Perception of in-school adolescents about adolescentfriendly characteristics of healthcare services received in Ibadan Metropolis, Nigeria

Introduction: Adolescence was previously assumed to be a diseases free stage of life. It is however now known that adolescents are not only  involved in risky health behaviours but they also have their own share of health problems that other age groups face. The adolescent-friendly model helps to create adolescent-responsive health systems, Nigeria currently has no country-specific report on the adolescentfriendly characteristics of the health services rendered to her adolescents. This study identified various health problems for which in-school adolescents in Ibadan North-East Local Government Area sought healthcare and determined their perception of received healthcare services with regards to its “adolescent-friendliness”.Methods: This was a school-based cross-sectional study that utilized quantitative method of data collection. A multi-stage systematic random sampling technique was employed to select 500 students for school survey. Self-administered, semistructured questionnaire was used to collect data. Descriptive statistics and Chisquare test at α=0.05 were used for data analysis.Results: Perceived malaria (52.4%), acne (36.2%), menstrual pain (17.0%) and depression (3.0%) were the common health problems adolescents sought health care for. Majority of the adolescents perceived the health services received as being adolescent-friendly. These health services were perceived to be accessible by (87%), acceptable by (93.2%), appropriate by (81.4%), effective by (91.4%), and equitable by (82.2%) of the respondents. Adolescents who sought mental care perceived least adolescent-friendliness of received healthcare services.Conclusion: Adolescents in Ibadan currently view received health services as adolescent-friendly. However, the management of mental health  problems in adolescents should incorporate adolescent friendly elements entrenched at every level of the health system. Keywords: In-school adolescents, Adolescent health problems, Adolescent-friendly health services, Health seeking behaviour,Nigeria

Biological Resolution of Virulence Genes of Salmonella Species from different Microbiomes

The pathogenic promiscuity of virulence associated macromolecules in Salmonella infection is a key driver to their wide epidemiology and curtailing  such distribution is contingent upon proper clarification of these virulence genes. This study was therefore aimed at determining the virulence  genes of Salmonella species from different microbiomes. To achieve this, a total of three hundred (300) biological specimens were aseptically  collected and processed for Salmonella presence using the BAM USFDA technique prior to their genotypic characterization while virulence gene  detection was carried out in a primer specific polymerase chain reaction. Results obtained depict the distribution of the following Salmonella species  viz; Salmonella gallinarum 19(26.39%), Salmonella heidelberg 19(26.39%), Salmonella enteritidis 18(25%) and Salmonella typhimurium  16(22.22%) while the occurrence of the virulence genes (InvA, SopE, AgfA and SpvC) were Salmonella enteritidis ( 7(38.8), 6(33.3), 9(50), 3(16.7),  Salmonella typhimurium ( 5(26.3), 3(15.8), 2(10.5), 7(36.8)), Salmonella heidelberg (0(0), 8(50), 4(25), 4(25), and Salmonella gallinarum (12(63.2),  6(31.6), 2(10.5), 7(36.8)) respectively. It was however found that the different microbiomes analyzed were ubiquitously rich in virulence genes  associated Salmonella species.   La promiscuité pathogène des macromolécules associées à la virulence dans l’infection à Salmonella est un facteur clé de leur large épidémiologie  et la réduction de cette distribution dépend de la clarification appropriée de ces gènes de virulence. Cette étude visait donc à déterminer les gènes  de virulence des espèces de Salmonella de différents microbiomes. Pour ce faire, un total de trois cents (300) échantillons biologiques ont été  collectés et traités de manière aseptique pour la présence de Salmonella à l’aide de la technique BAM USFDA avant leur caractérisation génotypique  tandis que la détection du gène de virulence a été effectuée dans une réaction en chaîne par polymérase spécifique à l’amorce. Les résultats  obtenus décrivent la distribution des espèces de Salmonella suivantes, à savoir ; Salmonella gallinarum 19(26,39%), Salmonella heidelberg  19(26,39%), Salmonella enteritidis 18(25%) et Salmonella typhimurium 16(22,22%) alors que la présence des gènes de virulence (InvA, SopE, AgfA et  SpvC) était Salmonella enteritidis ( 7(38,8), 6(33,3), 9(50), 3(16,7), Salmonella typhimurium ( 5(26,3), 3(15,8), 2(10,5), 7(36,8)), Salmonella heidelberg (0(  0), 8(50), 4(25), 4(25) et Salmonella gallinarum (12(63.2), 6(31.6), 2(10.5), 7(36.8)) respectivement. différents microbiomes analysés étaient  ubiquitairement riches en gènes de virulence associés aux espèces de Salmonella  &nbsp

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding: Bill & Melinda Gates Foundation

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician- administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda