Current Evidence and Diverse Perspectives on Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Introduction:  ADHD is one of the most common neurodevelopmental disorders in childhood and adolescence. Although the disorder starts to manifest early in childhood, a significant proportion of cases often persists into adulthood. ADHD negatively and significantly impacts social and occupational functioning and academic performance.  A number of extant theories and scientific evidence provide insight into the genesis and manifestations of ADHD and the attendant challenges of significant dysfunction that individuals may encounter at home, school, and the workplace. Method: This systematic review was conducted through a literature search for published peer-reviewed articles using standard PRISMA guidelines.  The goal of the study was to explore current theories, models, concepts, and risk factors about ADHD in published in peer-reviewed literature,. We made use of use several online databases— including PsycINFO, PubMed, Web of Science, ScienceDirect, and Medline in the process of searching for relevant studies. Relevant peer-reviewed publications since the 1980s when the term Attention-Deficit/Hyperactivity Disorder (ADHD) was introduced in DSM-III-R were included. Non-peer-reviewed publications, including dissertations,  editorials, commentaries, and materials published in languages other than English were excluded. Results and Discussion: The results of the review indicated that ADHD is characterized by a behavioral reaction that interferes with personal and social functioning. The factors associated with ADHD fall into several major thematic areas, including genetic and hereditary factors; dietary and nutritional factors; parenting and behavioral factors; adverse early life events, and high-risk environmental factors, crystallized by a number of developmental and behavioral theories. The review also identified a number of extant models and theories that attempt to explain the diverse perspectives associated with ADHD. Conclusion: This study has attempted to identify the major risk factors and diverse models and theories associated with ADHD.  The thematic risk factors include genetic and hereditary factors; dietary and nutritional factors; parenting and behavioral factors; adverse early life events, and high-risk environmental factors. The most prominent models identified include the biomedical model and the bio-psycho-social models, the latter being a more holistic approach which aims to treat both the patient and the disease. This review would provide an additional evidence base to individuals, families, and educators to make informed choices and decisions in the best interest of the affected children, including personal growth, healthcare, and medical needs, academic performance, and social skills development.

Absorbable versus silk sutures for surgical treatment of trachomatous trichiasis in Ethiopia: a randomised controlled trial.

BACKGROUND: Trachoma causes blindness through an anatomical abnormality called trichiasis (lashes touching the eye). Trichiasis can recur after corrective surgery. We tested the hypothesis that using absorbable sutures instead of silk sutures might reduce the risk of recurrent disease among patients with major trichiasis in a randomised trial. METHODS AND FINDINGS: 1,300 individuals with major trichiasis from rural villages in the Amhara Region of Ethiopia were recruited and assigned (1:1) by computer-generated randomisation sequence to receive trichiasis surgery using either an absorbable suture (polyglactin-910) or silk sutures (removed at 7-10 days) in an otherwise identical surgical technique. Participants were examined every 6 months for 2 years by clinicians masked to allocation. The primary outcome measure was recurrent trichiasis (≥one lash touching the eye) at 1 year. There was no difference in prevalence of recurrent trichiasis at 1 year (114 [18.2%] in the absorbable suture group versus 120 [19.7%] in the silk suture group; odds ratio = 0.90, 95% CI 0.68-1.20). The two groups also did not differ in terms of corneal opacification, visual acuity, conjunctival inflammation, and surgical complications. CONCLUSIONS: There was no evidence that use of absorbable polyglactin-910 sutures was associated with a lower prevalence of trichiasis recurrence at 1 year postsurgery than silk sutures. However, from a programmatic perspective, polyglactin-910 offers the major advantage that patients do not have to be seen soon after surgery for suture removal. The postoperative review after surgery using absorbable polyglactin-910 sutures can be delayed for 3-6 months, which might allow us to better determine whether a patient needs additional surgery. TRIAL REGISTRATION: ClinicalTrials.gov NCT00522860

Integrating an NTD with One of “The Big Three”: Combined Malaria and Trachoma Survey in Amhara Region of Ethiopia

The “big three” killer diseases are malaria, HIV/AIDS, and tuberculosis; control programs for these diseases are usually well developed and financed. The neglected tropical diseases (NTDs) are a group of ancient afflictions that are frequently sidelined by planners and are under-resourced. Opportunities of integrating the big three with NTDs have been talked about but not widely acted upon. There is potential synergy for an integrated trachoma and malaria control program since control of both diseases is community-based. The first step in accessing these synergies has been an integrated malaria prevalence and indicator and trachoma prevalence and risk factor survey. This has been achieved at the incremental cost of one additional staff member per field team. The results give unprecedented precision for the calculation of intervention targets for the integrated program and demonstrate that it is possible to integrate NTDs with the “big three.

Performance of Local Light Microscopy and the ParaScreen Pan/Pf Rapid Diagnostic Test to Detect Malaria in Health Centers in Northwest Ethiopia

Background: Diagnostic tests are recommended for suspected malaria cases before treatment, but comparative performance of microscopy and rapid diagnostic tests (RDTs) at rural health centers has rarely been studied compared to independent expert microscopy. Methods: Participants (N = 1997) with presumptive malaria were recruited from ten health centers with a range of transmission intensities in Amhara Regional State, Northwest Ethiopia during October to December 2007. Microscopy and ParaScreen Pan/PfH RDT were done immediately by health center technicians. Blood slides were re-examined later at a central laboratory by independent expert microscopists. Results: Of 1,997 febrile patients, 475 (23.8%) were positive by expert microscopists, with 57.7 % P.falciparum, 24.6 % P.vivax and 17.7 % mixed infections. Sensitivity of health center microscopists for any malaria species was.90 % in five health centers (four of which had the highest prevalence),.70 % in nine centers and 44 % in one site with lowest prevalence. Specificity for health center microscopy was very good (.95%) in all centers. For ParaScreen RDT, sensitivity was $90$70 % in six and,60 % in four centers. Specificity was $90 % in all centers except one where it was 85%. Conclusions: Health center microscopists performed well in nine of the ten health centers; while for ParaScreen RDT they performed well in only six centers. Overall the accuracy of local microscopy exceeded that of RDT for all outcomes. Thi

Evaluation of light microscopy and rapid diagnostic test for the detection of malaria under operational field conditions: a household survey in Ethiopia.

BACKGROUND: In most resource-poor settings, malaria is usually diagnosed based on clinical signs and symptoms and not by detection of parasites in the blood using microscopy or rapid diagnostic tests (RDT). In population-based malaria surveys, accurate diagnosis is important: microscopy provides the gold standard, whilst RDTs allow immediate findings and treatment. The concordance between RDTs and microscopy in low or unstable transmission areas has not been evaluated. OBJECTIVES: This study aimed to estimate the prevalence of malaria parasites in randomly selected malarious areas of Amhara, Oromia, and Southern Nations, Nationalities and Peoples' (SNNP) regions of Ethiopia, using microscopy and RDT, and to investigate the agreement between microscopy and RDT under field conditions. METHODS: A population-based survey was conducted in 224 randomly selected clusters of 25 households each in Amhara, Oromia and SNNP regions, between December 2006 and February 2007. Fingerpick blood samples from all persons living in even-numbered households were tested using two methods: light microscopy of Giemsa-stained blood slides; and RDT (ParaScreen device for Pan/Pf). RESULTS: A total of 13,960 people were eligible for malaria parasite testing of whom 11,504 (82%) were included in the analysis. Overall slide positivity rate was 4.1% (95% confidence interval [CI] 3.4-5.0%) while ParaScreen RDT was positive in 3.3% (95% CI 2.6-4.1%) of those tested. Considering microscopy as the gold standard, ParaScreen RDT exhibited high specificity (98.5%; 95% CI 98.3-98.7) and moderate sensitivity (47.5%; 95% CI 42.8-52.2) with a positive predictive value of 56.8% (95% CI 51.7-61.9) and negative predictive value of 97.6% (95% CI 97.6-98.1%) under field conditions. CONCLUSION: Blood slide microscopy remains the preferred option for population-based prevalence surveys of malaria parasitaemia. The level of agreement between microscopy and RDT warrants further investigation in different transmission settings and in the clinical situation

Clearing the Backlog: Trichiasis Surgeon Retention and Productivity in Northern Ethiopia

Blindness from trachoma is caused by the abrasive effect of trichiasis (in-turned eyelashes). Surgery is performed to correct this anatomical abnormality, and prevent blindness. Despite the progress made in many regions in controlling the active/infectious stages of this disease, the global prevalence of trichiasis remains about the same. Current surgical activity is barely keeping abreast of incident trichiasis; this is undermining all the other efforts to control trachoma. We examine staff retention and productivity in Amhara Region, Ethiopia, where many hundreds of health care workers have been trained to perform the surgery. We found that the majority of people trained to do the surgery are now not in a position to do so. Amongst the sub-set that is still active within the programme, surgical productivity is low, with most surgery performed during “outreach campaigns” Insufficient surgical instruments and consumables were frequent problems. Strengthened health-systems management can overcome many of the problems that are holding back the delivery of an effective trichiasis surgical service

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial.

Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (<six lashes touching eye). This trial investigated whether epilation is noninferior to surgery for managing minor trichiasis

Mapping local patterns of childhood overweight and wasting in low- and middle-income countries between 2000 and 2017

A double burden of malnutrition occurs when individuals, household members or communities experience both undernutrition and overweight. Here, we show geospatial estimates of overweight and wasting prevalence among children under 5 years of age in 105 low- and middle-income countries (LMICs) from 2000 to 2017 and aggregate these to policy-relevant administrative units. Wasting decreased overall across LMICs between 2000 and 2017, from 8.4% (62.3 (55.1–70.8) million) to 6.4% (58.3 (47.6–70.7) million), but is predicted to remain above the World Health Organization’s Global Nutrition Target of <5% in over half of LMICs by 2025. Prevalence of overweight increased from 5.2% (30 (22.8–38.5) million) in 2000 to 6.0% (55.5 (44.8–67.9) million) children aged under 5 years in 2017. Areas most affected by double burden of malnutrition were located in Indonesia, Thailand, southeastern China, Botswana, Cameroon and central Nigeria. Our estimates provide a new perspective to researchers, policy makers and public health agencies in their efforts to address this global childhood syndemic

An impact evaluation of two rounds of mass drug administration on the prevalence of active trachoma: A clustered cross sectional survey.

INTRODUCTION:We investigated the impact of two round of mass drug administration on trachoma prevalence in Plateau and Nasarawa States of Nigeria. The mass drug administration was conducted as a component of the SAFE Strategy, a combination of interventions recommended for the global elimination of blinding trachoma. METHODS:The study consisted of a two-stage cross-sectional clustered sample survey in which 3990 people from 793 households were screened for clinical signs of trachoma. RESULTS:Of the total 3990 people examined, 1530 were children, of which 808 (53%) were boys and 704 (47%) were girls. The impact of intervention as measured by the changes in overall prevalence of follicular trachoma were as follows: At baseline the overall prevalence of follicular trachoma among children 1-9 years of age was 6.4%, 95% CI [5.8, 7.0]; the overall prevalence of trachomatous trichiasis in the total population was 0.20%, 95% CI [0.16, 0.25]. At follow up, the overall prevalence of follicular trachoma among children 1-9 years of age was 3.4%, 95% CI [1.9, 4.9]; the overall prevalence of trachomatous trichiasis in the total population was 0.20%, 95% CI [0.00, 0.05]. The highest statistically significant reduction (96%) in follicular trachoma prevalence was observed in Doma Local Government Area of Nasarawa State from baseline prevalence of 13.6%, 95% CI [9.7, 17.5] to follow-up prevalence of 0.5%, 95% CI [0.0, 1.5] and the lowest reduction (58%) in follicular trachoma prevalence was observed in Langtang North Local Government Area of Plateau State from baseline prevalence of 15.8%, 95% CI [9.3, 22.3] to 6.6%, 95% CI [1.6, 11.6], (p<0.05). CONCLUSION:A significant reduction in the overall prevalence of follicular trachoma was achieved after two rounds of mass drug administration. In the absence of significant activities pertaining to facial cleanliness and environmental sanitation components of the SAFE strategy in the intervention areas, the observed deep reductions in prevalence could mainly be attributed to mass drug administration. Therefore, two rounds of mass azithromycin administration may be as effective as guideline-recommended three or more rounds in reducing active trachoma prevalence but findings should be replicated in more robustly designed studies