Prevalence of osteoarthritis in lower middle- and low-income countries: a systematic review and meta-analysis.

Evidence from the Global Burden of Disease studies suggests that osteoarthritis (OA) is a significant cause of disability globally; however, it is less clear how much of this burden exists in low-income and lower middle-income countries. This study aims to determine the prevalence of OA in people living in low-income and lower middle-income countries. Four electronic databases (MEDLINE, EMBASE, CINAHL and Web of Science) were systematically searched from inception to October 2018 for population-based studies. We included studies reporting the prevalence of OA among people aged 15 years and over in low-income and lower middle-income countries. The prevalence estimates were pooled across studies using random effects meta-analysis. Our study was registered with PROSPERO, number CRD42018112870.The search identified 7414 articles, of which 356 articles were selected for full text assessment. 34 studies were eligible and included in the systematic review and meta-analysis. The pooled prevalence of OA was 16·05% (95% confidence interval (CI) 12·55-19·89), with studies demonstrating a substantial degree of heterogeneity (I2 = 99·50%). The pooled prevalence of OA was 16.4% (CI 11·60-21.78%) in South Asia, 15.7% (CI 5·31-30·25%) in East Asia and Pacific, and 14.2% (CI 7·95-21·89%) in Sub Saharan Africa. The meta-regression analysis showed that publication year, study sample size, risk of bias score and country-income categories were significantly associated with the variations in the prevalence estimates. The prevalence of OA is high in low-income and lower middle-income countries, with almost one in six of the study participants reported to have OA. With the changing population demographics and the shift to the emergence of non-communicable diseases, targeted public health strategies are urgently needed to address this growing epidemic in the aging population.

Interventions for HIV-associated nephropathy.

BACKGROUND: Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretroviral therapy, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. OBJECTIVES: To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. SEARCH METHODS: In January 2012 we searched the Cochrane Renal Group's Specialised Register, AIDS Education Global Information System (AEGIS database), ClinicalTrial.gov, the WHO International Clinical Trials Registry Portal, and reference lists of retrieved articles without language restrictions. In our original review we searched CENTRAL, MEDLINE, EMBASE, and AIDSearch, in addition to contacting individual researchers, research organisations and pharmaceutical companies. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. DATA COLLECTION AND ANALYSIS: We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. For dichotomous outcomes results were to be expressed as risk ratios with 95% confidence intervals, and for continuous scales of measurement the mean difference was to be used. MAIN RESULTS: We identified four relevant ongoing studies: one is still ongoing; two have completed recruitment but are yet to be published; and the fourth study was suspended for unspecified reasons. No completed RCTs or quasi-RCTs were identified. We summarised and tabulated the data from the observational studies, however no formal analyses were performed. AUTHORS' CONCLUSIONS: There is currently no RCT-based evidence upon which to base guidelines for the treatment of HIVAN, however three ongoing studies have been identified. Data from observational studies suggest steroids and angiotensin-converting enzyme inhibitors appear to improve kidney function in patients with HIVAN, however no formal analyses were performed in this review. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.

Interventions for the prevention of mycobacterium avium complex in adults and children with HIV.

BACKGROUND: Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and is an independent predictor of mortality and shortened survival. OBJECTIVES: To determine the effectiveness and safety of interventions aimed at preventing MAC infection in adults and children with HIV infection. SEARCH METHODS: We searched MEDLINE, EMBASE, and The Cochrane Library (search date December 2012). SELECTION CRITERIA: Randomised controlled trials comparing different strategies for preventing MAC infection in HIV-infected individuals. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details. Development of MAC infection and survival were compared using risk ratios (RR) and 95% confidence intervals (CI). The quality of evidence has been assessed using the GRADE methodology. MAIN RESULTS: Eight studies met the inclusion criteria. Placebo-controlled trials: There was no statistically significant difference between clofazimine and no treatment groups in the number of patients that developed MAC infection (RR 1.01; 95% CI 0.37 to 2.80). Rifabutin (one study; RR 0.48; 95% CI 0.35 to 0.67), azithromycin (three studies; RR 0.37; 95% CI 0.19 to 0.74) and clarithromycin (one study; RR 0.35; 95% CI 0.21 to 0.58) were more effective than placebo in preventing the development of MAC infection. There was no statistically significant difference between those treated with clofazimine (one study; RR 0.98; 95% CI 0.41 to 2.32), rifabutin (one study RR 0.91; 95% CI 0.78 to 1.05), azithromycin (three studies, pooled RR 0.96; 95% CI 0.69 to 1.32) and placebo in number of reported deaths. One study found that the risk of death was reduced by 22% in patients treated with clarithromycin compared to those treated with placebo (RR 0.78; 95% CI 0.64 to 0.96). Monotherapy vs. monotherapy: Patients treated with clarithromycin (RR 0.60; 95% CI 0.41 to 0.89) and azithromycin (RR 0.60; 95% CI 0.40 to 0.89) were 40% less likely to develop MAC infection than those treated with rifabutin. There was no statistically significant difference between those treated with clarithromycin (RR 0.98; 95% CI 0.83 to 1.15), azithromycin (RR 0.98; 95% CI 0.77 to 1.24) and rifabutin in the number of reported deaths. Combination therapy versus monotherapy: There was no statistically significant difference between patients treated with a combination of rifabutin and clarithromycin and those treated with clarithromycin alone (RR 0.74; 95% CI 0.46 to 1.20); and those treated with combination of rifabutin and azithromycin and those treated with azithromycin alone (RR 0.59; 95% CI 1.03). Patients treated with a combination of rifabutin plus clarithromycin were 56% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.44; 95% CI 0.29 to 0.69). Patients treated with a combination of rifabutin plus azithromycin were 65% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.35; 95% CI 0.21 to 0.59). There was no statistically significant difference in the number of reported deaths in all the four different comparisons of prophylactic agents. AUTHORS' CONCLUSIONS: Based on limited data, azithromycin or clarithromycin appeared to be a prophylactic agent of choice for MAC infection. Further studies are needed, especially direct comparison of clarithromycin and azithromycin. In additions, studies that will compare different doses and regimens are needed.

Social disorganization and history of child sexual abuse against girls in sub-Saharan Africa: a multilevel analysis.

BACKGROUND: Child sexual abuse (CSA) is a considerable public health problem. Less focus has been paid to the role of community level factors associated with CSA. The aim of this study was to examine the association between neighbourhood-level measures of social disorganization and CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 adolescents from six countries in sub-Saharan Africa between 2006 and 2008. RESULTS: The percentage of adolescents that had experienced CSA ranged from 1.04% to 5.84%. There was a significant variation in the odds of reporting CSA across the communities, suggesting 18% of the variation in CSA could be attributed to community level factors. Respondents currently employed were more likely to have reported CSA than those who were unemployed (odds ratio [OR]=2.05, 95% confidence interval [CI] 1.48 to 2.83). Respondents from communities with a high family disruption rate were 57% more likely to have reported CSA (OR=1.57, 95% CI 1.14 to 2.16). CONCLUSION: We found that exposure to CSA was associated with high community level of family disruption, thus suggesting that neighbourhoods may indeed have significant important effects on exposure to CSA. Further studies are needed to explore pathways that connect the individual and neighbourhood levels, that is, means through which deleterious neighbourhood effects are transmitted to individuals.

Exploring variations in under-5 mortality in Nigeria using league table, control chart and spatial analysis.

BACKGROUND: Under-5 mortality rate (U5MR) is the probability of a child born in a specific year or period dying before reaching the age of 5. Nigeria has a high rate of U5MR and accounts for a significant proportion of the high U5MR in sub-Sahara Africa. There are differences in health and social practice in the different states in Nigeria, coupled with the differences in developmental priorities of each State government. There is therefore the need to identify the states with high and low U5MR, to further explore the risk factors and make recommendations for planning. This study investigates variation in U5MR in Nigeria using Shewhart's theory of variation and control charts. METHODS: We used data from the birth histories included in the 2008 Nigerian Demographic and Health Survey to estimate U5MR using a synthetic cohort life table. We plotted control charts of the proportion of under-5 mortality for the 37 states (included federal capital Abuja) in Nigeria. The Local Indicators of Spatial Association was used as a measure of the overall clustering and is assessed by a test of a null hypothesis. RESULTS: On average, more than 1 in every 10 children born in Nigeria (159 per 1000 live births) does not survive to their fifth birthday. Kwara and Osun states had the lowest U5MR (less than 60 per 1000 live births), while Jigawa, Kano, Sokoto, Niger and Adamawa states had the highest U5MR (more than 200 per 1000 live births). There is a wide variation in the U5MR between the 37 states. The funnel plot identifies 27 (73%) states within the 99% control limits indicating common-cause variation. Four states were above the upper control limit (higher than the average) and six states were below the lower control limit (lower than the average), indicating special-cause variation. CONCLUSIONS: U5MR is high in Nigeria; the rates are in three digits. There is a wide variation in the U5MR in Nigeria, with 27% showing evidence of special-cause variation which merits further investigation to identify possible causes. However, the vast majority of states (73%) are consistent with common-cause variation.

The cost-utility analysis of adult male circumcision for prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa: a probabilistic decision model.

OBJECTIVE: The aim of this study was to assess the cost-utility of adult male circumcision (AMC) versus no AMC in the prevention of heterosexual acquisition of HIV in men in sub-Saharan Africa. METHODS: A decision tree was constructed and parameterized using data from published sources. The economic evaluation was conducted from the perspective of government health care payer. Benefits (disability adjusted life years [DALYs]) and costs were discounted at 3%. Costs were assessed in 2008 US dollars. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results. The uncertainty surrounding the estimates of cost effectiveness was illustrated through a cost-effectiveness acceptability curve and cost-effectiveness plane. RESULTS: In the base-case analysis, AMC can be regarded as cost saving because it is associated with higher DALYs gained and lower costs than no AMC. The probability that AMC is cost effective is above 0.96 at a threshold value of $150 and remains high over a wide range of threshold values. Thus, there is very little uncertainty surrounding the decision to adopt AMC for prevention of heterosexual acquisition of HIV in men. The results were found to be sensitive to varying any of the following parameters: DALYs averted, discount, and circumcision efficacy. CONCLUSIONS: AMC is found to be cost saving. AMC may be seen as a promising new form of strategy for prevention of heterosexual acquisition of HIV in men, but should never replace other known methods of HIV prevention and should always be considered as part of a comprehensive HIV prevention package.

Interventions for HIV-associated nephropathy.

BACKGROUND: Human immunodeficiency virus associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in Human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretrovirals, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. OBJECTIVES: To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. SEARCH STRATEGY: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Renal Group's specialised register, MEDLINE, EMBASE, AIDSearch, reference lists of articles and conference proceedings without language restrictions. We searched the international clinical trials registry platform search portal and also contacted individual researchers, research organisations and pharmaceutical companies that manufacture the drugs used for interventions. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. DATA COLLECTION AND ANALYSIS: We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. We applied the inclusion criteria to identify four relevant ongoing studies, one is ongoing while the remaining two have completed recruitment and are yet to be published. The fourth study was suspended for an unknown reason. MAIN RESULTS: No completed RCTs or quasi-RCTs were identified to be included in the study. AUTHORS' CONCLUSIONS: There is no RCT-based evidence upon which to base guidelines for the treatment of HIVAN. However, steroids and ACEI appear to improve the kidney function of patients in the observational studies that were identified. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.

A trend analysis and sub-regional distribution in number of people living with HIV and dying with TB in Africa, 1991 to 2006.

BACKGROUND: The tuberculosis (TB) bacillus and the Human Immunodeficiency Virus (HIV) have formed a powerful alliance and are together responsible for more than five million deaths per year. TB is leading to increased mortality rates among people living with HIV/acquired immunodeficiency syndrome (AIDS). The aim of this study was to investigate the geographical and temporal distribution of TB-HIV deaths in Africa in order to identify possible high-risk areas. METHODS: Time trends in the 16-year study period from 1990 to 2005 were analyzed by multilevel Poisson growth curve models. Moran global and local indicators of spatial associations were used to test for evidence of global and local spatial clustering respectively. RESULTS: Eastern, Southern, Western, and Middle Africa experienced an upward trend in the number of reported TB-HIV deaths. The spatial distribution of TB cases was non-random and clustered, with a Moran's I = 0.454 (p = .001). Spatial clustering suggested that 13 countries were at increased risk of TB-HIV deaths, and six countries could be grouped as "hot spots". CONCLUSION: Evidence shows that there is no decline in growth in the number of deaths due to TB among HIV positive in most Africa countries. There is presence of 'hot-spots' and very large differences persist between sub-regions. Only by tackling TB and HIV together will progress be made in reversing the burden of both diseases. There is a great need for scale-up of preventive interventions such as the World Health Organization '3I's strategy' (intensified case finding, isoniazid preventive therapy and infection control).

A population-based study of effect of multiple birth on infant mortality in Nigeria.

BACKGROUND: Multi-foetal pregnancies and multiple births including twins and higher order multiples births such as triplets and quadruplets are high-risk pregnancy and birth. These high-risk groups contribute to the higher rate of childhood mortality especially during early period of life. METHODS: We examined the relationship between multiple births and infant mortality using univariable and multivariable survival regression procedure with Weibull hazard function, controlling for child's sex, birth order, prenatal care, delivery assistance; mother's age at child birth, nutritional status, education level; household living conditions and several other risk factors. RESULTS: Children born multiple births were more than twice as likely to die during infancy as infants born singleton (hazard ratio = 2.19; 95% confidence interval: 1.50, 3.19) holding other factors constant. Maternal education and household asset index were associated with lower risk of infant mortality. CONCLUSION: Multiple births are strongly negatively associated with infant survival in Nigeria independent of other risk factors. Mother's education played a protective role against infant death. This evidence suggests that improving maternal education may be key to improving child survival in Nigeria. A well-educated mother has a better chance of satisfying important factors that can improve infant survival: the quality of infant feeding, general care, household sanitation, and adequate use of preventive and curative health services.

Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse: a multilevel analysis of six countries in Sub-Saharan Africa.

BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008. RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata. CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents' experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries' political, social, economic, legal, and cultural impact on childhood sexual abuse.

A comparative study of the socioeconomic factors associated with childhood sexual abuse in sub-Saharan Africa.

BACKGROUND: Childhood sexual abuse (CSA) is a problem of considerable proportion in Africa where up to one-third of adolescent girls report their first sexual experience as being forced. The impact of child hood sexual abuse resonates in all areas of health. The aim of this study was to describe the prevalence of childhood sexual abuse and variations across socioeconomic status in six sub-Saharan countries. METHODS: Datasets from Demographic and Health Surveys (DHS) in six sub-Saharan African countries conducted between 2003 and 2007 were used to access the relationship between CSA and socio economic status using multiple logistic regression models. RESULTS: There was no association between CSA and education, wealth and area of settlement. However, there was contrasting association between CSA and working status of women. CONCLUSION: This study concurs with other western studies which indicate that CSA transcends across all socio economic group. It is therefore important that effective preventive strategies are developed and implemented that will cross across all socio-economic groups.