Hematological predictors of preeclampsia among pregnant women attending ante-natal clinic at Arba Minch General Hospital, South Ethiopia: A comparative cross-sectional study

Background

Preeclampsia is a kind of pregnancy-related hypertension that affects 5.47 % of pregnancies in Ethiopia and 18.25 % of pregnant women who visit Arba Minch public health facilities for antenatal care. This study sought to identify hematological preeclampsia markers in pregnant women who received prenatal care at Arba Minch General Hospital.

Methodology

An institution-based comparative cross-sectional study was done from July 22 to October 30, 2021 at Arba Minch General Hospital. A total of 136 pregnant women were included in the study (46 with preeclampsia and 90 without preeclampsia). Epidata version 4.4. was used to enter data, and SPSS version 25.0 and Stata version17 were used for analysis. An independent sample t-test was used to examine the hematological parameter differences between study groups. Potential hematological markers were determined using receiver operating characteristic (ROC) analysis of the area under the curve (AUC). Statistical significance was defined if P value less than 0.05.

Results

A total of 136 pregnant women were studied. The complete blood count analysis showed that there were means differences in Red Cell Distribution (RDW) (p < 0.036), neutrophil-to-lymphocyte ratio (NLR) (p < 0.016) and relative lymphocyte count (Lymp%) (p < 0.047). The ROC analysis of the AUC for RDW, NLR and Lymp% resulted in 0.607, 0.609, 0.600 respectively.

Conclusion

RDW, NLR and Lymphocyte count could be potential candidate tools for the diagnosis and screening of preeclampsia. However, the robustness of the markers should be tested with prospective studies assessing changes present in each trimester.

Glucose-6-phosphate dehydrogenase deficiency among neonates with jaundice in Africa; systematic review and meta-analysis

Background

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused by a structural abnormality in the enzyme. G6PD deficiency is most prevalent among African, Asian, and Mediterranean people. This study aimed to investigate how prevalent G6PD deficiency is in African neonates with jaundice.

Methods

The public sources, such as PubMed, Science Direct, Google Scholar, and Africa Journal Online were searched for articles that reported the prevalence of G6PD deficiency published before March 21st, 2022. The Joanna Briggs Institute's (JBI) critical assessment checklist was used to evaluate the quality of individual studies. STATA-17 was used to do the statistical analysis. The pooled prevalence of G6PD deficiency in neonates with jaundice in Africa was calculated using a forest plot and a random effects model. I2 statistics and Galbraith plots were used to assess heterogeneity. Publication bias was assessed using a funnel plot and Egger's statistical test.

Results

Ten studies involving 1555 neonates with jaundice were involved in the study. G6PD deficiency was prevalent in 24.60% of African neonates with jaundice (95% CI:12.47-36.74) with considerable heterogeneity (I2 = 100%). Nigerian neonates with jaundice had the highest G6PD deficiency (49.67%), whereas South Africans had the lowest (3.14%).

Conclusion

G6PD deficiency has been implicated in a significant portion of African neonates with jaundice, notwithstanding the need for greater research on predisposing variables from other countries. Therefore, it should be thought of performing screening and diagnostic laboratory tests for G6PD deficiency.

Willingness to Receive COVID-19 Vaccination Among Adult Diabetes Patients in Woldia Comprehensive Specialized Hospital, North Ethiopia; A Cross-Sectional Study

BACKGROUND

According to recently published data, individuals infected with COVID-19 having concomitant diabetes may experience disease worsening or even death. The purpose of this study was to determine diabetes patients' willingness to get the COVID-19 vaccine as well as its magnitude and determinants.

METHODS

Three hundred eighty six diabetes patients who visited Woldia Comprehensive Specialized Hospital during February and March 2022 participated in this institution-based cross-sectional study. Descriptive statistics were used to demonstrate frequencies and percentages, while logistic regression was used to identify the relevant determinants of vaccination readiness. Age, gender, income, place of residence, COVID-19 exposure, length of diabetes, awareness of and attitudes toward the COVID-19 immunization were all evaluated as associated factors.

RESULTS

Out of 386 study participants, 268 (69.43%) were male and 146 (37.82) completed their secondary schooling. From 386 study participants 82.6% (95% CI; 78.5-86.3%) were willing to get vaccinated. The uptake of the COVID-19 vaccination among diabetes patients was independently influenced by sex (Adjusted Odd Ratio [AOR] = 6.84 (2.98, 15.68)), exposure to the illness (AOR 8.98 (3.22, 25.04)), attitude (AOR = 2.63 (1.2, 5.77)), and length of the disease (AOR = 0.62 (0.51, 0.76)).

CONCLUSION

Most of the study participants were willing to get the COVID-19 immunization. The relevant agency should make the immunization available in order to enhance disease control and reduce infection-related complications with special consideration of diabetes patients.

Anthropometric indices, blood pressure, and lipid profile status among women using progestin-only contraceptives: comparative cross-sectional study

BACKGROUND

The major types of hormonal contraception used currently in Ethiopia are progestogen-only. This study aimed to assess the differences in anthropometry indices, blood pressure, and lipid profile among women using progestin-only contraceptives in selected health facilities of Jimma town, southwest Ethiopia.

METHODS

A facility-based comparative cross-sectional study was conducted among women of reproductive age using Depo-medroxyprogesterone acetate (DMPA) and implant in selected health facilities from April 11 to May 11, 2019. A total of 146 women (45 DMPA and 51 implant users and 50 non-users) were selected randomly for inclusion in the study. One-way analysis of variance was used to examine variations in health outcomes while Bonferroni post-hoc tests were conducted to determine significance of variations between multiple outcomes.

RESULTS

There was a statistically significant difference in the mean Body Mass Index (p = 0.045), Hip-to-waist ratio (p = 0.012), systolic blood pressure (p = 0.027), diastolic blood pressure (DBP) (p = 0.017), total cholesterol (TC) (p = 0.005), low-density lipoprotein (p = 0.023) and triacylglycerol (TAG) (p = 0.000) between women using progestin-only contraceptives and non-users. DMPA users had higher TC (p = 0.024) than non-users. Results from Pearson correlation analysis showed that DBP of DMPA users was higher with longer duration of use.

CONCLUSION

The findings suggest the need for family planning service providers to undertake appropriate client profiling before recommending a particular method to women seeking the services in order to minimize adverse health risks, especially for those who may have pre-existing conditions.

Overview of rabies post-exposure prophylaxis access, procurement and distribution in selected countries in Asia and Africa, 2017-2018

BACKGROUND

Rabies is a neglected zoonotic disease with a global burden of approximately 59,000 human deaths a year. Once clinical symptoms appear, rabies is almost invariably fatal; however, with timely and appropriate post-exposure prophylaxis (PEP) consisting of wound washing, vaccine, and in some cases rabies immunoglobulin (RIG), the disease is almost entirely preventable. Access to PEP is limited in many countries, and when available, is often very expensive.

METHODS

We distributed a standardized assessment tool electronically to a convenience sample of 25 low- and middle-income countries in Asia and Africa to collect information on rabies PEP procurement, forecasting, distribution, monitoring and reporting. Information was collected from national rabies focal points, focal points at the World Health Organization (WHO) country offices, and others involved in procurement, logistics and distribution of PEP. Because RIG was limited in availability or unavailable in many countries, the assessment focused on vaccine. Data were collected between January 2017 and May 2018.

RESULTS

We received responses from key informants in 23 countries: 11 countries in Asia and 12 countries in Africa. In 9 of 23 (39%) countries, rabies vaccine was provided for free in the public sector and was consistently available. In 10 (43%) countries, all or some patients were required to pay for the vaccine in the public sector, with the cost of a single dose ranging from US$ 6.60 to US$ 20/dose. The primary reason for the high cost of the vaccine for patients was a lack of funding at the central level to subsidize vaccine costs. In the remaining 4 (17%) countries, vaccine was provided for free but was often unavailable so patients were required to purchase it instead. The majority of countries used the intramuscular route for vaccine administration and only 5 countries exclusively used the dose-sparing intradermal (ID) route. Half (11/22; 50%) of all countries assessed had a standardized distribution system for PEP, separate from the systems used for routine childhood vaccines, and almost half used separate storage facilities at both central and health facility levels. Approximately half (9/22; 41%) of all countries assessed reported having regular weekly, monthly or quarterly reporting on rabies vaccination.

CONCLUSIONS

While all countries in our assessment had rabies vaccines available in the public sector to some extent, barriers to access include the high cost of the vaccine to the government as well as to patients. Countries should be encouraged to use ID administration as this would provide access to rabies vaccine for many more people with the same number of vaccine vials. In addition, standardized monitoring and reporting of vaccine utilization should be encouraged, in order to improve data on PEP needs.

Clinical management and humoral immune responses to rabies post-exposure prophylaxis among three patients who received solid organs from a donor with rabies

BACKGROUND

The rabies virus causes a fatal encephalitis and can be transmitted through organ transplantation. In 2013, a man developed rabies 18 months after receiving a kidney from a donor with rabies, who was not known to have been infected when the organs were procured. Three additional persons who received organs from the same donor (liver, kidney, heart), all of whom were not vaccinated for rabies before transplantation, received rabies post-exposure prophylaxis (PEP) with rabies immune globulin and 5 doses of rabies vaccine as soon as the diagnosis of rabies was made in the donor (18 months after their transplant surgeries). We describe their clinical management.

METHODS

As the 3 recipients were all on immunosuppressive medications, post-vaccination serologic testing was performed using the rapid fluorescent focus inhibition test to measure rabies virus neutralizing antibodies (RVNAs). An acceptable antibody response to administration of rabies vaccine was defined as detection of RVNAs at a concentration ≥0.1 IU/mL from a serum specimen collected ≥7 days after the fifth vaccine dose.

RESULTS

All 3 recipients demonstrated an acceptable antibody response despite their immunosuppressed states. More than 36 months have passed since their transplant surgeries, and all 3 recipients have no evidence of rabies.

CONCLUSIONS

The survival of 3 previously unvaccinated recipients of solid organs from a donor with rabies is unexpected. Although the precise factors that led to their survival remain unclear, our data suggest that PEP can possibly enhance transplant safety in settings in which donors are retrospectively diagnosed with rabies.

Assigning focal persons to notify more tuberculosis patients: lessons learned in southern Ethiopia

SETTING

Health centres in Southern Ethiopia.

OBJECTIVE

To determine factors contributing to the large variations in the notification of smear-positive tuberculosis (TB) cases.

DESIGN

A cross-sectional study in selected health centres from areas with high and low case notification was conducted and health system and health care worker (HCW) related determinants were examined.

RESULTS

A total of 50 (61.0%) health centres and 172 (65.2%) HCWs from high case notification areas, and 32 (39.0%) health centres and 92 (33.8%) HCWs from low case notification areas were included in the study. Assignment of a full-time TB focal person at the TB clinic (adjusted odds ratio [aOR] 5.8, 95%CI 1.5-22.4) and availability of TB recording tools (aOR 7.0, 95%CI 1.5-32.5) were independent predictors of high case notification rates. HCW knowledge about TB screening, diagnosis and treatment was positively associated with case notification (aOR 2.53, 95%CI 1.42-4.48).

CONCLUSION

Increased TB case notification was associated with the presence of a full-time focal person, availability of TB recording tools and good knowledge about TB among HCWs. Putting in place these measures in all health centres could increase TB notification in the region.