Frequency of Reporting and the Quality of Randomized Controlled Trials Published in the Nigerian Journal of Ophthalmology

Aim: To determine the frequency of reporting and the methodological quality of randomized controlled trials in the Nigerian Journal of Ophthalmology (NJO) from 1993 – 2001.Materials and methods: Back issues of NJO published from 1993 to 2001 were searched for reports of randomized controlled trials. The quality of identified trials was assessed using standard Cochrane methods.Results: One out of 104 articles published in the 9 volumes of NJO from 1993 – 2001 can be described as a randomized controlled trial. Complete information regarding the method of allocation concealment, masking of providers and recipients of care, and masking of outcome assessors was not provided. It was not clear whether all patients were followed-up for 6months or 1 year, or whether there was a differential loss to follow-up between the study groups.Conclusions: Only one randomized controlled trial was published in the Nigerian Journal of Ophthalmology between 1993-2001. Assessment of the methodological quality of the reported trial was hampered by lack of complete information on parameters used to assess trial quality in this study.Key words: clinical trials, reporting, methodological quality, Nigerian Journal of Ophthalmolog

Association between footwear use and neglected tropical diseases: a systematic review and meta-analysis

BACKGROUND The control of neglected tropical diseases (NTDs) has primarily focused on preventive chemotherapy and case management. Less attention has been placed on the role of ensuring access to adequate water, sanitation, and hygiene and personal preventive measures in reducing exposure to infection. Our aim was to assess whether footwear use was associated with a lower risk of selected NTDs. METHODOLOGY We conducted a systematic review and meta-analysis to assess the association between footwear use and infection or disease for those NTDs for which the route of transmission or occurrence may be through the feet. We included Buruli ulcer, cutaneous larva migrans (CLM), leptospirosis, mycetoma, myiasis, podoconiosis, snakebite, tungiasis, and soil-transmitted helminth (STH) infections, particularly hookworm infection and strongyloidiasis. We searched Medline, Embase, Cochrane, Web of Science, CINAHL Plus, and Popline databases, contacted experts, and hand-searched reference lists for eligible studies. The search was conducted in English without language, publication status, or date restrictions up to January 2014. Studies were eligible for inclusion if they reported a measure of the association between footwear use and the risk of each NTD. Publication bias was assessed using funnel plots. Descriptive study characteristics and methodological quality of the included studies were summarized. For each study outcome, both outcome and exposure data were abstracted and crude and adjusted effect estimates presented. Individual and summary odds ratio (OR) estimates and corresponding 95% confidence intervals (CIs) were calculated as a measure of intervention effect, using random effects meta-analyses. PRINCIPAL FINDINGS Among the 427 studies screened, 53 met our inclusion criteria. Footwear use was significantly associated with a lower odds of infection of Buruli ulcer (OR=0.15; 95% CI: 0.08-0.29), CLM (OR=0.24; 95% CI: 0.06-0.96), tungiasis (OR=0.42; 95% CI: 0.26-0.70), hookworm infection (OR=0.48; 95% CI: 0.37-0.61), any STH infection (OR=0.57; 95% CI: 0.39-0.84), strongyloidiasis (OR=0.56; 95% CI: 0.38-0.83), and leptospirosis (OR=0.59; 95% CI: 0.37-0.94). No significant association between footwear use and podoconiosis (OR=0.63; 95% CI: 0.38-1.05) was found and no data were available for mycetoma, myiasis, and snakebite. The main limitations were evidence of heterogeneity and poor study quality inherent to the observational studies included. CONCLUSIONS/SIGNIFICANCE Our results show that footwear use was associated with a lower odds of several different NTDs. Access to footwear should be prioritized alongside existing NTD interventions to ensure a lasting reduction of multiple NTDs and to accelerate their control and elimination. PROTOCOL REGISTRATION PROSPERO International prospective register of systematic reviews CRD42012003338

Are hygiene and public health interventions likely to improve outcomes for Australian Aboriginal children living in remote communities? A systematic review of the literature

Background Australian Aboriginal children living in remote communities still experience a high burden of common infectious diseases which are generally attributed to poor hygiene and unsanitary living conditions. The objective of this systematic literature review was to examine the epidemiological evidence for a relationship between various hygiene and public health intervention strategies, separately or in combination, and the occurrence of common preventable childhood infectious diseases. The purpose was to determine what intervention/s might most effectively reduce the incidence of skin, diarrhoeal and infectious diseases experienced by children living in remote Indigenous communities. Methods Studies were identified through systematically searching electronic databases and hand searching. Study types were restricted to those included in Cochrane Collaboration Effective Practice and Organisation of Care Review Group (EPOC) guidelines and reviewers assessed the quality of studies and extracted data using the same guidelines. The types of participants eligible were Indigenous populations and populations of developing countries. The types of intervention eligible for inclusion were restricted to those likely to prevent conditions caused by poor personal hygiene and poor living environments. Results The evidence showed that there is clear and strong evidence of effect of education and handwashing with soap in preventing diarrhoeal disease among children (consistent effect in four studies). In the largest well-designed study, children living in households that received plain soap and encouragement to wash their hands had a 53% lower incidence of diarrhoea (95% CI, 0.35, 0.59). There is some evidence of an effect of education and other hygiene behaviour change interventions (six studies), as well as the provision of water supply, sanitation and hygiene education (two studies) on reducing rates of diarrhoeal disease. The size of these effects is small and the quality of the studies generally poor. Conclusion Research which measures the effectiveness of hygiene interventions is complex and difficult to implement. Multifaceted interventions (which target handwashing with soap and include water, sanitation and hygiene promotion) are likely to provide the greatest opportunity to improve child health outcomes in remote Indigenous communities

Evidence for perinatal and child health care guidelines in crisis settings: can Cochrane help?

<p>Abstract</p> <p>Background</p> <p>It is important that healthcare provided in crisis settings is based on the best available research evidence. We reviewed guidelines for child and perinatal health care in crisis situations to determine whether they were based on research evidence, whether Cochrane systematic reviews were available in the clinical areas addressed by these guidelines and whether summaries of these reviews were provided in Evidence Aid.</p> <p>Methods</p> <p>Broad internet searches were undertaken to identify relevant guidelines. Guidelines were appraised using AGREE and the clinical areas that were relevant to perinatal or child health were extracted. We searched The Cochrane Database of Systematic Reviews to identify potentially relevant reviews. For each review we determined how many trials were included, and how many were conducted in resource-limited settings.</p> <p>Results</p> <p>Six guidelines met selection criteria. None of the included guidelines were clearly based on research evidence. 198 Cochrane reviews were potentially relevant to the guidelines. These reviews predominantly addressed nutrient supplementation, breastfeeding, malaria, maternal hypertension, premature labour and prevention of HIV transmission. Most reviews included studies from developing settings. However for large portions of the guidelines, particularly health services delivery, there were no relevant reviews. Only 18 (9.1%) reviews have summaries in Evidence Aid.</p> <p>Conclusions</p> <p>We did not identify any evidence-based guidelines for perinatal and child health care in disaster settings. We found many Cochrane reviews that could contribute to the evidence-base supporting future guidelines. However there are important issues to be addressed in terms of the relevance of the available reviews and increasing the number of reviews addressing health care delivery.</p

Albendazole for lymphatic filariasis (Review)

Background Mass treatment with albendazole co-administered with another antifilarial drug is part of a global programme to eliminate lymphatic filariasis. We sought reliable evidence of the effects of albendazole on the disease and the parasite. Objectives To summarize the effects of albendazole alone or in combination with antifilarial drugs for clinical treatment and community control of lymphatic filariasis. Search strategy We searched the Cochrane Infectious Diseases Group Specialized Register (August 2005), CENTRAL (The Cochrane Library Issue 3, 2005), MEDLINE (1966 to August 2005), EMBASE (1974 to August 2005), LILACS (1982 to August 2005), and reference lists.We also contacted researchers, the World Health Organization, and GlaxoSmithKline. Selection criteria Randomized and quasi-randomized controlled trials of albendazole alone or combined with another antifilarial drug for treating individuals with lymphatic filariasis, or for reducing transmission in endemic communities. Data collection and analysis Two authors independently assessed eligibility and trial quality, and extracted data. Authors contacted investigators for missing information or clarification. Main results Seven trials including 6997 participants (995 with detectable microfilariae) met the criteria. A comparison of albendazole and placebo detected no effect on microfilariae prevalence (920 participants; 3 trials); one trial (499 participants) reported significantly lower microfilariae density at six months. Albendazole performed slightly worse than ivermectin in two trials (436 participants). Compared with diethylcarbamazine (DEC), two small trials (56 participants) found little difference in microfilariae prevalence over an extended follow up. One larger trial (502 participants) found a statistically significant effect for DEC at six months, but none at three months. Microfilariae prevalence and density were statistically significantly lower with the combination of albendazole and ivermectin compared with ivermectin alone in two of three trials (649 participants). Two trials compared albendazole plus DEC with DEC alone and found no statistically significant difference in microfilariae prevalence, though one trial favoured the combination at six months (risk ratio 0.62, 95% confidence interval 0.32 to 1.21; 491 participants). This trial also found a statistically significant reduction in microfilariae density. Authors’ conclusions There is insufficient evidence to confirm or refute that albendazole co-administered with DEC or ivermectin is more effective than DEC or ivermectin alone in clearing microfilariae or killing adult worms. Albendazole combined with ivermectin appears to have a small effect on microfilaraemia, but this was not consistently demonstrated. The effect of albendazole against adult and larval filarial parasites, alone and in combination with other antifilarial drugs, deserves further rigorous research

Albendazole for lymphatic filariasis (Review)

Background Mass treatment with albendazole, co-administered with another antifilarial drug, is being promoted as part of a global programme to eliminate lymphatic filariasis. Objectives To assess the effects of albendazole on patients or populations with filarial infection, and on morbidity in patients with filarial infection; and to assess the frequency of adverse events for albendazole both given singly or in combination with another antifilarial drug (diethylcarbamazine or ivermectin). Search strategy We searched the Cochrane Infectious Disease Group’s trial register (September 2003), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2003), MEDLINE (September 2003), EMBASE (September 2003), LILACS (September 2003); and checked the reference lists and contacted experts, international organizations, and a pharmaceutical company. Selection criteria Randomized and quasi-randomized controlled trials of albendazole singly or in combination with anti-filarial drugs in people or populations with lymphatic filariasis. Data collection and analysis Two reviewers assessed eligibility and trial methodological quality.We calculated relative risks (RR) with 95% confidence intervals (CI) for binary outcomes, and where appropriate, combined them in a meta-analysis using the fixed effect model or random effects model. Main results Four small studies met the inclusion criteria (a total of 2473 children and adults, of whom 536 had detectable microfilariae). No effect of albendazole on microfilaraemia was demonstrated in two studies (placebo controlled, RR 0.97, 95% CI 0.87 to 1.09, n = 195). When compared to ivermectin, albendazole performed worse (RR 0.84, 95%CI 0.72 to 0.98, 2 studies of patients initially microfilariae positive, n = 198). When compared to diethylcarbamazine, no statistically significant difference was detected, but numbers were small (n = 56). Two studies compared albendazole plus ivermectin to ivermectin alone on the presence ofmicrofilaraemia. Results weremixed: one study showed the combination to be more effective (RR 0.27, 95% CI 0.11 to 0.70, n = 52), but the other did not demonstrate a statistically significant difference (RR 1.04, 95% CI 0.87 to 1.25, n = 145). A further study compared albendazole plus diethylcarbamazine to diethylcarbamazine alone and did not demonstrate a difference on microfilaraemia prevalence. No study examined the effects of the drugs on adult worms. Authors’ conclusions There is insufficient reliable research to confirm or refute whether albendazole alone, or co-administered with diethylcarbamazine or ivermectin, has an effect on lymphatic filariasis

Albendazole for the control and elimination of lymphatic filariasis: systematic review

OBJECTIVES The Global Programme to Eliminate Lymphatic Filariasis recommends albendazole in combination with other antifilarial drugs. This systematic review examines albendazole in treatment and control of lymphatic filariasis. DATA SOURCES The Cochrane Controlled Trials Register, MEDLINE and EMBASE to April 2005; contacting experts, international organisations and drug manufacturers. METHODS Randomised or quasi-randomised controlled trials included; two reviewers independently assessed eligibility, quality, and extracted data. We calculated the relative risk of microfilaraemia (mf) prevalence using fixed effect, or random effects model in case of heterogeneity. RESULTS Six trials met inclusion criteria. Three trials compared albendazole with placebo: no effect was demonstrated on mf prevalence, but density was lower in one of the three studies at 6 months. Three trials added albendazole to ivermectin, with no demonstrable effect; prevalence tended to be lower at 4-6 months but not at 12 months (4-6 months; RR 0.49, 95% CI 0.18 to 1.39, n = 255, 2 trials; 12 months: RR 1.00, 95% CI 0.88 to 1.13, n = 348, 2 trials). Mf density was significantly lower in two of the three trials; one of two trials measuring density at 12 months showed a difference. Three trials added albendazole to diethylcarbamazine; two were small trials with no difference demonstrated; the third study tended to favour combination at 6 months (RR = 0.62, 95% CI 0.32 to 1.21, n = 491), with a significant difference for density. CONCLUSIONS The effect of albendazole against adult and larval filarial parasites, alone and in combination with other antifilarial drugs, deserves further rigorous research