Effectiveness of nirmatrelvir/ritonavir and molnupiravir in non-hospitalized adults with COVID-19: systematic review and meta-analysis of observational studies.

OBJECTIVE: To determine the effectiveness of nirmatrelvir/ritonavir and molnupiravir among vaccinated and unvaccinated non-hospitalized adults with COVID-19. METHODS: Observational studies of nirmatrelvir/ritonavir or molnupiravir compared to no antiviral drug treatment for COVID-19 in non-hospitalized adults with data on vaccination status were included. We searched MEDLINE, EMBASE, Scopus, Web of Science, WHO COVID-19 Research Database and medRxiv for reports published between 1 January 2022 and 8 November 2023. The primary outcome was a composite of hospitalization or mortality up to 35 days after COVID-19 diagnosis. Risk of bias was assessed with ROBINS-I. Risk ratios (RR), hazard ratios (HR) and risk differences (RD) were separately estimated using random-effects models. RESULTS: We included 30 cohort studies on adults treated with nirmatrelvir/ritonavir (n = 462 279) and molnupiravir (n = 48 008). Nirmatrelvir/ritonavir probably reduced the composite outcome (RR 0.62, 95%CI 0.55-0.70; I2 = 0%; moderate certainty) with no evidence of effect modification by vaccination status (RR Psubgroup = 0.47). In five studies, RD estimates against the composite outcome for nirmatrelvir/ritonavir were 1.21% (95%CI 0.57% to 1.84%) in vaccinated and 1.72% (95%CI 0.59% to 2.85%) in unvaccinated subgroups.Molnupiravir may slightly reduce the composite outcome (RR 0.75, 95%CI 0.67-0.85; I2 = 32%; low certainty). Evidence of effect modification by vaccination status was inconsistent among studies reporting different effect measures (RR Psubgroup = 0.78; HR Psubgroup = 0.08). In two studies, RD against the composite outcome for molnupiravir were -0.01% (95%CI -1.13% to 1.10%) in vaccinated and 1.73% (95%CI -2.08% to 5.53%) in unvaccinated subgroups. CONCLUSIONS: Among cohort studies of non-hospitalized adults with COVID-19, nirmatrelvir/ritonavir is effective against the composite outcome of severe COVID-19 independent of vaccination status. Further research and a reassessment of molnupiravir use among vaccinated adults are warranted. REGISTRATION: PROSPERO CRD42023429232.

Life-course trajectories of body mass index and cardiovascular disease risks and health outcomes in adulthood: Systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to assess the effect of life course body mass index (BMI) trajectories (childhood to adulthood) on cardiovascular disease (CVD) risk factors and outcomes. METHODS: Prospective or retrospective cohort studies were identified that assessed the association of BMI trajectories with CVD risks and outcomes from databases published in English. The pooled effect sizes were estimated using a random-effects model. FINDINGS: Seventeen eligible studies were included in this systematic review. The results revealed that a persistently overweight trajectory from childhood to adulthood was associated with a higher risk of hypertension (RR: 2.49; 95% CI: 1.9, 3.28) and type 2 diabetes (RR: 4.62; 95% CI: 2.36, 9.04) compared with a trajectory characterized by a normal BMI throughout both childhood and adulthood. Similarly, the risk of hypertension (RR: 2.38; 95% CI: 1.70, 3.33) and type 2 diabetes (RR: 3.66; 95% CI: 2.57, 5.19) was higher in those with normal-to-overweight trajectory compared with participants with a stable normal weight trajectory. CONCLUSION: The findings suggest that lifetime BMI trajectories may be influential on health outcomes, and preventive strategies should be designed accordingly. Implementing appropriate preventive strategies at all life stages may reduce CVD risks and adverse outcomes later in life.

Burdens of non-communicable disease attributable to metabolic risk factors in Australia, 1990-2019: joinpoint regression analysis of the Global Burden of Disease Study.

BACKGROUND: Long-term and comparative assessments of trends in non-communicable disease (NCD) burden attributable to metabolic risk are sparse. This study aimed to assess burdens and trends of NCD attributable to metabolic risk factors in Australia, 1990-2019. DESIGN: Population-based observational study. SETTINGS AND DATA SOURCE: Data were extracted from the Global Burden of Disease Study 2019 for Australia and trends in NCD burden attributable metabolic risks were estimated using the joinpoint regression model. MAIN OUTCOME MEASURES: NCD deaths and disability-adjusted life-years (DALYs) attributed to metabolic risk factors, 1990-2019. RESULTS: Results indicate a 1.1% yearly increase in exposure to combined metabolic risk factors from 1990 to 2019. Between 1990 and 2019, the estimated absolute number of deaths from NCDs attributed to combined metabolic risks increased by 17.0%. However, metabolic risk-related NCD burdens in Australia decreased between 1990 and 2019. In 2019, 34.0% of NCD deaths and 20.0% of NCD DALYs were attributed to metabolic risk factors, compared with 42.9% and 24.4%, respectively, in 1990. In 2019, cardiovascular diseases (CVDs), neoplasms and chronic kidney diseases were the most common NCD deaths attributed to metabolic risks. High body mass index accounted for the highest proportion of diabetes deaths (47.0%) and DALYs (58.1%) as well as chronic kidney disease deaths (35.4%) and DALYs (39.7%). Similarly, high systolic blood pressure contributed to a high proportion of chronic kidney disease deaths (60.9%) and DALYs (53.2%), and CVDs deaths (44.0%) and DALYs (46.0%). CONCLUSION: While the contribution of metabolic risk factors to the burden of NCDs has declined from 1990 to 2019, their role in NCD death and disability remains a challenge as the prevalence of these risk factors has increased. Prevention strategies should focus on metabolic risks particularly high body mass index and high systolic blood pressure to substantially reduce NCD burdens.

The effect of dietary patterns on maternal anaemia in North Shewa, Ethiopia: A case-control study with Propensity Score Analysis.

OBJECTIVE: This study aimed to assess the effect of dietary patterns during pregnancy on anaemia. DESIGN, SETTING AND PARTICIPANTS: A case-control study with propensity score analysis was conducted among pregnant women selected from five health facilities in North Shewa Zone, Ethiopia from November 2018 to March 2019. A multivariable conditional logistic regression model was applied after propensity score matching to assess the effect of dietary patterns on anaemia, and a p < 0.05 was taken as significant. Four hundred and seventeen pregnant women were included (105 cases and 312 controls) with a 1:3 case-to-control ratio. Cases were pregnant women with a haemoglobin level <11 gram/Deci litter (g/dL), and controls were pregnant women with a haemoglobin level ≥11.0 g/dL. RESULTS: A low dietary diversity score (adjusted odd ratio (AOR) = 2.14; 95% confidence interval (CI): 1.24, 3.69), reducing food intake (AOR = 6.89; 95% CI: 3.23, 14.70) and having no formal education (AOR = 3.13; 95% CI: 1.18, 8.32) were associated with higher odds of anaemia among pregnant women. CONCLUSIONS: During pregnancy, intake of a low diversified diet, reduced food intake and low educational status were associated with higher odds of anaemia. Dietary counselling should be emphasised and strengthened in the existing prenatal health service program, with women strongly encouraged to increase their diversified food intake instead of reducing it during pregnancy.

Effects of exercise-based cardiac rehabilitation delivery modes on exercise capacity and health-related quality of life in heart failure: a systematic review and network meta-analysis.

BACKGROUND: This review aimed to compare the relative effectiveness of different exercise-based cardiac rehabilitation (ExCR) delivery modes (centre-based, home-based, hybrid and technology-enabled ExCR) on key heart failure (HF) outcomes: exercise capacity, health-related quality of life (HRQoL), HF-related hospitalisation and HF-related mortality. METHODS AND RESULTS: Randomised controlled trials (RCTs) published through 20 June 2021 were identified from six databases, and reference lists of included studies. Risk of bias and certainty of evidence were evaluated using the Cochrane tool and Grading of Recommendations Assessment, Development and Evaluation, respectively. Bayesian network meta-analysis was performed using R. Continuous and binary outcomes are reported as mean differences (MD) and ORs, respectively, with 95% credible intervals (95% CrI). One-hundred and thirty-nine RCTs (n=18 670) were included in the analysis. Network meta-analysis demonstrated improvements in VO2peak following centre-based (MD (95% CrI)=3.10 (2.56 to 3.65) mL/kg/min), home-based (MD=2.69 (1.67 to 3.70) mL/kg/min) and technology-enabled ExCR (MD=1.76 (0.27 to 3.26) mL/kg/min). Similarly, 6 min walk distance was improved following hybrid (MD=84.78 (31.64 to 138.32) m), centre-based (MD=50.35 (30.15 to 70.56) m) and home-based ExCR (MD=36.77 (12.47 to 61.29) m). Incremental shuttle walk distance did not improve following any ExCR delivery modes. Minnesota living with HF questionnaire improved after centre-based (MD=-10.38 (-14.15 to -6.46)) and home-based ExCR (MD=-8.80 (-13.62 to -4.07)). Kansas City Cardiomyopathy Questionnaire was improved following home-based ExCR (MD=20.61 (4.61 to 36.47)), and Short Form Survey 36 mental component after centre-based ExCR (MD=3.64 (0.30 to 6.14)). HF-related hospitalisation and mortality risks reduced only after centre-based ExCR (OR=0.41 (0.17 to 0.76) and OR=0.42 (0.16 to 0.90), respectively). Mean age of study participants was only associated with changes in VO2peak. CONCLUSION: ExCR programmes have broader benefits for people with HF and since different delivery modes were comparably effective for improving exercise capacity and HRQoL, the selection of delivery modes should be tailored to individuals' preferences.

Population attributable fraction estimates for factors associated with different types of anaemia among women in Ethiopia: multilevel multinomial analysis.

OBJECTIVE: This study aimed to identify factors for different levels of anaemia among Ethiopian women and to estimate the population attributable fraction (PAF). DESIGN: This study was a detailed analysis of data of the 2016 Ethiopian Demographic and Health Survey data. Adjusted OR (AOR) with 95 % CI was computed using multilevel multinomial regression models, and the PAF were estimated using these AOR. SETTING: This study was conducted in Ethiopia. PARTICIPANTS: Women of reproductive age. RESULTS: The PAF showed that the proportion of mild anaemia cases attributable to having no formal education was 14·6 % (95 % CI 3·4, 24·5), high gravidity (≥4) was 11·2 % (95 % CI 1·2, 19·9) and currently breast-feeding was 5·2 % (95 % CI 0·0, 10·7). Similarly, the proportion of moderate-severe anaemia cases attributable to being in a rural residence was 38·1 % (95 % CI 15·9, 54·8); poorest wealth quantile, 12·6 % (95 % CI 2·9, 24·6); giving birth in the last 5 years, 10·5 % (95 % CI 2·9, 18·2) and unimproved latrine facilities, 17 % (95 % CI 0, 32·5). CONCLUSIONS: The PAF suggest that rural residency, low education, low wealth status, high parity, pregnancy and breast-feeding contribute substantially to the occurrence of anaemia among women in Ethiopia. Mild anaemia could be reduced by setting intervention strategies targeting women with low education, multigravida women and breast-feeding women, while preventing moderate-severe anaemia may require increasing income and improving living environments through the accessibility of hygienic latrines.

The effect of dietary patterns on hypertensive disorders of pregnancy in North Shewa, Ethiopia: A propensity score matched case-control study.

OBJECTIVE: This study aimed to assess the effect of dietary patterns during pregnancy on HDP. A propensity score matched case-control study was conducted with 340 pregnant women (71 cases and 269 controls) in North Shewa Zone, Ethiopia. Data were collected through an interviewer-administered questionnaire and maternal anthropometry measurements. After propensity score matching, a conditional logistic regression model was used to identify the independent predictors of HDP by adjusting for the confounders. A p-value of < 0.05 was taken as statistically significant. RESULTS: A high dietary diversity score (Adjusted Odd Ratio (AOR) = 0.45; 95% CI: 0.21, 0.93) was associated with a lower odds of HDP. Being merchant (AOR = 3.71 (95% CI: 1.16, 11.89), having previous history of HDP (AOR = 27.58; 95% CI: 4.53, 168.06) and high hemoglobin level (AOR = 2.26; 95% CI: 1.66, 3.09) were associated with an increased odds of HDP. Diet is an amendable factor, and the promotion of diversified diet is an important approach for preventing the occurrence of HDP. Women should be counselled to diversify their dietary intake to include a high amount of vegetables, legumes, and fruit.

Spatial distribution and determinant factors of anaemia among women of reproductive age in Ethiopia: a multilevel and spatial analysis.

OBJECTIVE: The aim of this study was to assess the spatial distribution and determinant factors of anaemia among reproductive age women in Ethiopia. METHODS: An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey data was undertaken. Getis-Ord Gi* statistics were used to identify the hot and cold spot areas for anaemia among women of reproductive age. A multilevel logistic regression model was used to identify independent predictors of anaemia among women of reproductive age. RESULTS: Older age (adjusted OR [AOR]=0.75; 95% CI 0.64 to 0.96), no education (AOR=1.37; 95% CI 1.102 to 1.72), lowest wealth quantile (AOR=1.29; 95% CI 1.014 to 1.60), currently pregnant (AOR=1.28; 95% CI 1.10 to 1.51, currently breast feeding (AOR=1.09; 95% CI 1.025 to 1.28), high gravidity (AOR=1.39; 95% CI 1.13 to 1.69) and HIV positive (AOR=2.11; 95% CI 1.59 to 2.79) are individual factors associated with the occurrence of anaemia. Likewise, living in a rural area (AOR=1.29; 95% CI 1.02 to 1.63) and availability of unimproved latrine facilities (AOR=1.18; 95% CI 1.01 to 1.39) are community-level factors associated with higher odds of anaemia. The spatial analysis indicated that statistically high hotspots of anaemia were observed in the eastern (Somali, Dire Dawa and Harari regions) and north-eastern (Afar) parts of the country. CONCLUSION: The prevalence rate of anaemia among women of reproductive age varied across the country. Significant hotspots/high prevalence of anaemia was observed in the eastern and north-eastern parts of Ethiopia. Anaemia prevention strategies need to be targeted on rural residents, women with limited to no education, women who are breast feeding, areas with poor latrine facilities and women who are HIV positive.

Maternal dietary patterns and risk of adverse pregnancy (hypertensive disorders of pregnancy and gestational diabetes mellitus) and birth (preterm birth and low birth weight) outcomes: a systematic review and meta-analysis.

OBJECTIVE: Epidemiological studies have indicated that dietary patterns during pregnancy are associated with adverse pregnancy and birth outcomes such as hypertensive disorders of pregnancy (HDP), gestational diabetes mellitus (GDM), preterm birth (PTB) and low birth weight (LBW). However, the results of these studies are varied and inconsistent. The present study aimed to assess the association between dietary patterns and the risk of adverse pregnancy and birth outcomes. DESIGN: Systematic review and meta-analysis. Seven databases were searched for articles. Two reviewers performed the study selection and data extraction. A random-effects model was used to estimate pooled effect sizes of eligible studies. SETTING: Studies conducted all over the world were incorporated. SUBJECTS: The review focused on pregnant women. RESULTS: A total of twenty-one studies were identified. Adherence to a healthy dietary pattern (intake of vegetables, fruits, legumes, whole grains) was significantly associated with lower odds (OR; 95 % CI) of pre-eclampsia (0·78; 0·70, 0·86; I2=39·0 %, P=0·178), GDM (0·78; 0·56, 0·99; I2=68·6 %, P=0·013) and PTB (0·75; 0·57, 0·93; I2=89·6 %, P=0·0001). CONCLUSIONS: Our review suggests that dietary patterns with a higher intake of fruits, vegetables, legumes, whole grains and fish are associated with a decreased likelihood of adverse pregnancy and birth outcomes. Further research should be conducted in low-income countries to understand the impact of limited resources on dietary intake and adverse pregnancy and birth outcomes.

The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis.

BACKGROUND: Geographic access to obstetric care facilities has a significant influence on women's uptake of institutional delivery care. However, this effect was not consistent across studies. Some studies reported that geographic access to obstetric care facilities had no influence on the use of facility delivery. Therefore, this systematic review and meta-analysis synthesized and pooled the influence of geographic access on institutional delivery service uptake in low and middle-income countries. METHODS: Multiple combinations of search terms were used to search articles from six databases and a hand search of reference lists performed. We included observational studies conducted in low and middle-income countries which reported the influence of geographic access on delivery care use. The pooled effects of geographic access on institutional delivery care use were calculated using a random-effects model with a 95% confidence interval. FINDINGS: In this study a total of 31 studies were included. Among these studies, 15 met criteria for inclusion in the meta-analyses, while the remaining 16 were summarized using qualitative synthesis. Studies included in the analysis where women had to walk 60 minutes or less to access a health facility delivery were significantly heterogeneous. Having access to obstetric care facilities within five kilometres was significantly associated with institutional deliveries (pooled OR = 2.27; 95% CI = 1.82, 2.82). Similarly, a travelling time of 60 minutes or less was significantly associated with higher odds of health facility delivery (pooled OR = 3.30; 95% CI = 1.97, 5.53). Every one-hour and one-kilometre increase in travel time and distance, respectively, was negatively associated with institutional delivery care use. INTERPRETATION: Geographic access measured in either physical distance and/or travel time was significantly associated with women's use of facility delivery. The greater the distance and/or travel time to obstetric care facilities, the greater the barrier and the lesser the service uptake.

Perceived Psychological, Economic, and Social Impact of Khat Chewing among Adolescents and Adults in Nekemte Town, East Welega Zone, West Ethiopia.

The main aim of this study was to assess psychological, economic, and social impact of khat chewing among adolescents, in Nekemte town, East Welega Zone. A community based cross-sectional study was conducted from March to June 2016 using both quantitative and qualitative methods of data collection. A total of 359 samples were included in the study. A pretested, interviewer based structured questionnaire was employed during data collection. The study found the current prevalence of khat chewing practices was 48.6%. Perceived psychological problems especially depression and anxiety were associated with khat chewing practices. The risk of depression was about 25 times higher among khat chewers compared to nonchewers. Similarly the risk of anxiety among khat chewers was about 5 times higher compared to nonchewers. Generally current khat chewing practices in the study area are relatively high. The occurrence of reported, perceived psychological problems mainly depression and anxiety was significantly higher among khat chewers compared to nonchewers. Thus efforts like creating awareness about negative effect, making different recreation methods available, and formulating common conventions regarding khat use mainly by young generations are necessary to decrease the magnitude of chewing practices and thereby its associated consequences.

Treatment outcomes for multidrug-resistant tuberculosis under DOTS-Plus: a systematic review and meta-analysis of published studies.

BACKGROUND: Anti-tuberculosis drug resistance is a major public health problem that threatens the progress made in tuberculosis care and control worldwide. Treatment success rates of multidrug-resistant tuberculosis (MDR-TB) is a key issue that cannot be ignored. There is a paucity of evidence that assessed studies on the treatment of MDR-TB, which focus on the effectiveness of the directly observed treatment, short-course (DOTS)-Plus program. Therefore, it is crucial to assess and summarize the overall treatment outcomes for MDR-TB patients enrolled in the DOTS-Plus program in recent years. The purpose of this study was to thus assess and summarize the available evidence for MDR-TB treatment outcomes under DOTS-Plus. METHODS: A systematic review and meta-analysis of published literature was conducted. Original studies were identified using the databases MEDLINE®/PubMed®, Hinari, and Google Scholar. Heterogeneity across studies was assessed using the Cochran's Q test and I2 statistic. Pooled estimates of treatment outcomes were computed using the random effect model. RESULTS: Based on the 14 observational studies included in the meta-analysis, it was determined that 5 047 patients reported treatment outcomes. Of these, the pooled prevalence, 63.5% (95% CI: 58.4-68.5%) successfully completed full treatment (cured or treatment completed) with a pooled cure rate of 55.6%, whereas 12.6% (95% CI: 9.0-16.2%) of the patients died, 14.2% (95% CI: 11.6-16.8%) defaulted from therapy, and 7.6% (95% CI: 5.6-9.7%) failed therapy. Overall 35.4% (95% CI: 30-40.8%) of patients had unsuccessful treatment outcomes. An unsatisfactorily high percentage 43% (95% CI: 32-54%) of unsuccessful treatment outcomes was observed among patients who were enrolled in standardized treatment regimens. CONCLUSION: This study revealed that patients with MDR-TB exhibited a very low treatment success rate compared to the World Health Organization 2015 target of at least 75 to 90%. The high default rate observed by conducting this literature review could possibly explain the spread of the MDR-TB strain in various populations. A better treatment success rate was observed among patients in individualized treatment regimens than in standardized ones. Conducting further individual-based meta-analysis is recommended to identify potential factors for defaulting treatment using large-scale and multi-center studies.

Practice and Intention to use long acting and permanent contraceptive methods among married women in Ethiopia: Systematic meta-analysis.

BACKGROUND: The long acting and permanent contraceptive methods (LAPCMs) has not used unlike that of short-acting methods in Ethiopia. Ethiopia is the second most populous country in Sub Saharan Africa with a high total fertility rate, and high maternal and child mortality rates. This study summarized the evidence of practice and intention to use long acting and permanent family planning methods among women in Ethiopia using systemic review and meta-analysis. METHODS: A systematic review and meta-analysis of the published and unpublished observational studies were conducted. Original studies were identified using databases of Medline/Pubmed, and Google Scholar. Heterogeneity across studies was checked using Cochrane Q test statistic and I(2)test. The pooled proportion of intention to use and the practice of long acting and permanent contraceptive methods were computed using a/the random effect model. RESULTS: Based on the ten observational studies included in the meta-analysis, the pooled prevalence of intention to use long acting and permanent contraceptive methods among married women according to the random effect model was 42.98 % (95 % CI 32.53, 53.27 %). On the other hand, the pooled practice of long acting and permanent methods of contraceptive among the study participants was 16.64 % (95 % CI 12.4 to 20.87 %). CONCLUSION: This meta-analysis revealed that women's intention to use LAPCMs is generally good but their utilization is low. It is recommended, therefore, that LAPMCs must be made more readily available and accessible to women at the lower level of health service delivery who are in need of it.

Is protease inhibitors based antiretroviral therapy during pregnancy associated with an increased risk of preterm birth? Systematic review and a meta-analysis.

BACKGROUND: Antiretroviral therapy is recommended during pregnancy to decrease the risk of perinatal transmission of HIV-1 infection and to improve maternal health. However, some studies have reported that antiretroviral treatment (ART) containing protease inhibitors (PI) is associated with an increased risk of preterm birth. In contrast, other studies have reported no increased risk. This meta-analysis was conducted to derive a more reliable estimate of the association between the prenatal use of PI based ART regimen and preterm birth. METHODS: A systemic review and meta-analysis was conducted using published studies which were identified through a computerized search using the Medline/PubMed database, Google Scholar and Health Inter Network Access to Research Initiative (HINARI). The analysis was undertaken using STATA version 11.0 software and studies were described by forest plot. Heterogeneity across studies was checked using Cochran Q test and I2 test. An adjusted odd ratio with 95% confidence intervals [95% CI] was pooled using a random effects model. RESULTS: The Cochrane Q test (Q test p = 0.051) showed a good homogeneity among studies. However, medium heterogeneity was observed in up to 46% of the sample using the I2 test (I2 = 46.5%). The Egger weighted regression method (p = 0.04) showed evidence of publication bias, but Begg rank correlation statistics (p = 0.47) did not show evidence of publication bias. The pooled analysis of 10 studies showed that protease based ART exposure during pregnancy was associated with an increased risk of preterm birth (pooled odds ratio 1.32 (95% CI, 1.04 to 1.59). CONCLUSIONS: This meta-analysis revealed that the PI based ART exposure during pregnancy is significantly associated with an increased risk of preterm birth. There should be strong cautions against initiating ART during pregnancy and PI based ARV should be replaced by others drug regime. Protease inhibitor ART drugs should not be included as part of therapy during pregnancy.

Correlation of fasting and postprandial plasma glucose with HbA1c in assessing glycemic control; systematic review and meta-analysis.

BACKGROUND: Glycemic control in diabetes mellitus is a cornerstone in reducing morbidity and mortality of the disease. Achieving glycemic control or reducing hyperglycemia significantly decreases the microvascular and macrovascular complications of diabetes. Even though measurement of glycated hemoglobin (HbA1c) remains the gold standard for assessment of glycemic control, there is no consensus whether fasting or postprandial plasma glucose (PPG) is a better predictor of glycemic control in resource-poor settings when HbA1c is not available. The aim of this systematic review and meta-analysis was to summarize evidences on the significance of fasting and postprandial plasma glucose, and their correlation with HbA1c. METHODS: Relevant studies were identified through systematic search of online databases (e.g. EMBASE, MEDLINE/PubMed and Cochrane library) and manual search of bibliographies of the included studies. Original research papers describing the correlations or associations of fasting and postprandial plasma glucose with HbA1c were included. The MedCalc software was used for data entry and analysis. We used the random effect model to estimate the pooled correlations of fasting and postprandial plasma glucose with HbA1c. Heterogeneity assessment and robustness analysis was also performed. RESULT: From total 126 articles identified, 14 articles were eligible for systemic review. Eleven of these eligible studies evaluated the correlations of fasting and postprandial plasma glucose to the standard HbA1c values and used in meta-analysis. Seven of these studies (63.5 %) found better or stronger correlations between PPG and HbA1c than fasting plasma glucose (FPG). In all the studies that estimated the relative contribution FPG and PPG to the overall hyperglycemia, decreases in PPG was accounted for greater decrease in HbA1c compared with decreases in FPG value. PPG also showed a better sensitivity, specificity and positive predictive value than FPG. The pooled correlation coefficient (r) between PPG and HbA1c was 0.68 (P < 0.001, 95 % CI; 0.56-0.75) slightly higher than pooled correlation coefficient of FPG (r = 0.61(P < 0.001, 95 % CI; 0.48-0.72)). CONCLUSION: PPG has a closer association with HbA1c than FPG. Hence, PPG is better in predicting overall glycemic control in the absence of HbA1c.

Assessment of knowledge and practice of health workers towards tuberculosis infection control and associated factors in public health facilities of Addis Ababa, Ethiopia: A cross-sectional study.

BACKGROUND: Tuberculosis is the leading causes of mortality among infectious diseases worldwide. The risk of transmission from patients to health workers is doubles that of the general population. The close contact to the infectious case before diagnosis is the major risk for tuberculosis infection. The aim of the study was to assess knowledge and practice of health professionals towards tuberculosis infection control and its associated factors in health facilities of Addis Ababa, Ethiopia. METHODS: A cross-sectional study was conducted from February 29 to April 15/2014 in selected health facilities in Addis Ababa. Five hundred ninety health workers were included in the study. The sample size was assigned to each health facility proportional to their number of health workers. Study subjects were selected from each stratum by simple random sampling technique. Interviewer administered structured questionnaire was used to collect information. Logistic regression was used to identify factors associated with knowledge and practice of health workers towards tuberculosis infection control. RESULT: Five hundred eighty two participants with 98.6% response rate were involved in the study. Of these, 36.1% had poor knowledge and 51.7% unsatisfactory practice score towards tuberculosis infection control. Having more than six years working experience in health facility (AOR = 2.51; 95% CI: 1.5-4.1) and tuberculosis related training (AOR = 2.51 95% CI; 1.5, 4.1) were significantly associated with knowledge on tuberculosis infection control. Having experience in tuberculosis clinic (AOR =1.93; 95% CI: 1.12, 3.34) and tuberculosis related training (AOR = 1.48; 95% CI: 1.87, 2.51) were significantly associated with practice on tuberculosis infection control. CONCLUSION: One third of health workers had relatively poor knowledge and nearly half of them had unsatisfactory practice on tuberculosis infection control. Tuberculosis training and work experiences in health facility are determinant factor to knowledge. Whereas tuberculosis related training and experience in tuberculosis clinic are predictor to practice. So, training of the health professionals, on job orientations of junior health workers, and farther study including private health workers are recommended.

Prevalence of hypertension in Ethiopia: a systematic meta-analysis.

BACKGROUND: Hypertension has been increasing in developing countries including Ethiopia. Other than smaller studies, there is no national prevalence study on hypertension in Ethiopia. These smaller studies reported varied prevalence of hypertension. This study is intended to summarize and pool the results of smaller region based studies to provide a national level estimate of the prevalence of hypertension. METHODS: The studies were identified through internet search using the data base of MEDLINE/PubMed, Google scholar, EMBASE, HINARI, Cochrane library and reference lists of previous prevalence studies. We also made manual searches to identify relevant articles. Descriptive information for the original studies is presented in a table and the quantitative results were presented in forest plots. The Cochrane Q test and I2 test statistic were used to test heterogeneity across studies. The Pooled estimate of prevalence of hypertension was computed by a random effects model. RESULTS: One hundred eight titles were identified through electronic searching using keywords. Of these, nine studies were meet the inclusion criteria. A random effect meta-analysis of the results from these 9 studies was conducted to provide an estimate of the prevalence of hypertension in the Ethiopian population. The analysis showed that the prevalence of hypertension among Ethiopian population was estimated to be 19.6 % (95 % CI: 13.7 %, 25.5 %). Subgroup analyses indicated that the prevalence of hypertension is higher in the urban population (23.7 %) than rural and urban combined (14.7 %). The prevalence of hypertension among males (20.6 %) and females (19.2 %) was similar. CONCLUSION: This study found that the prevalence of hypertension in Ethiopia is increasing. This evidence suggests that attention has to be given to primary prevention of hypertension in the Ethiopian adult population, especially in the urban population by integrating it with health extension programs.

Association between HIV/AIDS and multi-drug resistance tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Human immunodeficiency virus (HIV), multi-drug resistant tuberculosis (MDR) is emerging as major challenge facing tuberculosis control programs worldwide particularly in Asia and Africa. Findings from different studies on associations of HIV co-infection and drug resistance among patients with TB have been contradictory (discordant). Some institution based studies found strongly increased risks for multi-drug resistant TB (MDR TB) among patients co-infected with TB and HIV, whereas other studies found no increased risk (it remains less clear in community based studies. The aim was to conduct a systematic review and meta-analysis of the association between multi-drug resistant tuberculosis and HIV infection. METHODS AND FINDINGS: Systematic review of the published literature of observational studies was conducted. Original studies were identified using databases of Medline/Pubmed, Google Scholar and HINARI. The descriptions of original studies were made using frequency and forest plot. Publication bias was assessed using Funnel plot graphically and Egger weighted and Begg rank regression tests statistically. Heterogeneity across studies was checked using Cochrane Q test statistic and I(2). Pool risk estimates of MDR-TB and sub-grouping analysis were computed to analyze associations with HIV. Random effects of the meta-analysis of all 24 observational studies showed that HIV is associated with a marginal increased risk of multi-drug resistant tuberculosis (estimated Pooled OR 1.24; 95%, 1.04-1.43). Subgroup analyses showed that effect estimates were higher (Pooled OR 2.28; 95%, 1.52-3.04) for primary multi-drug resistance tuberculosis and moderate association between HIV/AIDS and MDR-TB among population based studies and no significant association in institution settings. CONCLUSIONS: This study demonstrated that there is association between MDR-TB and HIV. Capacity for diagnosis of MDR-TB and initiating and scale up of antiretroviral treatment, and collaborations between HIV and TB control programs need to be considered and strengthened.

Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia.

INTRODUCTION: Hepatitis B (HB) is a serious infection that affects liver and caused by hepatitis B virus (HBV). HB is a serious global public health problem and the health professionals are most at risk. It is contagious and easy to be transmitted from one infected individual to another by blood to blood contact, mother to child, unprotected sexual intercourse, sharing of eating utensils and other barber shop and beauty salon equipment. The aim of this study was to assess knowledge and practices about transmissions and prevention of hepatitis B among medical and health science students on clinical attachment in Haramaya University. METHODS AND FINDINGS: A cross sectional study was conducted among 322 health science and medical students who are starting clinical attachment (year II, III, IV, V and IV) from February 1-15, 2013. Self-administered structured questionnaire was used to collect information. Out of 322 distributed questionnaires, 322 were returned with a response rate of 100.0%. Majority of the students (91%) were in the age group 20-24 and 232 (72%) of the respondents were male. Majorities (95.3%) of students were not fully vaccinated against Hepatitis B and 48.4% of the students were not aware about the availability of post exposure prophylaxis for HB. Mean scores for knowledge and practice were 11.52±2.37 and 2.76±1.1 respectively. Significant and positive linear correlations between knowledge-practice (r = 0.173, p = 0.002) was observed. Study department was significantly associated with mean knowledge and practice of study respondents. CONCLUSION: This study indicates that lack of awareness about Hepatitis B, its route of transmission and modes of prevention among the medical students entering into the profession. Similarly, 95.3% the students were not fully vaccinated against Hepatitis B, which makes them vulnerable to the disease.

Determinant factors associated with occurrence of tuberculosis among adult people living with HIV after antiretroviral treatment initiation in Addis Ababa, Ethiopia: a case control study.

INTRODUCTION: Tuberculosis (TB) is a leading morbidity and mortality, and the first presenting sign in majority of people living with Human Immune deficiency Virus (PLWH). Determinants of active TB among HIV patients on anti retroviral treatment (ART) are not well described in resource limited settings. The aim of this study was to assess determinant factors for the occurrence of TB among people living with HIV after ART initiation in public hospitals and health centers in Addis Ababa, Ethiopia. METHODS AND FINDINGS: A case control study was conducted from December 2011 to February 2012 in 2 public hospitals and 13 health centers in Addis Ababa. The study population consisted of 204 cases and 409 controls. Cases were adult people living with HIV who developed TB after ART initiation and controls were adult people living with HIV who did not develop TB after ART initiation. An interviewer administered structured questionnaire was used to collect information. After adjustment for potential confounders, presence of isoniazid prophylaxis (adjusted odd ratio [AOR] 0.35, 95% confidence interval [CI] 0.125, 0.69) and cotrimoxazole prophylaxis (AOR = 0.19; 95% CI: 0.06, 0.62) had protective benefit against risk of TB. In contrary, bedridden (AOR = 9.36; 95% CI: 3.39, 25.85), having World Health Organization (WHO) clinical stage III/IV (AOR = 3.40; 95% CI: 1.69, 6.87) and hemoglobin level <10 mg/dl (AOR = 7.43; 95% CI; 3.04, 18.31) at enrollment to ART care were predictors for increased risk of tuberculosis in PLWH after ART initiation. CONCLUSION: Increasing coverage of isoniazid preventive therapy and cotrimoxazole preventive therapy reduced risk of TB among HIV patients who started treatment. All PLWH should be screened for TB, but for patients who have advanced disease condition (WHO clinical stage III/IV, being bedridden and having hemoglobin level <10 mg/dl) intensified screening is highly recommended during treatment follow up.