Diabetes self-management education interventions in the WHO African Region: A scoping review.

INTRODUCTION: Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. MATERIALS AND METHODS: The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. RESULTS: Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. CONCLUSIONS: The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.

Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

BACKGROUND: Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women's FGM/C intention for their daughters in Sierra Leone. METHODS: We used cross-sectional data from the women's file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15-49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios. RESULTS: Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4-8.0]. Among the covariates, women aged 20-24 [aOR = 2.3, CrI = 1.5-3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3-3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors. CONCLUSION: FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone.

Correction: Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs).

[This corrects the article DOI: 10.1371/journal.pone.0192513.].

Analysis of socioeconomic differences in the quality of antenatal services in low and middle-income countries (LMICs).

The desired results of increasing access and availability of antenatal care (ANC) services may not be realized if the quality of care offered is not adequate. We analyzed the content/quality of antenatal care to determine whether there are socioeconomic (education and wealth) inequalities in the services provided in 59 low and middle income countries in six WHO regions-Africa, East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and South Asia. We aggregated the most recent (2005-2015) Demographic and Health Survey for each country. The quality of content was measured on eight recommended ANC services-(1) monitoring of blood pressure; (2) tetanus injection; (3) urine analysis for protein; (4) blood test; (5) information about danger signs (6); weight (7); height measurements and (8) provision of iron-folate supplement. Descriptive and Poisson regression techniques were applied to analyse the data. We found considerable wealth and educational differences prior to controlling for known covariates. Between wealth and education, however, the disparities in the latter are larger than the former. Whereas the socioeconomic differences remained at post adjusting for residence, place and number of antenatal care, parity and region, the magnitude of change was minimal. Higher number of ANC content was provided in "other" forms of private facilities; the Latin America and Caribbean region recorded the highest number of content compared to the other regions. The hypothesized socioeconomic status on content/number of ANC services was generally supported, although the associations are substantially constrained to other variables. Efforts are made to increase the number and timing of ANC services; due recognition is needed for the content offered.