Burden and determinants of anemia among lactating women in Ethiopia: evidence from demographic health survey.

Globally one-third of global population are victims of anemia, significantly impacting maternal and infant health and linked to poor cognition, productivity, and mortality risks. We used randomly selected 4040 lactating mothers' record from nationally representative survey. Descriptive statistics were weighted, and the standard hemoglobin cutoff point (below 12 g/dl) was used. Bivariable and multivariable multilevel binary logistic regression model considering the individual and community-level factors associated with anemia was employed. Crude and adjusted odds ratios with a 95% confidence interval were reported. In Ethiopia, 32.3% (95% CI 30.9-33.7%) of lactating women were anemic, with 23.4% having mild, 7.3% moderate, and 1.2% severe anemia. Pastoral regions (Afar, Somalia, and Oromia region) had higher burden of anemia than the others. The advanced age of the mother above 45 years (AOR = 1.43 (1.11-1.82), unemployment (AOR = 1.19; 95% CI 1.08-1.32), household wealth index (AOR = 0.56; 95% CI 0.50-0.63), extended family size (AOR = 1.20; 95% CI 1.04-1.46), and not using family planning (AOR = 1.70; 95% CI 1.49-1.93) were significant factors associated with anemia. Anemia is a moderate public health problem and associated with location and other factors to be addressed via effective interventions.

Investigating latent syphilis in HIV treatment-experienced Ethiopians and response to therapy.

OBJECTIVES: We investigated people with HIV (PWH) receiving combination antiretroviral therapy (cART) for latent syphilis infection prevalence, risk factors, treatment response, and neurosyphilis. METHODS: A prospective follow-up study was conducted on PWH and latent syphilis. The cases were randomly assigned to receive either benzathine penicillin G (BPG) or doxycycline (DOXY), and the posttreatment response was evaluated after 12 and 24 months. The traditional algorithm was used for serodiagnosis, and a semi-quantitative rapid plasma reagin (RPR) test monitored disease activity and treatment effectiveness. RESULTS: Of the 823 participants, 64.8% were women, and the mean age was 41.7±10 years. Thirty-one (3.8%) of the participants (22 males and nine females) had latent syphilis. The risk factors were male sex (aOR = 3.14), increasing age (aOR = 1.04 per year), and cART duration (aOR = 1.01 per month). Baseline RPR titers were: ≤1:4 in 19 (61.3%), between 1:8 and 1:32 in 10 (32.2%), and >1:32 in 2 (6.4%). None of the seven cerebrospinal fluid analyses supported a neurosyphilis diagnosis. In the 12th month of treatment, 27 (87.1%) had adequate serological responses, three (9.7%) had serological nonresponse, and one (3.2%) had treatment failure. Syphilis treatment was repeated in the last four cases with the alternative drug. In terms of adequate serologic response, both therapies were comparable at the 12th month, p = 0.37. All cases responded to treatment in the 24th month. CONCLUSION: In PWH receiving cART, latent syphilis occurred more in men than women, suggesting an investigation of sexual practices and the impact of antenatal syphilis screening. Syphilis disease activity reduces in the latent stage. Therefore, the routine cerebrospinal fluid analysis contributes little to the diagnosis of asymptomatic neurosyphilis and the treatment success of latent syphilis. DOXY is an alternative to BPG, and cART improves serologic response to latent syphilis treatment.

Patient Survival With and Without Radiation Therapy for Early-Stage Diffuse Large B-Cell Lymphoma in the Era of PET and Rituximab.

Purpose: The benefit of radiation therapy (RT) becomes uncertain in the treatment of early stage diffuse large B-cell lymphoma (DLBCL) in the era of rituximab, positron emission topography (PET), and computed tomography (CT). We sought to retrospectively review modern patients with early stage I-II DLBCL treated with rituximab and staged by PET-CT to better define which patients benefit from consolidative RT. Methods and Materials: Patients with early stage I-II DLBCL from 1998 to 2017 were reviewed coinciding with our institutional utilization of rituximab with the standard regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone and PET-CT. Relevant clinical information was used to calculate National Comprehensive Cancer Network international prognostic index (IPI) scores. Kaplan-Meier survival analysis and a Cox proportional hazards model were used for overall survival (OS). Results: Seventy-seven patients received chemoimmunotherapy alone, and 41 received chemoimmunotherapy plus RT. Median follow-up time was 9.5 years. On univariate analysis, extranodal disease (P = .04) and National Comprehensive Cancer Network IPI (P < .001) were significantly correlated with OS. Five-year OS was 87% versus 67%, and 10-year OS was 67% versus 58%, numerically higher favoring RT (P = .16). On multivariate Cox regression analysis of OS controlling for IPI and extranodal disease, the addition of RT was associated with improved OS (hazard ratio of 0.4, P = .01). Conclusions: The current analysis supports the use of consolidative RT in early stage DLBCL given an OS benefit on multivariate analysis. Further prospective randomized data are needed to confirm these findings.

Eligibility Criteria Perpetuate Disparities in Enrollment and Participation of Black Patients in Pancreatic Cancer Clinical Trials.

PURPOSE: Clinical trials determine safety and efficacy of cancer therapeutics and establish standards of care. Minority patient participation in cancer clinical trials is dismal. We aimed to determine the impact of eligibility criteria on disparities in pancreatic ductal adenocarcinoma (PDAC) clinical trial candidacy. METHODS: Traditional PDAC trial eligibility criteria were obtained from ClinicalTrials.gov. Patients with PDAC who sought care at Virginia Commonwealth University Health from 2010 to 2019 were included. Clinical data were obtained from billing codes and discrete values in the electronic medical record. Eligibility criteria differences between racial groups were determined using chi-squared tests and unconditional maximum likelihood-based odds ratios. RESULTS: Among 676 patients, most identified as Black or White race (42.5% and 51.6%, respectively). Using traditional criteria, Black patients were more likely to be ineligible for participation compared with White patients (42.4% v 33.2%, P = .023) secondary to hypoalbuminemia (14.1% v 7.9%, P = .023), HIV (3.1% v 0.3%, P = .010), hepatitis B (1.7% v 0%, P = .043), and hepatitis C (9.1% v 3.4%, P = .005). Black patients were also numerically more likely to be ineligible because of renal dysfunction, recent coronary stenting, and uncontrolled diabetes mellitus. Prior cancer treatment excluded fewer Black than White patients (9.1% v 14.0%, P = .072), most attributable to lower rates of neoadjuvant chemotherapy received. Strategic eligibility criteria revisions could equalize ineligibility rates between Black and White patients (26.8% v 24.8%, P = .581). CONCLUSION: Traditional eligibility criteria differentially exclude Black patients from participating in PDAC clinical trials. These criteria perpetuate disparities, limit generalizability, and are often not medically justifiable. Revised criteria may improve participant diversity, without compromising safety or study results.

Uptake of provider initiated HIV counseling and testing (PICT) among out patient department (OPD) clients with possible clinical signs of HIV infection in Addis Ababa.

BACKGROUND: Developments have been seen in recent years in global efforts to address the AIDS epidemnic. HIV counseling and testing (VCT) is the key entry point to prevention, care, treatment and support services. To improve the slow uptake besides VCT different alternatives have been proposed, namely provider-initiated HIV counseling and testing (PICT). OBJECTIVES: To assess uptake of provider initiated HIV counseling and testing among out patient department (OPD) clients with possible clinical signs of HIV infection and factors associated with it. METHODS: Facility based cross sectional study was conducted on 423 OPD clients with possible clinical signs of HIV infection in 12 government health centers in Addis Ababa. Once the health facilities were selected randomly from each sub cities, study subjects who came to the health centers were interviewed consecutively. RESULT: The pre-test and post-test acceptability rates among those who showed willingness to PICT, were 0.98 and 0.96 respectively where as the overall acceptability rate of all study participants was 0.67. Compared with age group 15-24, subjects 25-34 years old have higher rate of willingness (Adj.OR = 8.98, 95% CI = 1.2-66.5) and acceptability (Adj.OR = 6.4 CI = 1.2-33.6). On the other hand those who had "less" support for PITC were less likely to be willing (AOR = 0.03; CI = 0.002-0.43) and accept the test (AOR = 0.02; 95% CI = 0.02-0.3) than who supported it "extremely". CONCLUSION: Though knowledge about PICT among the study subjects was not satisfactory the relatively high willingness and acceptability identified in this study is promising for wider application towards strengthened prevention and control of HIV/AIDS. We recommend that PICT needs to be implemented at all levels of health facilities in Ethiopia.

HIV prevalence among clients with possible clinical signs of HIV infection: using the provider initiated testing and counseling approach.

BACKGROUND: Variations on HIV estimates have been reported using routine antenatal care (ANC) sentinel surveillance and voluntary counseling and testing (VCT). But there have been widespread concerns about the low participation rates of ANC and the slow uptake of the routine VCT in many parts of sub-Saharan Africa including Ethiopia. Thus estimates of HIV prevalence based on provider initiated HIV testing and counseling (PITC), can improve our understanding of the issues related to uptake, barriers and outcomes of HIV testing and counseling, and to develop and test different models for optimizing the use of voluntary testing and counseling in a way that ensures that people, are not put at risk. OBJECTIVES: To estimate the prevalence of HIV among out patient department (OPD) clients with possible clinical signs of HIV infection using the provider initiated testing and counseling approach. METHODS: Institution based cross-sectional study was conducted on 259 OPD clients with possible clinical signs of HIV infection in 12 government health centers in Addis Ababa. RESULT: The HIV prevalence rate was 37.5% with 95% CI (31.6 - 43.4%). After adjusting for independent variables subjects in age group 35-44 years were about 4 times more likely to be positive for HIV than age group 15-24 years (AOR =3.58; 95% CI=1.31-9.82) and the odds of HIV infection in the 25-34 years was 2.41 (95% CI= 1.01-5.78) higher than age group 15-24. HIV prevalence significantly declines with educational status from 57.4% among illiterates to about 31-34% among those who read and write and with primary and above educational levels. About half of the participants perceived themselves as having risk for HIV, of whom 41.7% were HIV positive, higher than those who perceived no risk (31%), but significantly lower than among those who remained neutral (61%). Those with prior HIV testing were about 2 times less likely to be HIV positive compared to those who had never been tested CONCLUSION: The relatively high HIV prevalence rate noted in this study indicates how useful the PITC approach is in detecting cases. We recommend that PITC needs to be implemented at all levels of health facilities in Ethiopia.