Exploring the cultural appropriateness of a psychosocial intervention,the Thinking Healthy Programme-Peer delivered (THPP), for perinatal depression in Lilongwe,Malawi

BackgroundPerinatal depression is a common and disabling mental health problem in Malawi and other Low- and middle-income countries. There is evidence for effective psychosocial interventions for perinatal depression, but no such intervention has been developed for use in Malawi. The broad aim of this study was to explore the cultural appropriateness of a psychosocial intervention for perinatal depression called the Thinking Healthy Programme-Peer delivered for adaptation and use in Lilongwe, Malawi.MethodsA qualitative exploratory design was used. Data were collected through conducting five Focus Group Discussions, involving thirty-eight purposefully selected participants including pregnant women, community volunteers and their supervisors, the Health Surveillance Assistants and maternal health care workers at implementation and policy level following observations of video recorded role plays of the Thinking Healthy Programme-Peer delivered sessions in theatre testing. A content analysis approach was used to analyse data.ResultsSix main themes were generated regarding the appropriateness of the content and delivery of the Thinking Healthy Programme-Peer delivered intervention, including: 1) Focus of the intervention; 2) Cultural appropriateness of the content; 3) Language used; 4) Context; 5) Provider of the intervention; and 6) Flexibility in the delivery of the intervention. The Thinking Healthy Programme-Peer delivered intervention was deemed appropriate for the target population, though with recommendations to: review illustrations to enhance clarity, use culturally appropriate stories and idioms, use daily spoken language, and adapt the number and duration of sessions to meet the needs of individual clients.ConclusionsThese findings highlight important areas to inform adaptation of the Thinking Healthy Programme-Peer delivered and add to the growing evidence of cultural adaptation of psychosocial interventions for perinatal depression.     

Guillain–Barre in a patient with ankylosing spondylitis secondary to ulcerative colitis on infliximab therapy

We describe a 47-year-old woman with severe spondylarthropathy secondary to ulcerative colitis who developed a Guillain–Barre after the use of anti-TNF-α. She first developed ulcerative colitis in November 1997. In 2003, she developed uveitis and, in 2005, axial and enthesitis form of spondylarthropathy. In May 2007, her condition was exacerbated. Therapy with infliximab has been initiated. The patient received 5-mg/kg infusions of infliximab. She had significant improvement in her arthritis and was in remission for her ulcerative colitis. She was admitted to the hospital 2 weeks after her third dose of infliximab for having developed paraesthesia of her hands and lower limbs. Neurophysiology studies demonstrated an acquired segmental demyelinating polyneuropathy consistent with Guillain–Barre syndrome (GBS). Laboratory investigations were unremarkable. She was treated with intravenous corticosteroids with no improvement. After this, she received infusions of intravenous gammaglobulin (IVIg) with complete recovery of the muscle strength within a few weeks. A follow-up electromyographic study 3 months later showed normal finding. The development of GBS in our patient may be secondary to her anti-TNF-α treatment. At present, she remains off anti-TNF-α therapy.     

Fatigue and severity of rheumatoid arthritis in Moroccan patients

The aim of this study was to assess fatigue aspects in Moroccan patients with rheumatoid arthritis (RA) and its relationships with disease-specific variables especially parameters of functional and structural severity. A total of 248 patients with RA were included. Patients’ and disease characteristics were identified. Disease activity was measured clinically using physical examination, biologically and by the disease activity scores (DAS28). Radiographs were evaluated by using Sharp’s method as modified by van der Heijde. Functional disability was measured by using the Moroccan version of Health Assessment Questionnaire (HAQ). Immunological abnormalities and treatment (doses and duration) were identified. Fatigue was evaluated by using a 0–100 visual analogue scale (VAS fatigue) and the multidimensional assessment of fatigue (MAF). Quality of life (QoL) was assessed using the Arabic version of the generic instrument SF-36. The mean age of patients was 47.5?±?11.7?years [25–72]; 37.5% of patients had a high activity of disease and 11.3% were in remission. The mean Sharp score was 107.13?±?91, and the mean score of HAQ was 1.40?±?0.63. All domains of QoL were deteriorated; 89.51% of our patients experienced fatigue. The mean total score of MAF was 30.21?±?11.32. A low level of education, low socioeconomic status, atlantoaxial subluxation, hip involvement, the presence of a Sj?gren syndrome, and cigarette smoking had a negative impact on fatigue scores. The severity of fatigue was correlated with the duration of RA, the intensity of joint pain, the activity of disease, the importance of structural damage, the degree of functional impairment, and the rate of anti-cyclic citrullinated protein (CCP) antibodies (P?<?0.05). Patients receiving methotrexate had better scores of fatigue. Also, severity of fatigue was correlated with the deterioration of all domains of QoL. Fatigue is a major issue for our patients with RA and must be included in the routine assessment of patients. In our sample, fatigue appears to be related to disease activity, functional disability, structural damage, and immunological status and had a negative impact on QoL.     

The practical value of biologics registries in Africa and Middle East: challenges and opportunities

Biologics, including tumor necrosis factor (TNF) inhibitors, are increasingly used for the treatment of inflammatory conditions such as rheumatoid arthritis (RA), psoriatic arthritis, and ankylosing spondylitis. The efficacy of these drugs has been demonstrated in randomized controlled trials (RCTs). However, these studies are conducted in controlled environments, and the results may not necessarily reflect clinical outcomes in daily clinical practice. In Europe and other western countries, numerous biologics registries that enroll and monitor patients receiving biologics have been established. These registries follow patients irrespective of whether they continue with the initial biologic drug. Thus, real-life efficacy data from these registries can be used to assess the long-term safety of biologics through longitudinal studies. In Africa and Middle East (AFME), such registries currently exist only in Morocco and South Africa. In light of the increasing availability of biologics and scarcity of long-term safety data of these agents in the AFME population, there is a need to establish biologics registries in other countries across the region. This review discusses the value of biologics registries versus RCTs as well as safety and efficacy data from observational studies presented as lessons from well-established biologics registries. In addition, the rationale for establishing such registries in the AFME region is also presented.     

Factors influencing quality of life in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by ECOS 16 questionnaire

Objective  

The aim of the study was to evaluate factors influencing quality of life (QOL) in Moroccan postmenopausal women with osteoporotic vertebral fracture assessed by the Arabic version of ECOS 16 questionnaire.     

Prevalence of hospital-acquired infection in a Moroccan university hospital

BACKGROUND: Infection control and hospital-acquired infection (HAI) prevalence reports from developing countries are often not well established because of the lack of staff and resources. The aim of this study was to estimate the prevalence of HAI in a Moroccan hospital as well as to identify its predisposing factors. METHODS: A one-day prevalence survey was conducted in April 2005 at Ibn Sina University Hospital which included all inpatients who had been in the hospital for at least 48 hours. RESULTS: Among 658 patients surveyed, the prevalence of HAI was 17.8%. The prevalence was higher in intensive care units (50%). The most frequently infected sites were urinary tract (35%) and surgical wounds (32.5%). Microbiological documentation was available in only 31.6% of HAIs. The most frequently isolated organisms were Staphylococcus aureus (30%) and Proteus mirabilis (25%). Results of multiple logistic regression analysis indicated that HAI is linked to the surgical category, a hospital stay of more than 10 days, and the use of intravascular and urinary devices. CONCLUSIONS: The prevalence of HAI is high at our center. This survey provided the principal information for future surveillance and prevention programs in Morocco.     

Characterization of diarrhoeagenic Escherichia coli isolates in Jordanian children

In a prospective study carried out among Jordanian children in Amman, a total of 73/250 (29.2%) stool specimens were positive for 1 or more diarrhoeagenic Escherichia coli strains using a multiplex polymerase chain reaction method. This study indicated that diarrhoeagenic E. coli isolates were found frequently more in stools of children with diarrhoea (34%) than without diarrhoea (23.1%), but without any significant difference (p > 0.05). The predominant diarrhoeagenic E. coli strains associated with diarrhoea were enteropathogenic E. coli (11.3%), followed by enterotoxigenic E. coli (9.8%) and enteroaggrative E. coli (9%), whereas in the control group these were 4.3%, 11.1% and 6%, respectively. Enteroinvasive E. coli strains (2.9%) were found only in stools of children with diarrhoea. This study revealed the absence of enterohaemorrhagic E. coli in both diarrhoeal and control stools, and found that diarrhoeagenic E. coli isolates were highly resistance to tetracycline (55%), co-trimoxazole (60%) and ampicillin (89%), which are commonly used antibiotics in Jordan.