Do adult patients with diabetes mellitus living in rural part of Ethiopia and having poor social support have disproportionately poor self-care practice? A systematic review and meta-analysis

ObjectiveThis systematic review and meta-analysis is aimed at determining the pooled national percentage of diabetic self-care practice and its determinants among adult diabetic patients in Ethiopian.MethodsDifferent electronic databases including PubMed/Medline and search engines such as Google scholar were used to retrieve published studies. The Joanna Briggs Institute quality appraisal checklists were used to appraise the quality of studies. Data were extracted using excel spreadsheets and analyses were done by STATA 14. Heterogeneity among studies was diagnosed using the I² test. The DerSimonian and Laird random-effects model was employed for substantial heterogeneity (I2 > 50%). The pooled estimate of diabetic self-care and odds ratio was reported based on the 95% CI.ResultsA total of 3861 studies were identified, of which only 19 studies have reached the final qualitative synthesis and quantitative analysis. Well over half of the Ethiopian diabetic patients have good self-care 54.04% (47.07–61.01, I² = 97.3, P < 0.001). Subgroup analysis by region showed that the highest pooled estimate was observed in Southern Nations Nationalities and Peoples 81.96% (71.85–92.04), I² = 89.1, p < 0.002), whereas the lowest was from the Harari region 44.53% (32.16–56.89%) I² = 94%, p < 0.001). Being knowledgeable about diabetes Mellitus 2.69 (1.62, 4.46; I2 = 99%, p < 0.001), having good social support 2.25 (1.49–3.39; I² = 99%, p = 0.00), owning private glucometer 3.04(1.64, 5.65; I² = 97.4, P < 0.001), and being urban residents 3.26 (2.24, 4.74; I² = 96.3%, P < 0.001) promote diabetic victims to apply self-care practice.ConclusionsDespite the life-threatening complications of diabetes Mellitus, the percentage of patients applying self-care has remained low in Ethiopia, depicting the high proportion of diabetic patients are prone to develop long and short-term sequelae of diabetes Mellitus. Therefore, improving the client’s awareness about the disease and counseling clients about the significance of social support are believed to be possible strategies to improve self-care practice and policymakers are strongly recommended to combat complications to attain sustainable development goal 3.4 Aims to reduce premature death.RegistrationThe protocol has been registered under the prospective Register of Systematic Review and Meta-analysis (PROSPERO) and received a unique registration number CRD42020151014.     

Clinical Activity and Polymerase Chain Reaction Evidence of Chlamydial Infection after Repeated Mass Antibiotic Treatments for Trachoma

It is unclear how the prevalence of clinically active trachoma correlates with the prevalence of ocular chlamydial infection at the community level. In 24 villages from a cluster-randomized clinical trial of mass azithromycin distributions in Ethiopia, the correlation between the prevalence of clinical activity (on examination) and chlamydial infection (by polymerase chain reaction) was moderately strong before mass antibiotic treatments (Pearson''s correlation coefficient r = 0.75, 95% confidence interval [CI] = 0.52–0.87), but decreased at each time point during four biannual treatments (at 24 months, r = 0.15, 95% CI = −0.14–0.41). One year after the final treatment, the correlation coefficient had increased, but not to the pre-treatment level (r = 0.55, 95% CI = 0.30–0.73). In a region with hyperendemic trachoma, conjunctival examination was a useful indicator of the prevalence of chlamydial infection before treatments, less useful during mass treatments, but regained utility by one year after treatments had stopped.     

A rationale for continuing mass antibiotic distributions for trachoma

Background

Fungal infections are diagnosed increasingly often in patients affected by hematological diseases and their mortality has remained high. The recent development of new antifungal drugs gives the clinician the possibility to assess the combination of antifungal drugs with in-vitro or in animal-model synergistic effect.

Methods

We analyzed retrospectively the safety and efficacy of caspofungin-based combination therapy in 40 children and adolescents, most of them were being treated for a malignant disease, who developed invasive aspergillosis (IA) between November 2002 and November 2005.

Results

Thirteen (32.5%) patients developed IA after hematopoietic stem cell transplantation (HSCT), 13 after primary diagnosis, usually during remission-induction chemotherapy, and 14 after relapse of disease. Severe neutropenia was present in 31 (78%) out of the 40 patients. IA was classified as probable in 20 (50%) and documented in 20 (50%) patients, respectively. A favorable response to antifungal therapy was obtained in 21 patients (53%) and the probability of 100-day survival was 70%. Different, though not significant, 100-day survival was observed according to the timing of diagnosis of IA: 51.9% after HSCT; 71.4% after relapse; and 84.6% after diagnosis of underlying disease, p 0.2. After a median follow-up of 0.7 years, 20 patients are alive (50%). Overall, the combination therapy was well tolerated. In multivariate analysis, the factors that were significantly associated to a better overall survival were favorable response to antifungal therapy, p 0.003, and the timing of IA in the patient course of underlying disease, p 0.04.

Conclusion

This study showed that caspofungin-based combination antifungal therapy is an effective therapeutic option also for pediatric patients with IA. These data need to be confirmed by prospective, controlled studies.     

Chlamydia on children and flies after mass antibiotic treatment for trachoma

There are various approaches to control trachoma. These include the elimination of the ocular strains of Chlamydia trachomatis that cause the disease and to decrease the spread of infection by other measures such as fly control. Here, we examined how these two are related (i.e., how treating children with antibiotics affects carriage of Chlamydia by flies). Flies were collected in villages that had received mass oral azithromycin distribution and were compared with flies in untreated villages. Polymerase chain reaction (PCR) was performed to detect chlamydial DNA on the flies. Conjunctival swabs were also taken to assay for chlamydial prevalence in the children. Chlamydia was found on 23% of the flies in the untreated villages but only 0.3% in treated villages. Prevalence of trachoma in children proved to be an excellent predictor of the prevalence on flies (correlation coefficient, 0.89). Thus, treating children with antibiotics may drastically reduce the role of flies as a vector.     

Geostatistical Modeling of Malaria Endemicity using Serological Indicators of Exposure Collected through School Surveys

Ethiopia has a diverse ecology and geography resulting in spatial and temporal variation in malaria transmission. Evidence-based strategies are thus needed to monitor transmission intensity and target interventions. A purposive selection of dried blood spots collected during cross-sectional school-based surveys in Oromia Regional State, Ethiopia, were tested for presence of antibodies against Plasmodium falciparum and P. vivax antigens. Spatially explicit binomial models of seroprevalence were created for each species using a Bayesian framework, and used to predict seroprevalence at 5 km resolution across Oromia. School seroprevalence showed a wider prevalence range than microscopy for both P. falciparum (0–50% versus 0–12.7%) and P. vivax (0–53.7% versus 0–4.5%), respectively. The P. falciparum model incorporated environmental predictors and spatial random effects, while P. vivax seroprevalence first-order trends were not adequately explained by environmental variables, and a spatial smoothing model was developed. This is the first demonstration of serological indicators being used to detect large-scale heterogeneity in malaria transmission using samples from cross-sectional school-based surveys. The findings support the incorporation of serological indicators into periodic large-scale surveillance such as Malaria Indicator Surveys, and with particular utility for low transmission and elimination settings.     

HIV and tuberculosis coinfection in the southern region of Ethiopia: a prospective epidemiological study

HIV has played a key role in TB, modifying its incidence and clinical presentation. This study describes the prevalence of HIV among TB patients attending health facilities in the southern region of Ethiopia. The HIV prevalence was 18% for female and 21% for male TB patients. 15% and 30%, respectively, of the rural and urban patients with TB were HIV positive (p<0.05). 19% (51/261) smear-positive PTB, 26% (36/137) smear-negative PTB and 11% (10/94) of the extrapulmonary TB patients were HIV positive. The proportion of patients with extra-PTB varied from 11% to 38% across the centres and was highest in the zones with the lowest HIV prevalence. In the light of limited diagnostic facilities, clinicians often make a clinical diagnosis of TB without laboratory confirmation. The increase in the number of TB cases could be due to HIV. However, the number of health facilities offering TB treatment in the area also increased (from 53 to 236) during the same period and the increase in TB is likely to be the result of a combination of factors, including improved detection and HIV. It is important to consider this multi-factorial phenomenon when interpreting the increase of TB in a geographical area.     

No evidence of PERV infection in healthcare workers exposed to transgenic porcine liver extracorporeal support

BACKGROUND: Clinical xenotransplantation holds great promise by providing one solution to the shortage of human organs for transplantation, while also posing a potential public health threat by facilitating transmission of infectious disease from source animals to humans. One potential vector for infectious disease transmission is healthcare workers (HCW) who are involved in administering xenotransplantation procedures. METHODS: In this study, we studied 49 healthcare workers involved in the care of two subjects who participated in a study of porcine liver perfusion as treatment of fulminant hepatic failure. We looked for serologic and virologic evidence of transmission of porcine endogenous retrovirus, and found that HCW had no evidence of infection. CONCLUSIONS: Results of our survey demonstrate that application of standard precautions may be sufficient to prevent transmission of porcine endogenous retrovirus, an agent of concern in ex vivo xenotransplantation products.     

Phenolic compounds from the roots of Lindera fruticosa

The phenolic compounds isolated from the roots of Lindera fruticosa included four new compounds, 2-methoxy-3,4-methylenedioxybenzophenone (1), (S)-2-methoxy-3,4-methylenedioxybenzhydryl alcohol (2), 3-hydroxy-5-methoxybiphenyl (3), and 1-methoxy-2,5,7-trihydroxyxanthone (4). Three previously identified phenolics were also identified, namely, 3,5-dimethoxybiphenyl (5), benzyl 2-hydroxy-6-methoxybenzoate (6), and 1,7-dihydroxyxanthone (7). These compounds were evaluated for their inhibitory effects on human acyl-CoA:cholesterol acyltransferase activity and on the in vitro oxidation of low-density lipoprotein.