Preexisting Diabetes and Breast Cancer Treatment Among Low-Income Women.

IMPORTANCE: Diabetes is associated with poorer prognosis of patients with breast cancer. The association between diabetes and adjuvant therapies for breast cancer remains uncertain. OBJECTIVE: To comprehensively examine the associations of preexisting diabetes with radiotherapy, chemotherapy, and endocrine therapy in low-income women with breast cancer. DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included women younger than 65 years diagnosed with nonmetastatic breast cancer from 2007 through 2015, followed up through 2016, continuously enrolled in Medicaid, and identified from the linked Missouri Cancer Registry and Medicaid claims data set. Data were analyzed from January 2022 to October 2023. EXPOSURE: Preexisting diabetes. MAIN OUTCOMES AND MEASURES: Logistic regression was used to estimate odds ratios (ORs) of utilization (yes/no), timely initiation (≤90 days postsurgery), and completion of radiotherapy and chemotherapy, as well as adherence (medication possession ratio ≥80%) and persistence (<90-consecutive day gap) of endocrine therapy in the first year of treatment for women with diabetes compared with women without diabetes. Analyses were adjusted for sociodemographic and tumor factors. RESULTS: Among 3704 women undergoing definitive surgery, the mean (SD) age was 51.4 (8.6) years, 1038 (28.1%) were non-Hispanic Black, 2598 (70.1%) were non-Hispanic White, 765 (20.7%) had a diabetes history, 2369 (64.0%) received radiotherapy, 2237 (60.4%) had chemotherapy, and 2505 (67.6%) took endocrine therapy. Compared with women without diabetes, women with diabetes were less likely to utilize radiotherapy (OR, 0.67; 95% CI, 0.53-0.86), receive chemotherapy (OR, 0.67; 95% CI, 0.48-0.93), complete chemotherapy (OR, 0.71; 95% CI, 0.50-0.99), and be adherent to endocrine therapy (OR, 0.71; 95% CI, 0.56-0.91). There were no significant associations of diabetes with utilization (OR, 0.95; 95% CI, 0.71-1.28) and persistence (OR, 1.09; 95% CI, 0.88-1.36) of endocrine therapy, timely initiation of radiotherapy (OR, 1.09; 95% CI, 0.86-1.38) and chemotherapy (OR, 1.09; 95% CI, 0.77-1.55), or completion of radiotherapy (OR, 1.25; 95% CI, 0.91-1.71). CONCLUSIONS AND RELEVANCE: In this cohort study, preexisting diabetes was associated with subpar adjuvant therapies for breast cancer among low-income women. Improving diabetes management during cancer treatment is particularly important for low-income women with breast cancer who may have been disproportionately affected by diabetes and are likely to experience disparities in cancer treatment and outcomes.

Poor Sleep Quality and Factors Among Reproductive-Age Women in Southwest Ethiopia.

Background: Adequate sleep is vital for physical and mental wellbeing. Sleep-related problems including poor quality of sleep have been increasing throughout the world among reproductive-aged women. Poor sleep quality has been related with number of diseases and health problems However, evidences are scarce regarding poor sleep quality and its associated factors among women of the reproductive age group in Ethiopia. Objective: To assess sleep quality and associated factors among women of reproductive age group in Mizan Aman town, Southwest Ethiopia. Method: Community-based cross-sectional study was conducted among 606 reproductive-aged women from 06 November to 20 December 2020, in Mizan Aman town. Data were collected using structured interview administered questionnaires. Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. Multivariable logistic regression was applied using an adjusted odds ratio with a corresponding 95% confidence interval to evaluate the statistical significance of associated factors. Result: The overall prevalence of poor sleep quality was 71.3%. The late age group of 42-49 (AOR, 95% CI; 1.21 (1.08-5.76), palpable/visible thyroid gland (AOR, 95% CI; 2. 12 (1.08-3.82), current substance use (AOR, 95% CI; 1.76 (1.11-6.10) and having premenstrual syndrome (AOR, 95% CI; 1.86 (1.38-3.12) were significantly associated with poor sleep quality among reproductive age group women. Conclusion: Significant majority of reproductive age group women faced poor sleep quality. Therefore, screening of sleep patterns among this particular age group is warranted. Moreover, education about sleep hygiene needs to be given considering the identified factors to improve sleep quality.

Factors Associated With HIV Preventive Behavior Among Adults in Majang Zone of Gambella Region, Southwest Ethiopia.

Background: HIV-positive people can spread the virus through unprotected sex; however, HIV can be avoided if populations are educated about the risks. In underdeveloped nations, evidence suggests that the ABC method for HIV prevention is quite effective. As a result, the goal of this study was to determine the magnitude of HIV prevention behavior among adults in the Majang zone of Southwest Ethiopia, as well as the factors that influence it. Methods: A community-based cross-sectional study was carried out from March 1st to May 31st, 2019. The data were collected through a face-to-face interview using a modified validated questionnaire among systematically selected study participants. The collected data were coded and entered using Epidata manager version 4.0.2.101 and analyzed using SPSS version 21. A logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. The level of significance was declared at a p-value less than 0.05. Results: Of the 772 adults interviewed, the proportion of adults who had good HIV preventive behavior was 51.8%, 95% CI [48.3-55.3%]. Two hundred forty (31.9%) were used abstinence as a type of HIV preventive behavior followed by being faithful (16.1%) and consistent condom use (7.3%). The study also found that respondents with the age group ≥27 years old (AOR = 1.56, 95% CI [1.3-3.12]), marital status (being married (AOR = 6.30, 95% CI [4.48-11.4]), and divorced/widowed (AOR = 5.50, 95% CI [2.60-12.4]) and having good knowledge of HIV prevention methods (AOR = 2.18, 95% CI [1.71-4.00]) were the factors associated with good HIV preventive behavior. Conclusion and Recommendation: In the study area, overall HIV prevention behavior was average. The characteristics linked with successful HIV prevention behavior among adults in the Majang community included increasing age, being married or divorced/widowed, and having a solid understanding of HIV prevention approaches. As a result, policy-level and multi-sectorial intervention approaches from all stakeholders are necessary to develop short- and long-term strategies to address the problem and improve the community's quality of life.

The Effect of the COVID-19 Pandemic on the Social Inequalities of Health Care Use in Hungary: A Nationally Representative Cross-Sectional Study.

BACKGROUND: The social representation of restricted health care use during the COVID-19 pandemic has not been evaluated properly yet in Hungary. OBJECTIVE: Our study aimed to quantify the effect of COVID-19 pandemic measures on general practitioner (GP) visits, specialist care, hospitalization, and cost-related prescription nonredemption (CRPNR) among adults, and to identify the social strata susceptible to the pandemic effect. METHODS: This cross-sectional study was based on nationally representative data of 6611 (Nprepandemic = 5603 and Npandemic = 1008) adults. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing health care use by odds ratios (ORs) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to the pandemic effect, the interaction of the time of data collection with the level of education, marital status, and Roma ethnicity, was tested and described by iORs. RESULTS: While the CRPNR did not change, the frequency of GP visits, specialist care, and hospitalization rates was remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic. Roma proved to be not specifically affected by the pandemic in any studied aspect, and the pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (iORGP visits, high-school vs. primary-education = 0.434; 95% CI 0.243-0.776, ORspecialist visit, high-school vs. primary-education = 0.598; 95% CI 0.364-0.985), and stronger among married adults (iORGP visit, widowed vs. married = 2.284; 95% CI 1.043-4.998, iORspecialist visit, widowed vs. married = 1.915; 95% CI 1.157-3.168), on the frequency of GP visits and specialist visits. The prepandemic CRPNR inequality by the level of education was increased (iORhigh-school vs. primary-education = 0.236; 95% CI 0.075-0.743). CONCLUSION: Primary educated and widowed adults did not follow the general trend, and their prepandemic health care use was not reduced during the pandemic. This shows that although the management of pandemic health care use restrictions was implemented by not increasing social inequity, the drug availability for primary educated individuals could require more support.

Public health interventions on prescription redemptions and secondary medication adherence among type 2 diabetes patients: systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Despite the inadequate filling of prescriptions among chronic care patients has been a problem, little is known about the intervention effect on it. OBJECTIVE: The aim of this systematic review and meta-analysis (SRMA) was to investigate the effectiveness of various public health interventions on primary and secondary medication adherence among T2DM patients. METHODS: Searching was done from the major databases; Cochrane Library, Medline/PubMed, EBSCOhost, and SCOPUS. A hand search was made to find grey works of literature. Articles focused on interventions to enhance primary and secondary medication among type 2 diabetes mellitus patients were included. After screening and checking eligibility, the methodological quality was assessed. Secondary medication adherence was synthesized descriptively due to measurement and definition variations across studies. Finally, a meta-analysis was made using the fixed effects model for primary medication adherence. RESULTS: 3992 studies were screened for both primary and secondary medication adherences. Among these, 24 studies were included in the analysis for primary (5) and secondary (19) medication adherence. Pooled relative medication redemption difference was RD = 8% (95% CI: 6-11%) among the intervention groups. Age, intervention, provider setting, and IDF region were determinant factors of primary medication adherence. About two-thirds of the studies revealed that interventions were effective in improving secondary medication adherence. CONCLUSION: Both primary and secondary medications were enhanced by a variety of public health interventions for patients worldwide. However, there is a scarcity of studies on primary medication adherence globally, and in resource-limited settings for the type of adherences. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00878-0.

Short-term insomnia symptoms are associated with level and not type of physical activity in a sample of Indian college students.

OBJECTIVE: There is diverse results on the association between physical activity and sleep. So this study investigated association of level and type of physical activity with short term insomnia among college students. METHODS: A cross sectional study was conducted among college students in India. The sample was 662 students with 359 males and 303 females. The predictor variables were type and level of physical activity and predicted variables were sleep complaints.Physical activity components were aseesesed through international physical activity questionnaire and sleep complaints using Pitsburg sleep questionnaire. The binary logistic regression models were used for data analysis. Level of significance was set at p ≤ 0.05 for all the analysis. RESULTS: The age (mean + SD) of the participants were 23.2 ± 3.5 years. The self reported symptoms of short trem insomnia such as global sleep quality (adjusted odds ratio(AOR) = 15.58), subjective sleep quality (AOR = 6.01), sleep latency (AOR = 5.09), sleep duration (AOR = 0.13), sleep disturbances (AOR = 4.88), day time sleep dysfunction (AOR = 5.59) had shown association with level of physical activity. There was no association of type of physical activity with any other predicted variables. CONCLUSIONS: The findings of the present study supports that level of physical activity is a key predictor of short term insomnia symptoms among college students. There should be Interventions to maintain and improve the level of physical activity among students.

Is Prescription Nonredemption a Source of Poor Health Among the Roma? Cross-Sectional Analysis of Drug Consumption Data From the National Health Insurance Fund of Hungary.

Background: The health status of the Roma is inferior to that of the general population. The causes of poor health among this population are still ambiguous, but they include low utilization of healthcare services. Our study aimed to investigate prescription redemptions in segregated Roma colonies (SRC) where the most disadvantaged quartile of Roma people are living. Methods: A cross-sectional study was carried out with data obtained from the National Institute of Health Insurance Fund Management in the settlements belonging to the study area of the "Public Health-Focused Model Program for Organizing Primary Care Services." The study included 4,943 residents of SRC and 62,074 residents of the complementary area (CA) of the settlements where SRC were located. Crude and age- and sex-standardized redemption ratios for SRC and CA were calculated for each Anatomic Therapeutic Chemical (ATC) group and for the total practice by ATC group. Standardized relative redemptions (RR) with 95% confidence intervals were calculated for SRC, with CA as a reference. Results: The crude redemption ratios were 73.13% in the SRC and 71.15% in the CA. RRs were higher in the SRC than in the CA for cardiovascular, musculoskeletal system, and alimentary tract and metabolism drugs (11.5, 3.7, and 3.5%, respectively). In contrast, RRs were lower in the SRC than in the CA for anti-infective agents (22.9%) due to the poor redemption of medicines prescribed for children or young adults. Despite the overall modest differences in redemption ratios, some ATC groups showed remarkable differences. Those include cardiovascular, alimentary and musculoskeletal drugs. Conclusion: Redemption of prescriptions was significantly higher among Roma people living in SRC than among those living in CA. The better redemption of cardiovascular and alimentary tract drugs was mainly responsible for this effect. These findings contradict the stereotype that the Roma do not use health services properly and that prescription non-redemption is responsible for their poor health.

Diabetes mellitus, metabolic syndrome, and physical activity among Ethiopians: A systematic review.

BACKGROUND AND AIMS: The incidence of diabetes mellitus (DM) is increasing worldwide, and there is growing appreciation for the impact of limited physical activity on the disease. This study aimed to determine whether the current research on DM in Ethiopia has sufficiently identified and focused on the importance of limited physical activity according to the Global Physical Activity Questionnaire (GPAQ) in the disease etiology. METHODS: This was a systematic review, performed according to the PRISMA checklist. We searched primary studies of diabetes, diabetes-related complications, determinants, and magnitude of related morbidities in Ethiopia in PubMed, Medline, and ISI Web of Science databases. Reviews, editorial communications, reports, and letters were excluded. RESULTS: Among 363 articles that were identified from all databases, 28 were included. It was found that 39% of the studies measured and included limited physical activity as a predisposing lifestyle factor in diabetes, while 17.86% either did not report or did not include this variable at all. Although 42.86% of the studies identified limited physical activity as an etiological factor in diabetes, it was not measured according to the GPAQ guidelines. CONCLUSIONS: These data suggest that Ethiopian researchers do not give sufficient attention to the role of physical activity and its definition per GPAQ as a preventative factor for reducing the severity of diabetes symptoms. We suggest that physical activity research and promotion should be advocated in Ethiopia, and that researchers should seek advice on how to re-frame their work in the future.

Effect of diabetes self-management education (DSME) on glycated hemoglobin (HbA1c) level among patients with T2DM: Systematic review and meta-analysis of randomized controlled trials.

BACKGROUND AND AIMS: Type 2 Diabetes mellitus (T2DM) has been a global public health issue causing in physical, financial and psychosocial crises. The aim of this systematic review and meta-analysis (SRMA) was to evaluate the Diabetes Self-Management Education or Support (DSME/S) on glycosylated hemoglobin (HbA1c) among T2DM patients. METHODS: This SRMA was made according to preferred reporting Items for systematic review and Meta-analysis (PRISMA) guidelines. The relevant articles were searched from four databases: Cochrane Library, MEDLINE (EBSCOhost), MEDLINE/PubMed and SCOPUS. Quality assessment was carried out. Pooled standard mean difference in HbA1c were calculated to obtain the effect size with random effect assumption. Subgroup analysis was conducted for assessing heterogeneity among the studies. RESULTS: A total of 1312 studies were identified from databases. Among these 25 studies met inclusion criteria. From these 20 were included in the meta-analysis. In meta-analysis a pooled standard mean difference in HbA1c was -0.604 (95% confidence interval = -0.854 -0.353, I2 = 90.3, p < 0.001). In subgroup analysis a significant reduction was seen among studies with less than four months, upper middle followed by lower middle income countries (LMICs), Western Pacific (WP) followed by Middle Eastern and Northern African (MENA) regions with moderate to substantial heterogeneity. CONCLUSION: However, there is paucity of studies in underdeveloped countries. Therefore, further studies validated to these contexts are needed to evaluate the DSME effectiveness. TRIAL REGISTRATION: PROSPERO database CRD42020124236.

Exclusive breastfeeding cessation and associated factors among employed mothers in Dukem town, Central Ethiopia.

BACKGROUND: Employed women tend to exclusively breastfeed less than non-employed women. Early returning to work has been major reason why employed women stop exclusive breastfeeding. The aim of this study was to investigate exclusive breastfeeding (EBF) cessation and associated factors among employed mothers in Dukem town, Central Ethiopia. METHODS: A cross-sectional study was conducted from February to March 2015 using total sample of 313 randomly selected permanently employed women. Information regarding participants' work-related factors, health service and sociodemographic factors were collected by face to face interview using structured questionnaire. Data were checked for completeness, entered and analyzed by SPSS version 20. Binary logistic regression was done to identify factors associated with exclusive breastfeeding cessation. The strength of association was measured using odds ratio with 95% confidence intervals. RESULTS: Prevalence of exclusive breastfeeding cessation was 75.7% (95% CI 71.0, 80.5%). Having a short duration of maternity leave (AOR 9.3; 95% CI 3.8, 23), being a full time employee (AOR 3.5; 95% CI 1.7, 11), being private organization employee (AOR=2.1, 95% CI(1, 4.3)), lack of flexible work time (AOR 3.0; 95% CI 1.2, 7.5), not pumping breast milk (AOR 4.3; 95% CI 1.7, 11), lack of a lactation break (AOR 6.7; 95% CI 3,14.5) and work place far away from her child (AOR 3.1; 95% CI 3.1, 6.3), were significantly associated with cessation of EBF among employed mothers. CONCLUSION: Prevalence of exclusive breastfeeding cessation was much higher than the international and national expectation. The concerned governmental bodies should consider improving the legislation of the 3 months postpartum maternity leave to reduce employed mother's exclusive breastfeeding cessation.

The Effect of Haplotypes in the CETP and LIPC Genes on the Triglycerides to HDL-C Ratio and Its Components in the Roma and Hungarian General Populations.

BACKGROUND: The triglycerides (TG) to high-density lipoprotein (HDL)-cholesterol (HDL-C) ratio (TG/HDL-C) is a well-known predictor for cardiovascular diseases (CVDs) with great heritability background. The cholesteryl ester transfer protein (CETP) and hepatic lipase (LIPC) gene affect TG/HDL-C ratio. This study aims to explore the association between haplotypes (H) in CETP (based on 5 single nucleotide polymorphisms (SNPs)) and LIPC (based on 6 SNPs) genes and the TG/HDL-C ratio and its components, among Roma and Hungarian general populations. METHODS: The prevalence of haplotypes and their effect on HDL-C, TG and TG/HDL-C ratio were calculated in both populations and compared. RESULTS: Ten haplotypes in CETP and 6 in LIPC gene were identified. Three haplotypes in CETP and 3 in LIPC have significant effect on HDL-C level, whereas two in CETP and 3 in LIPC on TG level. The H6 in CETP (ß = 0.52, p = 0.015; odds ratio (OR) = 1.87, p = 0.009) and H5 in LIPC (ß = 0.56, p < 0.001; OR = 1.51, p = 0.002) have a significant increasing effect on TG/HDL-C ratio and have shown higher prevalence among the Roma, as compared to Hungarian general population. The H2 in the CETP gene has a decreasing effect on the TG/HDL-C ratio (OR = 0.58, p = 0.019) and is significantly less frequent among the Roma. CONCLUSIONS: Accumulation of harmful haplotypes in CETP and LIPC genes might have a role in the elevated TG/HDL-C ratio in the Roma population, which contributes to a higher risk in the development of cardiovascular diseases.

The effectiveness of diabetes self-management education (DSME) on glycemic control among T2DM patients randomized control trial: systematic review and meta-analysis protocol.

BACKGROUND: Type 2 Diabetes mellitus (T2DM) has been a global pandemic resulting in physical, financial and psychosocial crises. Thus, it is important to investigate pooled effectiveness of Diabetes Self-Management Education (DSME) on glycemic control among T2DM patients. OBJECTIVE: The aim of this systematic review and meta-analysis is to investigate the association between DSME or Support (DSME/S) and glycemic control among T2DM patients. METHODS: The systematic review and meta-analysis will include studies conducted throughout the world from 2010 to 2019. T2DM patients and their clinical, anthropometric, biomarkers from baseline to end line will be recorded. We will search all relevant articles from five databases namely; Cochrane Library, BioMed Central, MEDLINE (EBSCOhost), MEDLINE/PubMed and SCOPUS. Key terms will be used for questing relevant articles. Further efforts will be made to check quality of studies base on quality assessment instruments. Finally, the report will be made according Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Pooled standard mean difference in HbA1c will be used to calculate the effect size between the variables with random effects analysis assumption. Further subgroup analysis will be carried out for assessing the risk difference among groups. CONCLUSION: Based on the existing and eligible researches this systematic review and meta-analysis will bring the best evidence on the effectiveness of DSME/S on glycemic control among the T2DM patients. Moreover, the subgroup analysis will inform the effectiveness heterogeneity based on continent, International Diabetes Federation (IDF) region, intervention period, World bank economic classification and glycemic markers used to follow the patients. The proposed review has been registered in the International PROSPERO website with registration number CRD42020124236.

Prevalence of poor sleep quality in the Ethiopian population: a systematic review and meta-analysis.

BACKGROUND: Only a limited amount of data is available from lower-income countries regarding the prevalence of poor quality of sleep. This meta-analysis of the scientific literature was performed to estimate the pooled prevalence of poor sleep quality in the Ethiopian population. METHODS: The study protocol followed was the Preferred Reporting of Items for Systematic Review and meta-analysis (PRISMA) statement. RESULTS: The nine studies which met the inclusion criteria provided data based on a total of 9103 participants who were studied at various health and academic institutions. The incidences of self-reported poor sleep quality ranged from 26 to 66.2%. The pooled estimate of poor sleep quality was 53%.There was a high prevalence of reported poor quality of sleep among younger subjects and among those who were studied in community (noninstitutional) settings. CONCLUSION: The pooled prevalence of poor sleep quality is quite high among Ethiopians.

The significant association between maternity waiting homes utilization and perinatal mortality in Africa: systematic review and meta-analysis.

OBJECTIVE: A proper uptake of maternity waiting homes (MWHs) is important to improve maternal and child health (MCH). The aim of this review is to generate the best existing evidences concerning the MWHs utilization and its impact on perinatal mortality (PNM) among pregnant mothers in Africa. Both relevant quantitative and qualitative studies, investigated and reported from databases were explored. Meta-analysis of the studies was displayed by tables and forest plots. The Stata version 14 was used with the fixed effect model and 95% confidence interval. RESULTS: In this review, a total of 68,805 births were recorded in this review. About 1.6% and 7.2% PNM occurred among non-exposed and exposed mothers respectively. Fifty percent of the studies showed there is a significant association between MWHs use and PNM. Meta-analysis revealed that utilizing MWHs have a significant effect in a reducing PNM by 82.5% (80.4%-84.5%), I2 = 96.5%. Therefore, use of MWHs has a potential to reduce PNM among pregnant mothers. The review revealed that MWHs relevance to achieving sustainable development goals (SDGs) concerning reducing newborn mortality. Therefore, the utilization rate of MWHs must be enhanced to achieve SDGs.

The prevalence of macro and microvascular complications of DM among patients in Ethiopia 1990-2017: Systematic review.

BACKGROUND: The prevalence of diabetes mellitus (DM) has been growing rapidly in the world. It is smashing particularly the lower and middle income countries (LMICs) severely. Due to its acute and chronic complications many lives have fallen under its bad shadow. Therefore, we aimed to review the existing evidence on major types and specific complications of DM among diabetic patients in Ethiopia. METHODS: Both relevant quantitative and qualitative studies, conducted after 1990s, investigated and reported DM and complications from MEDLINE/PubMed, CINAHL, SCOPUS, DAOJ and Cochrane library databases were explored. In addition, System for Information for grey literature in Europe (SINGLE) database was investigated for the existence of unpublished grey literature. Total of 161 titles were identified and 17 studies met the inclusion criteria. Findings were narrated descriptively. RESULTS: In this review 17 studies were included, and both macro and micro complications were summarized. Among the diabetic complications retinopathy, nephropathy, metabolic syndrome, impotence and depression were the main findings among diabetic patients in Ethiopia. CONCLUSION: The burden of DM and its microvascular and macrovascular complications have been increasing among diabetic patients in Ethiopia. The increased duration of the diseases, lower socio economic level, existence of other complications, old age attributed the diabetic complications. Therefore, close monitoring and follow up of diabetic patients is necessary to reduce the incidence and prevalence of diabetic complications among the patients.

Role of maternity waiting homes in the reduction of maternal death and stillbirth in developing countries and its contribution for maternal death reduction in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Every family expect to have a healthy mother and new born baby after pregnancy. Especially for parents, pregnancy is a time of great anticipation. Access to maternal and child health care insures safer pregnancy and its outcome. MWHs is one the strategy. The objective was to synthesize the best available evidence on effectiveness of maternity waiting homes on the reduction of maternal mortality and stillbirth in developing countries. METHODS: Before conducting this review non-occurrences of the same review is verified. To avoid introduction of bias because of errors, two independent reviewers appraised each article. Maternal death and stillbirth were the primary outcomes. Review Manager 5 were used to produce a random-effect meta-analysis. Grade Pro software were used to produce risk of bias summary and summary of findings. RESULT: In developing countries, maternity waiting homes users were 80% less likely to die than non-users (OR = 0. 20, 95% CI [0.08, 0.49]) and there was 73% less occurrence of stillbirth among users (OR = 0.27, 95% CI [0.09, 0.82]). In Ethiopia, there was a 91% reduction of maternal death among maternity waiting homes users unlike non-users (OR = 0.09, 95% CI [0.04, 0.19]) and it contributes to the reduction of 83% stillbirth unlike non-users (OR = 0.17, 95% CI [0.05, 0.58]). CONCLUSION: Maternity waiting home contributes more than 80% to the reduction of maternal death among users in developing countries and Ethiopia. Its contribution for reduction of stillbirth is good. More than 70% of stillbirth is reduced among the users of maternity waiting homes. In Ethiopia maternity waiting homes contributes to the reduction of more than two third of stillbirths.

Slaying little dragons: the impact of the Guinea Worm Eradication Program on dracunculiasis disability averted from 1990 to 2016.

Background: The objective of this study was to document the worldwide decline of dracunculiasis (Guinea worm disease, GWD) burden, expressed as disability-adjusted life years (DALYs), from 1990 to 2016, as estimated in the Global Burden of Disease study 2016 (GBD 2016). While the annual number of cases of GWD have been consistently reported by WHO since the 1990s, the burden of disability due to GWD has not previously been quantified in GBD. Methods: The incidence of GWD was modeled for each endemic country using annual national case reports. A literature search was conducted to characterize the presentation of GWD, translate the clinical symptoms into health sequelae, and then assign an average duration to the infection. Prevalence measures by sequelae were multiplied by disability weights to estimate DALYs. Results: The total DALYs attributed to GWD across all endemic countries (n=21) in 1990 was 50,725 (95% UI: 35,265-69,197) and decreased to 0.9 (95% UI: 0.5-1.4) in 2016. A cumulative total of 12,900 DALYs were attributable to GWD from 1990 to 2016. Conclusions: Using 1990 estimates of burden propagated forward, this analysis suggests that between 990,000 to 1.9 million DALYs have been averted as a result of the eradication program over the past 27 years.