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Durão S, Effa E, Mbeye N, Mthethwa M, McCaul M, Naude C, Brand A, Blose N, Mabetha D, Chibuzor M, Arikpo D, Chipojola R, Kunje G, Vandvik PO, Esu E, Lewin S, Kredo T. Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Res Policy Syst 2024; 22:48. [PMID: 38627761 PMCID: PMC11020907 DOI: 10.1186/s12961-024-01133-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach. METHODS We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10-13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed. RESULTS Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants. CONCLUSIONS Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.
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Affiliation(s)
- Solange Durão
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Emmanuel Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nyanyiwe Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mashudu Mthethwa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Trust, Oslo, Norway
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Simon Lewin
- Department of Health Sciences Alesund, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tamara Kredo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Bosch-Capblanch X, Esu E, Oringanje CM, Dongus S, Jalilian H, Eyers J, Auer C, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A systematic review of human experimental studies. Environ Int 2024; 187:108612. [PMID: 38640611 DOI: 10.1016/j.envint.2024.108612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 03/21/2024] [Accepted: 03/27/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s exposing large proportions of the population. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF. OBJECTIVES To systematically assess the effects of exposure to RF-EMF on self-reported non-specific symptoms in human subjects and to assess the accuracy of perceptions of presence or absence of RF-EMF exposure. METHODS Eligibility criteria: experimental studies carried out in the general population and in individuals with idiopathic environmental intolerance attributed to EMF (IEI-EMF), in any language. INFORMATION SOURCES Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos, Embase and EMF portal, searched till April 2022. Risk of Bias (ROB): we used the RoB tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS we synthesized studies using random effects meta-analysis and sensitivity analyses, where appropriate. RESULTS Included studies: 41 studies were included, mostly cross over trials and from Europe, with a total of 2,874 participants. SYNTHESIS OF RESULTS considering the primary outcomes, we carried out meta-analyses of 10 exposure-outcomes pairs. All evidence suggested no or small non-significant effects of exposure on symptoms with high (three comparisons), moderate (four comparisons), low (one comparison) and very low (two comparisons) certainty of evidence. The effects (standard mean difference, where positive values indicate presence of symptom being exposed) in the general population for head exposure were (95% confidence intervals) 0.08 (-0.07 to 0.22) for headache, -0.01 (-0.22 to 0.20) for sleeping disturbances and 0.13 (-0.51 to 0.76) for composite symptoms; and for whole-body exposure: 0.09 (-0.35 to 0.54), 0.00 (-0.15 to 0.15) for sleeping disturbances and -0.05 (-0.17 to 0.07) for composite symptoms. For IEI-EMF individuals SMD ranged from -0.19 to 0.11, all of them with confidence intervals crossing the value of zero. Further, the available evidence suggested that study volunteers could not perceive the EMF exposure status better than what is expected by chance and that IEI-EMF individuals could not determine EMF conditions better than the general population. DISCUSSION Limitations of evidence: experimental conditions are substantially different from real-life situations in the duration, frequency, distance and position of the exposure. Most studies were conducted in young, healthy volunteers, who might be more resilient to RF-EMF than the general population. The outcomes of interest in this systematic review were symptoms, which are self-reported. The available information did not allow to assess the potential effects of exposures beyond acute exposure and in elderly or in chronically ill people. It cannot be ruled out that a real EMF effect in IEI-EMF groups is masked by a mix with insensitive subjects. However, studies on symptoms reporting and/or field perceptions did not find any evidence that there were particularly vulnerable individuals in the IEI-EMF group, although in open provocation studies, when volunteers were informed about the presence or absence of EMF exposure, such differences were consistently observed. INTERPRETATION available evidence suggests that acute RF-EMF below regulatory limits does not cause symptoms and corresponding claims in the everyday life are related to perceived and not to real EMF exposure status.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, USA.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Christian Auer
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Mthethwa M, Mbeye NM, Effa E, Arikpo D, Blose N, Brand A, Chibuzor M, Chipojola R, Durao S, Esu E, Kallon II, Kunje G, Lakudzala S, Naude C, Leong TD, Lewin S, Mabetha D, McCaul M, Meremikwu M, Vandvik PO, Kredo T. Newborn and child health national and provincial clinical practice guidelines in South Africa, Nigeria and Malawi: a scoping review. BMC Health Serv Res 2024; 24:221. [PMID: 38374031 PMCID: PMC10877834 DOI: 10.1186/s12913-024-10682-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Low and middle-income countries remain disproportionately affected by high rates of child mortality. Clinical practice guidelines are essential clinical tools supporting implementation of effective, safe, and cost-effective healthcare. High-quality evidence-based guidelines play a key role in improving clinical management to impact child mortality. We aimed to identify and assess the quality of guidelines for newborn and child health published in South Africa, Nigeria and Malawi in the last 5 years (2017-2022). METHODS We searched relevant websites (June-July 2022), for publicly available national and subnational de novo or adapted guidelines, addressing newborn and child health in the three countries. Pairs of reviewers independently extracted information from eligible guidelines (scope, topic, target population and users, responsible developers, stakeholder consultation process, adaptation description, assessment of evidence certainty). We appraised guideline quality using the Appraisal of Guidelines for Research & Evaluation (AGREE II) instrument. RESULTS We identified 40-guidelines from the three countries. Of these, 8/40 reported being adopted from a parent guideline. More guidelines (n = 19) provided guidance on communicable diseases than on non-communicable diseases (n = 8). Guidelines were most often developed by national health ministries (n = 30) and professional societies (n = 14). Eighteen guidelines reported on stakeholder consultation; with Nigeria (10/11) and Malawi (3/6) faring better than South Africa (5/23) in reporting this activity. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used in 1/7 guidelines that reported assessing certainty of evidence. Overall guidelines scored well on two AGREE II domains: scope and purpose median (IQR) score 68% (IQR 47-83), and clarity of presentation 81% (67-94). Domains critical for ensuring credible guidance scored below 20%: rigour of development 11% (4-32) and editorial independence 6% (0-27). CONCLUSION National ministries and professional societies drive guideline activities in Malawi, Nigeria and South Arica. However, the methods and reporting do not adhere to global standards. We found low AGREE II scores for rigour of guideline development and editorial independence and limited use of GRADE or adaptation methods. This undermines the credibility of available guidelines to support evidence-informed care. Our findings highlight the importance of ongoing efforts to strengthen partnerships, capacity, and support for guideline development.
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Affiliation(s)
- Mashudu Mthethwa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Nyanyiwe Masingi Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Emmanuel Effa
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Solange Durao
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ekpereonne Esu
- Cochrane Nigeria, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Idriss Ibrahim Kallon
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Suzgika Lakudzala
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Lilongwe, Malawi
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Trudy D Leong
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Simon Lewin
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Health Sciences Ålesund, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Martin Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
- Division of Clinical Pharmacology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Röösli M, Dongus S, Jalilian H, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A systematic review and meta-analysis on human observational studies. Environ Int 2024; 183:108338. [PMID: 38104437 DOI: 10.1016/j.envint.2023.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/01/2023] [Accepted: 11/19/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). OBJECTIVES The objective is to systematically review the effects of longer-term or repeated local and whole human body radiofrequency electromagnetic field (RF-EMF) exposure on the occurrence of symptoms. Primary hypotheses were tinnitus, migraine and headaches in relation to RF-EMF exposure of the brain, sleep disturbances and composite symptom scores in relation to whole-body RF-EMF exposure. METHODS Eligibility criteria: We included case-control and prospective cohort studies in the general population or workers estimating local or whole-body RF-EMF exposure for at least one week. INFORMATION SOURCES We conducted a systematic literature search in various databases including Web of Science and Medline. Risk of bias: We used the Risk of Bias (RoB) tool developed by OHAT adapted to the topic of this review. SYNTHESIS OF RESULTS We synthesized studies using random effects meta-analysis. RESULTS Included studies: We included 13 papers from eight distinct cohort and one case-control studies with a total of 486,558 participants conducted exclusively in Europe. Tinnitus is addressed in three papers, migraine in one, headaches in six, sleep disturbances in five, and composite symptom scores in five papers. Only one study addressed occupational exposure. SYNTHESIS OF RESULTS For all five priority hypotheses, available research suggests that RF-EMF exposure below guideline values does not cause symptoms, but the evidence is very uncertain. The very low certainty evidence is due the low number of studies, possible risk of bias in some studies, inconsistencies, indirectness, and imprecision. In terms of non-priority hypotheses numerous exposure-outcome combinations were addressed in the 13 eligible papers without indication for an association related to a specific symptom or exposure source. DISCUSSION Limitations of evidence: This review topic includes various challenges related to confounding control and exposure assessment. Many of these aspects are inherently present and not easy to be solved in future research. Since near-field exposure from wireless communication devices is related to lifestyle, a particular challenge is to differentiate between potential biophysical effects and other potential effects from extensive use of wireless communication devices that may compete with healthy behaviour such as sleeping or physical activity. Future research needs novel and innovative methods to differentiate between these two hypothetical mechanisms. INTERPRETATION This is currently the best available evidence to underpin safety of RF-EMF. There is no indication that RF-EMF below guideline values causes symptoms. However, inherent limitations of the research results in substantial uncertainty. OTHER Funding: This review was partially funded by the WHO radioprotection programme. REGISTRATION The protocol for this review has been registered in Prospero (reg no CRD42021239432) and published in Environment International (Röösli et al., 2021).
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, CH-4123 Allschwil, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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Borst RAJ, Wehrens R, Nsangou M, Arikpo D, Esu E, Al Metleq A, Hobden O, Meremikwu M, Ongolo-Zogo P, Bal R, Kok MO. What makes knowledge translation work in practice? Lessons from a demand-driven and locally led project in Cameroon, Jordan and Nigeria. Health Res Policy Syst 2023; 21:127. [PMID: 38049826 PMCID: PMC10694879 DOI: 10.1186/s12961-023-01083-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/26/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Over the years, the knowledge translation (KT) field has moved from promoting linearized models to embracing the importance of interaction and learning. Likewise, there is now increased attention on the transfer of KT approaches to new environments. Some scholars, however, have warned that ideas about transferability still hinge on linear thinking and doing. In the current study, we therefore sought to use a more reflexive approach to KT and to study how actors align KT approaches with their local environments. METHODS Our (auto) ethnographic study took place in a wider KT project. This project intended to combine three components: (1) co-organizing demand-driven, locally led and embedded KT cycles in Cameroon, Jordan, and Nigeria, (2) building upon established KT methods and (3) equipping and empowering local teams. We conducted 63 semi-structured interviews with key KT actors, observed 472 h of KT practices, and collected a paper trail of documents. At the same time, we also compiled project exchanges, such as project documents, plans, protocols, field notes, meeting notes and an archive of (email) correspondence between project members. We analysed all data abductively. RESULTS We show that there were numerous moments where the design of our project indeed enabled us to align with local practices and needs. Yet this often did not suffice, and the project design sometimes conflicted with other logics and values. By analysing these tensions, we want to show that doing KT work which acts upon different values and knowledges and is sensitive towards the different effects that it produces demands both structuring projects in a specific way and requires significant alignment work of KT actors in practice. CONCLUSIONS We show that practising KT more reflexively relies on two important conditions. First, KT projects have to be structured with sufficient discretionary space. Second, even though the structure of a project is important, there will be continuous need for alignment work. It is important to facilitate such alignment work and to further support it. In the discussion of this paper, we therefore articulate three design principles and three sensitivities. These elements can be used to make future KT projects more reflexive and sensitive to (social) complexity.
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Affiliation(s)
- Robert A J Borst
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands.
| | - Rik Wehrens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Moustapha Nsangou
- Centre pour le Dévéloppement des Bonnes Pratiques en Santé, Yaoundé, Cameroon
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ali Al Metleq
- The Higher Population Council, General Secretariat, Amman, Jordan
| | - Olivia Hobden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Pierre Ongolo-Zogo
- Centre pour le Dévéloppement des Bonnes Pratiques en Santé, Yaoundé, Cameroon
| | - Roland Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
| | - Maarten Olivier Kok
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O Box 1738, 3000DR, Rotterdam, the Netherlands
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Ochu CL, Ntoimo L, Onoh I, Okonofua F, Meremikwu M, Mba S, Iniobong A, Nwafor O, Dalhat M, Ohonsi C, Arinze C, Esu E, Igumbor EU, Dan-Nwafor C, Ilori E, Adetifa I. Predictors of Lassa fever diagnosis in suspected cases reporting to health facilities in Nigeria. Sci Rep 2023; 13:6545. [PMID: 37085507 PMCID: PMC10121657 DOI: 10.1038/s41598-023-33187-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/08/2023] [Indexed: 04/23/2023] Open
Abstract
Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group 40-49 years (aOR = 1.40; 95% CI 1.21-1.62), males (aOR = 1.11; 95% CI 1.03-1.20), those with formal education (aOR = 1.33; 95% CI 1.13-1.56), artisans (aOR = 1.70; 95% CI 1.28-2.27), religious leaders (aOR = 1.62; 95% CI 1.04-2.52), farmers (aOR = 1.48; 95% CI 1.21-1.81), and symptomatic individuals (aOR = 2.36; 95% CI 2.09-2.68). Being a health worker (aOR = 0.69; 95% CI 0.53-0.91), a teacher (aOR = 0.69; 95% CI 0.53-0.89) and cases reporting in the 3rd quarter (aOR = 0.79; 95% CI 0.69-0.92) had lower odds. In a sex-disaggregated analysis, female farmers had higher odds of positivity (aOR = 2.43; 95% CI 1.76-3.38; p < 0.001) than male farmers (aOR = 1.52; 95% CI 1.19-1.96; p < 0.01). Fever (aOR = 2.39; 95% CI 2.00-2.84) and gastrointestinal (GI) symptoms (aOR = 2.15; 95% CI 1.94-2.37) had the highest odds among symptoms. Combination of fever and GI symptoms (aOR = 2.15; 95% CI 1.50-3.10), fever and neurological symptoms (aOR = 6.37; 95% CI 1.49-27.16), fever and musculo-skeletal symptoms (aOR = 2.95; 95% CI 1.37-6.33), fever and cardiopulmonary symptoms (aOR = 1.81; 95% CI 1.24-2.64), and cardiopulmonary and general symptoms (aOR = 1.50; 95% CI 1.19-1.89) were also predictive. Cumulative LF CPR appears high with clearly identified predictors. Targeted interventions with heightened index of suspicion for sociodemographic categories predictive of LF in suspected cases are recommended. Ethnographic and further epidemiological studies could aid better understanding of these associations.
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Affiliation(s)
- Chinwe Lucia Ochu
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Lorretta Ntoimo
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Ikenna Onoh
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Friday Okonofua
- Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria
| | - Martin Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Sandra Mba
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Akanimo Iniobong
- Department of Health Emergency Preparedness and Response, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Obinna Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Mahmood Dalhat
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
- Infectious Diseases Control Centre, Kaduna, Kaduna State, Nigeria
| | - Cornelius Ohonsi
- Department of Prevention Programmes and Knowledge Management, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Chinedu Arinze
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Ehimario Uche Igumbor
- Centre for Infectious Disease Research, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chioma Dan-Nwafor
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria.
| | - Elsie Ilori
- Department of Surveillance and Epidemiology, Nigeria Centre for Disease Control, Abuja, Nigeria
| | - Ifedayo Adetifa
- The Office of the Director General, Nigeria Centre for Disease Control, Abuja, Nigeria
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7
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Bosch-Capblanch X, Esu E, Dongus S, Oringanje CM, Jalilian H, Eyers J, Oftedal G, Meremikwu M, Röösli M. The effects of radiofrequency electromagnetic fields exposure on human self-reported symptoms: A protocol for a systematic review of human experimental studies. Environ Int 2022; 158:106953. [PMID: 34735955 PMCID: PMC8668868 DOI: 10.1016/j.envint.2021.106953] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/13/2021] [Accepted: 10/21/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND The technological applications of radiofrequency electromagnetic fields (RF-EMF) have been steadily increasing since the 1950s across multiple sectors exposing large proportions of the population. This fact has raised concerns related to the potential consequences to people's health. The World Health Organization (WHO) is assessing the potential health effects of exposure to RF-EMF and has carried out an international survey amongst experts, who have identified six priority topics to be further addressed through systematic reviews, whereof the effects on symptoms is one of them. We report here the systematic review protocol of experimental studies in humans assessing the effects of RF-EMF on symptoms. OBJECTIVE Our objectives are to assess the effects of exposure to electromagnetic fields (compared to no or lower exposure levels) on symptoms in human subjects. We will also assess the accuracy of perception of presence of exposure in volunteers with and without idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ELIGIBILITY CRITERIA We will search relevant literature sources (e.g. the Web of Science, Medline, Embase, Epistemonikos) for randomized trials (comparing at least two arms) and randomised crossover trials of RF-EMF exposure that have assessed the effects on symptoms. We will also include studies that have measured the accuracy of the perception of the presence or absence of exposure. We will include studies in any language. STUDY APPRAISAL AND SYNTHESIS Studies will be assessed against inclusion criteria by two independent reviewers. Data on study characteristics, participants, exposure, comparators and effects will be extracted using a specific template for this review, by two independent reviewers. Discrepancies will be solved by consensus. Risk of bias (ROB) will be assessed using the ROB Rating Tool for Human and Animal Studies and the level of confidence in the evidence of the exposure-outcome relations will be assessed using the GRADE approach. For the perception studies, we will use adapted versions of the ROB tool and GRADE assessment. Where appropriate, data will be combined using meta-analytical techniques.
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Affiliation(s)
- Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH 45247, United States
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - John Eyers
- Independent Consultant & Senior Research Fellow, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, UK
| | - Gunnhild Oftedal
- Department of Electronic Systems, Norwegian University of Science and Technology - NTNU, Trondheim, Norway.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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8
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Röösli M, Dongus S, Jalilian H, Feychting M, Eyers J, Esu E, Oringanje CM, Meremikwu M, Bosch-Capblanch X. The effects of radiofrequency electromagnetic fields exposure on tinnitus, migraine and non-specific symptoms in the general and working population: A protocol for a systematic review on human observational studies. Environ Int 2021; 157:106852. [PMID: 34500362 PMCID: PMC8484767 DOI: 10.1016/j.envint.2021.106852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 05/19/2023]
Abstract
BACKGROUND Applications emitting radiofrequency electromagnetic fields (RF-EMF; 100 kHz to 300 GHz) are widely used for communication (e.g. mobile phones), in medicine (diathermy) and in industry (RF heaters). Concern has been raised that RF-EMF exposure affects health related quality of life, because a part of the population reports to experience a variety of symptoms related to low exposure levels below regulatory limits. OBJECTIVES To systematically review the effects of longer-term or repeated local and whole human body RF-EMF exposure on the occurrence of symptoms evaluating migraine, tinnitus, headaches, sleep disturbances and composite symptom scores as primary outcomes. METHODS We will follow the WHO handbook for guideline development. For the development of the systematic review protocol we considered handbook for conducting systematic reviews for health effects evaluations from the National Toxicology Program-Office of Health Assessment and Translation (NTP-OHAT) and COSTER (Recommendations for the conduct of systematic reviews in toxicology and environmental health research). ELIGIBILITY CRITERIA Peer-reviewed epidemiological studies in the general population or workers aiming to investigate the association between local or whole-body RF-EMF exposure for at least one week and symptoms are eligible for inclusion. Only cohort, case-control and panel studies will be included. INFORMATION SOURCES We will search the scientific literature databases Medline, Web of Science, PsycInfo, Cochrane Library, Epistemonikos and Embase, using a predefined search strategy. This search will be supplemented by a search in the EMF-Portal and checks of reference lists of relevant papers and reviews. STUDY APPRAISAL AND SYNTHESIS METHOD Data from included papers will be extracted according to predefined forms. Findings will be summarized in tables, graphical displays and in a narrative synthesis of the available evidence, complemented with meta-analyses. We will separately review effects of local, far field and occupational exposure. RISK OF BIAS The internal validity of included studies will be assessed using the NTP-OHAT Risk of Bias Rating Tool for Human and Animal Studies, elaborated to observational RF-EMF studies. EVIDENCE APPRAISAL To rate certainty of the evidence, we will use the OHAT GRADE-based approach for epidemiological studies. FRAMEWORK AND FUNDING This protocol concerns one of the ten different systematic reviews considered in a larger systematic review of the World Health Organization to assess potential health effects of exposure to RF-EMF in the general and working population. REGISTRATION PROSPERO CRD42021239432.
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Affiliation(s)
- Martin Röösli
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Stefan Dongus
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
| | - Hamed Jalilian
- Department of Occupational Health Engineering, Research Center for Environmental Pollutants, Faculty of Health, Qom University of Medical Sciences, Qom, Iran.
| | - Maria Feychting
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - John Eyers
- International Initiative for Impact Evaluation, 3ie, c/o LIDC, 20 Bloomsbury Square, London WC1A 2NS, United Kingdom.
| | - Ekpereonne Esu
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Chioma Moses Oringanje
- Department of Biology, College of Art & Sciences, Xavier University, Cincinnati, OH, USA.
| | - Martin Meremikwu
- Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Xavier Bosch-Capblanch
- Swiss Tropical and Public Health Institute, Socinstrasse 57, CH-4051 Basel, Switzerland; University of Basel, Petersplatz 1, CH-4003 Basel, Switzerland.
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9
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Effa E, Arikpo D, Oringanje C, Udo E, Esu E, Sam O, Okoroafor S, Oyo-Ita A, Meremikwu M. Human resources for health governance and leadership strategies for improving health outcomes in low- and middle-income countries: a narrative review. J Public Health (Oxf) 2021; 43:i67-i85. [PMID: 33856463 DOI: 10.1093/pubmed/fdaa264] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. METHODS Selected electronic databases were searched up until 30 May 2020. Two authors screened studies independently and extracted data from included studies. Quality assessment was done using the Mixed Methods Appraisal Tool. Thematic analysis of the outcomes was done. RESULTS We included 18 studies of variable designs across Africa, Asia, South America and the Pacific islands. Most were case-based studies and were of moderate to high quality. Several governance strategies with a positive impact on the health workforce and health outcomes identified included decentralization, central coordination and facilitation process, posting and transfer policies as well as the setting up of human resource units. CONCLUSIONS Governance and leadership strategies targeting the HRH crises in LMIC are variable, interdependent and complex. While some show benefits in improving health workforce outcomes, only a few have an impact on population health outcomes.
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Affiliation(s)
- E Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - D Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - C Oringanje
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Udo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - E Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - O Sam
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - S Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - A Oyo-Ita
- Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - M Meremikwu
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
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10
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Chibuzor M, Arikpo I, Aquaisua E, Esu E, Okoroafor SC, Omar S, Effa E, Oyo-Ita A, Meremikwu M. Implementation of health workforce information systems: a review of eight sub-Saharan country experiences. J Public Health (Oxf) 2021; 43:i27-i40. [PMID: 33856471 DOI: 10.1093/pubmed/fdaa263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/29/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resource planning and policies. There is a lack of evaluative research on the capacity of HWRs to improve health systems. This review aims to assess the effectiveness of HWRs for improving health systems in low- and middle-income countries. METHODS We searched selected electronic databases from inception to 14 April 2020. Two authors independently screened studies and extracted data from included studies. We presented results as a narrative synthesis. RESULTS We included eight studies of moderate-high quality in this review. The results suggest that HWRs can improve the distribution and skill-mix of the health workforce, quality of health workforce data, availability and use of data for policy and planning, and user satisfaction. The evidence was derived from case studies, which limited our ability to infer a causal relationship. CONCLUSION More rigorous research from controlled experimental studies is needed to consolidate the available evidence from observational studies.
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Affiliation(s)
- M Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - I Arikpo
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria.,Department of Computer Science, University of Calabar, Calabar, Nigeria
| | - E Aquaisua
- Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - E Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - S C Okoroafor
- Health Systems Strengthening Cluster, World Health Organization Country Office, Abuja, Nigeria
| | - S Omar
- Inter-Country Support Team, World Health Organization, Ouagadougou, Burkina Faso
| | - E Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - A Oyo-Ita
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Department of Community Medicine, University of Calabar, Calabar, Nigeria
| | - M Meremikwu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.,Cross River Health and Demographic Surveillance System, University of Calabar, Calabar, Nigeria
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11
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Esu E, Ekanem U. Awareness and utilization of personal protective equipment among small-scale welders in Cross River State, Nigeria: a descriptive cross-sectional study. BUMJ 2021. [DOI: 10.38029/bumj.v4i1.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Rapid urbanization and industrialization in the many low- and middle-income countries means that there is a growing demand for the welding industry. Previous studies in Nigeria, and other low- and middle-income countries have reported a significant discrepancy between awareness and consistent and appropriate use of personal protective equipment (PPE). This study assessed the awareness and utilization of PPE among small-scale welders in Calabar South, Cross River State, Nigeria.
Methods: This study was conducted in Calabar South Local Government Area using a descriptive cross-sectional design. Data collection was with an interviewer-administered semi-structured questionnaire, and an observation checklist was used to monitor the use of PPE among small-scale welders.
Results: One hundred and sixteen small-scale welders were surveyed with a mean age of 34.9 ±9.1 years. Almost 90% of respondents had completed at least primary education. Eighty-one respondents (69.8%) were aware of PPE. Three-quarters of respondents (61/81) knew PPE protected the user from injury. The most frequently identified type of welding PPE among the respondents aware of PPE, were safety goggles (38.3%), hand gloves (25.9%), safety boots (19.8%), and coveralls (9.9%). 83.6% had access to PPE at work. However, only 14.4% reported using PPE consistently. Observation revealed that the PPE most frequently used, sunglasses, were not the recommended welding goggles.
Conclusion: The low utilization of PPE calls for stricter enforcement of occupational health and safety regulations among welders in the informal sector, including implementing PPE awareness programs.
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12
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Oyo-Ita A, Bosch-Capblanch X, Ross A, Oku A, Esu E, Ameh S, Oduwole O, Arikpo D, Meremikwu M. Effects of engaging communities in decision-making and action through traditional and religious leaders on vaccination coverage in Cross River State, Nigeria: A cluster-randomised control trial. PLoS One 2021; 16:e0248236. [PMID: 33861742 PMCID: PMC8051768 DOI: 10.1371/journal.pone.0248236] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
Background Vaccination coverage levels fall short of the Global Vaccine and Action Plan 90% target in low- and middle- income countries (LMICs). Having identified traditional and religious leaders (TRLs) as potential public health change agents, this study aimed at assessing the effect of training them to support routine immunisation for the purpose of improving uptake of childhood vaccines in Cross River State, Nigeria. Methods A cluster-randomised controlled study was conducted between 2016 and 2019. Of the 18 Local Government Areas (LGA) in Cross River State, eight (four urban and four rural LGAs) were randomized into the intervention and control study arms. A multi-component intervention involving the training of traditional and religious leaders was implemented in the four intervention LGAs. Baseline, midline and endline surveys collected information on children aged 0–23 months. The effect of the intervention on outcomes including the proportion fully up-to-date with vaccination, timely vaccination for pentavalent and measles vaccines, and pentavalent 1–3 dropout rates were estimated using logistic regression models using random effects to account for the clustered data. Results A total of 2598 children at baseline, 2570 at midline, and 2550 at endline were included. The intervention was effective in increasing the proportion with at least one vaccine (OR 12.13 95% CI 6.03–24.41p<0.001). However, there was no evidence of an impact on the proportion of children up-to-date with vaccination (p = 0.69). It was effective in improving timeliness of Pentavalent 3 (OR 1.55; 95% CI: 1.14, 2.12; p = 0.005) and Measles (OR 2.81; 96% CI: 1.93–4.1; p<0.001) vaccination. The odds of completing Pentavalent vaccination increased (OR = 1.66 95% CI: 1.08,2.55). Conclusion Informal training to enhance the traditional and religious leaders’ knowledge of vaccination and their leadership role can empower them to be good influencers for childhood vaccination. They constitute untapped resources in the community to boost routine immunisation. Pan African Clinical Trial Registry (PACTR) PACTR202008784222254.
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Affiliation(s)
- Angela Oyo-Ita
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- * E-mail:
| | - Xavier Bosch-Capblanch
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Amanda Ross
- University of Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Afiong Oku
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ekpereonne Esu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Public Health, Faculty of Allied Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
| | - Soter Ameh
- Department of Community Medicine, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Olabisi Oduwole
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Medical Laboratory Science, Achievers University, Owo, Ondo State, Nigeria
| | - Dachi Arikpo
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
| | - Martin Meremikwu
- Effective Health Care Alliance Programme, Institute of Tropical Disease, Research and Prevention, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria
- Department of Paediatrics, Faculty of Medicine, College of Medical Sciences, University of Calabar, Calabar, Cross River State, Nigeria
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13
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Ogunkola IO, Adebisi YA, Imo UF, Odey GO, Esu E, Lucero-Prisno DE. Rural communities in Africa should not be forgotten in responses to COVID-19. Int J Health Plann Manage 2020; 35:1302-1305. [PMID: 32790138 PMCID: PMC7436649 DOI: 10.1002/hpm.3039] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 11/08/2022] Open
Abstract
Rural areas in Africa make up a large proportion of the continent. Since the emergence of COVID-19 on the continent, major attention and responses have been placed on urban areas. Rural areas are typified by certain challenges which may serve as limitations to the provision of resources and tools for COVID-19 responses in these areas. These major challenges include limited access to these areas due to poor road networks which may hamper the possibility of conveying resources and manpower. Shortage of healthcare workforce in these areas, poor health facilities/structures and limited access to COVID-19 diagnostics services may also make containment challenging. It is therefore important that investment should be made in these areas towards providing the necessary tools, resources, and manpower to ensure effective containment of COVID-19 and to alleviate the plight caused by the pandemic in rural Africa. Rural communities in Africa should not be left behind in COVID-19 responses.
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Affiliation(s)
| | | | - Uchenna Frank Imo
- Department of Public Health, University of Calabar, Cross River State, Nigeria
| | - Goodness Ogeyi Odey
- Department of Public Health, University of Calabar, Cross River State, Nigeria
| | - Ekpereonne Esu
- Department of Public Health, University of Calabar, Cross River State, Nigeria
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14
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Olaleye A, Okusanya BO, Oduwole O, Esu E, Meremikwu M. A systematic review and meta-analysis of dihydroartemisinin-piperaquine versus sulphadoxine-pyrimethamine for malaria prevention in pregnancy. Int J Gynaecol Obstet 2019; 146:43-55. [PMID: 31050803 DOI: 10.1002/ijgo.12835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/23/2019] [Accepted: 05/01/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Intermittent preventive treatment (IPT) with sulphadoxine-pyrimethamine (SP) is recommended for preventing maternal and fetal effects of malaria in pregnancy. Increasing parasite resistance to SP has necessitated the search for an alternative medication. OBJECTIVE To compare dihydroartemisinin-piperaquine (DP) and sulphadoxine-pyrimethamine in preventing malaria during pregnancy. SEARCH STRATEGY Databases including CENTRAL, MEDLINE, and ICTRP were searched until August 2018. SELECTION CRITERIA Randomized and quasi-randomized controlled trials that compared DP with SP given to pregnant women to prevent adverse maternal or fetal effects of malaria were included. DATA COLLECTION AND ANALYSIS Quality of evidence was determined with GRADE criteria. Effectiveness measures were calculated using odds ratios at 95% confidence intervals. RESULTS Three randomized controlled trials were included. Compared with IPT-SP, moderate certainty evidence indicated that women who received IPT-DP had significantly lower risks of clinical malaria during pregnancy. High certainty evidence showed intermittent screening and treatment with DP did not reduce placental malaria or maternal parasitemia at delivery. Effect of DP on low birth weight and adverse birth outcomes was minimal. CONCLUSIONS Moderate certainty evidence suggests that IPT-DP may reduce maternal and placental malaria compared with IPT-SP, and monthly DP is more effective than SP in reducing placental malaria. PROSPERO ID CRD42018084651.
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Affiliation(s)
- Atinuke Olaleye
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Gynecology, Benjamin Carson (Sr) School of Medicine, Babcock University, Ilishan-Remo, Nigeria
| | - Babasola O Okusanya
- Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olabisi Oduwole
- Department of Medical Laboratory Science, Achievers University, Owo, Nigeria
| | - Ekpereonne Esu
- Department of Public Health, Faculty of Allied Medical Sciences, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Martin Meremikwu
- Department of Pediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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15
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Esu E, Berens-Riha N, Pritsch M, Nwachuku N, Loescher T, Meremikwu M. Intermittent screening and treatment with artemether-lumefantrine versus intermittent preventive treatment with sulfadoxine-pyrimethamine for malaria in pregnancy: a facility-based, open-label, non-inferiority trial in Nigeria. Malar J 2018; 17:251. [PMID: 29976228 PMCID: PMC6034215 DOI: 10.1186/s12936-018-2394-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 06/21/2018] [Indexed: 11/20/2022] Open
Abstract
Background The spread of SP resistance may compromise the effectiveness of intermittent preventive treatment of malaria in pregnancy (MiP) with sulfadoxine–pyrimethamine (IPTp-SP) across Africa. However, there is no recommended alternative medicine for IPTp or alternative strategy for prevention of MiP. This poses problems for the prevention of MiP. This study investigated, whether screening with a rapid diagnostic test for malaria at routine antenatal clinic attendances and treatment of only those who are positive (intermittent screening and treatment) with artemether–lumefantrine is as effective and safe as IPTp-SP in pregnant women. Methods During antenatal clinic sessions at the General Hospital Calabar, Nigeria, held between October 2013 and November 2014, 459 pregnant women were randomized into either the current standard IPTp-SP or intermittent screening and treatment with artemether–lumefantrine (ISTp-AL). All women received a long-lasting insecticide-treated net at enrolment. Study women had a maximum of four scheduled visits following enrolment. Haemoglobin concentration and peripheral parasitaemia were assessed in the third trimester (36–40 weeks of gestation). Birth weight was documented at delivery or within a week for babies delivered at home. Results In the third trimester, the overall prevalence of severe anaemia (Hb < 8 g/dl) and moderate (8–10.9 g/dl) anaemia was 0.8 and 27.7%, respectively, and was similar in both treatment groups (p = 0.204). The risk of third-trimester severe anaemia did not differ significantly between both treatment arms (risk difference − 1.75% [95% CI − 4.16 to 0.66]) although the sample was underpowered for this outcome due to several participants being unavailable to give a blood sample. The risk of third-trimester maternal parasitaemia was significantly lower in the ISTp-AL arm (RD − 3.96% [95% CI − 7.76 to − 0.16]). The risk of low birthweight was significantly lower in the ISTp-AL arm after controlling for maternal age, gravidity and baseline parasitaemia (risk difference − 1.53% [95% CI − 1.54 to − 1.15]). Women in the ISTp-AL arm complained of fever more frequently compared to women in the IPTp-SP arm (p = 0.022). Conclusions The trial results suggest that in an area of high malaria transmission with moderate sulfadoxine–pyrimethamine resistance, ISTp with artemether–lumefantrine may be an effective strategy for controlling malaria in pregnancy. Trial registration PACTR, PACTR201308000543272. Registered 29 April 2013, http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?dar=true&tNo=PACTR201308000543272 Electronic supplementary material The online version of this article (10.1186/s12936-018-2394-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ekpereonne Esu
- Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Leopoldstraße 7, 80802, Munich, Germany. .,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Nuria Nwachuku
- Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria
| | - Thomas Loescher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Ehiri J, Alaofè H, Asaolu I, Chebet J, Esu E, Meremikwu M. Emergency transportation interventions for reducing adverse pregnancy outcomes in low- and middle-income countries: a systematic review protocol. Syst Rev 2018; 7:65. [PMID: 29695299 PMCID: PMC5922314 DOI: 10.1186/s13643-018-0729-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 04/12/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Transportation interventions seek to decrease delay in reaching a health facility for emergency obstetric care and are, thus, believed to contribute to reductions in such adverse pregnancy and childbirth outcomes as maternal deaths, stillbirths, and neonatal mortality in low- and middle-income countries (LMICs). However, there is limited empirical evidence to support this hypothesis. The objective of the proposed review is to summarize and critically appraise evidence regarding the effect of emergency transportation interventions on outcomes of labor and delivery in LMICs. METHODS The following databases will be searched from inception to March 31, 2018: MEDLINE/PubMed, EMBASE, Web of Science, EBSCO (PsycINFO and CINAHL), the Cochrane Pregnancy and Child Birth Group's Specialized Register, and the Cochrane Central Register of Controlled Trials. We will search for studies in the grey literature through Google and Google Scholar. We will solicit unpublished reports from such relevant agencies as United Nations Fund for Population Activities (UNFPA), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the United States Agency for International Development (USAID), and the United Kingdom Department for International Development (DfID) among others. Data generated from the search will be managed using Endnote Version 7. We will perform quantitative data synthesis if studies are homogenous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesized, using the narrative synthesis approach. DISCUSSION Among the many barriers that women in LMICs face in accessing life-saving interventions during labor and delivery, lack of access to emergency transportation is particularly important. This review will provide a critical summary of evidence regarding the impact of transportation interventions on outcomes of pregnancy and childbirth in LMICs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017080092.
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Affiliation(s)
- John Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Ibitola Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Joy Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Avenue, Tucson, AZ 85724 USA
| | - Ekpereonne Esu
- Department of Public Health, University of Calabar Teaching Hospital, Moore Road, Calabar, Cross River State Nigeria
| | - Martin Meremikwu
- Department of Public Health, University of Calabar Teaching Hospital, Moore Road, Calabar, Cross River State Nigeria
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Esu E, Tacoli C, Gai P, Berens-Riha N, Pritsch M, Loescher T, Meremikwu M. Prevalence of the Pfdhfr and Pfdhps mutations among asymptomatic pregnant women in Southeast Nigeria. Parasitol Res 2018; 117:801-807. [PMID: 29332155 DOI: 10.1007/s00436-018-5754-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 01/08/2018] [Indexed: 10/18/2022]
Abstract
Sulfadoxine-pyrimethamine (SP) is the recommended drug for intermittent preventive treatment of malaria in pregnancy in most of sub-Saharan Africa. Resistance to SP is related to mutations in the dhfr and dhps gene of Plasmodium falciparum. This study determined the prevalence of Pfdhfr and Pfdhps polymorphisms found in asymptomatic pregnant women attending antenatal care in Calabar, Nigeria. From October 2013 to November 2014, asymptomatic pregnant women attending antenatal care clinics were enrolled after obtaining informed consent. Malaria diagnosis testing was done using thick and thin smears. Dried blood spot filter papers were collected. Parasite DNA was extracted from the filter papers using a chelex extraction. Extraction was followed by nested PCR and restriction enzyme digestion. P. falciparum infection was detected by microscopy in 7% (32/459) participants. Twenty-eight P. falciparum isolates were successfully genotyped. In the Pfdhfr gene, the triple mutation was almost fixed; S108N mutation was (100%), N51I (93%) and C59R mutations (93%), whereas the I164L mutation was absent. The prevalence of Pfdhps S436A, A437G, A581G and A613S mutations was 82.1% (23/28), 96.4% (27/28), 71.4% (20/28) and 71.4% (20/28) respectively. The K540E mutation was absent. The prevalence of the Pfdhfr triple mutation IRNI was 92.9% (26/28). The efficacy of SP as IPTp in Southeast Nigeria may be severely threatened. The continuous monitoring of SP molecular markers of resistance is required to assess thresholds. The evaluation of alternative preventive treatment strategies and drug options for preventing malaria in pregnancy may be necessary.
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Affiliation(s)
- Ekpereonne Esu
- Center for International Health (CIH), Ludwig-Maximilians-Universität (LMU), Leopoldstraße 7, 80802, Munich, Germany. .,Department of Public Health, College of Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Costanza Tacoli
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Prabhanjan Gai
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Nicole Berens-Riha
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Michael Pritsch
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Thomas Loescher
- Division of Infectious Diseases and Tropical Medicine, Medical Center of the University of Munich (LMU), Leopoldstrasse 5, 80802, Munich, Germany
| | - Martin Meremikwu
- Department of Paediatrics, College of Medical Sciences, University of Calabar, Calabar, Nigeria
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Esu E, Okoye I, Arikpo I, Ejemot-Nwadiaro R, Meremikwu MM. Providing information to improve body image and care-seeking behavior of women and girls living with female genital mutilation: A systematic review and meta-analysis. Int J Gynaecol Obstet 2017; 136 Suppl 1:72-78. [PMID: 28164289 DOI: 10.1002/ijgo.12058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Female genital mutilation (FGM) has become recognized worldwide as an extreme form of violation of the human rights of girls and women. Strategies have been employed to curb the practice. OBJECTIVE To conduct a systematic review of randomized and nonrandomized studies of the effects of providing educational interventions on the body image and care-seeking behavior of girls and women living with FGM with the view to ending the practice. SEARCH STRATEGY CENTRAL, MEDLINE, and other databases were searched up to August 10, 2015 without any language restrictions. SELECTION CRITERIA Studies that provided education to women and/or girls living with any type of FGM or residing in countries where FGM is predominantly practiced were included. DATA COLLECTION AND ANALYSIS Two authors independently screened and collected data. We summarized dichotomous outcomes using odds ratios and evidence was assessed using the GRADE system (Grading of Recommendations Assessment, Development, and Evaluation). RESULTS Educational interventions resulted in fewer women recommending FGM for their daughters and also reduced the incidence of FGM cases among daughters of women who received the educational interventions. CONCLUSION These findings need to be validated with large randomized trials. PROSPERO REGISTRATION 42015024637.
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Affiliation(s)
- Ekpereonne Esu
- Department of Public Health, University of Calabar, Calabar, Nigeria
| | - Ifeyinwa Okoye
- Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Iwara Arikpo
- Department of Computer Science, University of Calabar, Calabar, Nigeria.,Cross River Health and Demographic Surveillance System, Directorate of Research, University of Calabar, Calabar, Nigeria
| | | | - Martin M Meremikwu
- Department of Pediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Abayomi O, Chibuzor MT, Okusanya BO, Esu E, Odey E, Meremikwu MM. Supportive psychotherapy or client education alongside surgical procedures to correct complications of female genital mutilation: A systematic review. Int J Gynaecol Obstet 2017; 136 Suppl 1:51-55. [DOI: 10.1002/ijgo.12042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Olukayode Abayomi
- Department of Mental health; Ladoke Akintola University Teaching Hospital; Ogbomoso Oyo Nigeria
| | - Moriam T. Chibuzor
- Cochrane Nigeria; Institute of Tropical Diseases Research and Prevention Calabar; University of Calabar Teaching Hospital; Calabar Nigeria
| | - Babasola O. Okusanya
- Experimental and Maternal Medicine Unit; Department of Obstetrics and Gynecology; Faculty of Clinical Sciences; College of Medicine; University of Lagos; Idi-Araba Lagos Nigeria
| | - Ekpereonne Esu
- Department of Public Health; University of Calabar; Calabar Nigeria
| | - Edward Odey
- Department of Social Science Education; Faculty of Education; University of Calabar; Calabar Nigeria
| | - Martin M. Meremikwu
- Cochrane Nigeria; Institute of Tropical Diseases Research and Prevention Calabar; University of Calabar Teaching Hospital; Calabar Nigeria
- Department of Pediatrics; College of Medical Sciences; University of Calabar; Calabar Nigeria
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20
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Esu E, Udo A, Okusanya BO, Agamse D, Meremikwu MM. Antepartum or intrapartum deinfibulation for childbirth in women with type III female genital mutilation: A systematic review and meta-analysis. Int J Gynaecol Obstet 2017; 136 Suppl 1:21-29. [DOI: 10.1002/ijgo.12055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ekpereonne Esu
- Department of Public Health; College of Medical Science; University of Calabar; Calabar Nigeria
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
| | - Atim Udo
- Department of Obstetrics and Gynecology; College of Medical Science; University of Calabar; Calabar Nigeria
| | - Babasola O. Okusanya
- Experimental and Maternal Medicine Unit; Department of Obstetrics and Gynecology; Faculty of Clinical Sciences; College of Medicine; University of Lagos; Idi-Araba, Lagos Nigeria
| | - David Agamse
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
| | - Martin M. Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention; University of Calabar Teaching Hospital; Calabar Nigeria
- Department of Pediatrics; University of Calabar Teaching Hospital; Calabar Nigeria
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21
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Abstract
BACKGROUND Unintended pregnancy among adolescents represents an important public health challenge in high-income countries, as well as middle- and low-income countries. Numerous prevention strategies such as health education, skills-building and improving accessibility to contraceptives have been employed by countries across the world, in an effort to address this problem. However, there is uncertainty regarding the effects of these interventions, hence the need to review the evidence-base. OBJECTIVES To assess the effects of primary prevention interventions (school-based, community/home-based, clinic-based, and faith-based) on unintended pregnancies among adolescents. SEARCH METHODS We searched all relevant studies regardless of language or publication status up to November 2015. We searched the Cochrane Fertility Regulation Group Specialised trial register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 11), MEDLINE, EMBASE, LILACS, Social Science Citation Index and Science Citation Index, Dissertations Abstracts Online, The Gray Literature Network, HealthStar, PsycINFO, CINAHL and POPLINE and the reference lists of articles. SELECTION CRITERIA We included both individual and cluster randomised controlled trials (RCTs) evaluating any interventions that aimed to increase knowledge and attitudes relating to risk of unintended pregnancies, promote delay in the initiation of sexual intercourse and encourage consistent use of birth control methods to reduce unintended pregnancies in adolescents aged 10 years to 19 years. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias, and extracted data. Where appropriate, binary outcomes were pooled using a random-effects model with a 95% confidence interval (Cl). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 53 RCTs that enrolled 105,368 adolescents. Participants were ethnically diverse. Eighteen studies randomised individuals, 32 randomised clusters (schools (20), classrooms (6), and communities/neighbourhoods (6). Three studies were mixed (individually and cluster randomised). The length of follow up varied from three months to seven years with more than 12 months being the most common duration. Four trials were conducted in low- and middle- income countries, and all others were conducted in high-income countries. Multiple interventionsResults showed that multiple interventions (combination of educational and contraceptive-promoting interventions) lowered the risk of unintended pregnancy among adolescents significantly (RR 0.66, 95% CI 0.50 to 0.87; 4 individual RCTs, 1905 participants, moderate quality evidence. However, this reduction was not statistically significant from cluster RCTs. Evidence on the possible effects of interventions on secondary outcomes (initiation of sexual intercourse, use of birth control methods, abortion, childbirth, sexually transmitted diseases) was not conclusive.Methodological strengths included a relatively large sample size and statistical control for baseline differences, while limitations included lack of biological outcomes, possible self-report bias, analysis neglecting clustered randomisation and the use of different statistical tests in reporting outcomes. Educational interventionsEducational interventions were unlikely to significantly delay the initiation of sexual intercourse among adolescents compared to controls (RR 0.95, 95% CI 0.71 to 1.27; 2 studies, 672 participants, low quality evidence).Educational interventions significantly increased reported condom use at last sex in adolescents compared to controls who did not receive the intervention (RR 1.18, 95% CI 1.06 to 1.32; 2 studies, 1431 participants, moderate quality evidence).However, it is not clear if the educational interventions had any effect on unintended pregnancy as this was not reported by any of the included studies. Contraceptive-promoting interventionsFor adolescents who received contraceptive-promoting interventions, there was little or no difference in the risk of unintended first pregnancy compared to controls (RR 1.01, 95% CI 0.81 to 1.26; 2 studies, 3,440 participants, moderate quality evidence).The use of hormonal contraceptives was significantly higher in adolescents in the intervention group compared to those in the control group (RR 2.22, 95% CI 1.07 to 4.62; 2 studies, 3,091 participants, high quality evidence) AUTHORS' CONCLUSIONS A combination of educational and contraceptive-promoting interventions appears to reduce unintended pregnancy among adolescents. Evidence for programme effects on biological measures is limited. The variability in study populations, interventions and outcomes of included trials, and the paucity of studies directly comparing different interventions preclude a definitive conclusion regarding which type of intervention is most effective.
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Affiliation(s)
- Chioma Oringanje
- University of TucsonGIDP Entomology and Insect ScienceTucsonArizonaUSA85721
| | - Martin M Meremikwu
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria
| | - Hokehe Eko
- St. Georges University School of Medicine1 East Main Street, Suite 233, Bay ShoreNew YorkUSA11706
| | - Ekpereonne Esu
- University of CalabarDepartment of Public HealthCalabarNigeria540271
| | - Anne Meremikwu
- University of CalabarDepartment of Curriculum and TeachingCalabarCross River StateNigeria
| | - John E Ehiri
- University of Arizona, Mel & Enid Zuckerman College of Public HealthDivision of Health Promotion Sciences1295 N. Martin Avenue A256Campus POB: 245163TucsonArizonaUSAAZ 85724
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Affiliation(s)
| | - Ekpereonne Esu
- University of Calabar; Department of Public Health; Calabar Nigeria 540271
| | - Chioma Oringanje
- University of Tucson; GIDP Entomology and Insect Science; Tucson Arizona USA 85721
| | - Martin M Meremikwu
- University of Calabar Teaching Hospital; Department of Paediatrics; PMB 1115 Calabar Cross River State Nigeria
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Abstract
BACKGROUND In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation, many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This review evaluates intramuscular artemether compared with both quinine and artesunate. OBJECTIVES To assess the efficacy and safety of intramuscular artemether versus any other parenteral medication in treating severe malaria in adults and children. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE and LILACS, ISI Web of Science, conference proceedings and reference lists of articles. We also searched the WHO clinical trial registry platform, ClinicalTrials.gov and the metaRegister of Controlled Trials (mRCT) for ongoing trials up to 9 April 2014. SELECTION CRITERIA Randomized controlled trials (RCTs) comparing intramuscular artemether with intravenous or intramuscular antimalarial for treating severe malaria. DATA COLLECTION AND ANALYSIS The primary outcome was all-cause death.Two authors independently assessed trial eligibility, risk of bias and extracted data. We summarized dichotomous outcomes using risk ratios (RR) and continuous outcomes using mean differences (MD), and presented both measures with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 18 RCTs, enrolling 2662 adults and children with severe malaria, carried out in Africa (11) and in Asia (7). Artemether versus quinine For children in Africa, there is probably little or no difference in the risk of death between intramuscular artemether and quinine (RR 0.96, 95% CI 0.76 to 1.20; 12 trials, 1447 participants, moderate quality evidence). Coma recovery may be about five hours shorter with artemether (MD -5.45, 95% CI -7.90 to -3.00; six trials, 358 participants, low quality evidence), and artemether may result in fewer neurological sequelae, but larger trials would be needed to confirm this (RR 0.84, 95% CI 0.66 to 1.07; seven trials, 968 participants, low quality evidence). Artemether probably shortens the parasite clearance time by about nine hours (MD -9.03, 95% CI -11.43 to -6.63; seven trials, 420 participants, moderate quality evidence), and may shorten the fever clearance time by about three hours (MD -3.73, 95% CI -6.55 to -0.92; eight trials, 457 participants, low quality evidence).For adults in Asia, treatment with intramuscular artemether probably results in fewer deaths than treatment with quinine (RR 0.59, 95% CI 0.42 to 0.83; four trials, 716 participants, moderate quality evidence). Artemether versus artesunate Artemether and artesunate have not been directly compared in randomized trials in African children.For adults in Asia, mortality is probably higher with intramuscular artemether (RR 1.80, 95% CI 1.09 to 2.97, two trials,494 participants, moderate quality evidence). AUTHORS' CONCLUSIONS Although there is a lack of direct evidence comparing artemether with artesunate, artemether is probably less effective than artesunate at preventing deaths from severe malaria. In circumstances where artesunate is not available, artemether is an alternative to quinine.
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Affiliation(s)
- Ekpereonne Esu
- University of CalabarDepartment of Public HealthCalabarNigeria540271
| | - Emmanuel E Effa
- College of Medical Sciences, University of CalabarInternal MedicinePMB 1115CalabarNigeria540001
| | - Oko N Opie
- Federal College of EducationDepartment of General StudiesObuduNigeria
| | - Amirahobu Uwaoma
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria
| | - Martin M Meremikwu
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarNigeria
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Esu E, Effa E, Udoh E, Oduwole O, Odey F, Chibuzor M, Oyo-Ita A, Meremikwu M. Utilization of intermittent preventive treatment for malaria among pregnant women attending antenatal clinics in health facilities of Cross River State, Nigeria. Res Rep Trop Med 2013; 4:29-35. [PMID: 30890873 PMCID: PMC6065562 DOI: 10.2147/rrtm.s47677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective This study assessed the utilization of intermittent preventive treatment with sulfadoxine–pyrimethamine for the prevention of malaria in pregnancy against the national treatment policy among women attending health care facilities in Cross River State, Nigeria. Methods A clinical audit was carried out between January 2012 and March 2012 using case records of pregnant women who received antenatal care in health facilities in the state. Facilities were selected by simple random sampling. Information on the frequency of antenatal clinic (ANC) visits by the women, as well as parity, age, and adherence to intermittent preventive treatment (IPTp) doses was obtained using an audit checklist. Results A total of 322 pregnant women were assessed across 36 health care facilities. In addition, 246 (76%) of them attended the ANC in public health facilities. Age, parity, and gestational age at booking were recorded in more than 95% of the cases evaluated. The audit showed that 13.7% of the women did not utilize IPTp, 53.1% had one dose of IPTp (IPTp1), 24.2% had two doses of IPTp (IPTp2), while 3.1% had three doses of IPTp (IPTp3). The overall utilization of two doses or more of IPTp (IPTp2+) was 30.7%. Conclusion There was good documentation of the basic obstetric information of pregnant women in the health care facilities examined in this study, but the overall utilization of IPTp was very low. Efforts at ensuring early ANC booking and regular visits may be a potential means of increasing IPTp utilization in health care facilities in the state.
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Affiliation(s)
- Ekpereonne Esu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Emmanuel Effa
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Ekong Udoh
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Olabisi Oduwole
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Friday Odey
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Moriam Chibuzor
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria,
| | - Angela Oyo-Ita
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
| | - Martin Meremikwu
- Calabar Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria, .,College of Medical Sciences, University of Calabar, Calabar, Nigeria,
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Meremikwu MM, Donegan S, Sinclair D, Esu E, Oringanje C. Intermittent preventive treatment for malaria in children living in areas with seasonal transmission. Cochrane Database Syst Rev 2012; 2012:CD003756. [PMID: 22336792 PMCID: PMC6532713 DOI: 10.1002/14651858.cd003756.pub4] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In malaria endemic areas, pre-school children are at high risk of severe and repeated malaria illness. One possible public health strategy, known as Intermittent Preventive Treatment in children (IPTc), is to treat all children for malaria at regular intervals during the transmission season, regardless of whether they are infected or not. OBJECTIVES To evaluate the effects of IPTc to prevent malaria in preschool children living in endemic areas with seasonal malaria transmission. SEARCH METHODS We searched the Cochrane Infectious Diseases Group Specialized Register (July 2011), CENTRAL (The Cochrane Library 2011, Issue 6), MEDLINE (1966 to July 2011), EMBASE (1974 to July 2011), LILACS (1982 to July 2011), mRCT (July 2011), and reference lists of identified trials. We also contacted researchers working in the field for unpublished and ongoing trials. SELECTION CRITERIA Individually randomized and cluster-randomized controlled trials of full therapeutic dose of antimalarial or antimalarial drug combinations given at regular intervals compared with placebo or no preventive treatment in children aged six years or less living in an area with seasonal malaria transmission. DATA COLLECTION AND ANALYSIS Two authors independently assessed eligibility, extracted data and assessed the risk of bias in the trials. Data were meta-analysed and measures of effects (ie rate ratio, risk ratio and mean difference) are presented with 95% confidence intervals (CIs). The quality of evidence was assessed using the GRADE methods. MAIN RESULTS Seven trials (12,589 participants), including one cluster-randomized trial, met the inclusion criteria. All were conducted in West Africa, and six of seven trials were restricted to children aged less than 5 years.IPTc prevents approximately three quarters of all clinical malaria episodes (rate ratio 0.26; 95% CI 0.17 to 0.38; 9321 participants, six trials, high quality evidence), and a similar proportion of severe malaria episodes (rate ratio 0.27, 95% CI 0.10 to 0.76; 5964 participants, two trials, high quality evidence). These effects remain present even where insecticide treated net (ITN) usage is high (two trials, 5964 participants, high quality evidence).IPTc probably produces a small reduction in all-cause mortality consistent with the effect on severe malaria, but the trials were underpowered to reach statistical significance (risk ratio 0.66, 95% CI 0.31 to 1.39, moderate quality evidence).The effect on anaemia varied between studies, but the risk of moderately severe anaemia is probably lower with IPTc (risk ratio 0.71, 95% CI 0.52 to 0.98; 8805 participants, five trials, moderate quality evidence).Serious drug-related adverse events, if they occur, are probably rare, with none reported in the six trials (9533 participants, six trials, moderate quality evidence). Amodiaquine plus sulphadoxine-pyrimethamine is the most studied drug combination for seasonal chemoprevention. Although effective, it causes increased vomiting in this age-group (risk ratio 2.78, 95% CI 2.31 to 3.35; two trials, 3544 participants, high quality evidence).When antimalarial IPTc was stopped, no rebound increase in malaria was observed in the three trials which continued follow-up for one season after IPTc. AUTHORS' CONCLUSIONS In areas with seasonal malaria transmission, giving antimalarial drugs to preschool children (age < 6 years) as IPTc during the malaria transmission season markedly reduces episodes of clinical malaria, including severe malaria. This benefit occurs even in areas where insecticide treated net usage is high.
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Affiliation(s)
- Martin M Meremikwu
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria.
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Esu E, Lenhart A, Smith L, Horstick O. Effectiveness of peridomestic space spraying with insecticide on dengue transmission; systematic review. Trop Med Int Health 2010; 15:619-31. [PMID: 20214764 DOI: 10.1111/j.1365-3156.2010.02489.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To review the evidence on effectiveness of peridomestic space spraying of insecticides in reducing wild Aedes populations and interrupting dengue transmission. METHODS Comprehensive literature search of MEDLINE, EMBASE, LILACS, Web of Science, WHOLIS, MedCarib and CENTRAL, and a manual search of reference lists from identified studies. Duplicates were removed and abstracts assessed for selection. All field evaluations of peridomestic space spraying targeting wild adult Aedes vectors in dengue endemic countries were included. Data were extracted, and the methodological quality of the studies was assessed independently by two reviewers. RESULTS Fifteen studies met the inclusion criteria. Outcome measures were heterogeneous, foregoing the possibility of meta-analysis. Thirteen studies showed reductions in immature entomological indices that were not sustained for long periods. The remainder showed space spray interventions to be ineffective at reducing adult and/or immature entomological indices. Only one study measured human disease indicators, but its outcomes could not be directly attributed to space sprays alone. CONCLUSION Although peridomestic space spraying is commonly applied by national dengue control programmes, there are very few studies evaluating the effectiveness of this intervention. There is no clear evidence for recommending peridomestic space spraying as a single, effective control intervention. Thus, peridomestic space spraying is more likely best applied as part of an integrated vector management strategy. The effectiveness of this intervention should be measured in terms of impact on both adult and immature mosquito populations, as well as on disease transmission.
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Affiliation(s)
- Ekpereonne Esu
- Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria.
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Abstract
BACKGROUND Unintended pregnancy among adolescents represent an important public health challenge in developed and developing countries. Numerous prevention strategies such as health education, skills-building and improving accessibility to contraceptives have been employed by countries across the world, in an effort to address this problem. However, there is uncertainty regarding the effects of these intervention, and hence the need to review their evidence-base OBJECTIVES To assess the effects of primary prevention interventions (school-based, community/home-based, clinic-based, and faith-based) on unintended pregnancies among adolescents. SEARCH STRATEGY We searched electronic databases (CENTRAL, PubMed, EMBASE) ending December 2008. Cross-referencing, hand-searching, and contacting experts yielded additional citations. SELECTION CRITERIA We included both individual and cluster randomized controlled trials (RCTs) evaluating any interventions that aimed to increase knowledge and attitudes relating to risk of unintended pregnancies, promote delay in the initiation of sexual intercourse and encourage consistent use of birth control methods to reduce unintended pregnancies in adolescents aged 10-19 years. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed trial eligibility and risk of bias in studies that met the inclusion criteria. Where appropriate, binary outcomes were pooled using random effects model with a 95% confidence interval (Cl). MAIN RESULTS Forty one RCTs that enrolled 95,662 adolescents were included. Participants were ethnically diverse. Eleven studies randomized individuals, twenty seven randomized clusters (schools (19), classrooms (5), and communities/neighbourhoods (3). Three studies were mixed (individually and cluster randomized). The length of follow up varied from 3 months to 4.5 years. Data could only be pooled for a number of studies (15) because of variations in the reporting of outcomes. Results showed that multiple interventions (combination of educational and contraceptive interventions) lowered the rate of unintended pregnancy among adolescents. Evidence on the possible effects of interventions on secondary outcomes (initiation of sexual intercourse, use of birth control methods, abortion, childbirth, sexually transmitted diseases) is not conclusive.Methodological strengths included a relatively large sample size and statistical control for baseline differences, while limitations included lack of biological outcomes, possible self-report bias, analysis neglecting clustered randomization and the use of different statistical test in reporting outcomes. AUTHORS' CONCLUSIONS Combination of educational and contraceptive interventions appears to reduce unintended pregnancy among adolescents. Evidence for program effects on biological measures is limited. The variability in study populations, interventions and outcomes of included trials, and the paucity of studies directly comparing different interventions preclude a definitive conclusion regarding which type of intervention is most effective.
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Affiliation(s)
- Chioma Oringanje
- Institute of Tropical Disease Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
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Abstract
BACKGROUND Malaria causes repeated illness in children living in endemic areas. Policies of giving antimalarial drugs at regular intervals (prophylaxis or intermittent treatment) are being considered for preschool children. OBJECTIVES To evaluate prophylaxis and intermittent treatment with antimalarial drugs to prevent malaria in young children living in malaria-endemic areas. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group Specialized Register (August 2007), CENTRAL (The Cochrane Library 2007, Issue 3), MEDLINE (1966 to August 2007), EMBASE (1974 to August 2007), LILACS (1982 to August 2007), mRCT (February 2007), and reference lists of identified trials. We also contacted researchers. SELECTION CRITERIA Individually randomized and cluster-randomized controlled trials comparing antimalarial drugs given at regular intervals (prophylaxis or intermittent treatment) with placebo or no drug in children aged one month to six years or less living in a malaria-endemic area. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed methodological quality. We used relative risk (RR) or weighted mean difference with 95% confidence intervals (CI) for meta-analyses. Where we detected heterogeneity and considered it appropriate to combine the trials, we used the random-effects model (REM). MAIN RESULTS Twenty-one trials (19,394 participants), including six cluster-randomized trials, met the inclusion criteria. Prophylaxis or intermittent treatment with antimalarial drugs resulted in fewer clinical malaria episodes (RR 0.53, 95% CI 0.38 to 0.74, REM; 7037 participants, 10 trials), less severe anaemia (RR 0.70, 95% CI 0.52 to 0.94, REM; 5445 participants, 9 trials), and fewer hospital admissions for any cause (RR 0.64, 95% CI 0.49 to 0.82; 3722 participants, 5 trials). We did not detect a difference in the number of deaths from any cause (RR 0.90, 95% CI 0.65 to 1.23; 7369 participants, 10 trials), but the CI do not exclude a potentially important difference. One trial reported three serious adverse events with no statistically significant difference between study groups (1070 participants). Eight trials measured morbidity and mortality six months to two years after stopping regular antimalarial drugs; overall, there was no statistically significant difference, but participant numbers were small. AUTHORS' CONCLUSIONS Prophylaxis and intermittent treatment with antimalarial drugs reduce clinical malaria and severe anaemia in preschool children.
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Affiliation(s)
- M M Meremikwu
- University of Calabar Teaching Hospital, Department of Paediatrics, PMB 1115, Calabar, Cross River State, Nigeria.
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Parisi F, Carotti A, Esu E, Abbattista AD, Cicini MP, Squitieri C. Intermediate and long-term results after pediatric heart transplantation: incidence and role of pretransplant diagnosis. Transpl Int 1998. [DOI: 10.1111/j.1432-2277.1998.tb01187.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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