RESUMO
BACKGROUND: Lassa fever virus has been enlisted as a priority pathogen of epidemic potential by the World Health organization Research and Development (WHO R & D) Blueprint. Diagnostics play a crucial role in epidemic preparedness. This systematic review was conducted to determine the sensitivity and specificity of Lassa fever diagnostic tests for humans. METHODS: We searched OVID Medline, OVID Embase, Scopus and Web of Science for laboratory based and field studies that reported the performance of diagnostic tests for Lassa fever in humans from 1 January 1990 to 25 January 2019. Two reviewers independently screened all the studies and included only studies that involved the evaluation of a Lassa fever diagnostic test and provided data on the sensitivity and specificity. The quality of the studies was assessed using the QUADAS-2 criteria. Data on the study location, study design, type of sample, index test, reference tests and diagnostic performance were extracted from the studies. RESULTS: Out of a total of 1947 records identified, 1245 non-duplicate citations were obtained. Twenty-six (26) full-text articles examined which identified 08 studies meeting pre-defined criteria. Only one study was a field evaluation study. The sensitivity and specificity of the point of care (RDT) against the Nikisins qPCR were 91.2%(95% CI:75.2-97.7) and 86%(95% CI: 71.4-94.2) at temperatures 18-30 °C, while the sensitivity and specificity of the single IgM ELISA assay against standard RT-PCR were 31.1%(95%CI: 25.6-37) and 95.7%(95%CI:92.8-97.7). The sensitivity of the combined ELISA Antigen/IgM assay(against virus isolation), the recombinant IgM/IgG ELISA(against standard RT-PCR), and the IgM/IgG immunoblot(against IFA) were 88%(95%CI:77-95), 25.9%(95%CI:20.8-31.6), and 90.7%(95%CI:84.13-97.27) respectively. The specificity of the combined ELISA Antigen/IgM assay(against virus isolation), the recombinant IgM/IgG ELISA(against standard RT-PCR), and the IgM/IgG immunoblot(against IFA) were 90%(95%CI:88-91), 100%(95%CI:98.2-100), and 96.3%(95%CI:92.2-100) respectively. CONCLUSION: Lassa fever has assays for antigenaemia, IgM, IgG and PCR detection. The RDT reportedly performed well but more data are needed from other countries and at temperatures above 30 °C. Most combined immunoassays perform better than the single IgM. Multiplex and pan-Lassa assays are needed. More well conducted field studies are needed. TRIAL REGISTRATION: Prospero registration number: CRD42018091585 .
Assuntos
Testes Diagnósticos de Rotina/métodos , Febre Lassa/diagnóstico , Ensaio de Imunoadsorção Enzimática , Humanos , Immunoblotting , Vírus Lassa/genética , Vírus Lassa/patogenicidade , Sistemas Automatizados de Assistência Junto ao Leito , Reação em Cadeia da Polimerase , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Diabetes mellitus is a growing cause of disease burden globally. Its management is multifaceted, and adherence to pharmacotherapy is known to play a significant role in glycaemic control. Data on medication adherence among affected patients is unknown in Cameroon. In this study, the level of adherence and factors influencing non-adherence to antidiabetic medication among patients with type-2 diabetes was assessed. METHODS: A hospital-based cross-sectional study among adult patients receiving care in the diabetic clinics of the Limbe and Bamenda Regional Hospitals in Cameroon was conducted. Medication adherence was assessed using the Medication Compliance Questionnaire (MCQ). Factors associated with non-adherence to medication were determined using basic and adjusted multivariable logistic regression models. RESULTS: A total of 195 patients with type 2 diabetes were recruited. The prevalence of non-adherence to medication was 54.4% [95% confidence interval (CI): 47.1-61.5%]. In multivariable analysis, age > 60 years (aO.R. = 0.48, 95% CI: 0.25-0.94), alcohol consumption (aO.R. = 2.13, 95% CI: 1.10-4.14) and insulin alone therapy (aO.R. = 2.85, 95% CI: 1.01-8.08) were associated with non-adherence. Patients attributed their non-adherence to forgetfulness (55.6%), lack of finances (38.2%) and disappearance of symptoms (14.2%). CONCLUSIONS: Adherence to anti-diabetic medication is poor in this study with more than half of participants being non-adherent. Urgent interventions are required to tackle this problem in combined efforts to stem this looming diabetes epidemic.
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Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/psicologia , Adesão à Medicação/estatística & dados numéricos , Biomarcadores/análise , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Inquéritos e QuestionáriosRESUMO
Objective The level of male partner involvement in hospital delivery by pregnant women living with HIV in sub Saharan Africa (SSA) is low. We conducted a systematic review and meta-analysis to identify the approaches that are used in improving male partner involvement and their impact on the utilization of hospital delivery services by pregnant women living with HIV in SSA. Methods Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies carried out in SSA that reported an approach used in involving male partners and the impact on the uptake of hospital delivery services irrespective of the language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. A forest plot was used to show the impact of various male involvement approaches. A funnel plot was used to report publication bias. Results From an initial 2316 non-duplicate articles, 08 articles were included in the systematic review and meta-analysis. The overall pooled OR was 1.56 (95% CI 1.45-1.68). After stratification, the odds ratios were: 1.51 (95% CI 1.38-1.65), 1.58 (95% CI 1.38-1.80), 3.47 (95% CI 2.16-5.58) for complex community interventions without community health workers (CHWs), complex community interventions with community health workers, and verbal encouragement respectively. The overall I-square was 91.0% but after stratification into the three different approaches, the I-squared within the complex community intervention without CHWs group was 0.0%. Conclusions for Practice Complex community interventions and verbal encouragement increase the utilization of hospital delivery services by pregnant women living with HIV in SSA. The overall heterogeneity was high but very low for studies that used complex community interventions without CHWs. More well conducted studies (including randomized controlled trials) are needed in future to add to the quality of evidence.
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Parto Obstétrico , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais/psicologia , África Subsaariana , Agentes Comunitários de Saúde , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Gravidez , Apoio SocialRESUMO
BACKGROUND: Cardiovascular disease (CVD) is the leading cause of deaths globally, with greatest premature mortality in the low- and middle-income countries (LMIC). Many of these countries, especially in sub-Saharan Africa, have significant budget constraints. The need for current evidence on which interventions offer good value for money to stem this CVD epidemic motivates this study. METHODS: In this systematic review, we included studies reporting full economic evaluations of individual and population-based interventions (pharmacologic and non-pharmacologic), for primary and secondary prevention of CVD among adults in LMIC. Several medical (PubMed, EMBASE, SCOPUS, Web of Science) and economic (EconLit, NHS EED) databases and grey literature were searched. Screening of studies and data extraction was done independently by two reviewers. Drummond's checklist and the National Institute for Health and Care Excellence quality rating scale were used in the quality appraisal for all studies used to inform this evidence synthesis. RESULTS: From a pool of 4059 records, 94 full texts were read and 50 studies, which met our inclusion criteria, were retained for our narrative synthesis. Most of the studies were from middle-income countries and predominantly of high quality. The majority were modelled evaluations, and there was significant heterogeneity in methods. Primary prevention studies dominated secondary prevention. Most of the economic evaluations were performed for pharmacological interventions focusing on blood pressure, cholesterol lowering and antiplatelet aggregants. The greatest majority were cost-effective. Compared to individual-based interventions, population-based interventions were few and mostly targeted reduction in sodium intake and tobacco control strategies. These were very cost-effective with many being cost-saving. CONCLUSIONS: This evidence synthesis provides a contemporary update on interventions that offer good value for money in LMICs. Population-based interventions especially those targeting reduction in salt intake and tobacco control are very cost-effective in LMICs with potential to generate economic gains that can be reinvested to improve health and/or other sectors. While this evidence is relevant for policy across these regions, decision makers should additionally take into account other multi-sectoral perspectives, including considerations in budget impact, fairness, affordability and implementation while setting priorities for resource allocation.
RESUMO
BACKGROUND: Infant antiretroviral prophylaxis plays an important role towards ensuring the reduction of HIV transmission from mother to child in the postpartum period. However in sub Saharan Africa (SSA), the low level of involvement of male partners may hinder the uptake of such services by HIV positive mothers. We conducted a systematic review and meta-analysis to determine the impact of male partner involvement approaches on the uptake of infant antiretroviral prophylaxis in SSA. METHODS: In this systematic review and meta-analysis, Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched from 1st December 2015 up until 30th March 2016. Only studies carried out in SSA that reported an approach used in involving male partners and the impact on the uptake of infant antiretroviral prophylaxis irrespective of the Language and date of publication were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. Forest plots were generated using the random effect model. RESULTS: From an initial 2316 non-duplicate articles, 09 articles were included in the systematic review and meta-analysis. The pooled unadjusted odds ratio was 2.09(95% CI: 1.31 to 3.36) while the unadjusted odds ratios for enhanced psychosocial interventions (02 studies pooled), complex community interventions (02 studies pooled), verbal encouragement (02 studies pooled) and invitation letters(03 pooled studies) were 3.48(95% CI: 1.42 to 8.53), 1.85(95%CI: 0.85 to 4.03), 2.37(95%CI: 1.22 to 4.61) and 1.81(95%CI: 0.64 to 5.14) respectively. I squared was 89.5%, p < 0.001 and the heterogeneity was not explained by any of the variables in meta-regression. CONCLUSION: There was stronger evidence for enhanced psychosocial intervention and verbal encouragement in increasing the uptake of infant prophylaxis. The high heterogeneity suggests more studies are needed to draw a definite inference from the meta-analysis. More studies with larger sample sizes that are conducted using similar methods are needed in the future. TRIAL REGISTRATION: Prospero registration number: 42016032673 .
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Antirretrovirais/uso terapêutico , Antibioticoprofilaxia/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Parceiros Sexuais/psicologia , África Subsaariana , Humanos , Lactente , Masculino , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Adequate awareness of cardiovascular diseases (CVD) and their risk factors may help reduce the population's exposure to modifiable risk factors and thereby contribute to prevention and control strategies. There is limited data on knowledge among the general population in sub-Saharan Africa regarding CVD and risk factors. We aimed to assess the population awareness (and associated factors) of CVD types and risk factors in Buea, Cameroon. METHODS: This was a community-based cross-sectional study conducted in 2016 among randomly selected adults (>18 years). Data on socio-demographic characteristics, knowledge about CVD types, their risk factors and warning signs for CVD events (stroke and heart attack) were acquired using a self-administered questionnaire. Logistic regression analysis was used to investigate factors associated with moderate-to-good knowledge. RESULTS: Of the 1162 participants (61.7% women, mean age 32 years), 52.5% had overall poor knowledge (mean score 12.1 on total of 25) on CVD with only about a quarter correctly identifying types of CVD. Overall, 36, 63 and 45% were unaware of CVD risk factors, warning signs of heart attack and stroke respectively. In multivariable analysis; high level of education (aOR = 2.26 (1.69-3.02), p < 0.0001), high monthly income (aOR = 1.64 (1.07-2.51), p = 0.023), having a family history of CVD (aOR = 1.59 (1.21-2.09), p = 0.001) and being a former smoker (aOR = 1.11 (1.02-1.95), p = 0.043) were associated with moderate-to-good knowledge. CONCLUSIONS: There exists a significant gap in population awareness about CVDs in Cameroon and this is similar to previous reports. Cost-effective community health education interventions taking into account socioeconomic status may be beneficial in this setting.
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Conscientização , Doenças Cardiovasculares/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Camarões/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Classe Social , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Delayed entry into HIV care has complicated the challenges faced in sub-Saharan Africa due to the high HIV burden. A clear knowledge of the factors affecting delayed entry will be essential in directing interventions towards reducing delayed entry into HIV care. There exist very limited data on delayed entry in Cameroon despite its relevance; hence this study was conducted to determine the rate of delayed entry and its associated factors in HIV programmes in Cameroon. METHODS: Data used for this study was routine data obtained from the files of HIV patients who were diagnosed between January 1, 2015 and June 30, 2015 at Limbe and Buea regional hospital HIV centers in the South West region of Cameroon. Data analysis was done using SPSS version 20. RESULTS: Of the 223 patients included in the study, nearly one-quarter of patients (22.4 %) delayed to enter HIV care within 3 months. Those who delayed to enter care were less likely to present at first diagnosis (using HIV rapid test) with symptoms such as fever > 1 month (5 % versus 30 %, p = 0.01) and weight loss > 10 % (13 % versus 48 %, p < 0.001). Alcohol consumption, WHO stage and CD4 count levels were also associated with delayed entry in bivariate analysis. In multivariate analysis only CD4 count greater than 500cells/µl and WHO stages I and II were independently associated with delayed entry into HIV care within 3 months. CONCLUSION: In the South West region of Cameroon, approximately 1 out of 4 patients delay to enter HIV care. This high proportion of patients who delay to enter care correlates to the findings recorded by other studies in sub Saharan Africa. Interventions tackling delayed entry into HIV care might need to be favorably directed towards patients that have high CD4 counts and are at very early WHO clinical stages.
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Terapia Antirretroviral de Alta Atividade , Infecções por HIV/epidemiologia , Adolescente , Adulto , Instituições de Assistência Ambulatorial , Contagem de Linfócito CD4 , Camarões/epidemiologia , Estudos Transversais , Esquema de Medicação , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Organização Mundial da Saúde , Adulto JovemRESUMO
BACKGROUND: Adequate knowledge and practices on post exposure prophylaxis (PEP) for HIV among health care providers are crucial for HIV prevention. However there is limited data on PEP knowledge and practice from developing countries where the burden of HIV infection continues to increase. We assessed the knowledge of clinical medical students on PEP, their practices in response to occupational exposure to HIV, as well as the determinants of good knowledge on PEP. METHODS: A cross-sectional study was conducted in November 2014 involving 154 consecutively recruited clinical medical students (4(th)-6(th) year undergraduates). Data were acquired using a structured questionnaire. Knowledge on PEP was assessed using a questionnaire comprising 25 questions and categorized as: good (20 or more correct answers), moderate (13-19 correct answers) and poor (12 or fewer correct answers). RESULTS: For the 154 students included (57.8 % being male), the mean age was 23.2 ± 2.4 years, and 89 % had heard about PEP for HIV. The majority of students had moderate (61.7 %) and poor (32.5 %) knowledge on PEP. Overall knowledge score increased with increasing level of studies (p < 0.05). Only 10 (6.5 %) had had previous training on PEP, most of whom were senior level students (p = 0.01). Fifty-four students (35.1 %) knew the appropriate duration of PEP and this awareness increased with level of studies (p = 0.001). Of the 81 (52.6 %) who reported occupational exposure to HIV in the past, only 4 (4.9 %) received PEP. CONCLUSIONS: Overall, knowledge on PEP among clinical medical students in this setting was non-optimal with very low uptake PEP. Intensification of HIV curricula to involve PEP as well as continuous medical education programs and workshops are potential avenues to improve awareness in this vulnerable population.
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Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Profilaxia Pós-Exposição/estatística & dados numéricos , Estudantes de Medicina/psicologia , Adulto , Estudos Transversais , Doenças Endêmicas/prevenção & controle , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Exposição Ocupacional/estatística & dados numéricos , Estudantes de Medicina/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
INTRODUCTION: women in sub-Saharan Africa (SSA) are disproportionately affected by the HIV epidemic. In 2019, they constituted 59% of new infections; thus, they remain a key population for control. Public health interventions to prevent acquisition of HIV in this high-risk population are urgently needed. Tenofovir-based pre-exposure prophylaxis (TFV-PrEP) has been shown to reduce HIV infections in other key populations. However, comprehensive evidence regarding TFV-PrEP effectiveness in women living in SSA has not been determined. Therefore, we undertook a systematic review to determine the effectiveness of tenofovir-1% (TFV-1%) vaginal gel, oral tenofovir (TFV) and tenofovir-emtricitabine (TDF-FTC) pre-exposure prophylaxis for primary acquisition of HIV in at-risk women living in SSA. METHODS: OVID Medline, Embase, CENTRAL, Web of Science and Clinical Trials.gov were searched for eligible studies from 1st January 2020 to 31st July 2020. Only randomised controlled trials (RCTs) conducted in women living in SSA were included. Measures of effectiveness (hazard ratios (HR), incidence rate ratios (IRR)) were extracted from individual studies to determine the effectiveness of TFV-PrEP in preventing HIV infection among at-risk women living in SSA. RESULTS: from 2002 non-duplicate articles, four RCTs evaluating the effectiveness of one or more of the interventions against placebos were included. TFV-1% vaginal gel, oral TDF or TDF-FTC were not effective in preventing the acquisition of HIV infection in women living in SSA. However, poor adherence by study participants could have confounded the true effectiveness of TFV-PrEP in this high risk population. Meta-analysis was not conducted given the limited number of eligible studies identified from the search. CONCLUSION: the current evidence does not support the effectiveness of TFV-PrEP for HIV in SSA women. More studies aimed at addressing factors driving low adherence to HIV interventions in this high risk population are urgently needed in order to improve the design of future RCTs leading to the determination of more reliable estimates of TFV-1% vaginal gel or oral TDF or TDF-FTC effectiveness. Protocol registration: this systematic review was not registered in PROSPERO.
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Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Tenofovir/administração & dosagem , África Subsaariana , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/administração & dosagem , Feminino , Humanos , Adesão à Medicação/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: The prevalence of hypertension is highest in the African Region with 46% of adults aged 25 and above diagnosed with hypertension, while the lowest prevalence of 35% is found in the Americas. There is sparse evidence on the approaches used to prevent hypertension in Sub-Saharan Africa and the effectiveness of these approaches. It is therefore imperative that a systematic review; which synthesises all the available evidence on the approaches and their impact is conducted to inform public health policy and practice. OBJECTIVE: To synthesise evidence on the interventions used for the primary prevention of hypertension in Sub-Saharan Africa and to evaluate the effectiveness of these interventions in reducing blood pressure, hypertension prevalence and the risk factors for hypertension. METHODS AND RESULTS: This systematic review was reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Bibliographic databases were searched on the 4th-17th of January 2018 from 1970 to January 2018 and on the 5th of May 2019 from 1970 to May 2019, for studies focusing on the primary prevention of hypertension in communities in Sub-Saharan Africa. A narrative synthesis was conducted based on study interventions and outcomes. Also, a meta-analysis was carried out using pooled mean differences; using a random effects model of generic inverse variance option in RevMan. A total of 854 studies were identified after deduplication, with thirteen studies meeting the inclusion criteria. Six studies with varying interventions and methodologies observed a significant pooled reduction in systolic blood pressure of -3.3mmHg (95%CI -4.64 to -1.96) and a reduction of -2.26mmHg (95%CI -6.36 to 1.85) in diastolic blood pressure, which was not statistically significant (p = 0.28). Also, moderate to significant heterogeneity was observed (I2 = 68% and 99%) for the systolic and diastolic blood pressure respectively. Intervention and study design accounted for 100% heterogeneity for both systolic and diastolic blood pressure (r2 = 100%). CONCLUSION: Health promotion and interventions targeting various risk factors of hypertension and, salt consumption restriction interventions have been employed in Sub-Saharan Africa with varying levels of success. We recommend that higher quality studies and a meta-analysis are needed to evaluate the impact of these interventions and to inform public health policy and practice.
Assuntos
Hipertensão/prevenção & controle , Prevenção Primária/métodos , África Subsaariana/epidemiologia , Pressão Sanguínea , Estudos Transversais , Exercício Físico , Promoção da Saúde , Humanos , Hipertensão/epidemiologia , Meios de Comunicação de Massa , Estudos Observacionais como Assunto , Prevalência , Saúde Pública , Análise de Regressão , Fatores de RiscoRESUMO
INTRODUCTION: The scale-up of integrated Human Immunodeficiency Virus (HIV) and tuberculosis (TB) treatment has been an important intervention to curb the burden of HIV and TB co-infection worldwide. Uptake of and adherence to antiretroviral therapy (ART) are key determinants of the quality and therapeutic endpoints of this intervention. This study aims to conduct an up-to-date collection and synthesis of evidence on barriers to and facilitators of uptake of and adherence to ART in HIV/TB integrated treatment programs in sub-Saharan Africa (SSA). METHOD: A systematic review of peer-reviewed literature on the uptake of and adherence to ART in the context of integrated therapy for HIV and TB in SSA will be performed. We will review qualitative and quantitative studies reporting on the uptake of and adherence to ART during integrated treatment for TB and HIV among adults. These will include studies that involve HIV-infected TB patients initiating ART and studies involving PLWHA already on ART who are newly diagnosed with TB. Qualitative studies, quantitative studies, randomised trials and observational studies will be included. Six databases including Medline and Embase will be searched for relevant studies published from March 2004 to July 2019. Two authors will independently screen the search output and retrieve full texts of eligible studies. Disagreements between the two authors will be resolved by arbitration by a third author. Data will be abstracted from the eligible studies and synthesis will be done through descriptive synthesis for qualitative data and meta-analysis for quantitative data. ETHICS AND DISSEMINATION: This study will be a review of the literature and will not involve primary collection of individuals' data. Amendments to the protocol will be documented in the final review. The final study will be published in a peer-reviewed journal and presented at conferences. The review is expected to contribute to improving strategies to enhance uptake of and adherence to ART in integrated care. PROSPERO REGISTRATION NUMBER: CRD42019131933.
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Fármacos Anti-HIV/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Tuberculose/tratamento farmacológico , Adulto , África Subsaariana , Coinfecção/tratamento farmacológico , Infecções por HIV/complicações , Humanos , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento , Tuberculose/complicaçõesRESUMO
INTRODUCTION: Hypertension is the leading cardiovascular risk factor globally, associated with a high morbidity and mortality. The high prevalence of hypertension in sub-Saharan Africa (SSA) is associated with contrastingly low awareness, treatment and control rates. Adherence to medication remains a major determinant of optimal blood pressure control. This systematic review aims to determine the prevalence, and factors associated with adherence to antihypertensive pharmacotherapy among patients with hypertension in SSA. METHODS AND ANALYSIS: We will include studies published in Africa up to 31 December 2017. The following databases will be searched: PubMed, Embase, SCOPUS and Web of Science to identify potential studies without language restriction. To minimise chances of missing studies, resources specific to African literature such as WHO AFROLIB, African Index Medicus and African Journals Online will also be searched. Two reviewers will independently screen studies, extract data and critically appraise included studies for risk of bias, and a third reviewer will resolve discrepancies. A random-effects meta-analysis is planned to pool study-specific estimates to obtain a summary measure presented in Forest plots. Heterogeneity of included studies will be assessed using the χ2 test on Cochrane's Q statistic and quantified using I2. Publication bias will be assessed using the Egger's test and funnel plots. This protocol has been prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses for Protocols 2015 statement. ETHICAL AND DISSEMINATION: An ethical approval is not required for the proposed study, as it will be based on already published data. The end report will be presented at conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42017079838.
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Anti-Hipertensivos/uso terapêutico , Hipertensão/tratamento farmacológico , Adesão à Medicação , África Subsaariana , Doenças Cardiovasculares/prevenção & controle , Humanos , Fatores de Risco , Revisões Sistemáticas como AssuntoRESUMO
BACKGROUND: The low level of male partner involvement in Prevention of Mother to Child Transmission of HIV services such as safe infant feeding practices poses a serious challenge to the implementation of guidelines on safe infant feeding and may undermine efforts towards elimination of mother to child transmission of HIV in sub Saharan Africa(SSA). We conducted a systematic review and meta-analysis to identify the approaches that have been utilized to improve male partner involvement in PMTCT services as well as their impact on the uptake of safe infant feeding practices by HIV positive mothers in SSA. METHODS: In this systematic review and meta-analysis, Ovid Medline, Embase, PsycINFO, Cochrane library, ClinicalTrials.gov, Web of Science and Current Controlled Trials were searched. Only studies performed in SSA that reported an approach that specifically involved male partners and its impact on the uptake of safe infant feeding practices (irrespective of the language and date of publication) were included. Odds ratios were extracted or calculated from studies and combined in a meta-analysis using the statistical package Stata version 11.0. Forest plots were generated using the random effect model. RESULTS: From an initial 2416 non-duplicate articles, 06 articles were included in the systematic review and meta-analysis. The overall pooled unadjusted OR was 3.08[95%CI: 2.58-3.68], while the effect sizes for interventions aimed at promoting male partner involvement such as verbal encouragement, complex community intervention and enhanced psychosocial interventions were 1.93[95%CI: 1.34-2.79], 3.45[95%CI: 2.79-4.25] and 5.14[95%CI: 2.42-10.90] respectively. Using only adjusted odd ratios, the pooled adjusted OR = 1.78[95%CI: 1.35-2.34]. The I2 = 60.1% p = 0.057 using adjusted ORs. CONCLUSION: Interventions aimed at promoting male partner involvement such as enhanced psychosocial interventions, verbal encouragement and complex community interventions increase the uptake of safe infant feeding options. The heterogeneity was moderate among studies. More studies including randomised trials that will recruit larger, representative samples of patients are needed in the future. Prospero registration number: 42016032673.
Assuntos
Infecções por HIV/transmissão , Alimentos Infantis , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Mães , Segurança , Parceiros Sexuais , África Subsaariana , Feminino , Humanos , Lactente , Masculino , Parceiros Sexuais/psicologiaRESUMO
BACKGROUND: The viral load (VL) in patients receiving antiretroviral therapy (ART) is the best predictor of treatment outcome. The anticipated benefits of VL monitoring depend on the actual uptake of VL test results for clinical decisions. The objective of this study was to assess the uptake and utilization of VL test results for clinical decisions on HIV treatment in Cameroon, from 2013 to 2017. METHODS: This was a retrospective cohort analysis of data from files of patients receiving ART at Buea, Limbe, Bamenda and Bafoussam regional hospital HIV treatment centers. A simple random pick of six file blocks was performed in each shelf that corresponded to a year of initiation, and the contents of all selected files were reviewed and the information needed for the study entered a structured questionnaire. The data collected was recorded in Epi Info (version 7.1.5.2), and analyzed using SATA (version 12.1; StataCorp LP). RESULTS: Eight hundred and thirty files were reviewed. The mean duration on ART was 39.4±12 months. Viral load testing uptake was 24.33% and only one VL test had been done by all patients. Approximately 65% of the patients did the first VL after more than 24 months on ART. The median turnaround (TAT) time for VL testing was 6 days (Interquartile range (IQR) 3-7days). Among 201 patients who did a VL test, 94.55% had VL suppression (≤1000copies/mm3). Approximately 54% of the patients with virologic failure were switched to a second-line regimen. CONCLUSIONS: The uptake of viral load testing is low in North West, South West and West Regions of Cameroon. The current TAT for VL testing is plausible. The rate of switch to second line regimen is low. It is time to strengthen the scale up of VL testing and improve the rate of switch to second-line regimen in Cameroon.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Carga Viral , Adulto , Idoso , Antirretrovirais/farmacologia , Camarões , Tomada de Decisões , HIV/efeitos dos fármacos , Infecções por HIV/virologia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de Tratamento , Carga Viral/efeitos dos fármacos , Adulto JovemRESUMO
The rise of antimicrobial resistance is a global threat and Africa like any other developing setting is heavily affected. As one of its missions, the Africa CDC is poised to ensure this rising trend takes a diminishing route in the few years ahead. Diagnostics obviously play a pivotal role in AMR control and the advanced course in diagnostics (ACDx) has been instrumental in training critical decision makers over the past 7 years. This commentary presents an analysis of discussions and exchanges during the launch of the Africa CDC AMR surveillance network at the ACDX and the way forward for its implementation. The diagnostics priorities are also highlighted.
Assuntos
Anti-Infecciosos/farmacologia , Resistência Microbiana a Medicamentos , África , Tomada de Decisões , Países em Desenvolvimento , HumanosRESUMO
OBJECTIVES: To identify the approaches that are used in improving on male partner involvement in the prevention of mother-to-child transmission (PMTCT) of HIV and their impact on the uptake maternal antiretroviral therapy (ART) in sub-Saharan Africa (SSA). SETTING: This was a systematic review and meta-analysis of published studies carried out in SSA at all levels of healthcare (primary, secondary, tertiary and community). PARTICIPANTS: The participants of the studies included were HIV-positive pregnant women and breastfeeding mothers with their male partners. Studies were included if they were conducted in SSA and mentioned an approach used in improving male partner involvement with data on the impact on the uptake of maternal ART uptake. OUTCOMES: In the protocol, maternal ART uptake, infant prophylaxis, safe infant feeding options, condom use and family planning were envisaged. However, only maternal ART has been reported here due to limitations on the word count. RESULTS: From an initial 2316 non-duplicate articles, 17 articles were included in the systematic review and meta-analysis. In the combined model, the ORs for complex community interventions, enhanced psychosocial interventions, verbal encouragement and invitation letters were 4.22 (95% CI 2.27 to 7.77), 2.29 (95% CI 1.42 to 7.69), 2.39 (95% CI 1.26 to 4.53) and 1.21 (95% CI 0.89 to 1.63), respectively, whereas in the model using adjusted ORs, enhanced psychosocial interventions had a higher effect than any other intervention. The heterogeneity was moderate using adjusted ORs. CONCLUSION: Enhanced psychosocial interventions and complex community interventions increase male partner involvement and the uptake of PMTCT services more than any other intervention. Invitation letters had no effect. More randomised trials and observational studies (that have adjusted for potential confounders) are needed in the future. PROSPERO REGISTRATION NUMBER: 42016032673.
Assuntos
Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais/psicologia , África Subsaariana , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Apoio SocialRESUMO
BACKGROUND: Dengue hemorrhagic fever is the leading cause of hospitalization and death in children living in Asia and Latin America. There is an urgent need for an effective and safe dengue vaccine to reduce morbidity and mortality in this high-risk population given the lack of dengue specific treatment at present. This review aims to determine the efficacy, safety, and immunogenicity of CYD-TDV vaccine in children. METHODS: This is a systematic review including meta-analysis of randomized controlled clinical trial data from Embase, Medline, the Cochrane Library, Web of Science, and ClinicalTrials.gov. Studies that assessed CYD-TDV vaccine efficacy [(1 - RR)*100], safety (RR), and immunogenicity (weighted mean difference) in children were included in this study. Random effects model was employed to analyze patient-level data extracted from primary studies. RESULTS: The overall efficacy of CYD-TDV vaccine was 54% (40-64), while serotype-specific efficacy was 77% (66-85) for DENV4, 75% (65-82) for DENV3, 50% (36-61) for DENV1, and 34% (14-49) for DENV2. 15% (-174-74) vaccine efficacy was obtained for the unknown serotype. Meta-analysis of included studies with longer follow-up time (25 months) revealed that CYD-TDV vaccine significantly increased the risk of injection site reactions (RR = 1.1: 1.04-1.17; p-value = 0.001). Immunogenicity (expressed as geometric mean titers) in descending order was 439.7 (331.7-547.7), 323 (247 - 398.7), 144.1 (117.9-170.2), and 105 (88.7-122.8) for DENV3, DENV2, DENV1, and DENV4, respectively. CONCLUSION: CYD-TDV vaccine is effective and immunogenic in children overall. Reduced efficacy of CYD-TDV vaccine against DENV2 notoriously known for causing severe dengue infection and dengue outbreaks cause for serious concern. Post hoc meta-analysis of long-term follow-up data (≥25 months) from children previously vaccinated with CYD-TDV vaccine is needed to make a conclusion regarding CYD-TDV vaccine safety in children. However, CYD-TDV vaccine should be considered for use in regions where DENV2 is not endemic as currently there is no specific treatment for dengue infection.
RESUMO
BACKGROUND: The enormous challenge to maternal well-being with associated maternal wastages during labour has remained an unsurmountable problem in Cameroon which reflects the current high maternal mortality rate. Evidence abounds that cost-effective and affordable health interventions like the use of the partograph will contribute to curb the alarming number of intrapartum maternal deaths. However, little is known about the level of knowledge and utilization of this simple life-saving tool in the North-and South-West Regions, Cameroon. METHODS: Using a self-administered structured questionnaire, a cross-sectional study was conducted from January 4th-March 25th 2016 among non-physician obstetric care providers (OCPs) across urban public health institutions in these regions. Logistic regression models were used to identify factors associated with good knowledge and routine utilization of the partograph. RESULTS: Of the 79 eligible participants, 71 (89.9%) took part in the study. The mean age of the respondents was 37.9±10.0 years with majority being female (85.9%). Less than one-third (29.6%) of the respondents had good knowledge on the partograph and only 23 (32.4%) routinely used it in monitoring labour. OCPs working in Maternal and Infant Welfare Clinics were about 4 times more likely than those working in Regional/District Hospitals to have good knowledge on the partograph [AOR = 3.88 (95% CI:1.07-14.04)], p = 0.04. Little or no knowledge of the partograph and poor staff strength in the study centres were factors militating against its routine use. CONCLUSIONS: The knowledge and use of the partograph in this study is sub-optimal. Regular in-service training of OCPs superimposed with periodic workshops and seminars, provision of reasonable staff numbers, and mandatory institutional policies on routine use of the partograph are recommended as vital first steps towards ensuring the safety of women in labour in the North-and South-West Regions of Cameroon.
Assuntos
Mortalidade Materna , Monitorização Fisiológica/métodos , Complicações do Trabalho de Parto/prevenção & controle , Obstetrícia/organização & administração , Saúde Pública/métodos , Adulto , Camarões , Análise Custo-Benefício , Estudos Transversais , Feminino , Humanos , Capacitação em Serviço , Masculino , Pessoa de Meia-Idade , Tocologia , Obstetrícia/métodos , Gravidez , Administração em Saúde Pública , Classe SocialRESUMO
INTRODUCTION: Several studies have reported approaches used in improving the delivery of prevention of mother-to-child transmission (PMTCT) of HIV services through the involvement of male partners, but evidence from a systematic review is limited. We aim at determining the impact of male partner involvement on PMTCT in sub-Saharan Africa. METHODS AND ANALYSIS: This will be a systematic review of published literature. Interventional and observational studies on male involvement in PMTCT carried out in sub-Saharan Africa will be included irrespective of the year and language of publication. OVID Medline, Embase, PschINFO, and Cochrane database of controlled trials will be searched. After manual searching of articles, authors shall be contacted for further information. 2 authors (NFT and CJ) will independently screen potential articles for eligibility using defined inclusion and exclusion criteria. Critical Appraisal Skills Programme (CASP) tools, Jadad scale and the STROBE checklist will be used for critical appraisal, and the 2 authors will independently assess the quality of articles. Authors will independently extract data from studies using a pre-established data collection form, and any discrepancies will be sorted by a third author (TRK). Outcomes will be analysed using STATA V.12.0. The random effect model will be used to produce forest plots. The heterogeneity χ(2) statistics and I(2) will be used to assess for heterogeneity. Publication bias will be assessed using funnel plots. This protocol is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines. ETHICS AND DISSEMINATION: No ethical approval since included studies will be published studies that had already obtained ethical approvals. The findings will guide HIV programmes on the best approaches towards involving male partners in PMTCT with a view to improving PMTCT services in sub-Saharan Africa. PROSPERO REGISTRATION NUMBER: 42016032673.
Assuntos
Atenção à Saúde , Infecções por HIV/complicações , Serviços de Saúde , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Parceiros Sexuais , África Subsaariana , Feminino , HIV , Infecções por HIV/transmissão , Humanos , Masculino , Homens , Gravidez , Projetos de Pesquisa , Revisões Sistemáticas como AssuntoRESUMO
Takayasu arteritis is rare in black people. Doppler echocardiography may assist in its diagnosis with good response to steroids.