The intervention showed a decrease in average FBG, systolic blood pressure (SBP), low density lipoprotein cholesterol (LDL-C) by 47.3 mg/dL, 22.6mmHg and 31.4mg/dL, while high density lipoprotein cholesterol (HDL-C) and estimated glomerular filtration rate (eGFR) exhibited significant increase by 13.4 mg/dL and 11.5 ml/min/1.73m2 respectively (p<0.0001). In addition, diastolic blood pressure, lipid values, kidney function parameters, and liver function parameters showed significant decrease in post intervention compared to pre-intervention (p<0.05). Medication adherence of the patients increased significantly at 6-month follow-up (p<0.001).

Conclusion: These results also suggest the benefits of integrating clinical pharmacist services in multidisciplinary healthcare teams and diabetes management in Ethiopia.

Keywords: Clinical pharmacy; Ethiopia; Medication adherence; pharmaceutical care services; T2DMv Wachemo University.

Diagnostic performance of central and generalized adiposity in detecting risk of diabetes mellitus in adolescents

Danladi Ibrahim Musa — 2022-12-22

Background: The prevalence of type 2 diabetes mellitus (T2DM) is increasing in all age groups, including the adolescent globally.

Objective: This study examined the association of adiposity with the risk of T2DM in adolescents aged 11 to 19 years.

Methods: This study comprised 403 adolescent boys (202) and girls (201). Participants were assessed in three indices of body fat and fasting blood glucose (FBG). Multivariate regression models assessing the associations of the independent variables with risk of T2DM were conducted. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive capacities of the body fat proxies to detect risk of T2DM.

Results: The prevalence of glucose abnormalities was 13.6% and 1.8% for pre-diabetes and diabetes respectively. Among the body fat indices in boys, WHtR was the only independent predictor ( =0.599, p<0.001) of T2DM risk. Both the WHtR and WC had significant (p<0.001) Areas under curve (AUC), with WHtR as the best body fat indicator for identifying risk of T2DM in boys. The independent variables had no discriminatory capacities to detect T2DM risk in girls.

Conclusions: This study has demonstrated that central fat is more important than total fat in detecting risk of T2DM in Nigerian adolescent boys.

Keywords: Abdominal obesity; adolescents; anthropometry; ROC curve; T2DM.

Early detection of poor glycemic control in patients with diabetes mellitus in sub-Saharan Africa: a cohort study in Mozambique

Fausto Ciccacci — 2022-12-22

Introduction: WHO estimates 422 million cases of diabetes mellitus worldwide. Mozambique has the second-highest mortality related to DM in the African region.

Objectives: To provide data about a DM care service in Mozambique and to evaluate early outcomes of treatment.

Methods: The new patients diagnosed with DM in a two-years period in a health centre in Maputo (Mozambique) were included in a retrospective cohort study. Fasting blood glucose (FBG), waist circumference (WC) and BMI were collected at baseline and after three months.

Results: 188 patients were enrolled. Median BMI, WC and FBG at baseline were respectively 28 kg/m2(Inter Quartile Range [IQR]23.4-31.8), 98cm (IQR 87-105) and 209mg/dL (IQR 143-295). A non-pharmacological intervention was prescribed for six patients, while 182 patients received metformin 500 mg b.i.d. FBG was significantly reduced at control (226[±103.7]mg/dL vs 186[±93.2]mg/dL, p<0.000); however, glycemic control was reached in 74 patients (39.4%); not controlled patients changed regimen. Elderly patients had a higher glycemic control (adjusted Odds Ratio 2.50, 95% CI 1.11-5.06, p=0.002).

Conclusion: Strategies for early detection of scarce glycemic control are feasible in Mozambique and could lead to prompt regimen switch; an invasive therapeutic approach could be preferable in selected cases to achieve control.

Keywords: Diabetes Mellitus; Non-Communicable Diseases; Health Care.

Relationship between healthy habits and sociodemographic variables and risk of diabetes type 2

Ángel Arturo López González — 2022-12-22

Background: Type 2 diabetes is considered a worldwide public health problem due to its high prevalence and the important complications it causes.
Objectives: To assess the influence of healthy habits, especially physical activity and diet, on the risk of type 2 diabetes.
Material and methods: Descriptive and cross-sectional study in 1457 Spanish workers in which the influence of different sociodemographic
variables and lifestyle habits such as tobacco consumption, physical activity and adherence to the Mediterranean
diet in relation to the risk of presenting type 2 diabetes assessed with the Finrisk and Leicester scales was evaluated.
Results: The prevalence of moderate and high values of the Finrisk and Leicester scales decreased as the level of physical activity
assessed with the IPAQ questionnaire increased and as adherence to the Mediterranean diet increased. In the multivariate
analysis by binary logistic regression, high age, male sex, less favoured social class, low level of physical activity and low adherence
to the Mediterranean diet influence the increase in the prevalence of high diabetes risk values, while tobacco consumption
shows a protective effect.
Conclusion: Physical exercise and the Mediterranean diet have a beneficial effect on the risk of presenting type 2 diabetes with
Finrisk and Leicester scales.
Keywords: Diabetes mellitus; physical activity; Mediterranean diet; social class.

Knowledge, attitude, and perception of low back pain and activities that may prevent it among adolescents in Nigeria

Bashir Bello — 2022-12-22

Background: Awareness of activities that may result in low back pain (LBP) among adolescents is fundamental in preventing adulthood LBP.

Objective: The aim of this study was to investigate adolescents' knowledge, attitude, and perception of LBP and activities that may prevent LBP in Kano, North-western, Nigeria.
Methods: This was a cross-sectional survey involving 400 school-going adolescents recruited using a multistage random sampling technique. Data was analysed using descriptive statistics and Chi-square test with 0.05 set as level of significance.

Results: The mean age of the respondents was 16.0±1.50 years. LBP annual prevalence was 34.2%, with more girls (31.1%) reporting having LBP compared to boys (28.4%). More than half (59.3%) of the respondents had poor knowledge of LBP and activities that may prevent it. However, they had a good attitude (63%) and perception (74%) of LBP and activities that may prevent it. There was no significant association of levels of knowledge, attitude, and perception of LBP and activities that may prevent LBP with gender, age, and class of study (p > 0.05).

Conclusion: Adolescents in Kano, North-western Nigeria had poor knowledge of LBP and activities that may prevent it. Therefore, there is a need to embark on an LBP prevention program among adolescents in Kano, North-western Nigeria.

Keywords: Low back pain; prevention; adolescents; knowledge; attitude; perception.

Review of core stability exercise versus conventional exercise in the management of chronic low back pain

Obinna Dickson Nwodo — 2022-12-22

Exercise has been proven to be effective in the management of chronic low back pain. Over the years, core stability exercise (CSE) has gained popularity however there is lack of consensus on the best exercise treatment.

Aims: To review the effectiveness of core stability exercises or conventional exercises in the management of chronic low back pain (CLBP).

Methods: This study is a systematic review of randomized clinical trials which examined studies regarding core stability and conventional exercise by using Google scholar, Medline, PEDro and Cochrane from 2010 to 2021. The Methodological quality was evaluated using the PEDro scale. The included studies randomized participants into two different exercise groups.

Results: From the 58 potentially relevant trials, a total of 14 trials were included in the current analysis. The data indicated that core stability exercise was better than conventional exercise for short term pain relief. Ten studies included self reported back specific functional status, and compared to conventional exercise, core stability exercise resulted in significant improvement in function.

Conclusion: Compared to conventional exercise, core stability exercise is more effective in pain reduction and improved physical function in individuals with CLBP in the short term however, only two trials carried out follow-up assessments post intervention.

Keywords: Core stability exercise; conventional exercise; chronic low back pain.

Prevalence, patterns, functional disability of Bertolotti syndrome among patients with low back pain at Mulago National Referral Hospital

Nicholas Owen Alinda — 2022-12-22

Background: Bertolotti syndrome is a differential diagnosis in back pain. We know little about it in Uganda. This study aimed to describe the prevalence, clinical and radiological patterns of Bertolotti syndrome and functional disability associated with it.
Methods: We did a descriptive cross-sectional study at the spine outpatients’ clinic of Mulago National Referral Hospital. We screened patients with chronic low back pain for lumbosacral transitional vertebrae over four months and classified them according to Castellvi. We collected demographics, clinical symptoms, and functional disability data and summarized it descriptively.
Results: Out of 385 patients, we identified 39 with Bertolotti syndrome. The prevalence and the median age were at 10.1% and 49 years respectively, with most patients being females (66.7%) in the age range of (36 to 50) years, the pain started during the age range of 31-40. The commonest and least were type IIA (20.5%) and type IV (10.3%), respectively. Most patients (66.3%) had radicular symptoms, mainly the toe extension nerve root. The average visual analog scale was 6.3. However, most patients suffered from mild- to moderate disability (66.7%).
Conclusion: Bertolotti syndrome is common and functionally debilitating. We should consider it in the differential diagnosis of chronic low back pain.

Keywords: Bertolotti syndrome; Transitional vertebrae; Functional disability.

Primary spontaneous pneumothorax in a term neonate

Abiola O Adekoya — 2022-12-22

Pneumothorax is a rare but recognized cause of respiratory distress in the newborn. It can occur spontaneously or post-traumatic.
We report our experience in a term male neonate who had primary spontaneous pneumothorax. He had no surgical intervention but completely recovered with conservative management and supplemental oxygen.

A national survey of oral maxillofacial surgeons’ and trainees’ awareness and practice regarding psychological problems associated with facial trauma

Olufemi Kolawole Ogundipe — 2022-12-22

Background: The psychological problems associated with facial trauma may sometimes pose additional health concerns for the injured patient. Understanding the gaps in the Oral and Maxillofacial surgeons’ (OMFS) awareness of patient in need of specialist mental health intervention is important in ensuring holistic care for the trauma patient.

Objectives: To determine the knowledge, practices and self-assessed level of competence of Nigerian Oral maxillofacial surgeons/trainees regarding psychological problems associated with facial trauma and to determine their perceived need for training in assessment of psychological consequences following facial trauma.

Methods: A cross-sectional study was conducted in which a web-based structured questionnaire was sent to Oral and maxillofacial surgeons and trainees.

Results: Majority of respondents (85.2%) had encountered psychological problems in patients who have sustained facial trauma. Half (50.6%) of OMFS / trainees had high level of knowledge regarding psychological problems associated with facial trauma; depression, anxiety, post-traumatic stress disorder, body image disorder and acute stress syndrome were the five most common trauma related psychological problems mentioned. More respondents reported low level of competence in conducting mental state examination when compared to other skill sets. In-unit counselling was reported as the method of intervention by majority (69.1 %), followed by referral to the mental health specialists (17.3%). More than one third (40.7%) of OMFS were extremely interested in undergoing additional training in the psychological assessment of patients who have sustained facial trauma.

Conclusion: Nigerian Oral and maxillofacial surgeons frequently encounter psychological problems in patients with traumatic facial injuries. Notwithstanding their perceived self-assessed low level of competence in psychological assessment of trauma patients, objective assessment revealed a relatively high level of knowledge of psychological problems that can affect the facial trauma patient with many indicating a high perceived need for additional training in the psychological assessment of facial trauma patient. There is a need for incorporating psychological assessment into the management to ensure holistic care of trauma patients.

Keywords: Maxillofacial trauma; psychological problems; Nigeria.

High incidence of acute kidney injury among patients with major trauma at Mulago National Referral Hospital, Uganda: risk factors and overall survival

Badru Ssekitooleko — 2022-12-22

Introduction: Acute kidney injury (AKI) is a common and life-threatening complication of major trauma. Recognition is often delayed and management is frequently sub-optimal. We determined the incidence, risk factors and immediate outcomes of AKI in patients with major trauma at Mulago National Referral Hospital.
Methods: This was a prospective study. We recruited adult patients with ISS of > 16. The KDIGO criteria was used to stage AKI. Serum creatinine was measured at baseline, 24, 48, 72 hours and on discharge from the study. Participants were followed up for seven days if not yet discharged. Bivariate and multivariate analysis was done using modified Poisson regression with robust standard errors.
Results: 224 patients were recruited. The incidence was 67/1000 persons per day. The risk factors were male sex, delayed presentation, hypoglycemia at admission, RR=1.62 (95%CI 1.24-2.12) and non-operative management RR=1.39 (95%CI 1.02-1.89). Out of the 62 patients that died, 34 (54.8%) had AKI. The overall mortality rate was 39.5 patients per thousand per day.
Conclusion: There was a high incidence of AKI among patients with major trauma. Efforts to reduce morbidity and mortality should be prioritized.
Keywords: AKI=Acute kidney injury; major trauma; ISS = injury severity score.

Prevalence and causes of visual impairment amongst hearing impaired school-going children in sub-Saharan Africa: a scoping review

Michael Agyemang Kwarteng — 2022-12-22

Background: Learners living with hearing impairment are at a higher risk of visual impairment.

Purpose: To summarise relevant literature investigating the prevalence and causes of visual impairment amongst learners living with hearing impairment in sub-Saharan Africa.

Methods: A search of nine databases and the reference lists of retrieved studies were conducted using the standard methodology for scoping reviews as described in the PRISMA statement. The databases were MEDLINE, PubMed, EMBASE, the Cochrane Library, Global Health, OVID, Google Scholar, Web of Science, and Science Direct. A scoping review of articles published in the English language from 2000 to 2020 was conducted while considering the study design, sub-Saharan Africa, and school for the deaf. Descriptive statistics was used to analyse the data.

Results: The initial search retrieved eight studies, seven of which met the set inclusion criteria. All seven studies included employed a cross-sectional design. The prevalence of visual impairment ranged from 2.2-34.6% with the major cause being uncorrected refractive error (7.9-73.26%). The most common type of refractive error was myopia (42.2%) followed by hyperopia (28.6%) and astigmatism (28.6%).

Conclusion: This review has demonstrated that there is a paucity of high-quality and well-designed studies that have investigated the prevalence and causes of visual impairment amongst hearing-impaired children in sub-Saharan Africa suggesting the need for further research in this area.

Keywords: Visual impairment; prevalence; Africa; hearing impairment; ocular morbidity.

Childhood colostomies: patterns, indications and outcomes in a Nigerian University Teaching Hospital

Uchechukwu Obiora Ezomike — 2022-12-22

Background: Most childhood colostomies are done for decompression or diversion in gastrointestinal tract congenital anomalies.
Colostomy may be sited in the transverse or sigmoid colon as loop or defunctioning (divided) colostomies. Current pattern seems towards construction of more sigmoid and defunctioning colostomies.

Aims: To evaluate the patterns, indications and outcomes of childhood colostomies.

Patients and Methods: Retrospective chart review of all colostomies performed in children below 15 years from September 2010 to August 2020.

Results: There were 104 colostomies (55males; 49females; 65 sigmoid; 39 transverse colostomies; 3 loop; 101 defunctioning colostomies. Anorecatal Malformation (ARM)was indication in 32 males and 41 females; age range 2 days to 13 years. Hirschsprung’s Disease (HD) was indication in 18 males and 4 females; age range 6 weeks to 15 years.
In HD there were three loop colostomies (3/22) in transverse colon and 19 defunctioning colostomies (8 sigmoid, 11 transverse) while in ARM all 73 were defunctioning colostomies(P=0.01) In HD there were 14/22 transverse colostomies and 8/22 sigmoid colostomies while ARM had 24/73 transverse and 49/73
sigmoid colostomies (P =0.013) In HD 91% colostomies were done beyond infancy while in ARM 93% were before one year(P<0.0001). Mortalities were noted
in 1.9% patients.

Conclusion: Commonest indication for colostomy is ARM. There are more defunctioning than loop colostomies, and more sigmoid than transverse colostomies. of most colostomies in ARM were during infancy while mostly beyond infancy in HD.

Keywords: Childhood colostomies; oatterns; indications; outcomes.

Application of blended integrated revision course in clinical surgery in West Africa in response to Covid-19 pandemic: perception of trainee surgeons

Sebastian Okwuchukwu Ekenze — 2022-12-23

Background/Objective: This study assessed the surgery residents’ evaluation of blended delivery of the 2020 Integrated Revision Course in Clinical Surgery (IRCCS) of the West African College of Surgeons undertaken as a result of COVID-19
pandemic.

Methods: We performed a cross-sectional survey of 234 participants of the 2020 IRCCS using self-administered questionnaire. The survey assessed the previous traditional course and various aspects of the novel blended course using 5-point Likert scale.

Results: Overall, 186 (79.5%) responded. The blended course had overall mean rating of 4.92 (on a 5-point scale) compared to 4.05 for the previous traditional course. Of the virtual aspect of the blended course, didactic lectures had the best mean rating of 4.32, while unmanned OSCE had the least with mean rating of 3.30. Aspects of the multicentre component of the blended course were rated highly with conduct of manned OSCE receiving the best mean rating of 4.26. The major challenge of the blended course format was poor internet connectivity (n =102; 54.8%),

Conclusion: Blended format of surgical training course is well rated by the surgery residents, and may be an effective means of delivery of clinical and non-clinical course contents during periods of disruption.

Keywords: Surgical training; COVID-19 pandemic; virtual training; blended format; West Africa.

A reference interval study of serum 25-Hydroxyvitamin D among an African elderly population

Ifeyinwa Dorothy Nnakenyi — 2022-12-23

Background: Elderly people have increased risk factors for low serum vitamin D levels, which is worsened among the black race. Therefore, elderly Africans constitute a reference population for vitamin D study.

Aim: The aim of this study was to establish the reference interval of serum 25-hydroxyvitamin D (25(OH)D) among an African elderly population.

Methodology: This was a cross-sectional study of rural community dwellers in Enugu, south-eastern Nigeria aged 50 years and above, that satisfied the criteria of the reference population. Ethical approval and informed consent were obtained. Venous blood was collected from reference individuals and serum 25(OH)D was determined by enzyme-linked immunosorbent assay.
Data were analysed using a non-parametric, bootstrap method to obtain the central 95% reference limits and 90% confidence intervals of the lower and upper limits of the reference interval respectively.

Results: One hundred and twenty-four (62 males and 62 females) participants were recruited. The median (25th -75th percentile) of serum 25(OH)D was 56 (35 – 71) ng/ml. The 2.5th percentile defined the lower reference limit and it was 21 ng/ml with 90% confidence interval (20 – 23) ng/ml; while the 97.5th percentile defined the upper reference limit and it was 93 ng/ml with 90% confidence interval (90 – 98) ng/ml.

Conclusion: The reference interval for serum 25(OH)D for the selected African elderly population in Enugu, Nigeria was determined to be 21 to 93 ng/ml.

Keywords: Bootstrap method; elderly; reference interval; vitamin D.

Ethnic spice use and perceived health benefits among women in a Suburb of the Greater Accra Region of Ghana

Matilda Asante — 2022-12-23

Background: Spices have a long history of both culinary use and health benefits. Ethnic spices are spices specific to a particular geographic location. In Ghana, there are varying perceptions and uses of ethnic spices which are mostly not documented.

Objective: To assess the use and perceived health benefits of ethnic spices among women in Accra, Ghana.

Methods: A cross-sectional study was conducted among 370 women in randomly selected churches in Accra, Ghana. A semi-structured questionnaire was used to obtain sociodemographic data and information on ethnic spice use. Chi-square test was used to determine the association between socio-demographic characteristics of participants and perceived health benefits of ethnic spice usage.

Results: The most commonly consumed spices out of the 19 spices explored in this study were onion (98.4%), garlic (97.6%), ginger (96.8%) and chili pepper (84.1%). Majority of the participants perceived ginger (74.6%) and garlic (73.8%) as having health benefits. Age (p=.001) and self-reported health status (p=0.010) were significantly associated with perceived health benefits of the spices.

Conclusion: Onion, garlic, ginger and chili pepper were the four most commonly consumed ethnic spices. Age and self-reported health status of participants influenced perceived health benefits of ethnic spice usage.

Keywords: Spices; health benefits; perception; flavour.

The effect of obesity on metabolic parameters: a cross sectional study in adult women

Seyit Ramazan Karadogan — 2022-12-23

Background: In this study conducted in adult healthy women, it was aimed to determine the relationship between anthropometric measurements such as Body Mass Index (BMI), waist circumference, waist/height ratio and blood parameters, which are used to define obesity.

Methods: A total of 90 women, with a mean age of 38.4±8.8 years, 34 pre-obese between BMI: 25.0-29.9 kg/m2 and 56 obese BMI: ≥30.0 kg/m2, participated in the study.

Results: According to plasma atherogenic index (PAI), women with high cardiovascular risk had lower high-density lipoprotein (HDL) values, while low-density lipoprotein (LDL), triglyceride (TG), aspartate transaminase (AST) values were found to be higher (p<0.05). It was observed that obese women according to BMI had higher fasting glucose, TG, alanine transaminase (ALT), AST and urea values, and lower HDL and mean erythrocyte volume (MCV) values compared to pre-obese women (p<0.05). A moderately positive relationship was found between body fat percentage, waist circumference and waist/height ratio and fasting glucose and ALT levels of women, and a moderate negative relationship was found between vitamin D levels (p<0.05).

Conclusions: It is understood that the increase in body fat tissue, especially in the abdominal region, in adult healthy women has negative effects on blood parameters and the risk of developing chronic diseases will decrease by preventing this situation.

Keywords: Obesity; Abdominal Fat; Blood Chemical Analysis; Women's Health; Anthropometry.

Rs7537605 polymorphism in VAV3 gene and rs28665122 polymorphism in SEPS gene are not associated with Hashimoto's thyroiditis in North-East Algerian population

Warda Kherrour — 2022-12-23

Background: Hashimoto's thyroiditis (HT) is the most common form of autoimmune thyroid disease which leads, in most cases, to hypothyroidism. HT is also classified as a multifactorial disease, which is caused by an interaction between genetic and environmental factors. Current knowledge of HT genetics is still very limited, especially in Algerian population.

Objective: We wanted to investigate the association of two single-nucleotide polymorphisms (SNPs) inside VAV3 and SEPS genes with HT in Algerian population.

Methods: We conducted a case-control study that included 100 HT cases and 126 healthy controls that were recruited from three private endocrinology clinics. Two SNPs, rs7537605 and rs28665122 inside VAV3 and SEPS genes were genotyped using real-time polymerase chain reaction (real-time PCR). Binary logistic regression model was used to test the association of selected SNs with HT and linear regression model was used to test association of these SNPs with thyroid peroxidase antibodies (TPOAb) levels.

Results: Binary logistic regression results revealed no allelic association of the minor allele A between Hashimoto's thyroiditis cases and healthy controls (P=0.896) for the rs7537606 in VAV3 gene. The same observation was reported for the AA (P=0.477), AG (P=0.752) genotypes and for the genotypic models: dominant (P=1.0) and recessive (P=0.555). Also, there was no significant difference in the TT (P=0.230), TC (P=0.717) and allelic distribution of the minor allele T (P=0.859), and the combined models: TT + TC (P=1.0), TC + CC (P=0.138) between patients and controls for the rs28665122 polymorphism of
the SEPS1 gene.

Conclusion: This is the first genetic study that investigated the genetic association of rs7537605 and rs28665122 inside VAV3 and SEPS genes in Algerian population. Our results suggest that these two SNPs may not be involved in the pathogeneses of HT since we found no association between them and HT/TPOAb levels. Further research that will include larger sample size is required.

Keywords: Hashimoto’s thyroiditis; inflammation; hypothyroidism; rs7537605; rs28665122; Algerian population.

The association between headache presentation, normal examination and neuroimaging findings: a retrospective analysis of patients presenting to a tertiary referral centre

Sharania Moodley — 2022-12-23

Background: There is a high worldwide burden of headaches. Selection of patients with headaches for neuroimaging, in the absence of traditional red flags, is imperative in guiding further management.

Objectives: Determine the yield of neuroimaging findings in patients with headache and normal examination; and potentially identifying additional red flags.

Methods: A retrospective consecutive chart review of patients with a main complaint of headaches and normal clinical examination were assessed at a tertiary hospital, over a 10-year period.

Results: Cohort consisted of 114 patients. Unexpected or normal variants found in 20.2% of patients (23/114) and 11.4% (13/114) required change in management. The absence of nausea and vomiting (p=0.009) and absence of sharp type headaches in unexpected or normal variants group (p=0.03) were statistically significant. There was a higher chance of an abnormal neuroimaging study in men and HIV seropositive patients.

Conclusions: Decision to neuroimage should be determined on an individual basis (demographic factors, history of headache and examination) as normal examination cannot preclude patients from unexpected findings on neuroimaging. Headache with nausea and vomiting in isolation may be associated with normal neuroimaging reflecting primary type headaches. Findings support a lower threshold to neuroimage men and HIV seropositive patients with headaches despite normal clinical examination.

Keywords: Headache; normal clinical examination; neuroimaging; headache red flags.

The association of cardiometabolic disorders with sleep duration: a cross-sectional study

Dorcas R Prakaschandra — 2022-12-23

Background: Alterations in sleep duration and quality are linked to the development of cardiovascular risk factors and the metabolic syndrome (MetS). The aim of this study was to determine a sex stratified analysis on the role and associations of sleep duration on cardiometabolic risk factors, and the MetS.

Methods: Data from 1375 randomly selected participants (15-64 years) was collected for demographic, anthropometric, blood pressure and biochemistry data after overnight fasting, and derangements diagnosed according to published guidelines. Analysis of association between the MetS (harmonised criteria modified for South Asians), sleep duration (self-reported for a 24-hour period), and cardiometabolic risk factors was done using stepwise logistic regression.

Results: The BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP), fasting plasma glucose, total cholesterol, low density lipoprotein were higher (p< 0.05) in subjects who slept <6 hours, with lower HDL. Under 6 hours of sleep was independently associated with raised FPG in men (OR 1.71 95% CI [1.53,5.52]) only. More than 10 hours of sleep was independently associated with increased triglyceride levels in men (1.72[0.56, 5.23]) and women (2.25[1.93,5.42]).

Conclusion: The individual components of the Mets, particularly, increased triglycerides and blood glucose are associated with sleep deprivation or excess.

Keywords: Sleep Time; Metabolic Syndrome X; Cardiovascular Risk.

Self-reported oral hygiene practice and utilization of dental services by dental technology students in Port Harcourt, Rivers State, Nigeria

Grace Alade — 2022-12-23

Background: Dental technology students are Dental surgery technicians under training, trained to assist patients maintain good oral health. Hence, their oral hygiene is expected to be optimal.

Objective: To determine the oral self-care practices and pattern of utilization of dental services among dental technology students.

Material and Methods: This was a descriptive, cross-sectional study, consisting of 109 participants. The questionnaire had three sections. Section A had questions on sociodemographic, section B was on self-reported oral hygiene practices and section C was on pattern of dental service utilization. Statistical analysis was done using the SPSS version 20.0.

Results: The mean age was 23.66 years; age range was 18 – 42 years. There were 20 males and 89 females, 95.41% of the participants used toothbrushes and paste, while 4.59% used both chewing sticks and toothbrushes. 22% used horizontal/scrub method of toothbrushing, 10.1% used modified bass method, whereas 5.0% do not know which method of toothbrushing they use. 81.3% of the participants had visited the dentist previously for routine dental check-up while 10.71% visited for dental pain.

Conclusion: The self-reported oral hygiene practice of the dental technology students is commendable, however, further education on the importance of scaling and polishing is advocated.

Keywords: Dental technology; Dental utilization; Oral health practices.

In-vitro antioxidant potential and acetylcholinesterase inhibitory effect of Ficus benghalensis aerial root extract

Anand Ramasamy — 2022-12-23

Aim and objective: The aim of the current study was to evaluate the antioxidant effect, acetylcholinesterase (AChE) inhibitory effect and phytochemical screening of different extracts of aerial root extract of Ficus benghalensis using in-vitro methods.

Methods: The aerial root extract was prepared by successive extraction method using different organic solvents having increasing order of polarity. FB aerial root extract was screened for preliminary phytochemical analysis. FB aerial root extracts were evaluated for in-vitro acetylcholinesterase inhibitory effect by the Ellman’s method and anti-oxidant potential by DPPH assay and hydroxyl radical neutralizing assay.

Results: Preliminary phytochemical screening of FB extracts indicate the existence of the phytochemicals such as phenols, alkaloids, flavonoids, glycosides, anthraquinones, tannins and steroids. The results of the DPPH assay, hydroxyl radical scavenging assay and AChE inhibitory assay show that chloroform and ethyl acetate extracts are having significant antioxidant activity and acetylcholinesterase inhibitory effect as compared to the other extracts, respectively.

Conclusion: The results of the current study suggest that the aerial root extract of FB might be a potential drug source for treatment of neurodegenerative disorders like Alzheimer disease.

Keywords: Ficus benghalensis; antioxidant; DPPH; acetylcholinesterase; neurodegenerative disorder.

Assessing attitude towards condom use among truck drivers at transhipment location, Meerut District, India, using multidimensional condom attitude scale

Ashish Pundhir — 2022-12-23

Background: In India, unsafe sex has been documented among truck drivers. This study explores the factors influencing their attitude of trucker towards condom use.
Methods: A cross-sectional study design was adapted for this study in which 25 factors were chosen to assess attitude toward condom use on 7 point validated Likert scale UCLA Multidimensional Condom Attitude Scale on 5 subcomponents –Reliability, Pleasure, Stigma associated with condom use, embarrassment about negotiation and use of condom and about purchasing condom. Hundred truck drivers were recruited using convenient sampling and Mann-Whitney U and Kruskall Wallis Test were used to validate the subcomponents among those practicing unsafe sex.

Results: Positive attitudes regarding reliability and effectiveness of condom were significantly higher among adult entrants and those resting more than 10 hours during journey whereas positive attitude regarding pleasure associated with condoms and stigma towards it is significantly higher among truck drivers travelled long distances and resting more than 10 hours.

Conclusion: Adolescent entrants, those who have not travelled long distances and not rested more than 10 hrs requires improvement in the attitude towards condom use.

Keywords: Unsafe sex; condom use; India.

Awareness, knowledge, risk perception and uptake of maternal vaccination in rural communities of Ebonyi State, Nigeria

Ugochukwu Chinyem Madubueze — 2022-12-23

Introduction: Knowledge and uptake of maternal vaccination has been reported to be low in low- and middle-income countries.

Objectives: To determine the knowledge, uptake and determinants of uptake of maternal vaccination among women of childbearing age.

Methods: A cross sectional study was done among 607 women of childbearing age selected from rural communities in Ebonyi State using multi-staged sampling technique. A pretested, interviewer administered questionnaire was used. The proportion of maternal vaccination uptake and predictors of uptake was determined at 5% level of significant using multiple logistic regression model.

Results: Most of the respondents (39.9%) were in the 15-24 years age group. Only 1.3% and 41.5% were knowledgeable and had received any form of maternal vaccines respectively. The main reasons adduced for non-receipt of the vaccine was lack of information (65.8%) and not being pregnant (23.5%). Pregnancy was the predictor for uptake of maternal vaccine among the study population.

Conclusions: There was low level of knowledge and uptake of maternal vaccine among rural women and a myth that the vaccine is only given when pregnant. This calls for increase targeted enlightenment of rural women on maternal vaccine in order to improve uptake.

Keywords: Maternal vaccination; rural communities; Nigeria.

Discontinuation of contraceptives among adolescent girls aged 15-19 years in Nigeria: a descriptive analysis

Olaide Ojoniyi — 2022-12-23

Background: Adolescent girls are the mostly affected with maternal and child complications. Contraceptive use is an important tool in curbing sexual and reproductive health challenges especially among adolescent girls in the developing countries. Despite, the low use of contraceptives among adolescents in Nigeria, the possibility of discontinuation of use after initiation is strong.

Objective: This study aims to identify method of contraceptive use discontinued and reasons for discontinuation of contraceptives among unmarried adolescents aged 15-19 years in Nigeria.

Method: Data for 324 never married adolescent girls who had ever used a method to prevent pregnancy were drawn from the 2018 Nigerian Demographic and Health Survey. Descriptive statistics and chart were used to present the results.

Result: Findings showed that 20% of adolescents who had ever used contraceptive discontinued use in the last five years. Most of single adolescents who reported ever discontinued a contraceptive method are older, have secondary education, resides in Urban areas, were at least 15 years at sexual debut are from richer household. Most reported reasons for discontinuation were Infrequent sex and inconveniencey in use.

Conclusion: One in five of unmarried adolescents who ever use a method, discontinue use because of sexual frequency and
type of method used.

Keywords: Contraceptive; discontinuation; adolescents; unmarried; NDHS; Nigeria.

Experiences of LGBTI+ individuals in accessing right to health; a survey study from Turkey

Meltem Gunbegi — 2022-12-23

Background: In Turkey, LGBTI+s is experiencing discrimination in all areas of their lives.

Objectives: We aimed to determine the problems experienced by LGBTI+s living in Turkey in accessing their right to health.

Methods: An online questionnaire containing 37 open-ended and multiple-choice questions about respondent’s demographic characteristics, experiences in accessing and receiving health services was prepared. Between October 2018 and December 2019, the survey was disseminated via social media platforms and sent to LGBTI+ friendly institutions. 81 people responded to the survey.

Results: 43.2% had at least one chronic disease. Participants stated that 44.5% of them go to a health institution <3 times in a year. 91.4% of the participants declared that they never or rarely said their sexual identity/orientation at the health institutions, and 39.2% of them encountered negative behaviour when they did. 98.8% of the participants said that they think physicians do not have enough information about LGBTI+s.

Conclusions: The knowledge and attitude of healthcare professionals are one of the essential determinants of LGBTI+s' use of their right to health. Alienating and homophobic behaviors against LGBTI+s is the biggest problem for LGBTI+s to receive quality health care in Turkey.

Keywords: LGBTI+; health service; right to health; discrimination; access to health services.

Prevalence and correlates of antenatal depression at Chelstone First Level Hospital in Lusaka, Zambia: a cross-sectional study

Brian Maila — 2022-12-23

Background: Antenatal depression is associated with long-term disability in both mothers and new-borns. Inadequate data and research can constrain resource allocation and exacerbate the condition's symptoms.
Objective: The purpose of this study was to determine the prevalence of prenatal depression and the characteristics associated with it among women receiving prenatal care at Chelstone First Level Hospital in Lusaka.
Method: A cross-sectional survey of 281 pregnant women receiving prenatal care at Chelstone First Level Hospital was conducted using systematic random sampling. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess participants' depression, and related data were collected using a structured, pretested, and interviewer-administered questionnaire.
Results: Prenatal depression was identified in 26.3 percent of pregnant women surveyed (95 CI: 21% -32%), with antenatal depression being significantly more prevalent in women who did not have a satisfactory relationship with their partner/significant other (OR=1.70, 95CI: 1.40-3.10). Unemployment was found to be a risk factor for antenatal depression, with a 1.3 (95 CI:1.04-1.5) fold increased risk compared to employed women.

Conclusion: Depressive symptoms are common among pregnant women seeking antenatal care in primary care, and unemployment, as well as a lack of relationship satisfaction with the spouse/significant other, increases the risk of depression.

Keywords: Antenatal depression; associated factors; depression in pregnancy; depressive symptoms; depression; pregnancy; antenatal care.

Factors associated with adverse obstetric events following induction of labour: a retrospective study in a tertiary hospital in Ghana

Kwame Adu-Bonsaffoh — 2022-12-23

Background: Induction of labour (IOL) remains an indispensable intervention in obstetric practice; however, it may be associated with significant untoward perinatal outcomes. This study determined the major adverse outcomes of IOL and the associated factors at a tertiary hospital in Ghana

Methods: Retrospective study involving women with singleton gestations, conducted at the Korle Teaching Hospital in Ghana. Multivariable logistic regression was used to explore the factors associated with adverse outcomes of IOL.

Findings: A total of 195 women who had IOL were analysed with 161 (82.6%) and 34 (17.4%) undergoing vaginal and caesarean deliveries respectively. The main IOL methods used included Misoprostol (91.3%), Oxytocin (5.1%) and Foley’s catheter (3.6%). Composite adverse perinatal outcomes occurred in 46 neonates (23.6%) comprising perinatal deaths (7.2%) and or NICU admission (21.0%). Caesarean delivery following IOL was significantly associated with nulliparity, gestational age <41 weeks, hypertensive disorders in pregnancy and birth weight ≥3.5kg. Gestational age <41 weeks and birth weight <2.5kg were
significantly associated with adverse perinatal outcome. Five women (2.6%) had uterine rupture all of which occurred in the misoprostol group.

Conclusion: Induction of labour may result in significant perinatal complications which are related to both maternal (nulliparity and hypertension) and fetal (gestational age and birth weight) factors. Strict selection criteria and continuous fetal-maternal monitoring are strongly recommended to improve the birth outcomes of IOL.

Keywords: Induction of labour; adverse outcomes; Ghana.

Factors associated with successful vaginal birth after cesarean section among mothers who gave birth in Ambo town, Oromia, Central Ethiopia, a case-control study

Negash Kassa Mamo — 2022-12-23

Background: While Trial of labour after previous cesarean section for women with no contraindication for vaginal delivery is an important strategy to reduce short- and long-term morbidity related with repeated cesarean section, the rate of cesarean section and repeated cesarean section with its complication are increasing.

Objective: The objective of the study was to assess factors associated with successful vaginal birth among women with previous cesarean delivery in public hospitals of Ambo town in 2019.

Methods: A case-control study was conducted in Ambo public Hospitals in 2019. A total of 243 clients were included, of which 81 clients were cases and 162 clients were controls with controls to cases ratio of 2. A Lottery method was applied to select the controls and cases were selected consecutively. Bivariate, followed by multivariate analyses, were conducted with 95% CI and p-value <0.05 to identify factors associated with successful vaginal birth after cesarean delivery.

Result: Parity three and four(AOR = 3.45, 95%CI(1.16, 10.229), labour monitoring with partograph (AOR= 4.77, 95%CI: 1.65,13.88), prior vaginal birth after caesareans (AOR = 5.68, 95%CI:1.44,22.46), occiput-posterior position (AOR = 0.109, 95%CI: (0.02, 0.49), duration of labour after admission less than 8 hours (AOR = 4.57, 95%CI: 1.92,10.85) and artificial rupture of membrane (AOR = 5.02 95%CI: 1.67,15.06) were factors significantly associated with successful vaginal birth after previous cesarean section.

Conclusion: The study shows that parity, duration of labour, previous history of successful vaginal birth after cesarean section, artificial rupture of membrane, and partograph monitoring of labour were associated with successful vaginal birth after previous cesarean section. All Women with a history of cesarean section should be counselled and encouraged to undergo a trial of labour as long as it is not contraindicated.

Keywords: Previous cesarean section; vaginal birth after cesareans; Ambo; Ethiopia.

Association between dietary patterns and pregnancy induced hypertension: a case control study from Sudan

Kambal Nahla — 2022-12-23

Background: Dietary patterns and its associated factors and can play an essential role in development of preeclampsia and implication in pregnancy-induced hypertension (PIH).

Objective: This study was performed to determine nutritional factors associated with PIH among pregnant women in Khartoum, Sudan.

Methods: This study was a case-control involving 100 women with PIH and 200 normotensive pregnant women.

Results: The mean current weight in the control and PIH groups was 70.25 ± 12.35 and 72.42 ± 12.33 kg; whereas the mean energy intake in the control and PIH groups was 1991.58 ±140.72 and 2154.37 ± 130.85 kcal, respectively. The study results indicated a significantly lower risk of PIH among women ingesting fruits and legumes (odds ratio, 8.44 and 4.07, respectively; 95% confidence interval; P < 0.05).

Conclusion: PIH was positively associated with higher energy, fat, and protein intake. A lower risk of PIH was calculated for women whose dietary habits included fruits and legumes. Measures with which to ensure proper nutrition education are needed to obtain good health and pregnancy outcomes. PIH is a multifactorial disease with an unclear etiology, and the findings of this study will serve as a baseline for future studies in this field.

Keywords: Nutrition; pregnancy-induced hypertension; health; Sudan.

Pattern of cesarean deliveries among women in an urban and rural district in Egypt

Monira M Gad — 2022-12-23

Aim: to compare patterns of delivery at an urban and a rural district in Egypt over 3 years.

Methods: This retrospective study included 500 women and 50 obstetricians from each district from January, 2013 till December, 2015. Women answered a questionnaire about their deliveries. Obstetricians answered a questionnaire about their practice
of CS.

Results: CS rate in the rural district was 57.2% compared to 54.8% in the urban district in 2013. In 2014 and 2015, CS rates increased to 65.3% and 69%, respectively in the rural district compared to 56% and 57.7%, respectively in the urban district. 66% of obstetricians in the rural district performed CS for more than 50% of their patients compared to 76% of obstetricians in the urban district. 52% and 4% of obstetricians in the rural and urban districts, respectively, performed CS upon maternal request. 70.3% of women in the rural district who delivered by CS preferred to deliver vaginally. 51.4% of urban women who delivered by CS preferred to deliver vaginally. Level of education was the only factor showing statistical significance.

Conclusion: CS rates increased over time with higher rates in the rural area. Level of women's education was the only factor affecting delivery choice.

Keywords: Cesarean sections; CS rate; urban area; rural area; Egypt; obstetricians.

Obstetric outcome of female genital mutilation in the Gambia – an observational study

Patrick Idoko — 2022-12-23

Background: A 2010 survey in The Gambia among women of reproductive age put the prevalence rate of FGM/C at 76.3%. FGM/C was banned in 2015, but there is no real effort at enforcement of the ban. This study aimed to provide national data on obstetric outcomes to support advocacy and health education.
A multicentre observational study to assess the obstetric and neonatal outcomes of parturient women with and without FGM/C
was carried out across 4 healthcare facilities in The Gambia. The primary outcome was postpartum haemorrhage (>500ml) and
secondary outcomes were caesarean section, perineal tears (including episiotomy), neonatal resuscitation and perinatal death.
Of the 1,569 participants recruited into the study, 23% had no FGM/C while 77% had FGM/C of varying severity. The risk
of postpartum haemorrhage was doubled for women with type I FGM/C, tripled in type II FGM/C and increased by 5-fold
for those with type III and IV FGM/C. Caesarean section and perineal tears were also increased. FGM/C was associated with
increased risk for neonatal resuscitation and perinatal death.
FGM/C is associated with poor obstetric and neonatal outcomes in the Gambia with degree of risk correlating with the severity
of FGM/C.

Keywords: Female genital mutilation; obstetric outcome; Gambia.

Maternal health-seeking behaviour of peri-urban women living with disability in Busiro South Health sub District, Wakiso district, Uganda: a community-based study

Bonny Natukunda — 2022-12-23

Aim: We examined the maternal healthcare-seeking behaviour of peri-urban women with disabilities in Busiro South Health Sub District, Wakiso district, Uganda.

Methods: This community-based cross-sectional study. Data were collected using semi-structured questionnaires and focus group discussions. Chi-square was used to test for differences, and logistic regression to determine factors associated with maternal health-seeking behaviour at a 5% level of significance. Content analysis was used to analyse qualitative data.

Results: A total of 182 women with disabilities were enrolled. Overall, 150 (82.3%) of the disabled women had attended ANC and 147 (80.8%) had delivered their babies at a health facility. The participants' mean age was 31.9±7.8years (range: 17-49 years). ANC attendance among disabled women was influenced by maternal age 18-30 years (p = 0.010), number of times a disabled woman was pregnant (p = 0.003), parity (p = 0.018), a normal delivery (p = 0.048), receiving financial support from friends of partners (p < 0.001), distance of less than 5KM to the health facility (p = 0.024), friendliness of the health care providers (p=0.030) and availability of health providers (p < 0.001).

Conclusion: There is an urgent need for a multi-sectoral approach to better healthcare-seeking behaviour.

Keywords: Peri-urban; maternal health-seeking behaviour; disabled women; Uganda.

Forensic tool for sex prediction- hand dimensions

Renu Gupta — 2022-12-23

Background: Determination of sex from mutilated body fragments can perform vital role for identification of departed soul.
Forensic authority pacts with human identification from the hand measurements which is of prodigious assessment during tragedies, terror attacks and in criminality.

Objective: Present study explored the analytical role of the anthropometric measurements of hand dimensions, find demarking points for male and female, check percentage exactitude of sex determination in Western Indian population.

Methods: The study was piloted on a sample of 504 individuals. All the measurements were taken by standard procedure. Discriminant analysis and demarking points were created for all hand measurements.

Results: Males have a significantly higher values of all measurements than females. The left-hand length measurement unveiled noteworthy sexual dimorphism index (110.80). The higher value of the demarking point labelled as males. The best sexually dimorphic hand dimensions showed the utmost precision left hand length (95% in the male), followed by right hand length (76.1%).

Conclusion: All hand measurements like length, breadth and index are displaying sexual dimorphism, hence they can be used for determination of sex when isolated hand is found.
Keywords: Hand measurements; sexual dimorphism; demarking point; discriminant analysis.

Female empowerment to improve sexual and reproductive health outcomes and prevent violence in adolescent girls and young women in Uganda: evidence reviews for policy

Jessica Lewington — 2022-12-23

Background: Adolescent girls and young women in Uganda face numerous public health challenges including high HIV prevalence, teenage pregnancies, poor sexual and reproductive health rights, child marriage, and violence.

Objectives: This evidence review explores which interventions focusing on the empowerment of adolescent girls and young women to address these challenges are suitable for Ugandan policy.

Methods: We reviewed the literature to identify experimental studies and systematic reviews of interventions which improve sexual and reproductive health outcomes and/or prevent violence in adolescent girls and young women in low- and middle-income countries (LMICs). Two authors independently reviewed the studies identified through a comprehensive search strategy and assessed their quality. From this evidence base, two policy options were explored in depth considering benefits, harms, equity impacts, and costs, given the Ugandan context.
Results: The screen yielded 47 studies, of which 12 remained after applying inclusion and exclusion criteria and relevance, applicability and quality assessment. Feasible policy options included: a vertical cash-incentive approach at a national or local level to support girls’ attainment of education; and a horizontal integrated community approach focusing on skills and knowledge building. A combination of both is recommended for young female empowerment in Uganda, allowing for the full range of socio-cultural and economic drivers to be targeted.
Conclusion: Research into the link between female empowerment and sexual and reproductive health outcomes is still in early development. This review contributes to evidence on this topic and outlines an approach that is potentially suitable for adoption across similar LMICs in Africa.

Keywords: Sexual health; health policy; women's health.

HIV genotypic resistance among pregnant women initiating ART in Uganda: a baseline evaluation of participants in the Option B+ clinical trial

Alexander Amone — 2022-12-28

Background: Pre-treatment HIV drug resistance is a threat to elimination of mother to child HIV transmission and could lead to virological failure among HIV-positive pregnant women. We analysed genotypic HIV drug resistance (HIVDR) of baseline samples of participants enrolled in the Option B+ clinical trial in Uganda.
Methods: HIV-infected pregnant women attending antenatal care were enrolled from Uganda’s National Referral Hospital (Mulago) and Mityana District general hospital and surrounding health centers (HCs). Genotypic HIV testing was performed on blood samples from the first 135 enrolled women out of a subset of 136 participants (25%) who had a baseline VL>1000 copies/mL as one sample failed to amplify.
Results: 159/540 (29.4%) had a VL < 1000 copies/ml and 381/540 (70.6%) had a VL >1,000 copies/ml. Of the women with VL>1000 copies/ml, 32 (23.7%) had resistance mutations including 29/135 (21.5%) NNRTI mutations, 6/135 (4.4%) NRTI mutations and 3/135 (2.2%) had both NNRTI and NRTI mutations. The most common NNRTI resistance mutations were: K103KN (5), K103N (5), V179T (4) and E138A (4).
Conclusions: One quarter of the HIV-infected pregnant women in this trial at baseline had NNRTI genotypic resistance mutations. Our findings support new WHO guidelines for first-line ART that were changed to dolutegravir-based regimens.

Clinico-epidemiological profile of children living with HIV/AIDS managed at Heal Africa Hospital, Goma, Democratic Republic of the Congo

Emil Mapera — 2022-12-25

Background: Conflict in the DRC led to a poor health care. HIV/AIDS in children remains one of the leading causes of pediatric morbidity and mortality.
Methods: This cross-sectional study used a sample size of 238 files and aimed to determine the epidemiological profile of children
living with HIV at Heal Hospital in 2015.
Results: The age ranged from zero to fifteen, with a mean of 6.1 (±3.9) years. Records of PMTCT were noted in 12%. The mean birth weight was 3(±0.8) kg, most cases (88 percent) had normal vaginal delivery. Many of them (71 percent) were living with at least one parent. The majority of the children (92 percent) were from Goma, and 75 percent were diagnosed at WHO Stage 3. At least one episode of hospital admission was reported in 71 percent. Respiratory tract infections were the most common disease, and they were also the leading cause of death. Based on the CD4, which was the most cost-effective method of
monitoring, there was an improvement in immunity at the last visit.
Conclusion: This study pointed out the importance of PMTC and early management of children leaving with HIV/AIDS. Outreach would encourage voluntary HIV/AIDS testing for pregnant women in armed conflict zone.
Keywords: Central Africa; civil war; HIV/AIDS; pediatric; presentation.

Knowledge and perceptions about non-communicable diseases by people living with HIV: a descriptive cross-sectional study from Chitungwiza Central Hospital Zimbabwe

Alexander Cheza — 2022-12-23

Background: Sub-Saharan Africa has shown a rise in morbidity and mortality due to NCDs. PLHIV have shown to be more exposed to NCDs and identifying the knowledge gaps might help the management of NCDs in PLHIV.

Objective: The study was conducted in order to determine knowledge and perceptions regarding NCDs in PLHIV from Chitungwiza Hospital.

Methods: This was a cross-sectional survey on 324 participants from Chitungwiza Hospital. Data collection was through a designed questionnaire. Knowledge and perceptions were evaluated, and the associated risk factors were identified using the Logistic Regression Model.

Results: Results showed a 65% level of knowledge and 80% positive perceptions on NCDs. Participants <40 years of age were more knowledgeable (p=0.003) and history of NCD in the family influenced positively on knowledge (p=0.001). Females showed a more positive perception (p=0.043), both increasing age and low education negatively impacted the perceptions (p<0.001) as well as the knowledge (p=0.020).

Conclusion: Knowledge and perception were moderately high, but reduced with decreasing levels of education and increasing age. The study recommends educational campaigns to disseminate information about NCDs in PLHIV, targeting the least educated population groups and those older than 40 years of age.

Keywords: Non-Communicable Diseases (NCDs); HIV; Knowledge; Perceptions.

Overnutrition and its associated factors among adult human immunodeficiency virus positive patients on antiretroviral therapy, Northwest, Ethiopia

Yihenew Sewale — 2022-12-23

Background: Anti-retroviral therapy was introduced to treat human immunodeficiency virus patients; comorbidities affecting individuals with human immunodeficiency virus-positive have changed dramatically, with increasing the prevalence of overnutrition.
Overnutrition has increased from time to time in people living with the human immunodeficiency virus. However, there is scarce adequate documented evidence regarding nutrition on human immunodeficiency virus

Objective: The study aimed to assess the magnitude of over nutrition and its associated factors among human immunodeficiency virus receiving antiretroviral therapy

Methods: We used a cross-sectional study design to collect data from 422 participants from Debre Markos hospital. We used a systematic sampling technique to select the total number of participants. The outcomes of Data were entered, and coded using Epi-data version 4.1 and analysed using STATA Version 14.1. We performed a multivariable logistic regression model to identify determinants of over-nutrition at a p-value of less than 0.05.

Results: The magnitude of overnutrition was 19.7% (95%CI: 14.6-25.4). Age group > 45 years (AOR: 3.18:95%CI: 1.09, 9.22), being farmer (AOR: 0.068, 95%CI (0.007, 0.611), family size greater than or equal to 4 (AOR: 3.18:95%CI (1.09-9.22), viral load less than 1000 copies/ml (AOR: 4.45 95%CI (1.69-11.76), and use of prophylaxis therapy (AOR: 2.67:95%CI (1.138-6.291) were significantly associated with over nutrition.

Conclusions: In this study one-fifth of Human Immunodeficiency Virus/Acquired Immunodeficiency Virus patients had over nutrition. In this study, the magnitude of overnutrition is high associated with a viral load of fewer than 1000 copies/cell, age greater than 45, and having taken prophylaxis therapy. Therefore, education about lifestyle change, regular monitoring of weight, regular nutritional assessment, and intervention of the existed problems like doing regular exercise is highly recommended.

Keywords: Overnutrition; ART; HIV.

The evaluation of risk factors related to reduced bone mineral density in young people living with HIV

Özlem Aydın — 2022-12-23

Background: Low bone mineral density (BMD) is one of the comorbidities that develop in people living with HIV (PLWHIV).

Objective: This study was conducted to review the frequency and risk factors of reduced BMD according to age in HIV-infected patients in Turkey.

Material and Method: This retrospective cohort study included HIV-infected patients aged 18-50. Bone density was analysed using dual-energy X-ray absorptiometry (DXA) according to the Z-score in three different regions including the lumbar, total-hip and femoral-neck.

Results: The study included 224 PLWHIV with a mean age of 35.84-7.54, and 59.8% were ART naive. Of the patients, 40.6% had lower BMD than expected at least in one of the three examined regions including the lumbar, total hip and femoral neck. The low BMD ratios were found respectively as 11.6%, 11.6% and 28.6% in the femoral neck, total hip and lumbar regions. According to the logistic regression model, a high body mass index (p=0.003) and HIV-RNA level of ≥100.000IU/ml during the diagnosis in the ART-naive group (p=0.008) were associated with reduced bone demineralization. The low BMD frequency was high in the group that received ART for <24 months (p=0.001).

Conclusion: Performing bone demineralization screening in the naive and young patient group, independently from ART status prior to making the diagnosis of HIV is important for organizing the bone health improvement methods.

Keywords: HIV infection; bone density; antiretroviral therapy.

Seroprevalence and risk factors of Toxoplasmosis among HIV infected women of child-bearing age attending care and treatment clinics in Dar es Salaam, Tanzania

Upendo O Kibwana — 2022-12-23

Background: Toxoplasmosis in HIV-infected women of child-bearing age (HIV-WCB) increases the risk for congenital toxoplasmosis, leading to many complications. However, its magnitude is unknown in this population.

Objectives: The study aimed to determine the prevalence and factors associated with toxoplasmosis among HIV-WCB.

Methods: This was a cross-sectional study conducted from July to August 2020 among HIV- WCB attending care and treatment clinic (CTC) at Muhimbili National Hospital and Mnazi Mmoja hospital. Questionnaire and TORCH rapid test were used to obtain data and serological testing respectively. Data analysis was done using statistical package for social sciences (SPSS) version 20.

Results: Overall, 29.7% of the study participants were positive for anti-T. gondii IgG, whereas none tested positive for IgM. Multivariate analysis showed that the probability of being infected with T. gondii increased by 57.1% for participants who consumed raw vegetables (p=0.005, aOR=0.43, 95%CI = 1.24-8.77). Other common risk factors such as undercooked meat consumption, source of drinking water, and cat ownership at home showed no association.

Conclusion: A high number of HIV-WCB have not developed immunity to T. gondii in the study area. Introduction of routine screening during antenatal visits for pregnant women and further epidemiological studies are warranted in the country.

Keywords: T. gondii; HIV women.

Gender disparities in the socio-economic burden of HIV/AIDS among patients receiving care in an HIV clinic in Lagos, Nigeria

Titilope O Charles-Eromosele — 2022-12-23

Background: In sub-Saharan Africa, women are bearing a heavier burden than men in terms of rate of infection and socio-economic impact of HIV/AIDS. This study was aimed at assessing gender disparities in the socio-economic burden of HIV/AIDS.

Methods: This descriptive cross-sectional study was conducted among 422 HIV-positive adult patients attending an HIV clinic in Lagos, Nigeria, selected by multi-stage sampling and interviewed using a pretested, semi-structured questionnaire. Bivariate analysis was used to assess how the socioeconomic constructs differed by gender.

Results: This study revealed that females suffered more of the socio-economic consequences of having HIV/AIDS than males; cruelty and isolation were significantly higher among the females (p<0.0001), more females (50.0%) were discriminated against at the workplace compared to males (32.1%) (p=0.005), physical abuse (p=0.002) and extortion (p=0.029) were experienced by more of the females than the males. Also, the cost of care outside of antiretroviral therapy was significantly higher among the females (p= 0.002).

Conclusion: Quantifying the social and economic disparities between HIV-infected men and women has shown that the burden is by far higher among women than men. Focused interventions are therefore needed to control the spread of the disease and improve the quality of life of HIV-infected women.

Keywords: HIV/AIDS; gender disparities; women; Lagos; Nigeria.

Compliance and approach to voluntary HIV testing in a high-risk region for HIV transmission in Europe

Marija Milic — 2022-12-23

Background: The Kosovo province is being considered as a high-risk region for the spread of HIV.

Objective: To estimate the prevalence and factors associated with HIV testing in a sample of university students from the Serbian northern Kosovo province.

Material and Methods: A questionnaire examining socio-demographic characteristics, HIV–related knowledge, attitudes towards people living with HIV (PLHIV) and HIV testing was used in data collection. A total of 1,017 students from the University of Priština temporarily seated in Kosovska Mitrovica completed the questionnaire.

Results: Only 5.4% of students have previously been tested for HIV, even though the majority (70.9%) had a positive approach to HIV testing. Factors associated with having been tested for HIV were being male and younger, having interest in HIV testing and having previous contact with PLHIV. Being more knowledgeable about HIV and having stronger positive attitude towards PLHIV, being older, receiving information about HIV through friends and special educational programs, using condom at last sexual intercourse, having positive opinion on gays/lesbians and previous contact with PLHIV were associated with positive approach to HIV testing.

Conclusion: Having a positive approach to HIV testing does not suggest that students would take the HIV test. However, students who have low HIV-related knowledge, negative approach or lack of interest in HIV testing (believing that there is no need to take it) would likely never take the HIV test. Increasing HIV-related knowledge, acceptance of PLHIV and access to testing facilities should be public health priorities to raise HIV testing rates.

Keywords: HIV testing; attitude; knowledge; University students.

Diagnostic performance of chest CT findings of COVID-19 with RT-PCR negative

Soukaina Wakrim — 2022-12-23

COVID-19 presented with lung abnormalities on computed tomography (CT) scans in patient with false negative RT-PCR, which are helpful in diagnosis of this emerging global health emergency. It’s a case report the young woman of 35-year-old patient with 2019-nCoV pneumonia confirmed with IgM-IgG serology underwent thin-section Chest CT.
Our patient has the Chest CT with some lung abnormalities, the Ground-glass opacities, crazy paving pattern and smooth interlobular septal thickening. The clinical findings and with conspicuous ground grass opacity lesions in the peripheral and posterior lungs on CT are highly suspected of 2019-nCoV pneumonia.

Keywords: COVID-19; Tomography, Spiral Computed; COVID19 serological testing; COVID-19 diagnostic testing; Thorax.

The impact of systemic hypertension on outcomes in hospitalized COVID-19 patients – a systematic review

James Ayodele Ogunmodede — 2022-12-23

Background: Several observational reports from different parts of the world have shown that systemic hypertension (hypertension) was the single commonest comorbid condition in hospitalized COVID-19 patients. Hypertension is also the most prevalent comorbidity reported among patients who developed severe disease, were admitted to Intensive Care Unit, needed mechanical ventilatory support, or who died on admission. The objective of this systematic review is to study the association between hypertension and specific clinical outcomes of COVID-19 disease which are- development of severe COVID-19 disease, need for
admission in the intensive care unit (ICU) or critical care unit (CCU), need for mechanical ventilation or death

Methods: We searched the PubMed, SCOPUS, and Google Scholar databases up till June 28, 2020 for original research articles that documented the risk factors of mortality in patients with COVID-19 using the PRISMA guideline.

Results: One hundred and eighty-two articles were identified using pre-specified search criteria, of which 33 met the study inclusion criteria. Only three were prospective studies. Most studies documented hypertension as the most prevalent comorbidity. The association of hypertension with development of severe COVID-19 disease was not conclusive, majority of studies however found an associated with mortality.

Conclusion: Hypertension affects the clinical course and outcome of COVID-19 disease in many cohorts. Prospective studies are needed to further understand this relationship.

Keywords: Hypertension and COVID-19; SARS –Cov-2; severity; mortality; ICU care; mechanical ventilation.

Psychological impact of Covid-19 pandemic on dentists

Patil Bhagyashree Pramod — 2022-12-23

Background: The Covid-19 pandemic seems to have an incessant out-turn on the people in every field in some or the other way. It has been reported that maximum number of deaths in the countries during this pandemic are caused due to a term called death anxiety or phobia. There are certain parameters such as anxiety, apprehension, depression which if influence a person can alter one’s well-being.

Objective: The steadfast intent of this review article is to narrate the psychological impact of this pandemic on dentists. The eloquence and emergence of this topic will alarm all the medicos and paramedics to have a check on this scenario.

Methods: The article consists of detailed study from several articles from PubMed publications. Articles written only in English language were referred. Various keywords such as “Covid-19 pandemic” or “Psychological Impact” were used.

Results: The Covid-19 Pandemic has adversely affected all of us physically as well as psychologically. This article signifies the psychological impact of this pandemic on dentists.

Conclusion: The current studies that are carried out till date show an extensive impact on the psychology of the dental professionals. The following review article elaborates the importance of the same.

The association between different blood group systems and susceptibility to COVID-19: a single center cross-sectional study from Saudi Arabia

Nora Y Hakami — 2022-12-23

Background: Since the beginning of COVID-19 pandemic, many associated factors have been investigated to clarify the susceptibility and severity among the affected individuals. Biological markers can play an important role in identification of individual susceptibility to such pandemic. Growing evidence suggest the influence of different blood group systems on susceptibility to COVID-19 virus, with a particular blood type conferring selection advantage.

Objectives: The study aimed to determine the association of ABO, Rhesus (D) and P1 blood groups with COVID-19 susceptibility in Taif city, Western Saudi Arabia.

Methods: ABO, D and P1 blood antigens were determined in 104 blood samples of COVID-19 patients versus 100 control samples using either automated immunohematology analyser or test tube method. Statistical differences between patients and control samples were calculated based on p-value where results of ≤ 0.05 were considered significant.

Results: O+ve blood group constituted the predominant type among the studied samples. Determination of P1 antigen showed significant association where Anti-P1 was positive in 76.9% of patients compared to 61.0% of controls with a P value of 0.01 conferring the susceptibility of P1+ve patients to COVID-19.

Conclusion: Although our study showed no significant association between ABO and D, and susceptibility to COVID-19, there was a significant association between P1+ve and COVID-19. P1+ve participants were 2.131 times more associated with the risk of COVID-19 infection than those with Anti P1-ve. Thus, P1 antigen can be used as a biological marker for identification of individuals susceptibility to COVID-19. It is strongly advised that such individuals should consider extra protective measures.
Further studies on other contributing factors should also be considered for more scientific clarity.

Keywords: ABO Blood group; Rh(D); P1 antigen, COVID-19.

Short-term forecasting of confirmed daily COVID-19 cases in the Southern African Development Community region

Claris Shoko — 2022-12-23

Background: The coronavirus pandemic has resulted in complex challenges worldwide, and the Southern African Development Community (SADC) region has not been spared. The region has become the epicentre for coronavirus in the African continent. Combining forecasting techniques can help capture other attributes of the series, thus providing crucial information to address the problem.

Objective: To formulate an effective model that timely predicts the spread of COVID-19 in the SADC region.

Methods: Using the Quantile regression approaches; linear quantile regression averaging (LQRA), monotone composite quantile regression neural network (MCQRNN), partial additive quantile regression averaging (PAQRA), among others, we combine point forecasts from four candidate models namely, the ARIMA (p, d, q) model, TBATS, Generalized additive model (GAM) and a Gradient Boosting machine (GBM).

Results: Among the single forecast models, the GAM provides the best model for predicting the spread of COVID-19 in the SADC region. However, it did not perform well in some periods. Combined forecasts models performed significantly better with the MCQRNN being the best (Theil’s U statistic=0.000000278).

Conclusion: The findings present an insightful approach in monitoring the spread of COVID-19 in the SADC region. The spread of COVID-19 can best be predicted using combined forecasts models, particularly the MCQRNN approach.

Keywords: Combined Forecasts; LQRA; PLAQR; OPERA; Quantile Regression Neural Networks; COVID-19.

The impact of the COVID-19 pandemic on the Mediterranean region over 18 months: bridging the health outcomes and sustainable development goals

Sarah Cuschieri — 2022-12-24

Abstract

Background: The COVID-19 pandemic spread across the globe, including across the Mediterranean basin. This region presents diversity in economy, culture, and societal affairs. We attempted to evaluate the impact of COVID-19 on the population and on the Sustainable Development Goals (SDGs), our aim being to aid in the development of COVID-19 national plans.

Methods: Epidemiological data was obtained from ‘Our World in Data’ databases (January 2020 – July 2021). Case, mortality, and vaccination incidence comparisons were made across neighbouring countries. The SDG index, universal health coverage (UHC) and health workforce targets were collected for each country. Correlations between SDG targets and COVID-19 outcomes were analysed.

Results: Similarities in morbidity and mortality outcomes were present across neighbouring countries, with a bidirectional relationship between cumulative fully vaccinated population and infectivity fatality rates. Positive relationships were present between SDG indexes, UHC and health workforces and COVID-19 cases, deaths, and vaccinations.

Conclusion: At prima face, high-income countries seem to have sustained worse morbidity and mortality outcomes, despite having had better UHC and a greater health workforce in the pre-COVID-19 era however, one must also consider that factors such as health-seeking behaviour and underdiagnosis may have influenced this. Cross-border infectivity was, however, evident. Pan-Mediterranean action must therefore be taken to ensure COVID-19 transmissibility and mortality are reduced across borders, while ensuring an equitable health outcome across populations.

Keywords: COVID-19; Mediterranean; Morbidity; Mortality; Vaccination; Sustainable Development Goals; Outcome Assessment.

Medication counselling practices amid COVID -19 pandemic and associated factors in drug retail outlets of Jimma town, Southwest Ethiopia: cross-sectional study

Bekele Boche — 2022-12-24

Background: Patients’ good understanding and awareness of drug information received at the drug retail outlet is paramount to gaining expected outcomes. In the COVID-19 pandemic, the routine counselling practice faced multifactorial challenges.
Objectives: The study aimed to assess medication counseling practice and associated factors in drug retail outlets of Jimma town, southwest Ethiopia.
Methods: A facility-based cross-sectional study was conducted using an interviewer administered questionnaire. The data were analysed by using SPSS version 23. A multivariable logistic regression model was used to identify factors associated with medication
counselling practice.
Results: A total of 180 pharmacy professionals were enrolled in the study, about half (51.1%) of the participants reported good medication counselling provision for their patients. In A multivariable logistic regression analysis, reduced pharmacist’s level of communication (AOR=0.008; CI: 0.001-0.292; p= 0.009) and shortage of personal protective equipment (AOR=0.021; CI: 0.002-0.226; p=0.002) due Covid-19 were factors associated with poor medication counselling practice.

Conclusion: Reduced level of communication and shortage of personal protective equipment due to Covid-19 were factors associated with poor medication counselling practice. In general, Jimma town health offices and Oromia Region Health bureau should struggle in association with other stakeholders to improve the identified bottleneck of pharmacist’s counselling practice.

Keywords: Counseling practice; COVID -19; drug retail outlet; Jimma.

Bacteriological profile of wound infections and antimicrobial resistance in selected gram-negative bacteria

Altaf Bandy — 2022-12-25

Background: Managing wound infections is a challenging task. Understanding their resistance pattern is an essential step at reducing its burden in hospital settings.

Objective: To determine the bacteriological diversity of wound infections and the antimicrobial resistance exhibited by a selected Gram-negative bacterium in the Aljouf region of Saudi Arabia.

Methods: The study retrospectively analysed the antibiograms of wound infections from hospitalized patients for the year 2019. The European Centre for Disease Control guidelines were adopted for the classification of resistant bacteria. Multidrug-, extensive drug-, and carbapenem-resistant isolates are presented as frequencies and percentages.

Results: A total of 295 non-duplicate wound swab antibiograms were retrieved, 64.4% (190) and 35.6% (105) isolates were Gram-negative and Gram-positive bacterial infections respectively. Predominant pathogens included Staphylococcus species 21.0% (62), E. coli 16.3% (48) and K. pneumoniae 13.5% (40). 148 (77.9%), 42 (22.1%) and 43 (22.6%) of the Gram-negative isolates were multidrug-, extensively drug- and carbapenem-resistant. The antibiotic resistance exhibited by gram-negative bacteria was 43.4% (234/539), 59.1% (224/379) and 53.7% (101/188) towards carbapenems, 3rd - and 4th – generation cephalosporins.

Conclusions: The majority of wound infections are caused by multidrug-, extensively drug- and carbapenem-resistant Gram-negative bacteria. Further studies should focus on the molecular basis of this resistance.

Keywords: Wound infections; hospital; Gram-negative bacteria; antibiograms; multidrug-resistance; E. coli.

Knowledge and its factors associated towards the prevention of COVID-19 among pregnant women in Ethiopia

Muche Argaw Eniyew — 2022-12-25

Background: COVID-19 is caused by a single-stranded novel coronavirus that severely affects the respiratory system. The first human COVID-19 was reported in Wuhan city, China, in December 2019. Closing the gap and enhancing knowledge of pregnant women on COVID-19 prevention methods is crucial. However, the studies conducted in Ethiopia were inconsistent and non-conclusive. So, this review aimed to estimate the pooled knowledge prevalence on prevention of COVID 19 and factors associated among pregnant women in Ethiopia.

Methods: The data were extracted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We accessed studies through electronic web-based search from PubMed, Cochrane Library, and Google Scholar. We did all statistical analyses using STATA version 14 software with a random-effects model.

Results: Seven studies with 2,594 participants were included in this systematic review and the overall estimated status of assessment of knowledge towards prevention of COVID-19 among pregnant women in Ethiopia was 52.27% (31.60, 68.94). According to the region subgroup analysis, the highest ad the lowest estimated status of the knowledge is 85.34% in Jimma town and 19.01 in Metu town respectively in the Oromia region.

Conclusion: This systemic review showed that only half of the pregnant women in Ethiopia had good knowledge about COVID-19, and urban residence was significantly associated with knowledge towards the prevention of COVID-19 among pregnant women in this review. So, the responsible body better strengthen their awareness creation among rural residents and old-age pregnant women.

Keywords: COVID-19; pregnant women; knowledge; prevention.

Evaluation of potential drug-drug interactions and polypharmacy in hospitalized COVID-19 patients

Türkan Paşalı Kilit — 2022-12-25

Background: Drugs that are used in COVID-19 infection, may interact with each other, as well as with the drugs for comorbidities, used concomitantly with COVID-19 treatment.

Objectives: It is quite important to calculate and present the patients’ exposure to clinically important potential drug-drug interactions (pDDIs). We aimed to investigate the pDDIs and the burden of polypharmacy in COVID-19.

Methods: The medical records of 126 consecutive inpatients with COVID-19 treatment were retrospectively analyzed. The Lexi-interact database was used to investigate pDDIs.

Results: According to the Lexi-interact database, 605 pDDIs were detected. Of these pDDIs, 23 (3.8%) were A risk category interaction, 186 (30.7%) were B risk category interaction, 339 (56%) were C risk category interaction, 54 (8.9%) were D risk category interaction, and 3 (0.5%) were X risk category interaction. Sixty-five-point five percent of pDDIs (n=396) were clinically important pDDIs (C, D, and X categories), and 69 patients (54.8%) had at least one clinically important pDDIs. The most interacting drug was hydroxychloroquine (n=171, 28.3%). Hydroxychloroquine was also the most interacting drug in the C risk category (n=101, 29.8%) and had 19 pDDIs with metformin, 16 pDDIs with beta-blockers, 13 pDDIs with acetylsalicylic acid, and 10 pDDIs with insulin in the C risk category. Enoxaparin was the most interacting drug (n=25, 46.3%) in the D risk category and most of them were with acetylsalicylic acid (n=12). The most common possible clinical manifestations of pDDIs were QT prolongation, hypoglycemia, and hemorrhage. One hundred and eighteen patients (93.6%) used five or more drugs daily. There was a significant positive correlation between the number of drugs prescribed to patients and the number of clinically important pDDIs (r=0.80, p<0.001).

Conclusions: Clinically important pDDIs are common among COVID-19 patients and the majority of pDDIs require monitoring of therapy. COVID-19 patients should be closely observed for QT prolongation, hypoglycemia, and hemorrhage due to pDDIs during treatment.

Keywords: COVID-19; drug interactions; polypharmacy.

High burden of pulmonary tuberculosis and missed opportunity to initiate treatment among children in Kampala, Uganda

Samuel Kizito — 2022-12-27

Background: There is uncertainty about the actual burden of childhood TB in Uganda, but underestimation is acknowledged. We aimed at determining prevalence, factors associated with PTB among children attending PHC facilities in Kampala.

Methods: This was a cross-sectional study of 255 children, with presumed TB, attending six health facilities in Kampala, Uganda, in March 2015. Socio-demographic, clinical, and laboratory data were collected using a questionnaire. TB was diagnosed using “Desk Guide” algorithms. Sputum based on ZN/FM and/or Gene-Xpert. Logistic regression was used to assess associations with outcomes.

Results: Overall, prevalence of PTB 13.7 % (2.6 – 24.8). Among HIV-positive, the prevalence of PTB was 41.7%, while among malnourished children, 21.7% and contacts, 89.3%. The factors that influenced PTB included: tobacco smoker at home (OR =1.6, 95 % CI: 1.07 – 6.86), stunting (OR = 2.2, 95 % CI: 1.01 – 4.15). Only 5.3% of the smear-negative TB children and 81.3% of the smear-positive children were initiated on treatment within a month of diagnosis.

Conclusion: Clinical TB among children is underdiagnosed and undertreated. There is a need for more sensitive and specific diagnostic tests, need ways to disseminate and promote uptake of standardized clinical algorithms. Also, contact TB tracing should be strengthened so that such cases can be actively detected even at community level.

Keywords: Pediatric; pulmonary; tuberculosis.

The occurrence of antibiotic-resistant enteric bacteria in Selected Nigerian traditional dairy products

Roseline E Uzeh — 2022-12-27

Background: Wara and nono are popular dairy products in Nigeria, rich in nutrients, highly exposed to microbial contaminants during processing and sale and support microbial growth.

Objectives: To investigate occurrence and antibiotic resistance pattern of enteric bacterial pathogens in dairy products.

Methods: Dairy products were serially diluted and cultured on Eosin Methylene Blue agar, Salmonella-Shigella agar, McConkey agar and nutrient agar at 37°C for 24 h. Characterisation and identification of isolates with API 20E kit (Biomereux, France). Antibiotic susceptibility was with agar disc diffusion. Polyvalent O and H antisera for Salmonella serotyping.

Results: Salmonella enterica serovar Enteritidis, Salmonella enterica serovar Typhimurium, Salmonella enterica serovar Typhi, Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter aerogenes, Enterobacter cloacae and Serratia marcescens, were identified. Dominant enteric bacterium detected was E. coli followed by Salmonella spp. Serratia marcescens was the least occurring. The isolates were most resistant to trimethoprim-sulfamethoxazole (96.7%), amoxicillin (83.3%), augmentin (83.3%), chloramphenicol (66.7%), streptomycin (50%). They were resistant to ≥ 4 (multiple) antibiotics, E. coli 8, Salmonella spp. 7, Serratia marcescens 6 and Klebsiella spp. and Enterobacter spp. 4 each.

Conclusion: The presence of enteric bacterial pathogens in wara and nono and their resistance to multiple antibiotics was reported in this study.

Keywords: Nono; wara; antibiotic resistance; enteric bacteria.

A world free of malaria: It is time for Africa to actively champion and take leadership of elimination and eradication strategies

Chinedu Ogbonnia Egwu — 2022-12-25

The global burden of malaria seems unabated. Africa carries the greatest burden accounting for over 95% of the annual cases of malaria. For the vision of a world free of malaria by Global Technical Strategy to be achieved, Africa must take up the stakeholder’s role. It is therefore imperative that Africa rises up to the challenge of malaria and champion the fight against it. The fight against malaria may just be a futile or mere academic venture if Africans are not directly and fully involved. This work reviews the roles playable by Africans in order to curb the malaria in Africa and the world at large.

Accidents exposing blood to the staff of a hospital and university establishment in Algeria: Assessment and risk factors

Dalia Kheira Derkaoui — 2022-12-25

Background: Accidents exposing to blood AEB represent real public health problem in healthcare establishments. The objective of our study was to estimate the frequency of AEB As at our establishment as well as the risk factors that determine their occurrence.

Patients and Methods: A cross-sectional descriptive survey was conducted at a hospital university establishment over period from October 16 to December 3, 2018. The survey concerned accident exposing blood to the staff of our establishment. Data entry and analysis was carried out using Epi-Info software.

Results: A clear predominance of women was noted (79.2%) among the study population with a Sex ratio equal to 0.26. The average age was 27.7 ± 6.2 years.
The frequency of exposure to AEB among hospital staff was 48.5%. Needlestick injuries were the most common accident (88.3%), followed by splashing blood or body fluids (51.7%), and cutting with a sharp object (10.0%). Among the risk factors significantly associated with the occurrence of AEB, we can cite the medical profession (OR = 3.94; p<0.001), the surgical specialty (OR = 3.3; p <0.01), the male sex (OR = 3.7; p <0.01). Likewise, risk of AEB increased significantly with age (p <0.01) and professional seniority (p <0.02).

Keywords: Accidents exposing blood; hospital staff; Algeria.

Chemical and microbiological assessment of drinking water quality

Pınar Mursaloğlu Kaynar — 2022-12-25

Background: Access to an adequate amount of water is restricted because of the increase in the use of natural resources, which is caused by the rapid growing in world population and the climate change that global warming brings, and the development in the industry. Investigating the causes of water pollution, creating solutions for the problem, taking the control of the pollution, and maintaining monitorability are necessary.
Objectives: This study was carried out in order to determine microbiological and chemical characteristics of drinking water and their compatibility for human consumption with the aim of providing safety of drinking waters.
Methods: Thirty-four drinking water samples obtained from different sampling points in Ankara, Turkey, in 2019 were subjected to microbiological analysis and chemical analysis in terms of anions (bromide-Br-, chloride-Cl-, fluoride-F-, nitrate-NO3-, nitrite-NO2-, sulfate-SO4-2) by ion chromatography. Microbiological analyses were applied according to the international standards.
Results: None of the samples contained coliform bacteria, Escherichia coli and intestinal enterococci. It was established that concentrations of the specified anions in tested waters were within the acceptable levels of with the Council Directive 98/83/EC.
Conclusions: The determined chemical and microbiological qualities of these samples are suitable for drinking, and do not pose
any threats to public health.
Keywords: Drinking water; analysis; chemical; microbiological; quality.

Prevalence and risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, Eastern Ethiopia; Robust Poisson Regression Analysis

Ephrem Tefera Solomon — 2022-12-25

Background: Diarrhea is the second leading cause of under-five mortality in Ethiopia. Information on the prevalence and the impacting factors of diarrhea in the rural suburbs of Dire Dawa is inadequate.
Objective: This study was aimed at determining risk factors of diarrhea among children less than five years of age in the rural suburbs of Dire Dawa, eastern Ethiopia.
Methods: A cross-sectional study was conducted from 02 May 2018, to 31 May 2018. The required 1146 children for this study were selected from the rural suburbs of Dire Dawa using multi-stage sampling. Both bi-variable and multivariable Robust Poisson regressions were used for identifying the risk factors. Explanatory variables with a p-value < 0.05 were considered as independently associated with diarrhea.
Results: The prevalence of diarrhea among the children was 23% (95% CI: 20.7 - 25.4). The type of house floor (aPR [adjusted prevalence ratio] = 0.89, 95% CI: 0.84 - 0.95) and sharing latrine with neighbours (aPR = 1.18, 95% CI: 1.09 - 1.26) were the significant factors associated with childhood diarrhea.
Conclusion: Earthen house floor and shared use of latrine were the risk factors associated with childhood diarrhea. Hence, improving the house floor condition and construction of private latrine together with health education are recommended.
Keywords: Prevalence; diarrhea; rural Dire Dawa; Robust Poisson Regression.

Incidence of first attempt peripheral intravenous cannulation failure and its predictors among children admitted to Debre Tabor Referral Hospital, Northwest Ethiopia: institution based cross-sectional clinical study

Tigabu Munye Aytenew — 2022-12-25

Background: When the first piercing is failed to function, repeated puncturing imposes pain, complications, and delays the timeliness of pediatric care. In spite of the above challenges, incidence and predictors of first attempt peripheral intravenous cannulation failure are under-investigated in the study area and the nation at large.
Objective: This study aimed to determine the incidence of first attempt peripheral intravenous cannulation failure and its predictors among children.
Methods: Institution-based cross-sectional study design was conducted, and a total of 422 children were included in the study.
The study participants were selected using a simple random sampling technique. The data were collected by direct observation and interviewer-administered questionnaire. Stata version 14 was used for analysis, and finally, the association was declared using AOR at a 95% confidence level at p≤0.05.
Results: The incidence of first attempt peripheral intravenous cannulation failure rate was found to be 34.83% (132). Besides, self-payment funding, vein visibility with a tourniquet, forearm site, vein scope use, and child age of 24-59 months old were significantly associated with first attempt peripheral intravenous cannulation failure.
Conclusion: Generally, self-payment funding, vein visibility with a tourniquet, forearm site, vein scope use, and child age of 24-59 months old were independent predictors of first attempt peripheral intravenous cannulation failure.

Keywords: Peripheral IV cannulation; predictors; cross-sectional study

Predictors and factors associated with stunting among under- five-year children: a cross-sectional population-based study in Rwanda of the 2014-2015 demographic and Health Survey

Joselyne Rugema — 2022-12-25

Background: Globally, stunting affects 159 million Under-five-years-old (U-5) children. Stunting affects the physical, mental, and cognitive development of children increasing the risk of suffering and death. This paper aimed to determine the predictors and factors associated with stunting among under-five children in Rwanda.
Methods: We retrieved data from the Rwanda Demographic and Health Survey (RDHS) 2014-2015 data set. A sample of 3599 U-5 eligible children with complete and valid anthropometric data was taken. Stata software was used to analyze the data extracted using a developed checklist. Descriptive statistics and Logistic regression analysis were performed to test the association between study variables.
Results: Of 3599 U-5 children, 37.5% of children were stunted. The demographic characteristics: age (p< 0.001), sex (p<0.001), and place of residence (p< 0.001) and Household wealth index (p <0.001) were associated with stunting. Age, sex, and household wealth index were predictors of stunting.
Conclusion: Stunting is still a burden in Rwanda. Age and sex were predictors of stunting among children under 5 years of age.
Household wealth index was a predictor and significantly associated with stunting among children U-5 years in Rwanda. Investing in the interventions that target maternal and nutrition health support is imperative.
Keywords: Predictors; Stunting; children; under five years; Rwanda.

The effectiveness of locally-prepared peritoneal dialysate in the management of children with acute kidney injury in a south-east Nigerian tertiary hospital

Ngozi R Mbanefo — 2022-12-25

Background: Peritoneal dialysis (PD) is the preferred mode of renal replacement therapy (RRT) in children with acute kidney injury (AKI). The gold standard remains the use of commercially-prepared PD fluid. In resource-poor nations, its availability and affordability remain a challenge.
Aim: This study aims to report the effectiveness of locally-prepared PD fluid in the management of AKI in a south-east Nigerian tertiary hospital.
Subjects and Methods: This was a retrospective study conducted at the paediatric ward of the University of Nigeria Teaching hospital, Enugu. The case records of 36 children seen over three years, diagnosed with AKI and requiring PD were reviewed. The retrieved information comprised biodata, aetiology of AKI, indications for PD, pre-and post-dialysis estimated glomerular filtration rate (eGFR) and patient outcomes.
Results: The children (20 males and 16 females) were aged 3 to 36 months with a mean age of 9.92 ± 6.29 months. The common aetiologies of AKI were septicemia (30.6%), hemolytic uremic syndrome (19.4%), and toxic nephropathy (16.7%). The frequent indications for PD were uremic encephalopathy (58.3%) and severe metabolic acidosis (38.8%). The pre-and post-dialysis mean urine flow rate was 0.16 + 0.13 and 2.77 + 0.56 ml/kg/hour respectively. The eGFR before PD, at discontinuation, and a week later was 6.06 + 2.87, 24.44 + 15.71 and 59.07 + 22.22 mls/min/1.73m2 respectively.
Conclusion: PD with locally-prepared dialysate is safe, effective and a life-saving alternative in the management of AKI in children
Keywords: Peritoneal dialysis; renal replacement therapy; acute kidney injury; children; dialysate; developing country.

Indications for late preterm birth, and factors associated with short term maternal and neonatal outcomes at a tertiary care institution

Deeshah M Deelchand — 2022-12-25

Background: The preterm birth rate is rising mainly because of the marked increase in late preterm deliveries.
Objectives: To evaluate the indications for LPTB and the factors associated with the short term maternal and neonatal outcomes.
Methods: This retrospective study was conducted at a tertiary health care institution. The study sample included 191 women who delivered between October 2019 to November 2020.
Results: The majority (81%) were medically indicated LPTB, and mainly for maternal indications (77%). The most common maternal indication for LPTB was for hypertensive disease of pregnancy (HDP) (82.5%). There was a significant increase in the high care/ ICU admission for maternal indication of LPTB, maternal age < 20 years, and patients with HDP. There was 1 maternal death and 1 neonatal death. 48% of the neonates were admitted to NICU and 53% had neonatal complications. Neonates born by caesarean delivery were more likely to have respiratory complications and be admitted to NICU.
Conclusion: These maternal/ neonatal factors should be used to identify patients at risk of adverse maternal and neonatal
outcomes.
Keywords: Late preterm birth; indications; hypertensive disorder of pregnancy; short term maternal outcomes; short term neonatal outcomes; factors.

Traditional medicine trade and uses in the surveyed medicine markets of Western Kenya

Willy Kibet Chebii — 2022-12-25

Background: There exist vast traditional medicine and herbal remedies prescribed for diseases and socio-cultural ills that are sold in local medicine markets.
Objectives: To assess the common traditional medicine traded in the local medicine markets and used for treating common diseases.
Methods: The study was carried out in nine purposively selected medicine markets spread out in seven administrative counties of Western Kenya. Purposive sampling with elements of snow ball method was employed in the identification of willing respondents.
In addition, face to face interviews were conducted with the aid of a pre-tested semi-structured questionnaire that sought to extract a targeted and expertise information from the respondents.
Results: The survey recorded 45 commonly traded plant families composed of 78 genera and 87 medicinal plant species. Meliaceae, Apocynaceae and Fabaceae were leading plant families whereas Trichilia emetica, Azadirachta indica, Dregea schimperi and Aloe spp. were commonly traded.
Conclusion: Traditional medicine traded in the local medicine markets continue to play a significant role in the treatment of common diseases. Frequently traded medicinal plant species should be prioritized for conservation.
Keywords: Traditional Medicine; Common disease treated; Medicine markets.

Predictors of alcohol consumption among adolescents and young adults in Lusaka, Zambia

Kasoka Mungandi — 2022-12-25

Background: Alcohol consumption among young people in schools and communities presents a major problem of public health concern. We determined the predictors of alcohol consumption among adolescents and young adults in Lusaka, Zambia.
Methods: A cross-sectional study design was adopted. A total of 196 participants took part in the quantitative study. For the qualitative part, there were 13 participants. The study used multistage and purposive sampling methods. A semi-structured questionnaire and in-depth interviews were used. Quantitative data were analysed using STATA version 14. Ordered logistic regression analysis was used to assess the actual predictors, with confidence interval set at 95% and p-value at 0.05. Qualitative data were analysed thematically.
Results: The older age category (20-24) had a greater prevalence of alcohol consumption (63.3%) than the younger age category (36.7%). Age, being employed, unconducive learning environment, limited recreation and sports activities, and adult alcohol drinking culture decreased the odds of consuming alcohol. Limited parental care support increased the odds of alcohol consumption [AOR= 4.21; 95% CI: 1.32-13.45, p=0.015]. Futile alcohol regulatory measures were cited to be contributing to alcohol consumption.
Conclusion: Alcohol consumption was highly prevalent among young adults aged 20-24 years. There is need for continuous sensitization on substance abuse and its adverse effects in schools and communities at large. The strengthening, reviewing and amendment of the alcohol regulatory measures and policies should be considered.
Keywords: Alcohol; adolescents; young adults; predictors; Zambia.

Disruptive behaviours involving radiographers that impede a safe work environment. Survey at central hospitals in Harare Metropolitan Province, Zimbabwe

Bornface Chinene — 2022-12-25

Background: Understanding disruptive behaviours from the perspective of radiographers is important, as this professional group uses hazardous radiation in the execution of their duties, making patient safety of utmost concern.
Objective: Determine the disruptive behaviours involving radiographers at central hospitals in Harare Metropolitan Province, Zimbabwe.
Methods: A descriptive cross-sectional quantitative study was carried out at central hospitals in Harare Metropolitan Province, Zimbabwe, where 100 radiographers were randomly selected.
Results: Overall, 83% of radiographers had been exposed to an incident of DB in the preceding 12 months. Reported types of disruptive behaviour included: Verbal abuse (81%), sexual abuse (21%) and physical abuse (4%). Of the 21 radiographers that suffered sexual abuse, the majority 71 % (n=15) were female while 29% (n=6) were males. Prevalence odds ratio revealed that female radiographers were 1.8 times more likely than their male counterparts to be victims of the workplace sexual abuse (95% C.I.: 0 – 3.04). A significant 69% were abused by patients and their families/escorts, p=.001.
Conclusion: More than 8 out of 10 radiographers in this study were exposed to disruptive behaviours, mostly from the patients and patient’s family or escorts. A framework to increases awareness and address these behaviours is recommended.
Keywords: Disruptive behaviour; radiographers; Zimbabwe.