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Combating female genital mutilation in Northeast (Horn) Africa and its challenges
Get PDFBackground: This article investigates the practice of female genital
mutilation as a long-held custom in the countries of Northeast Africa,
known as Horn of Africa, where many women in rural and urban areas are
faced with different physical and psychic consequences in their future
lives. Objective: To investigate the prevalence of FGM in the Horn of
Africa and the traditional thinking of People about it. Methods: This
study was based on descriptive analysis method. The questions of the
study are (a) Why female circumcision is widely practiced in Horn of
Africa; (b) What are the mental and physical consequences of female
genital mutilation for the women; and (c) How regional and
international entities, whether governmental or NGOs, are combating
this tradition. Results: This article has found out that female genital
mutilation in Northeast African countries has resulted in many lifelong
diseases and sexual degradation in many women and the best way to
combat this tradition is to inform people by gradual (not abrupt)
trainings without any insult to the beliefs of the people. Conclusion:
This study reveals the Health education based on behavioral change. In
doing so, the unity of policies between regional and international
actors along with attracting the support of tribal elites is also
needed
A systematic review and meta-analysis of the prevalence and predictors of anemia among children in Ethiopia
Get PDFBackground: Anemia is a wide-spread public health problem characterized
by a decrease in hemoglobin concentration and/ or red blood cell volume
below an established cut-off value. In developing countries including
Ethiopia, about half of children are estimated to be anemic. Therefore,
the purpose of this study was to determine the pooled prevalence of
anemia and its predictor factors among children in Ethiopia. Method:
The studies were identified through explicit and exhaustive search of
reputable databases (PubMed, Google scholar, Science Direct, EMBASE,
Cochrane library, and the hand search of reference lists of previous
prevalence studies to retrieve more related articles. Thirty-nine
studies were selected based on a comprehensive list of inclusion and
exclusion criteria. Data were extracted using a standardized and
pre-tested data extraction checklist, and the analysis was done using
STATA 14 statistical software. To assess heterogeneity, the Cochrane Q
test statistic and I2 tests were used. In our analysis, considerable
heterogeneity was observed. Therefore, a random effect meta-analysis
model was used to estimate the pooled prevalence of anemia. Moreover,
the predictor factors of anemia were examined. Results: The forest plot
of 39 included studies revealed that the overall pooled prevalence of
anemia among children in Ethiopia was 34.4% (95% CI: 29.1, 39.7%).
Sub-group analysis showed that the highest anemia prevalence was
observed in Somali Region with a prevalence of 49.4 % (95% CI: 20.9,
77.8). Also, anemia in children was found to be highest in the age
group of less than five years (45.2, 95% CI: 39.6,50.8). Low literacy
of families: 1.3 (95% CI: 1.1, 1.7), low family socioeconomic status:
1.9 (95% CI: 1.1,3.01.3), having housewife mothers or with no job: 1.5
(95% CI: 1.4, 1.9) and rural residence: 3.3 (95% CI: 1.7,6.1) were
found to be predictors of anemia among children. Conclusion: In this
study, one in three children were anemic in Ethiopia. It is a moderate
public health problem in children in this study. Low literacy, low
socioeconomic status as well as rural residence of the families and
helminthic infection of the children were found to be predictors of
anemia in the children. Community and school-based interventions should
be strengthened to improve the problem
The efficacy of dapagliflozin for type 1 diabetes: a meta-analysis of randomized controlled studies
Get PDFIntroduction: The efficacy of dapagliflozin for type 1 diabetes remains
controversial. We conduct a systematic review and meta-analysis to
explore the treatment efficacy of dapagliflozin versus placebo in
patients with type 1 diabetes. Methods: We have searched PubMed,
EMbase, Web of science, EBSCO and Cochrane library databases through
May 2019 for randomized controlled trials (RCTs) assessing the effect
of dapagliflozin versus placebo for type 1 diabetes. This meta-analysis
is performed using the random-effect model. Results: Six RCTs are
included in the meta-analysis. Overall, compared with control group for
type 1 diabetes, dapagliflozin treatment shows favorable impact on
glycated hemoglobin HbA1c ( standard mean difference SMD=-3.93; 95%
confidence interval CI =-4.44 to -3.48; P<0.00001), HbA1c reduction
of 650.5% (risk ratio RR=1.98; 95% CI=1.65 to 2.39; P<0.00001),
and fasting plasma glucose FPG (SMD=-0.93; 95% CI=-1.77 to -0.10;
P=0.03). There is no statistical difference of hypoglycemia (RR=1.09;
95% CI=0.66 to 1.79; P=0.75) or adverse events (RR=1.07; 95% CI=0.96 to
1.20; P=0.20) between two groups, but the incidence of ketone-related
events is higher than those in control group (RR=0.28; 95% CI=3.96 to
11.52; P=0.01). Conclusions: Dapagliflozin treatment benefits to reduce
HbA1c and FPG for type 1 diabetes
Relationship of oxidative stress and antioxidant response with vaso-occlusive crisis in sickle cell anaemia
Get PDFBackground: Though sickle cell anaemia (SCA) is known to promote
oxidative stress, there is paucity of information on the relationship
between oxidative stress and vaso-occlusive crisis (VOC). Objective:
This study was undertaken to evaluate the relationship of oxidative
stress and antioxidant response with VOC in SCA. Methods: A
cross-sectional case-control study was carried out at University of
Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu Nigeria involving
116 individuals which included 36 SCA subject, 40 sickle cell carriers
(AS) and 40 healthy individuals (AA). Baseline information as well as
the frequency of VOC was obtained from the participants and anaemia as
well as oxidative stress and antioxidant indices were assessed in
blood. Results: Anaemia was prevalent (88.9 %) in SCA individuals
compared to AS (52.5%) and AA (47.5 %) individuals. Nitric oxide
scavenging (NOS) and superoxide dismutase (SOD) activities as well as
glutathione level were significantly (p<0.005) lower while catalase
activity was higher in SCA individuals compared to controls (AA and
AS). Higher malondialdehyde (MDA) level was associated with very severe
VOC while low level of NOS activity was associated with severe VOC in
SCA individuals. Conclusion: Sickle cell anaemia exhibited oxidative
stress and alteration in the levels of antioxidant indices which was
possibly associated with vaso-occlusive crisis
It is not always Tuberculosis! A case of pulmonary cryptococcosis in an immunocompetent child in Uganda
Get PDFPulmonary cryptococcosis is rare in immunocompetent individuals.
Limited data exist regarding its occurrence in children, especially in
developing countries. This case report describes an 8-year-old
HIV-negative child with pulmonary cryptococcosis, previously diagnosed
and treated for tuberculosis twice without improvement. Fine needle
aspiration biopsy confirmed the diagnosis of pulmonary cryptococcosis
and serum cryptococcal antigen test was positive. The child improved on
amphotericin and fluconazole treatment. Despite the limited diagnostic
capacity in many resource-constrained settings like Uganda, this case
report highlights the need to investigate other causes of pneumonia in
immunocompetent children that are not improving on conventional
antimicrobial treatments
Adolescent girls\u2019 perception about their ability to safely offer HIV self-test kits to sexual partners: a feasibility study in Siaya County, Kenya
Get PDFBackground: Adolescent girls (AG) in sub-Saharan Africa are at elevated
risk of acquiring HIV, yet few know the HIV status of their sexual
partners. Interventions to promote testing among partners are urgently
needed. Objectives: To explore AG\u2019s perceived ability to safely
distribute HIV self-tests to their partners, if partners would
self-test, and how to minimize partner violence. Methods: We recruited
HIV-negative AG ages 15-19 years with a partner of unknown HIV status
or who tested negative >6 months previously. Using mixed-methods for
data collection and regression and inductive thematic analysis for
quantitative and qualitative analysis, respectively, we determined
factors associated with the study objectives. Results: We enrolled 101
AG, median age 17.3 years, sexual debut 15-16 years, and 54.5% reported
652 lifetime partners. Most participants (95.0%) would offer
self-tests to their partners and 95.1% reported high-to-moderate chance
their partner would self-test. No participant attribute was associated
with perceived ability to offer self-test or likelihood of partner
testing. To avoid violence, AG recommended politeness, indirect
approach, voluntariness, and highlighting advantages of self-testing.
Conclusions: AG believe they can safely distribute self-tests to their
partners, and most partners would self-test, expanding utility of HIV
self-tests to include partners of AG
Knowledge, attitudes and practices of HIV-positive mothers regarding the benefits of exclusive breastfeeding at a regional hospital in the north east of Namibia
Get PDFBackground: In sub-Saharan Africa, over 1,000 newborns are infected
with HIV every day, despite available medical interventions.
Mother-to-child transmission (MTCT) remains one of the primary sources
of HIV infection in children and without interventions 40% of babies
born from HIV-positive mothers would be infected with the virus. It is
estimated that 300 000 children become infected with HIV worldwide,
whilst 1.5 million children die when their mothers opt for other
choices instead of breastfeeding. Objective: The purpose of the study
was to assess and describe the knowledge, attitudes and practices of
HIV-positive mothers regarding the benefits of exclusive breastfeeding
at Rundu Intermediate Hospital, Kavango East Region in Namibia. Method:
The study was a descriptive cross-sectional survey that used
convenience sampling, as the researcher sought to use subjects
available during the time of study to select 79 HIV positive mothers.
Results: Participants in this study (94%; n=51) had good knowledge of
the benefit of exclusive breastfeeding and that the benefits of
breastfeeding outweigh the risk of HIV transmission from mother to
child. The results confirmed that (77.2%; n=42) of the mothers opted to
take ART with the babies until they stop breastfeeding. Conclusion: HIV
positive mothers had good knowledge, attitudes and practices regarding
the benefits of exclusive breastfeeding. A significant number of
mothers were, however, not sure about breastfeeding exclusively for 6
months as they would stop if offered free formula milk for the baby.
Support by the fathers and others in the community is vital
Diabetes and COVID-19 in Congolese patients
Get PDFBackground: The global pandemic Coronavirus Disease 2019 (COVID-19) due
to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is
reported to be potentially severe in patients with morbid conditions.
One common reported comorbidities is diabetes. We aimed in this study
to precise the clinical characteristics and outcomes in a series of
congolese diabetic patients affected by COVID-19 infection. Patients
and methods: We retrospectely studied from 256 COVID-19 patients, a
cohort of 30 persons with previously known diabetes. The glycaemia
controls have been obtained by plasma glucose assay. All patients have
been tested positive to SARS-CoV-2 by RT-PCR method. Results: The
COVID-19 diabetic patients represented 11,7% of all COVID-19 patients
with confidence interval of 95% [7,77-15,65]. Older individuals and
male sex were predominent. Dyspnea and sauration of oxygen < 90 were
significatives and added risk factors were noted in 63.3% of patients,
particulary hyperglycaemia with hypertension or obesity. The mortality
rate at the percentage of 36.7% was more prevalent in patients with
added comorbidities (30%) versus without comorbidities (6.7%).
Conclusion: Congolese COVID-19 diabetic patients of male sex and older
age exhibiting arterial hypertension and obesity are the most exposed
to severe COVID-19 and increasead mortality rate
The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field
No full textBackground: Despite potential for community health workers (CHWs) to
effectively reduce morbidity and mortality in sub-Saharan Africa, they
still face multiple barriers including access to on-going and refresher
training. Digital technology offers a potential solution to improve the
provision of ongoing training for CHWs. Objectives: This report shares
participant insights and experiences following the implementation of a
mobile health (mHealth) assisted Integrated Community Case Management
(iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek
to document benefits and challenges of such an approach. Methods: CHWs
were trained to recognize, treat and prevent childhood pneumonia via
locally made videos preloaded onto low cost, ruggedized Android
tablets. Subsequent interviews were compiled with key stakeholders
including CHWs, CHW leaders and programme supervisors to better
understand the strengths, barriers and lessons learned following the
intervention. Results: Success factors included the establishment of
CHW leadership structures, the ability to use the tablets to learn on
an \u201cany pace, any place\u201d basis and using the tablets to
conduct community teaching and outreach. Barriers included appropriate
consideration of the implementation timeline and avoiding a \u201cone
size fits all\u201d approach to digital literacy training.
Conclusions: The strength of the program stemmed from a grassroots
approach that prioritized stakeholder input at all stages. Leadership
at a local level, a history of local engagement and trust built up over
a period time were also integral. As organizations aim to scale up
digitally enhanced training initiatives, it is paramount that attention
is paid to these human factors which are key for program success
Dendroclimatology in the Amazon basin: applications and potentialities
No full textOs efeitos de mudan\ue7as clim\ue1ticas na Amaz\uf4nia podem ser
estudados por meio da dendroclimatologia, a partir da an\ue1lise das
rela\ue7\uf5es entre as vari\ue1veis clim\ue1ticas e
meteorol\uf3gicas e o crescimento do xilema de esp\ue9cies
arb\uf3reas. O xilema constitui um verdadeiro arquivo natural porque
permite o registro dessas vari\ue1veis na madeira, o que pode ser de
grande utilidade para a compreens\ue3o dos impactos potenciais que as
atividades antr\uf3picas podem exercer sobre o clima. O objetivo
deste artigo \ue9 abordar aspectos inerentes ao estado da arte sobre
os m\ue9todos dendroclimatol\uf3gicos e sua aplica\ue7\ue3o nas
florestas tropicais da Amaz\uf4nia para an\ue1lise da
forma\ue7\ue3o de an\ue9is de crescimento em plantas lenhosas. A
revis\ue3o sobre o tema foi realizada em diversas bases
bibliogr\ue1ficas, tanto cl\ue1ssicas como mais recentes, e foi
constatado que, embora seja uma ci\ueancia antiga, ainda s\ue3o
poucos os estudos dendroclimatol\uf3gicos conduzidos na
Amaz\uf4nia. As florestas s\ue3o ecossistemas sens\uedveis e
estudos relacionados aos efeitos que podem sofrer em virtude de
mudan\ue7as clim\ue1ticas s\ue3o relevantes para o planejamento
socioecon\uf4mico e o desenvolvimento de pol\uedticas
p\ufablicas.The effects of climatic changes in the Amazon basin can be studied
through dendroclimatology, from the analysis of the relations between
climatic and meteorological variables and the growth of the xylem of
arboreal species. The xylem constitutes a true natural file because it
allows the recording of these variables in the wood, which can be very
useful for understanding the potential impacts that anthropic
activities may have on the climate. The objective of this article is to
discuss aspects inherent to the state of the art on dendroclimatic
methods and their application in the tropical forests of the Amazon
region for analysis of the formation of growth rings in woody plants.
The review on the subject was carried out in several bibliographic
bases, both classic and more recent, and it was found that, although it
is an ancient science, there are still few dendroclimatic studies
conducted in the Amazon basin. Forests are sensitive ecosystems and
studies related to the effects they may suffer from climate change are
relevant to socioeconomic planning and the development of public
policies