Prevalence and determinants of anemia among children aged from 6 to 59 months in Liberia: a multilevel analysis of the 2019/20 Liberia demographic and health survey data

BackgroundAnemia is a serious worldwide public health issue that happens at any stage of life but primarily affects young kids and pregnant mothers. Although anemia has a significant impact on child health, its magnitude and associated factors in children aged 6–59 months have not been yet studied in Liberia. Therefore, the aim of this study was to identify the prevalence and determinants of anemia in children aged 6–59 months in Liberia.MethodsThe data was extracted from Liberia Demographic and Health Survey, conducted from October 2019 to February 2020. The sample was obtained using a stratified two-stage cluster sampling technique. An overall weighted sample of 2,524 kids aged 6–59 months was involved in the final analysis. We used Stata version 14 software for data extraction and analysis. A multilevel logistic regression model was employed to identify factors associated with anemia. Variables with a P-value of <0.2 in the bivariable logistic regression analysis were selected as candidates for multivariable analysis. In multivariable analysis, the adjusted odds ratios (AOR) with the 95% confidence interval (CI) were declared as the determinants of anemia.ResultsThe prevalence of anemia in children aged 6–59 months in Liberia was 70.8% [95% CI: 68.9%, 72.5%]. Of these, 3.4% were severe anemia, 38.3% were moderate anemia and 29.1% were mild anemia. Children aged 6–23 and 24–42 months, being stunted, children from households with unimproved toilet facilities, children from households with unimproved water sources, and lack of media (television) exposure were significantly associated with higher odds of anemia. However, using mosquito bed nets, living in the Northwestern and Northcentral region were significantly associated with lower odds of anemia among children 6–59 months.ConclusionIn this study, anemia in kids aged 6–59 months in Liberia was a main public health issue. Age of the child, stunting, toilet facility, water source, exposure to television, mosquito bed net use, and region were significant determinants of anemia. Therefore, it is better to provide intervention for the early detection and management of stunted children. Similarly, interventions should be strengthened to address unimproved water sources, unimproved toilet facilities, and lack of media exposure

Trend, determinants, and future prospect of child marriage in the Amhara region, Ethiopia: a multivariate decomposition analysis

BackgroundChild marriage is a harmful traditional practice, which compromises children of their childhood and threatens their lives and health. In Ethiopia, 58% of women and 9% of men get married before the age of 18 years. Surprisingly, parents in the Amhara region make marriage promises of their children before they are even born, which will hinder the region from attaining the Sustainable Development Goal of ending child marriage. Thus, this study aimed to assess the trends, determinants, and future prospects of child marriage in the Amhara region of Ethiopia.MethodsA repeated cross-sectional study was conducted using four consecutive nationally representative Ethiopian demographic and health surveys (2000–2016). A logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify factors that contributed to the change in child marriage over time. Statistical significance was declared at a p-value of < 0.05. The child marriage practice in the Amhara region by the year 2030 was also predicted using different forecasting features of Excel.ResultsThe trend of child marriage over the study period (2000–2016) decreased from 79.9% (76.7, 82.8) to 42.9% (39.1, 46.9), with an annual average reduction rate of 2.9%. Approximately 35.2% of the decline resulted from an increase in the proportion of women who attained secondary and above-secondary education over the two surveys. A decrease in the proportion of rural women and a change in the behavior of educated and media-exposed women also contributed significantly to the decline in child marriage. The prevalence of child marriage in the Amhara region by the year 2030 was also predicted to be 10.1% or 8.8%.ConclusionThough there has been a significant decline in child marriage in the Amhara region over the past 16 years, the proportion is still high, and the region is not going to eliminate it by 2030. Education, residence, and media exposure were all factors associated with the observed change in child marriage in this study. Therefore, additional efforts will be required if child marriage is to be eliminated by 2030, and investing more in education and media access will hasten the region's progress in this direction

Dyslipidemia and serum cystatin C levels as biomarker of diabetic nephropathy in patients with type 2 diabetes mellitus

BackgroundDiabetic nephropathy is a leading cause of end-stage renal disease. The diagnostic markers of nephropathy, including the presence of albuminuria and/or a reduced estimated glomerular filtration rate, are not clinically ideal, and most of them are raised after a significant reduction in renal function. Therefore, it is crucial to seek more sensitive and non-invasive biomarkers for the diagnosis of diabetic nephropathy.Objective of the studyThis study aimed to investigate the serum cystatin C levels and dyslipidemia for the detection of diabetic nephropathy in patients with type 2 diabetes mellitus.MethodologyA hospital-based comparative cross-sectional study was conducted from December 2021 to August 2022 in Tikur, Anbessa specialized teaching hospital with a sample size of 140 patients with type2 diabetes mellitus. Socio-demographic data was collected using a structured questionnaire, and 5 mL of blood was collected from each participant following overnight fasting for biochemical analyses.ResultsIn type 2 diabetes patients with nephropathy, we found significant lipoprotein abnormalities and an increase in serum cystatin C (P < 0.001) compared to those without nephropathy. Serum cystatin C, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, very low-density lipoprotein, high density lipoprotein, and duration of diabetes were identified as being significantly associated with diabetic nephropathy (P < 0.05) in multivariable logistic regression analysis. The mean values of total cholesterol levels, triglyceride levels, and high-density lipoprotein cholesterol levels were also found to be significantly higher (P < 0.05) in females as compared to male type-2 diabetic patients. The fasting blood glucose levels and lipid profiles of the participants were found to be significantly associated with serum cystatin C levels.ConclusionThe present study found significant serum cystatin C and lipoprotein abnormalities in T2DM patients with diabetic nephropathy when compared with those without diabetic nephropathy, and these lipoprotein abnormalities were significantly associated with serum cystatin C levels

The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019: a systematic analysis of the Global Burden of Disease Study 2019

BACKGROUND: Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. METHODS: In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. FINDINGS: In 2019, there were 3·0 million deaths and 30·0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288·4 million DALYs from communicable diseases among children and adolescents globally (57·3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4·0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59·8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. INTERPRETATION: Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world. FUNDING: The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Behavioral intention and its predictors toward COVID-19 vaccination among people most at risk of exposure in Ethiopia: applying the theory of planned behavior model

Acceptance of a vaccine or hesitancy has great public health implications as these partly determine the extent to which people are exposed to infections that could have otherwise been prevented. There is a high need for a more updated understanding of the behavioral intention of the public toward COVID-19 vaccines and associated factors in light of the COVID-19 pandemic to give appropriate public health messages or actions. Thus, the study aimed to assess behavioral intention and its predictors toward COVID-19 vaccine among people most at risk of exposure in Ethiopia. A population-based anonymous online survey was conducted on individuals aged greater than 18 years from May 01, 2021 to June 30, 2021. The data were collected using a convenient sampling method through an online self-administered, structured questionnaire that was created onto Google survey tool (Google Forms) and disseminated to the public on different social media channels through online sharable platforms. Descriptive statistics were done. Bivariateand multivariable logistic regression was done to show the association of behavioral intention toward the COVID-19 vaccine. The associations of variables were declared with the use of 95% CI and P-value. A total of 1080 participants were included in this survey. Seven hundred one (64.9%) of the respondents had a behavioral intention to receive the COVID-19 vaccine. Males (AOR = 1.41 (95% CI = 1.004–2.53)), degree in level of education (AOR = 0.815 (95% CI = 0.254–0.916)), good knowledge (AOR = 4.21 (95% CI = 2.871–6.992)), attitude (AOR = 2.78 (95% CI = 1.654–4.102)), subjective norm (AOR = 1.214 (95% CI = 1.008–4.309)) and perceived behavioral control (AOR = 3.531 (95%CI = 1.689–5.201)) were found to be significantly associated with behavioral intention toward COVID-19 vaccine. Generally, the prevalence of behavioral intention in Ethiopia is low. Males, degree level of education, knowledge about vaccine, attitude toward vaccine subjective norm and perceived behavioral control were found to be significantly associated with intention to receive COVID-19 vaccine. Health education and communication from government sources are very crucial methods to alleviate the negative attitude, poor knowledge, and action need to improve or change the attitude and behavior of influential people within the community or organization to improve intention to take the vaccine

Attitude and level of COVID-19 vaccination and its determinants among patients with chronic disease visiting Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study.

IntroductionCoronavirus disease is a fatal viral disease caused by severe acute respiratory syndrome coronavirus 2. This study was aimed to assess the attitude, level of COVID-19 vaccine uptake, and its determinants among patients with chronic diseases visiting Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsAn institutional-based cross-sectional study was conducted among 422 randomly selected patients with chronic disease visiting Debre Tabor Comprehensive Specialized Hospital from February 1 to March 30, 2022. Bivariable and multivariable binary logistic regression analyses were done to identify associations between dependent and independent variables.ResultsAmong all participants, only 29.6% of patients were vaccinated with any of the COVID-19 vaccines at least one dose. Age from 31 to 40 years (AOR = 6.26, 95% CI: 2.69-14.56), attended collage and above (AOR = 6.3, 95% CI: 1.37, 28.68), positive attitude towards COVID-19 vaccine (AOR = 9.07, 95% CI: 4.51-18.22), good knowledge (AOR = 7.63, 95% CI: 1.08-16.85), history of COVID-19 (AOR = 4.33, 95% CI: 1.85-10.17), family history of COVID-19 (AOR = 3.99, 95% CI = 1.89-8.48), ever been tested for COVID-19 (AOR = 0.33, 95% CI: 0.15-0.74) were determinant factors for COVID-19 vaccine uptake.ConclusionCOVID-19 vaccine uptake among patients with chronic disease was very low. The main reasons for not being vaccinated were doubts about vaccine efficacy, the vaccine may cause disease by itself, and fear of adverse effects. Therefore, different stakeholders should enforce vaccine uptake and awareness creation

Attitude and level of COVID-19 vaccination and its determinants among patients with chronic disease visiting Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia: A cross-sectional study

Introduction Coronavirus disease is a fatal viral disease caused by severe acute respiratory syndrome coronavirus 2. This study was aimed to assess the attitude, level of COVID-19 vaccine uptake, and its determinants among patients with chronic diseases visiting Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia. Methods An institutional-based cross-sectional study was conducted among 422 randomly selected patients with chronic disease visiting Debre Tabor Comprehensive Specialized Hospital from February 1 to March 30, 2022. Bivariable and multivariable binary logistic regression analyses were done to identify associations between dependent and independent variables. Results Among all participants, only 29.6% of patients were vaccinated with any of the COVID-19 vaccines at least one dose. Age from 31 to 40 years (AOR = 6.26, 95% CI: 2.69–14.56), attended collage and above (AOR = 6.3, 95% CI: 1.37, 28.68), positive attitude towards COVID-19 vaccine (AOR = 9.07, 95% CI: 4.51–18.22), good knowledge (AOR = 7.63, 95% CI: 1.08–16.85), history of COVID-19 (AOR = 4.33, 95% CI: 1.85–10.17), family history of COVID-19 (AOR = 3.99, 95% CI = 1.89–8.48), ever been tested for COVID-19 (AOR = 0.33, 95% CI: 0.15–0.74) were determinant factors for COVID-19 vaccine uptake. Conclusion COVID-19 vaccine uptake among patients with chronic disease was very low. The main reasons for not being vaccinated were doubts about vaccine efficacy, the vaccine may cause disease by itself, and fear of adverse effects. Therefore, different stakeholders should enforce vaccine uptake and awareness creation

Current updates on generations, approvals, and clinical trials of CAR T-cell therapy

Chimeric antigen receptor (CAR) T-cell therapy is a novel, customized immunotherapy that is considered a ‘living’ and self-replicating drug to treat cancer, sometimes resulting in a complete cure. CAR T-cells are manufactured through genetic engineering of T-cells by equipping them with CARs to detect and target antigen-expressing cancer cells. CAR is designed to have an ectodomain extracellularly, a transmembrane domain spanning the cell membrane, and an endodomain intracellularly. Since its first discovery, the CAR structure has evolved greatly, from the first generation to the fifth generation, to offer new therapeutic alternatives for cancer patients. This treatment has achieved long-term and curative therapeutic efficacy in multiple blood malignancies that nowadays profoundly change the treatment landscape of lymphoma, leukemia, and multiple myeloma. But CART-cell therapy is associated with several hurdles, such as limited therapeutic efficacy, little effect on solid tumors, adverse effects, expensive cost, and feasibility issues, hindering its broader implications

Evaluation and comparison of post-vaccination adverse effects among Janssen and Oxford-AstraZeneca vaccinated adult individuals in Debre Tabor Town: A cross- sectional survey in Northwest Ethiopia

COVID 19 vaccination has recently been launched globally to halt the pandemic. But COVID 19 vaccines have some adverse effects that raise concerns in the global community. This study aimed to evaluate and compare the adverse effects of Janssen and Oxford-AstraZeneca vaccinated adults. A community-based cross-sectional study was conducted from March 15 to 30, 2022 among 421 (211 Janssen and 210 Astra Zeneca vaccinated) adults recruited by a convenience sampling technique in Debre Tabor Town, Northwest Ethiopia. Data were collected via face-to-face interviews and by reviewing the immunization card. Chi-square test, independent t-test, and Mann-Whitney test were used to compare the adverse symptoms and related parameters between the two vaccines. A linear regression model was also used to identify predictors of the number of post-vaccination symptoms. The majority (75.8%) of participants reported at least one side effect after vaccination. Adverse symptoms had a significantly greater occurrence (p < .05) among recipients of the AstraZeneca vaccine (84.8%) than receivers of the Janssen vaccine (66.8%). The main adverse symptoms were injection site pain, fever, fatigue, arthralgia, and myalgia in both vaccines. Significant variations (p < .05) between the receipts of the two vaccines were shown in injection site pain, fever, and arthralgia. The total number of symptoms was significantly higher (p < .05) in participants with female sex, younger age, BMI <25 kg/m2, no prior COVID 19, and those who had received AstraZeneca vaccine. Thus, the authors advise that they should receive vaccines with no hesitation, while continuous tracking of vaccine safety is kept in place