In the ever-evolving landscape of Alzheimer’s treatment,lecanemab(Leqembi)has emerged as a promising drug.Unlike conventional therapies that merely alleviate symptoms,lecanemab is a humanized monoclonal antibody with...In the ever-evolving landscape of Alzheimer’s treatment,lecanemab(Leqembi)has emerged as a promising drug.Unlike conventional therapies that merely alleviate symptoms,lecanemab is a humanized monoclonal antibody with a distinct focus.It targets protofibrils,insoluble fibrils,amyloid oligomers,and soluble amyloid-beta protofibrils,which are known to be especially damaging to neurons,with high accuracy.展开更多
BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic.Tuberculosis annual risk for children could be as high as 4%particularly in hig...BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic.Tuberculosis annual risk for children could be as high as 4%particularly in high tuberculosis(TB)prevalent communities.Isoniazid(INH)Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.AIM To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos,Nigeria.METHODS This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children<6 years old enrolled for INH across 32 private hospitals in Lagos,Nigeria.The study took place between July and September 2020.Data was collected on independent variables(age,gender,type of facility,TB screening,dose and weight)and outcome variables(INH outcome and proportion lost to follow up across months 1-6 of INH treatment).RESULTS About 53.8%of the participants were female,95.4%were screened for TB and none was diagnosed of having TB.The participants’age ranged from 1 to 72 mo with a mean of 36.01±19.67 mo,and 40.2%were between the ages of 1-24 mo.Only 155(59.2%)of the 262 participants initiated on INH completed the six-month treatment.Cumulatively,107(41.0%)children were lost to follow-up at the end of the sixth month.Of the cumulative 107 loss to follow-up while on INH,largest drop-offs were reported at the end of month 2,52(49%)followed by 20(19%),17(16%),11(10.2%)and 7(6.5%)at months 3,4,5 and 6 respectively.The analysis showed that there was no significant association between age,gender,type of facility and completion of INH treatment(P>0.005).CONCLUSION This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos,Nigeria.The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early 展开更多
BACKGROUND In 2019,the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing(HIVST)to improve access to human immunodeficiency virus(HIV)testing services ...BACKGROUND In 2019,the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing(HIVST)to improve access to human immunodeficiency virus(HIV)testing services among undertested populations in the country.Also,as part of the campaign to increase HIV testing services in Nigeria,the Nigerian Ministry of Health developed standard operating procedures for using HIVST kits.AIM To systematically review the acceptability and strategies for enhancing the uptake of HIVST in Nigeria.METHODS The systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Different databases were searched to get the necessary materials needed for this review.Standardized forms developed by the authors were used for data extraction to minimize the risk of bias and ensure that the articles used for the study were properly screened.Identified articles were first screened using the titles and their abstracts.The full papers were screened,and the similarities of the documents were determined.Qualitative,quantitative,and mixed-method studies were evaluated using the Critical Appraisal Skills Programme and Critical Appraisal Framework criteria.RESULTS All the publications reviewed were published between 2015 and 2022,with 33.3%published in 2021.Most(77.8%)of the studies were cross-sectional,43.3%were conducted in Lagos State,and 26.3%were conducted among young people.The study revealed a high level of acceptability of HIVST.Certain factors,such as gender,sexual activity,and previous testing experience,influence the acceptability of HIV self-testing,with some individuals more likely to opt-out.The cost of the kit was reported as the strongest factor for choosing HIVST services,and this ranged from 200 to 4000 Naira(approximately United States Dollar 0.55-11.07),with the majority willing to pay 500 Naira(approximately United States Dollar 1.38).Privately-owned,registered pharmacies,youthfriendly centres,supermarkets,and online展开更多
BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated ...BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users,which are more objective and critical for the understanding of product uptake.Direct head-to-head comparison of consumer preferences for oral-versus bloodbased HIVST is lacking.AIM To examine the existing literature on preferences for oral-vs blood-based HIVST,determine the factors that impact these preferences,and assess the potential implications for HIVST programs.METHODS Databases such as PubMed,Medline,Google Scholar,and Web of Science were searched for articles published between January 2011 to October 2022.Articles must address preferences for oral-vs blood-based HIVST.The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study.RESULTS The initial search revealed 2424 records,of which 8 studies were finally included in the scoping review.Pooled preference for blood-based HIVST was 48.8%(9%-78.6%),whereas pooled preference for oral HIVST was 59.8%(34.2%-91%)across all studies.However,for male-specific studies,the preference for blood-based HIVST(58%-65.6%)was higher than that for oral(34.2%-41%).The four studies that reported a higher preference for blood-based HIVST were in men.Participants considered blood-based HIVST to be more accurate and rapid,while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.CONCLUSION Consistently in the literature,men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity,autonomy,privacy,and confidentiality,whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.Misinformation and展开更多
Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of...Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of from the 1 July 2004 to December 31, 2005 in the CHU of Conakry Any women aged from 25 to 65 years old who has agreed to the screening of cervical cancer by colposcopy was included. Statistical tests of sensitivity, specificity, and predictive values positive and negative were computed directly and compare among all participants. Results: During the study period, we included a total of 9339 women. For all precancerous and cancerous lesions, sensitivity and specificity were 93% and 64% respectively. With a positive predictive value of 46% and the negative predictive value of 90%, low and high grade precancerous lesions were found with: a sensitivity of 91%, the specificity of 64%. The positive predictive value of 37%, and the negative predictive value of 91% were estimed. Intra epithelial lesions (LIEBG) low-grade squamous sensitivity was 94%, specificity of 62%, the positive predictive value of 31%, the negative predictive value of 95%. For lesions intra epithelial highgrade squamous (LIEHG), the sensitivity was 85%, 10%, the positive predictive value of 74% specificity, negative predictive value of 95%. Conclusion: Colposcopy is a reference method of detection of precancerous lesions of the cervix to promote cancer.展开更多
Background:A high performing physician workforce is critical to attain nationally set health sector goals.Ethiopia has expanded training of medical doctors.However,little is known about junior doctors’performance.Und...Background:A high performing physician workforce is critical to attain nationally set health sector goals.Ethiopia has expanded training of medical doctors.However,little is known about junior doctors’performance.Understanding medical practice is essential to inform medical education and practice,establish licensure examination and guide workforce management decisions.We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice,and to determine composition of subjects in national licensing examination.Methods:We conducted a cross-sectional study with national representative sample of junior doctors.After calculating a sample size of 198,we used a two-stage stratified cluster sampling method to select study participants.We collected data using a structured questionnaire comprising 222 tasks.Study participants reported in interviews on frequency of,competence at,and importance of doing each task for improved health outcome.We developed proportions,averages,graphs and tables.Using the results of practice analysis and experts’ratings,relative weights of subjects in the national licensing examination for medical undergraduates were determined.Results:A total of 191 junior doctors participated.Most were males(74.6%)and had less than 2 years of experience(69.8%).Junior doctors frequently performed tasks of internal medicine and pediatrics.Their participation in obstetrics and gynecology,ophthalmology,psychiatry and dentistry services was infrequent.Junior doctors had competency gaps to conduct clinical procedures,research and health programming tasks.Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination,with more than threequarters of the items focusing on internal medicine,pediatrics,surgery,obstetrics and gynecology,and public health.Conclusion:Junior doctors in Ethiopia rarely managed psychiatry,ophthalmology and dental patients.They had competence gaps in clinical procedures,research and health 展开更多
Background:Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system.In 2010,Ethiopia established a national authority aiming t...Background:Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system.In 2010,Ethiopia established a national authority aiming to ensure competence and ethics of health professionals.Subsequently,subnational regulators were established and regulatory frameworks were developed.Although there were anecdotal reports of implementation gaps,there was lack of empirical evidence to corroborate the reports.We conducted a national study to explore health professional regulation practices and gaps focusing on registration,licensing,ethics,scope of practice,and continuing professional development.Methods:We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers.We used two stage stratified cluster sampling to select health professionals.The quantitative data were subjected to descriptive and multivariable logistic regression analysis.We conducted thematic analysis of the qualitative data.Results:We interviewed 554 health professionals in the quantitative survey.And 31 key informants participated in the qualitative part.Nearly one third of the respondents(32.5%)were not registered.Many of them(72.8%)did not renew their licenses.About one fifth of them(19.7%)did nothing against ethical breaches encountered during their clinical practices.Significant of them ever practiced beyond their scope limits(22.0%);and didn’t engage in CPD in the past 1 year(40.8%).Majority of them(97.8%)never identified their own CPD needs.Health regulators and managers stressed that regulatory bodies had shortage of skilled staff,budget and infrastructure to enforce regulation.Regulatory frameworks were not fully implemented.Conclusions:Health professionals were not regulated well due to limited capacity of regulators.This might have affected quality of patient care.To ensure effective implementation of health profes展开更多
Background:Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality.In recent times,the contrasting coexistence of undernutrition including micronutrient deficiencies ...Background:Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality.In recent times,the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual,household or population level and/or at different times in life.The objective of this study was to examine individual,neighborhood and country level factors that are associated with the double burden of childhood malnutrition.Methods:We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low-and middle-income countries.We analyzed data of 138,782 children(level 1)living in 13,788 communities(level 2)from 27 countries(level 3).Results:The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5%in Burundi to as high as 29.5%in Timor Leste.After adjusting for all level factors,we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey,were part of a multiple birth,were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates.The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance;44.3%and 21.0%of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively.Conclusions:Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors.Therefore,strategies in tackling the double burden of malnutrition must consider these shared drivers,contextual barriers and geographical clustering effects.展开更多
<strong>Background:</strong> Africa remains the epicenter of the global burden of malnutrition and the only region the number of stunted children is on the rise. A major cause of morbidity and mortality am...<strong>Background:</strong> Africa remains the epicenter of the global burden of malnutrition and the only region the number of stunted children is on the rise. A major cause of morbidity and mortality amongst children, it has been associated with factors such as poverty, food insecurity, maternal education and socio-economic inequalities. The role of research publication has been noted in providing an important connection between knowledge creation and translation of evidence to practice. Therefore, to determine the trend and the efforts put in place to eliminate malnutrition in the African region, bibliometric analysis was used to cumulatively present research productivity. The aim of this study was to assess childhood malnutrition research productivity in Africa, quantifying gaps, the most significant factors associated with the citations and future bibliometrics study path. <strong>Methods:</strong> A search of the PubMed database was conducted in December 2020 in order to obtain the childhood malnutrition research volume of each African country over a twenty-year period. The search was conducted and metadata of publications and articles gathered from the PubMed database using the PubMedR package. A comparative weighting for population and Gross Domestic Product (GDP) was done by calculating the ratio of the number of articles from each country to their respective populations and GDP. Poisson regression models were used to examine the publication productivity time trends over the twenty-year period. The association between research productivity, population size and GDP were examined using the Pearson correlation analysis. <strong>Results: </strong>A total of 11,758 articles on childhood malnutrition indexed on PubMed were returned and described in this study. Six countries—South Africa, Ethiopia, Egypt, Nigeria, Kenya and Malawi account for about half of total publications. However, when controlled for population and GDP, much smaller countries Cape Verde, Swaziland, Gambia were most productive. Africa’s展开更多
In this manuscript, the authors have studied obstetrical surgery in the context of Ebola virus disease in Guinea. No protocol recommends childbirth outside of Ebola treatment center, although it has no technical platf...In this manuscript, the authors have studied obstetrical surgery in the context of Ebola virus disease in Guinea. No protocol recommends childbirth outside of Ebola treatment center, although it has no technical platform and no qualified providers in this area. These were unknown MVE cases in pregnant women/parturient women aged 25 and 40 years, with no education, who were confirmed in the RT-PCR test after surgical management. To fight Ebola virus transmission, traditional protection protocols must be strengthened. Training, supervision and monitoring of providers are key elements for the protection of staff in the event of an EVD outbreak. Improving working conditions and strengthening hand washing, usage of PPE/EPP, decontamination of equipment with 0.5% chlorine solution, hygiene of premises, immunization of personnel involved, are effective measures to combat EVD.展开更多
<strong>Background:</strong> Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, chil...<strong>Background:</strong> Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. <strong>Methods: </strong>We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. <strong>Results: </strong>A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe展开更多
<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive a...<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. <strong>Methods: </strong>We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. <strong>Results: </strong>Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. <strong>Conclusions:</strong> Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.展开更多
<strong>Background: </strong>The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductiv...<strong>Background: </strong>The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. <strong>Methods:</strong> We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. <strong>Results: </strong>Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. <strong>Conclusions</strong>: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstr展开更多
<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interven...<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. <strong>Results:</strong> “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. <strong>Conclusion:</strong> The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.展开更多
<strong>Background:</strong> There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these ...<strong>Background:</strong> There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. <strong>Methods:</strong> We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. <strong>Results:</strong> A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing 展开更多
<strong>Background: </strong>Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health service...<strong>Background: </strong>Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. <strong>Results: </strong>A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-展开更多
文摘In the ever-evolving landscape of Alzheimer’s treatment,lecanemab(Leqembi)has emerged as a promising drug.Unlike conventional therapies that merely alleviate symptoms,lecanemab is a humanized monoclonal antibody with a distinct focus.It targets protofibrils,insoluble fibrils,amyloid oligomers,and soluble amyloid-beta protofibrils,which are known to be especially damaging to neurons,with high accuracy.
文摘BACKGROUND Nigeria is one of the thirty high burden countries with significant contribution to the global childhood tuberculosis epidemic.Tuberculosis annual risk for children could be as high as 4%particularly in high tuberculosis(TB)prevalent communities.Isoniazid(INH)Preventive Therapy has been shown to prevent TB incidence but data on its implementation among children are scarce.AIM To determine the completion of INH among under six children that were exposed to adults with smear positive pulmonary TB in Lagos,Nigeria.METHODS This was a hospital-based retrospective cross-sectional review of 265 medical records of eligible children<6 years old enrolled for INH across 32 private hospitals in Lagos,Nigeria.The study took place between July and September 2020.Data was collected on independent variables(age,gender,type of facility,TB screening,dose and weight)and outcome variables(INH outcome and proportion lost to follow up across months 1-6 of INH treatment).RESULTS About 53.8%of the participants were female,95.4%were screened for TB and none was diagnosed of having TB.The participants’age ranged from 1 to 72 mo with a mean of 36.01±19.67 mo,and 40.2%were between the ages of 1-24 mo.Only 155(59.2%)of the 262 participants initiated on INH completed the six-month treatment.Cumulatively,107(41.0%)children were lost to follow-up at the end of the sixth month.Of the cumulative 107 loss to follow-up while on INH,largest drop-offs were reported at the end of month 2,52(49%)followed by 20(19%),17(16%),11(10.2%)and 7(6.5%)at months 3,4,5 and 6 respectively.The analysis showed that there was no significant association between age,gender,type of facility and completion of INH treatment(P>0.005).CONCLUSION This study demonstrated suboptimal INH completion rate among children with only 6 out of 10 children initiated on INH who completed a 6-mo treatment in Lagos,Nigeria.The huge drop-offs in the first 2 mo of INH calls for innovative strategies such as the use of 60-d INH calendar that would facilitate reminder and early
文摘BACKGROUND In 2019,the Nigerian Ministry of Health published the first operational guidelines for human immunodeficiency virus self-testing(HIVST)to improve access to human immunodeficiency virus(HIV)testing services among undertested populations in the country.Also,as part of the campaign to increase HIV testing services in Nigeria,the Nigerian Ministry of Health developed standard operating procedures for using HIVST kits.AIM To systematically review the acceptability and strategies for enhancing the uptake of HIVST in Nigeria.METHODS The systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Different databases were searched to get the necessary materials needed for this review.Standardized forms developed by the authors were used for data extraction to minimize the risk of bias and ensure that the articles used for the study were properly screened.Identified articles were first screened using the titles and their abstracts.The full papers were screened,and the similarities of the documents were determined.Qualitative,quantitative,and mixed-method studies were evaluated using the Critical Appraisal Skills Programme and Critical Appraisal Framework criteria.RESULTS All the publications reviewed were published between 2015 and 2022,with 33.3%published in 2021.Most(77.8%)of the studies were cross-sectional,43.3%were conducted in Lagos State,and 26.3%were conducted among young people.The study revealed a high level of acceptability of HIVST.Certain factors,such as gender,sexual activity,and previous testing experience,influence the acceptability of HIV self-testing,with some individuals more likely to opt-out.The cost of the kit was reported as the strongest factor for choosing HIVST services,and this ranged from 200 to 4000 Naira(approximately United States Dollar 0.55-11.07),with the majority willing to pay 500 Naira(approximately United States Dollar 1.38).Privately-owned,registered pharmacies,youthfriendly centres,supermarkets,and online
文摘BACKGROUND The evidence on preferences for oral-vs blood-based human immunodeficiency virus self-testing(HIVST)has been heterogenous and inconclusive.In addition,most evaluations have relied on hypothetical or stated use cases using discreet choice experiments rather than actual preferences among experienced users,which are more objective and critical for the understanding of product uptake.Direct head-to-head comparison of consumer preferences for oral-versus bloodbased HIVST is lacking.AIM To examine the existing literature on preferences for oral-vs blood-based HIVST,determine the factors that impact these preferences,and assess the potential implications for HIVST programs.METHODS Databases such as PubMed,Medline,Google Scholar,and Web of Science were searched for articles published between January 2011 to October 2022.Articles must address preferences for oral-vs blood-based HIVST.The study used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to ensure the quality of the study.RESULTS The initial search revealed 2424 records,of which 8 studies were finally included in the scoping review.Pooled preference for blood-based HIVST was 48.8%(9%-78.6%),whereas pooled preference for oral HIVST was 59.8%(34.2%-91%)across all studies.However,for male-specific studies,the preference for blood-based HIVST(58%-65.6%)was higher than that for oral(34.2%-41%).The four studies that reported a higher preference for blood-based HIVST were in men.Participants considered blood-based HIVST to be more accurate and rapid,while those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.CONCLUSION Consistently in the literature,men preferred blood-based HIVST over oral HIVST due to higher risk perception and desire for a test that provides higher accuracy coupled with rapidity,autonomy,privacy,and confidentiality,whereas those with a higher preference for oral HIVST did so because these were considered non-invasive and easy to use.Misinformation and
文摘Objective: This study was conducted to evaluate the role of colposcopy in the screening of cervical cancer at the UTH in Conakry. Material and Methods: We conducted a descriptive study on over a period of 18 months of from the 1 July 2004 to December 31, 2005 in the CHU of Conakry Any women aged from 25 to 65 years old who has agreed to the screening of cervical cancer by colposcopy was included. Statistical tests of sensitivity, specificity, and predictive values positive and negative were computed directly and compare among all participants. Results: During the study period, we included a total of 9339 women. For all precancerous and cancerous lesions, sensitivity and specificity were 93% and 64% respectively. With a positive predictive value of 46% and the negative predictive value of 90%, low and high grade precancerous lesions were found with: a sensitivity of 91%, the specificity of 64%. The positive predictive value of 37%, and the negative predictive value of 91% were estimed. Intra epithelial lesions (LIEBG) low-grade squamous sensitivity was 94%, specificity of 62%, the positive predictive value of 31%, the negative predictive value of 95%. For lesions intra epithelial highgrade squamous (LIEHG), the sensitivity was 85%, 10%, the positive predictive value of 74% specificity, negative predictive value of 95%. Conclusion: Colposcopy is a reference method of detection of precancerous lesions of the cervix to promote cancer.
基金financially supported by strengthening human resources for health(HRH)project funded by USAID.
文摘Background:A high performing physician workforce is critical to attain nationally set health sector goals.Ethiopia has expanded training of medical doctors.However,little is known about junior doctors’performance.Understanding medical practice is essential to inform medical education and practice,establish licensure examination and guide workforce management decisions.We conducted a practice analysis study to identify gaps in Ethiopian medical education and practice,and to determine composition of subjects in national licensing examination.Methods:We conducted a cross-sectional study with national representative sample of junior doctors.After calculating a sample size of 198,we used a two-stage stratified cluster sampling method to select study participants.We collected data using a structured questionnaire comprising 222 tasks.Study participants reported in interviews on frequency of,competence at,and importance of doing each task for improved health outcome.We developed proportions,averages,graphs and tables.Using the results of practice analysis and experts’ratings,relative weights of subjects in the national licensing examination for medical undergraduates were determined.Results:A total of 191 junior doctors participated.Most were males(74.6%)and had less than 2 years of experience(69.8%).Junior doctors frequently performed tasks of internal medicine and pediatrics.Their participation in obstetrics and gynecology,ophthalmology,psychiatry and dentistry services was infrequent.Junior doctors had competency gaps to conduct clinical procedures,research and health programming tasks.Practice analysis results and expert ratings generated comparable recommendations for composition of a national licensing examination,with more than threequarters of the items focusing on internal medicine,pediatrics,surgery,obstetrics and gynecology,and public health.Conclusion:Junior doctors in Ethiopia rarely managed psychiatry,ophthalmology and dental patients.They had competence gaps in clinical procedures,research and health
基金supported during proposal development,data collection,data analysis and manuscript development by strengthening human resources for health(HRH)project funded by USAID。
文摘Background:Health workforce regulation plays key roles in ensuring the availability of competent health workers and improving performance of the health system.In 2010,Ethiopia established a national authority aiming to ensure competence and ethics of health professionals.Subsequently,subnational regulators were established and regulatory frameworks were developed.Although there were anecdotal reports of implementation gaps,there was lack of empirical evidence to corroborate the reports.We conducted a national study to explore health professional regulation practices and gaps focusing on registration,licensing,ethics,scope of practice,and continuing professional development.Methods:We conducted a mixed methods cross-sectional survey using structured interview with a national representative sample of health professionals and key informant interviews with health regulators and managers.We used two stage stratified cluster sampling to select health professionals.The quantitative data were subjected to descriptive and multivariable logistic regression analysis.We conducted thematic analysis of the qualitative data.Results:We interviewed 554 health professionals in the quantitative survey.And 31 key informants participated in the qualitative part.Nearly one third of the respondents(32.5%)were not registered.Many of them(72.8%)did not renew their licenses.About one fifth of them(19.7%)did nothing against ethical breaches encountered during their clinical practices.Significant of them ever practiced beyond their scope limits(22.0%);and didn’t engage in CPD in the past 1 year(40.8%).Majority of them(97.8%)never identified their own CPD needs.Health regulators and managers stressed that regulatory bodies had shortage of skilled staff,budget and infrastructure to enforce regulation.Regulatory frameworks were not fully implemented.Conclusions:Health professionals were not regulated well due to limited capacity of regulators.This might have affected quality of patient care.To ensure effective implementation of health profes
文摘Background:Malnutrition is a key global health challenge and a major contributor to childhood morbidity and mortality.In recent times,the contrasting coexistence of undernutrition including micronutrient deficiencies and overweight/obesity called double burden of malnutrition has been noted at individual,household or population level and/or at different times in life.The objective of this study was to examine individual,neighborhood and country level factors that are associated with the double burden of childhood malnutrition.Methods:We conducted multivariable multilevel logistic regression analyses on the most recent demographic and health datasets from surveys conducted between 2015 and 2020 in low-and middle-income countries.We analyzed data of 138,782 children(level 1)living in 13,788 communities(level 2)from 27 countries(level 3).Results:The results of our analysis show variation in childhood malnutrition across the 27 countries from as low as 6.5%in Burundi to as high as 29.5%in Timor Leste.After adjusting for all level factors,we found that those who were wasted/overweight tended to have had an episode of diarrhea or fever in the last two weeks preceding the survey,were part of a multiple birth,were being breastfed at the time of the survey and born to mothers with more than one under 5-child resident in neighborhoods with high illiteracy and unemployment rates.The intra-neighbourhood and intra-country correlation coefficients were estimated using the intercept component variance;44.3%and 21.0%of variance in odds of double burden of childhood malnutrition are consequent upon neighborhood and country level factors respectively.Conclusions:Evidence of geographical clustering in childhood malnutrition at community and country levels was found in our study with variability due to neighborhood level factors twice that of country level factors.Therefore,strategies in tackling the double burden of malnutrition must consider these shared drivers,contextual barriers and geographical clustering effects.
文摘<strong>Background:</strong> Africa remains the epicenter of the global burden of malnutrition and the only region the number of stunted children is on the rise. A major cause of morbidity and mortality amongst children, it has been associated with factors such as poverty, food insecurity, maternal education and socio-economic inequalities. The role of research publication has been noted in providing an important connection between knowledge creation and translation of evidence to practice. Therefore, to determine the trend and the efforts put in place to eliminate malnutrition in the African region, bibliometric analysis was used to cumulatively present research productivity. The aim of this study was to assess childhood malnutrition research productivity in Africa, quantifying gaps, the most significant factors associated with the citations and future bibliometrics study path. <strong>Methods:</strong> A search of the PubMed database was conducted in December 2020 in order to obtain the childhood malnutrition research volume of each African country over a twenty-year period. The search was conducted and metadata of publications and articles gathered from the PubMed database using the PubMedR package. A comparative weighting for population and Gross Domestic Product (GDP) was done by calculating the ratio of the number of articles from each country to their respective populations and GDP. Poisson regression models were used to examine the publication productivity time trends over the twenty-year period. The association between research productivity, population size and GDP were examined using the Pearson correlation analysis. <strong>Results: </strong>A total of 11,758 articles on childhood malnutrition indexed on PubMed were returned and described in this study. Six countries—South Africa, Ethiopia, Egypt, Nigeria, Kenya and Malawi account for about half of total publications. However, when controlled for population and GDP, much smaller countries Cape Verde, Swaziland, Gambia were most productive. Africa’s
文摘In this manuscript, the authors have studied obstetrical surgery in the context of Ebola virus disease in Guinea. No protocol recommends childbirth outside of Ebola treatment center, although it has no technical platform and no qualified providers in this area. These were unknown MVE cases in pregnant women/parturient women aged 25 and 40 years, with no education, who were confirmed in the RT-PCR test after surgical management. To fight Ebola virus transmission, traditional protection protocols must be strengthened. Training, supervision and monitoring of providers are key elements for the protection of staff in the event of an EVD outbreak. Improving working conditions and strengthening hand washing, usage of PPE/EPP, decontamination of equipment with 0.5% chlorine solution, hygiene of premises, immunization of personnel involved, are effective measures to combat EVD.
文摘<strong>Background:</strong> Many policy makers deliberating on comprehensive sexual and reproductive health and rights services need reliable evidence to make choices that benefit women, adolescents, children and the wider society. While universal health coverage discourse provides an opportunity to expand access through evidence based interventions, many gaps exist. Research prioritization has proved to be very helpful in identifying relevant areas especially in constrained resource settings. The purpose of this paper is to present the results of the World Health Organization Africa Region research prioritization for sexual and reproductive health and rights. These priorities hope to guide the region for the next three years. <strong>Methods: </strong>We used the Child Health and Nutrition Research Initiative approach to identify priority questions among many potential areas for research prioritization on sexual and reproductive health and rights. The implementation process was organized in three phases. The first phase involved sending out an online survey to various experts with experience in sexual and reproductive health rights. These questions were received by a technical team from World Health Organization headquarters for review. 634 questions were identified for potential research and grouped into 12 themes. The second phase involved experts who reviewed the questions. The team merged questions with duplications, removed the questions that were out of scope and finally refined the wordings. In the final phase, experts worked in groups to score and rank top ten priority questions for each of the 12 thematic areas. <strong>Results: </strong>A list of 120 priority questions for sexual and reproductive health and rights were prioritized by 67 participants drawn from 16 organizations. Most of the priority research questions (45%) focused on the theme of gender-based violence, 35% prioritized services in sexual and reproductive health and rights in humanitarian settings while 15% prioritized preventing unsafe
文摘<strong>Background:</strong> Unsafe abortion is a commonly neglected sexual and reproductive health and rights issue despite the serious health problems it causes to women and girls in their reproductive ages. It is classified as a main cause of maternal mortality and morbidity. This paper has considered questions that have the greatest potential to successfully reduce unsafe abortions in the resource poor settings. <strong>Methods: </strong>We adapted the Child Health and Nutrition Research Initiative (CHNRI) to identify and prioritize many competing sexual and reproductive health and rights research ideas that impact the health of the populations. The implementation was done in three phases which included generation and collection of research ideas from various experts virtually in August 2019 consolidation of the potential questions through thematic analysis conducted in September 2019. Finally, scoring and ranking of the research questions was done in a workshop of experts. <strong>Results: </strong>Out of a list of 45 priority research questions, two questions were ranked the highest scoring 28 out of the possible 30. The research priorities include: “The effectiveness of interventions (e.g. counseling or incentives or home visits) to increase post abortion uptake and continuance”, “Reducing repeat abortion on improving maternal health outcomes” and “Evaluation of community-based awareness programs to reduce unwanted pregnancies and encourage women to seek help early”. <strong>Conclusions:</strong> Ten key research priorities in preventing unsafe abortion were identified. The priority list covers areas of focus that could effectively impact preventing unsafe abortions while also acting as a knowledge base for researchers, policy makers and other interested stakeholders who would want to invest in this area.
文摘<strong>Background: </strong>The use of mobile phones continues to rise rapidly in the provision of health related services. Many countries have adopted the use of mobiles to provide sexual and reproductive health and rights and especially among the adolescents where specific messages are tailored for various audiences with specific messages. The purpose of this paper is to present the results of a research priority setting exercise on mHealth and innovative strategies. <strong>Methods:</strong> We adapted Child Health and Nutrition Research Initiative methodology to identify and set research priorities on mHealth and innovative strategies that respond to sexual and reproductive health and rights services. General potential research questions were gathered online from multiple stakeholders in the region and sent for consolidation consolidated to technical experts in World Health Organization headquarters. The second phase involved a meeting with experts to review and thematically analyze the questions list of 33 questions producing a list of 22 research questions. The questions were scored against a six point criteria and ranked accordingly. Ten top priority research questions were identified. <strong>Results: </strong>Lists of 33 priority research questions for mHealth and innovative strategies were proposed for discussions by 67 stakeholders. The questions were reviewed, scored and ranked in a technical meeting by experts. The highest ranking questions at 87% include evaluation of mHealth for data management and sexual and reproductive health and rights decision making, assessment of innovative local financing techniques to support community based sexual reproductive health and rights and evaluation of the role of mobile technologies in referral and counter referral. <strong>Conclusions</strong>: Information and communication technology is developing drastically and has a great potential in improving health especially in sexual and reproductive health and rights service delivery. This potential must be demonstr
文摘<strong>Background:</strong> Cervical cancer has been ranked among the leading causes of deaths among women in Africa. Despite this, priority setting mechanisms used in planning for programmes and interventions that respond to sexual and reproductive health and rights services particularly in cervical cancer prevalence, prevention and treatment have not adequately taken into account research based evidence to respond appropriately. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method. A wide range of stakeholders identified potential research areas in an online survey. A technical working group comprising of 67 participants reviewed the questions for modification and removal of out scope questions. Finally, scoring and ranking was done to provide the top ten priorities questions. <strong>Results:</strong> “Cost-benefit analysis of systematic human papillomavirus vaccination compared to the current cost of cervical cancer in public health care systems” scored 27. This was followed by two research questions ranked at 24 points: “assessment of women’s and girls’ knowledge on the importance of early cervical cancer screening,” and “human papilloma virus vaccination and contributions of new technologies to the supply and storage of vaccines, including human papillomavirus vaccine”. <strong>Conclusion:</strong> The study identified 10 priority research questions that can guide the agenda for cervical cancer prevalence, prevention and treatment in the WHO Africa region. The identified priorities will be of use to policy makers, researchers and programmers and other stakeholders who can invest in areas that greatly affect cervical cancer prevalence, prevention and treatment.
文摘<strong>Background:</strong> There is an increasing emphasis on conducting research to identify gender based violence issues to enable development of appropriate programs and interventions. However, these efforts are mixed in quality and often raise ethical questions. The increased pressure on policy makers to move to a more evidence-based approach in addressing gender based issues creates the need for this research prioritization activity. Inadequate evaluative evidence in this area poses a challenge in the planning for responsive interventions especially in resource limited settings. The purpose of this paper is to present gender based violence research priority areas for the WHO Africa Region. <strong>Methods:</strong> We utilized a modified version of the Child Health and Nutrition Research Initiative approach to reach consensus on research priorities on the thematic area of gender based violence. In three phases, we first conducted an online survey with sexual and reproductive health and rights experts in academia, ministries of health, non-governmental organizations and other health actors with a wide range of experiences. These questions were consolidated by three experts from World Health Organization headquarters into themes. Secondly, experts were invited in a meeting in Cape Town South Africa to analyze and generate relevant areas of research based on the themes. Finally, a smaller group of experts prioritized research areas based on agreed criteria. <strong>Results:</strong> A list of 10 priority research questions for addressing gender based violence were scored and ranked. Four priority research questions scored 30 points out of the possible 30 points and were thus ranked as the highest priority. These included questions that “engage young adolescents in behavioral interventions to influence gender roles”, “determinants of gender based violence analysis”, “both long and short term complications of gender based violence on survivors” and “assessment of men’s involvement in addressing
文摘<strong>Background: </strong>Despite increased recognition of the need for sexual and reproductive health and rights in humanitarian settings, evidence focusing on mainstreaming reproductive health services such as maternal, neonatal mortality, human immunodeficiency virus transmission and unsafe abortion still remains inadequate. The ability to understand the magnitude of the needs and highlight existing gaps is supported by improved data which is critical to informing effective policies, programming and funding decisions. The purpose of this report is to present the results of a research prioritization exercise on sexual and reproductive health and rights services in humanitarian settings for the WHO Africa region for the next three years. <strong>Methods:</strong> We adapted the Child Health and Nutrition Research Initiative method in three phases. Experts from the region participated in an online survey to identify key areas for research in sexual and reproductive health and rights. To identify potential areas for research, the experts ensured answerability, effectiveness, deliverability, equity and potential impact of the questions. The research areas they identified were reviewed by World Health Organization technical team from headquarters. In a meeting of 67 participants, the questions were subjected to further review and analysis. Using a modified for scoring criteria, the questions were scored and ranked to provide the top ten priority questions to address sexual and reproductive health and rights services in humanitarian settings. <strong>Results: </strong>A list of 21 priority research questions on sexual and reproductive health and rights services in humanitarian settings were scored and ranked. Top ten priorities research questions were identified. Those that scored highly by scoring 30 points out of the possible maximum of 30 include: “determining the prevalence and associated factors of unwanted pregnancies and abortions performed in emergency and humanitarian settings”, “evidence on gender-
