Community-based interventions for preventing diarrhoea in people living with HIV in sub-Sahara Africa: A systematic review

BackgroundHigh prevalence rates of people living with HIV (PLHIV) are more predominant in sub-Saharan Africa compared to any region globally. Nonetheless, many people in the region have little access to safe water and live in poor sanitation environment. This region is, therefore, faced with a challenge in protecting PLHIV from infectious diseases that are transmitted through unhygienic conditions.AimThis systematic review was conducted to identify effective community-based interventions for the prevention of diarrhoea among PLHIV in sub-Saharan Africa. MethodsStudies included in this systematic review were sought from PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ, Web of science, WHO Global Index Medicus Library, Cochrane and ProQuest (GeoRef). Articles were appraised using MMAT scale. ResultsFrom a search finding of 3,849 articles, only nine papers whose participants were people living with HIV and had incidence or prevalence of diarrhoea as an outcome met our inclusion criteria. Community-based interventions such as water treatment and safe storage were associated with 20% -53% reduction in diarrhoea episodes among PLHIV. The review has also demonstrated that the impact of hand hygiene and health education on the prevention of diarrhoeal infections is not adequately assessed. ConclusionFuture studies are, therefore, warranted to assess the effect of hand hygiene and health education interventions on prevention and reduction of diarrhoea in PLHIV in Sub-Saharan Africa

Examining Surgical Patients’ Expectations of Nursing Care at Kenyatta National Hospital in Nairobi, Kenya

Good service is defined when it meets the expectations of its customers. Likewise, nursing is a profession that aims at meeting patients’ needs and expectations. Many studies have been done at Kenyatta National Hospital (KNH) in Nairobi, Kenya regarding customer care satisfaction in various departments. However, little is known on patients’ expectations regarding nursing care. Therefore, this study was carried out to examine surgical patients’ expectations of nursing care in surgical wards. A descriptive cross-sectional quantitative study was conducted at Kenyatta National Hospital in general surgical wards from April to June, 2012. The study population were adult postoperative patients admitted in the general surgical wards. The sample size was 168 and systemic random sampling technique was used in selecting the participants. The data collection tool was a structured questionnaire with open and closed questions. Ethical clearance was obtained from University of Nairobi and Kenyatta National Hospital Ethics Committee. Participation in the study was voluntary and based on patients’ ability to give informed consent. A total of 167 adult patients from general surgical wards responded to the questionnaire. Most patients agreed that they expected nurses to be knowledgeable with an average response of 86% and strongly disagreed that nurses should be rude and harsh (44%). 46% of participants agreed that they expected nurses to be responsive with mean of (M=3.61). It was found that most patients’ expectations were met and because of this, many felt satisfied with the nursing care provided. It is recommended that nurses should pay more attention to what patients expect from nursing care

The Effect of Improved Water, Sanitation and Hygiene on Linear Growth Amongst Children Living in Developing Countries: A Systematic Review

Constant exposure to poor water, sanitation and hygiene (WaSH) contribute to environmental enteric dysfunction; a disorder that is frequently implicated as a cause of linear growth failure. We aimed to evaluate the efficacy of WaSH on linear growth amongst children aged 0-59 months. We reviewed fourteen (14) studies retrieved from AMED, CINAHL, DOAJ, PubMed, PsycINFO, Google Scholar, and EMBASE databases following guidelines developed by PROSPERO and COCHRANE. The screening process was summarized using a PRISMA flow diagram, and the methodologies were critically appraised by a Mixed Method Appraisal Tool. The following search terms were employed in the search strategy: sanitation and/or improved water supply and/or WaSH and/or stunting and/or linear growth and/or environmental enteric dysfunction. No difference was seen in mean height for age Z-score (0.01, 95% CI-0.16 to 0.18) between children who received WaSH interventions and those who did not. Only five (5) studies reported a significant association between WaSH and child linear growth (P < 0.001). All combination intervention studies included in this review did not establish any significant benefit of WaSH and nutrition integration, presumably due to methodological limitations and a short duration of exposure to the interventions. Although robust sanitation coverage could be an important component amongst proven interventions to stimulate linear growth, stunted growth is embedded within myriad determinants beyond improved WaSH. More research is needed to quantify the complementary effect of WaSH and nutrition co-programming. This systematic review was registered in the PROSPERO database with registration number CRD42022322462

Immunological Responses to Helminths and HIV-1 Co-Infections

Helminth infections result from either ingestion or contact with contaminated fecal matter. To date, there is insufficient evidence as to whether helminths have influence on HIV-1 specific immune responses as literature results are indeterminate. We evaluated the effect of helminth infections on HIV disease progression through the monitoring of 2 outcomes: (1) plasma HIV-1 RNA Viral load (V/L) and (2) Cluster of Differentiation (CD4+) T-lymphocyte count amongst helminth-HIV-1 co-infected persons. We hypothesized that (1) concurrent helminth infections may damage immune control, resulting in escalating VL and reduced CD4+ T-lymphocyte count (2) and that, subject to successful treatment, a decrease in plasma VL could slow down disease progression. We reviewed 2032 citations, evaluated 432 abstracts, and read 10 articles (See PRISMA diagram). The methodologies were appraised using a Mixed Method Appraisal Tool (MMAT). At enrolment, plasma VL were significantly higher in individuals with helminths (5.01 log10 vs. 3.41 log10, p < 0.001). The magnitude of effect ranged from 5.28 log10 copies/mL at baseline and 4.67 log10 copies/mL, (p  < 0.05) after treatment and a trend for 0.61 log10 lower VL. All but one RCT reported  decline in plasma VL and significant interactions were seen in the successfully treated groups (p < 0.001). CD4+ T-lymphocyte count values were not significantly different in the co-infection groups relative to those with HIV-infection alone. This evidence supports that WaSH and HIV/AIDS co-programming could promote health of PLWHA. We suggest large scale trials for future studies. This systematic review registration number is CRD42022364296

Immunological Responses to Helminths and HIV-1 Co-Infections

Helminth infections result from either ingestion or contact with contaminated fecal matter. To date, there is insufficient evidence as to whether helminths have influence on HIV-1 specific immune responses as literature results are indeterminate. We evaluated the effect of helminth infections on HIV disease progression through the monitoring of 2 outcomes: (1) plasma HIV-1 RNA Viral load (V/L) and (2) Cluster of Differentiation (CD4+) T-lymphocyte count amongst helminth-HIV-1 co-infected persons. We hypothesized that (1) concurrent helminth infections may damage immune control, resulting in escalating VL and reduced CD4+ T-lymphocyte count (2) and that, subject to successful treatment, a decrease in plasma VL could slow down disease progression. We reviewed 2032 citations, evaluated 432 abstracts, and read 10 articles (See PRISMA diagram). The methodologies were appraised using a Mixed Method Appraisal Tool (MMAT). At enrolment, plasma VL were significantly higher in individuals with helminths (5.01 log10 vs. 3.41 log10, p < 0.001). The magnitude of effect ranged from 5.28 log10 copies/mL at baseline and 4.67 log10 copies/mL, (p  < 0.05) after treatment and a trend for 0.61 log10 lower VL. All but one RCT reported  decline in plasma VL and significant interactions were seen in the successfully treated groups (p < 0.001). CD4+ T-lymphocyte count values were not significantly different in the co-infection groups relative to those with HIV-infection alone. This evidence supports that WaSH and HIV/AIDS co-programming could promote health of PLWHA. We suggest large scale trials for future studies. This systematic review registration number is CRD42022364296

The Effect of Improved Sanitation on Linear Growth Amongst Children Living in Developing Countries: a Systematic Review

Constant exposure to poor sanitation contribute to the environmental enteric dysfunction-a disorder that is frequently implicated as a cause of linear growth failure. We aimed to evaluate the efficacy of water, sanitation, and hygiene (WaSH) interventions on linear growth amongst children aged 0-24 months. We reviewed fourteen studies retrieved from AMED, CINAHL, DOAJ, PubMed, PsycINFO, Google Scholar, and EMBASE databases following guidelines developed by PROSPERO and COCHRANE. The screening process was summarized using a PRISMA flow diagram, and the methodologies were critically appraised by a Mixed Method Appraisal Tool. No difference was seen in mean height for age Z-score (0.01, 95% CI-0.16 to 0.18) between children who received WaSH interventions and those who did not. Only 5 studies reported a significant association between WaSH and child linear growth (P < 0.001). All combination intervention studies include in this review did not establish any significant benefit of WaSH and nutrition integration. Although robust sanitation coverage could be an important component amongst proven interventions to stimulate linear growth, stunted growth is embedded within myriad determinants beyond improved sanitation. More research is needed to quantify the complementary effect of WaSH and nutrition co-programming. This systematic review was registered in the PROSPERO database with registration number CRD42022322462

The porphyrias: Advances in diagnosis and treatment

The inborn errors of heme biosynthesis, the porphyrias, are 8 genetically distinct metabolic disorders that can be classified as "acute hepatic," "hepatic cutaneous," and "erythropoietic cutaneous" diseases. Recent advances in understanding their pathogenesis and molecular genetic heterogeneity have led to improved diagnosis and treatment. These advances include DNA-based diagnoses for all the porphyrias, new understanding of the pathogenesis of the acute hepatic porphyrias, identification of the iron overloadinduced inhibitor of hepatic uroporphyrin decarboxylase activity that causes the most common porphyria, porphyria cutanea tarda, the identification of an X-linked form of erythropoietic protoporphyria due to gain-of-function mutations in erythroidspecific 5-aminolevulinate synthase (ALAS2), and new and experimental treatments for the erythropoietic prophyrias. Knowledge of these advances is relevant for hematologists because they administer the hematin infusions to treat the acute attacks in patients with the acute hepatic porphyrias, perform the chronic phlebotomies to reduce the iron overload and clear the dermatologic lesions in porphyria cutanea tarda, and diagnose and treat the erythropoietic porphyrias, including chronic erythrocyte transfusions, bone marrow or hematopoietic stem cell transplants, and experimental pharmacologic chaperone and stem cell gene therapies for congenital erythropoietic protoporphyria. These developments are reviewed to update hematologists on the latest advances in these diverse disorders. (Blood. 2012;120(23):4496-4504

Combined Effect of Co-trimoxazole Prophylaxis and Safe Water on Diarrhea Amongst HIV-Exposed Infants and People Living With HIV/AIDS: A Systematic Review

Irrespective of co-trimoxazole prophylaxis, diarrhea among HIV-exposed infants (HEI) and people living with HIV (PLWHA) remains unacceptably high. We aimed to determine the combined effect of improved water supply interventions and co-trimoxazole prophylaxis on frequency and severity of diarrhea among HEI and PLWHA. Using key search terms of safe sanitation, improved water supply, WaSH, co-trimoxazole prophylaxis, HIV-exposed, PLWHA, morbidity, mortality, diarrhea; we searched for published articles in PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptance practice developed by PROSPERO and COCHRANE. A PRISMA flow diagram was used to explain on the number of articles retrieved, retained, excluded and justifications for every action. A Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the methodology of the selected studies. Safe water supply interventions and co-trimoxazole prophylaxis together reduced diarrhea episodes by up to 67% (IRR _ 0.33, 95% CI 0.24–0.46, P < 0.0001). The combined interventions resulted in 27% risk reduction in HIV disease progression whilst safe water alone was associated with reductions in the longitudinal prevalence of reported diarrhea of up to 53% among HIV exposed infants aged ≤2 years (LPR = 0.47, 95% CI: 0.30–0.73, P < 0.001). An expanded WaSH response in fighting HIV is critical to prevent diarrhea and rapid disease progression. The protocol was published in the PROSPERO database with registration number CRD42021240512

Experiences and concerns of patients with recurrent attacks of acute hepatic porphyria: A qualitative study

Background: The acute hepatic porphyrias (AHPs) are rare inborn errors of heme biosynthesis, characterized clinically by life-threatening acute neurovisceral attacks. Patients with recurrent attacks have a decreased quality of life (QoL); however, no interactive assessment of these patients' views has been reported. We conducted guided discussions regarding specific topics, to explore patients' disease experience and its impact on their lives. / Methods: Sixteen AHP patients experiencing acute attacks were recruited to moderator-led online focus groups. Five groups (3–4 patients each) were conducted and thematic analyses to identify, examine, and categorize patterns in the data was performed. / Results: All patients identified prodromal symptoms that began days prior to acute severe pain; the most common included confusion (“brain fog"), irritability, and fatigue. Patients avoided hospitalization due to prior poor experiences with physician knowledge of AHPs or their treatment. All patients used complementary and alternative medicine treatments to avoid hospitalization or manage chronic pain and 81% reported varying degrees of effectiveness. All patients indicated their disease impacted personal relationships due to feelings of isolation and difficulty adjusting to the disease's limitations. / Conclusion: Patients with recurrent attacks recognize prodromal warning symptoms, attempt to avoid hospitalization, turn to alternative treatments, and have markedly impaired QoL. Counseling and individualized support is crucial for AHP patients with recurrent attacks

Combined Effect of Co-trimoxazole Prophylaxis and Safe Water on Diarrhea Amongst HIV-Exposed Infants and People Living With HIV/AIDS: A Systematic Review

Irrespective of co-trimoxazole prophylaxis, diarrhea among HIV-exposed infants (HEI) and people living with HIV (PLWHA) remains unacceptably high. We aimed to determine the combined effect of improved water supply interventions and co-trimoxazole prophylaxis on frequency and severity of diarrhea among HEI and PLWHA. Using key search terms of safe sanitation, improved water supply, WaSH, co-trimoxazole prophylaxis, HIV-exposed, PLWHA, morbidity, mortality, diarrhea; we searched for published articles in PubMed, EMBASE, PsycINFO, AMED, CINAHL, DOAJ and Google Scholar databases guided by the acceptance practice developed by PROSPERO and COCHRANE. A PRISMA flow diagram was used to explain on the number of articles retrieved, retained, excluded and justifications for every action. A Mixed Method Appraisal Tool (MMAT) was used to assess the quality of the methodology of the selected studies. Safe water supply interventions and co-trimoxazole prophylaxis together reduced diarrhea episodes by up to 67% (IRR _ 0.33, 95% CI 0.24–0.46, P < 0.0001). The combined interventions resulted in 27% risk reduction in HIV disease progression whilst safe water alone was associated with reductions in the longitudinal prevalence of reported diarrhea of up to 53% among HIV exposed infants aged ≤2 years (LPR = 0.47, 95% CI: 0.30–0.73, P < 0.001). An expanded WaSH response in fighting HIV is critical to prevent diarrhea and rapid disease progression. The protocol was published in the PROSPERO database with registration number CRD42021240512