Can flash glucose monitoring improve glucose management for Aboriginal and Torres Strait Islander peoples with type 2 diabetes? A protocol for a randomised controlled trial

Background: Aboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology’s use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting. Methods: This is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia. Discussion: The trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021

Prevalence and Determinants of Early Antenatal Care Visit among Pregnant Women Attending Antenatal Care in Debre Berhan Health Institutions, Central Ethiopia

Antenatal care (ANC), which is given to pregnant women, is widely used for prevention, early diagnosis and treatment of general medical and pregnancy-related complications. This study assessed the prevalence of early ANC visit and associated factors among pregnant women attending ANC in Debre Berhan town. An institution based cross-sectional study design was used to collect data from pregnant mothers with a face to face interview technique. Bivariate and multivariate analyses were used to identify associated factors for early ANC visit. A total of 446 pregnant women were included in the study. One hundred seventeen (26.2%) pregnant mothers started their first ANC visit early. The multivariate analysis showed that mothers with no parity before (AOR = 3.65, 95%CI: 2.14, 6.24), had good knowledge on early ANC (AOR = 3.10, 95%CI: 1.80, 5.33) and planned pregnancy (AOR = 1.66, 95%CI: 1.06, 2.61) were significantly associated with early ANC visit. The prevalence of early ANC visit was low. Awareness creation on the importance of early ANC visit needs to be emphasized at the time of service provision as well as at community levels.Les soins prénatals (SP), que reçoivent les femmes enceintes, sont largement utilisés pour la prévention, le diagnostic précoce et le traitement des complications liées à la grossesse et à des conditions médicales générales. Cette étude a évalué la prévalence de début de consultation prénatale et les facteurs associés chez les femmes enceintes qui fréquentent les centres des SP dans la ville de Debre Berhan. Une conception de l'étude transversale basée dans une institution a été utilisée pour recueillir des données auprès des femmes enceintes à l’aide de la technique de l’interview face à face. Des analyses bivariées et multivariées ont été utilisées pour identifier les facteurs associés au début de la consultation prénatale. Au total, 446 femmes enceintes ont participé à l'étude. Cent dix-sept (26,2%) femmes enceintes ont commencé leur première consultation prénatale tôt. L'analyse multivariée a montré que les mères sans parité avant (AOR = 3,65, IC 95 % : 2,14, 6,24) , étaient bien renseignées sur les SP précoce (AOR = 3,10 , IC 95 % : 1,80, 5,33 ) et la grossesse planifiée (AOR = 1,66 , IC 95 % : 1,06 , 2,61) étaient significativement associées à la consultation prénatale précoce . La prévalence de la consultation natale précoce était faible. Il faut mettre l’accent sur la sensibilisation à l'importance de la consultation précoce des SP lors de la prestation de services aussi bien qu'au niveau de la communauté

Prevalence and Determinants of Early Antenatal Care Visit among Pregnant Women Attending Antenatal Care in Debre Berhan Health Institutions, Central Ethiopia

Antenatal care (ANC), which is given to pregnant women, is widely used for prevention, early diagnosis and treatment of general medical and pregnancy-related complications. This study assessed the prevalence of early ANC visit and associated factors among pregnant women attending ANC in Debre Berhan town. An institution based cross-sectional study design was used to collect data from pregnant mothers with a face to face interview technique. Bivariate and multivariate analyses were used to identify associated factors for early ANC visit. A total of 446 pregnant women were included in the study. One hundred seventeen (26.2%) pregnant mothers started their first ANC visit early. The multivariate analysis showed that mothers with no parity before (AOR = 3.65, 95%CI: 2.14, 6.24), had good knowledge on early ANC (AOR = 3.10, 95%CI: 1.80, 5.33) and planned pregnancy (AOR = 1.66, 95%CI: 1.06, 2.61) were significantly associated with early ANC visit. The prevalence of early ANC visit was low. Awareness creation on the importance of early ANC visit needs to be emphasized at the time of service provision as well as at community levels. Keywords: Prevalence, Early ANC visit, Pregnant women, Ethiopia.(Afr J Reprod Health 2013; 17[4]: 130-136

Prevalence of Active Trachoma and Its Associated Factors among Rural and Urban Children in Dera Woreda, Northwest Ethiopia: A Comparative Cross-Sectional Study

BACKGROUND: Trachoma is the most common infectious cause of blindness worldwide. Once an epidemic in most parts of the world, it has largely now disappeared from developed countries. However, it continues to be endemic in many developing countries like Ethiopia. Even if several studies were conducted in different parts of Ethiopia, most of them did not show the independent predictors for rural and urban children separately. Therefore, this study aimed at assessing the prevalence and associated factors of active trachoma in urban and rural children. METHODS: Community based comparative cross-sectional study was conducted in Dera woreda. Multistage sampling technique was used to select 671 children of one up to nine years of age. Data were collected by face to face interview and observation using a structured and pretested questionnaire. Binary Logistic Regression Model was fitted to consider adding independent predictors of outcome. RESULTS: Out of 671 children, 20 (9.3%) of urban and 85 (18.6%) of rural children were positive for active trachoma. Having discharge on eye (AOR = 6.9, 95% CI: 1.79-27.89), presence of liquid waste around the main house (AOR = 5.6, 95% CI: 1.94-16.18), and living in households without latrine (AOR = 4.39, 95% CI: 1.39-13.89) were significantly associated with active trachoma of urban children. Rural children who had discharge on their eye (AOR = 5.86, 95% CI: 2.78-12.33), those who had unclean face (AOR = 4.68, 95% CI: 2.24-9.81), and those living in households with feces around their main houses (AOR = 1.94, 95% CI: 1.04-3.62) were significantly associated with active trachoma. CONCLUSION: The result showed that the prevalence of active trachoma in urban areas of the district was below WHO threshold of 10% to determine trachoma as public health problem. However, in rural areas of the district it is far from elimination of trachoma as a public health problem. Thus, in order to improve awareness of the community there is a need of health education programs regarding facial cleanliness, utilization of latrine, and proper solid waste and liquid waste disposal using multidisciplinary approach

RPN (Radius, Position of tumour, iNvasion of renal sinus) Classification and Nephrometry Scoring System: An Internationally Developed Clinical Classification To Describe the Surgical Difficulty for Renal Masses for Which Robotic Partial Nephrectomy Is Planned

Background: The surgical difficulty of partial nephrectomy (PN) varies depending on the operative approach. Existing nephrometry classifications for assessment of surgical difficulty are not specific to the robotic approach. Objective: To develop an international robotic-specific classification of renal masses for preoperative assessment of surgical difficulty of robotic PN. Design, setting, and participants: The RPN classification (Radius, Position of tumour, iNvasion of renal sinus) considers three parameters: tumour size, tumour position, and invasion of the renal sinus. In an international survey, 45 experienced robotic surgeons independently reviewed de-identified computed tomography images of 144 patients with renal tumours to assess surgical difficulty of robot-assisted PN using a 10-point Likert scale. A separate data set of 248 patients was used for external validation. Outcome measurements and statistical analysis: Multiple linear regression was conducted and a risk score was developed after rounding the regression coefficients. The RPN classification was correlated with the surgical difficulty score derived from the international survey. External validation was performed using a retrospective cohort of 248 patients. RPN classification was also compared with the RENAL (Radius; Exophytic/endophytic; Nearness; Anterior/posterior; Location), PADUA (Preoperative Aspects and Dimensions Used for Anatomic), and SPARE (Simplified PADUA REnal) scoring systems. Results and limitation: The median tumour size was 38 mm (interquartile range 27–49). The majority (81%) of renal tumours were peripheral, followed by hilar (12%) and central (7.6%) locations. Noninvasive and semi-invasive tumours accounted for 37% each, and 26% of the tumours were invasive. The mean surgical difficulty score was 5.2 (standard deviation 1.9). Linear regression analysis indicated that the RPN classification correlated very well with the surgical difficulty score (R2 = 0.80). The R2 values for the other scoring systems were: 0.66 for RENAL, 0.75 for PADUA, and 0.70 for SPARE. In an external validation cohort, the performance of all four classification systems in predicting perioperative outcomes was similar, with low R2 values. Conclusions: The proposed RPN classification is the first nephrometry system to assess the surgical difficulty of renal masses for which robot-assisted PN is planned, and is a useful tool to assist in surgical planning, training and data reporting. Patient summary: We describe a simple classification system to help urologists in preoperative assessment of the difficulty of robotic surgery for partial kidney removal for kidney tumours

Predictors of mortality among children on Antiretroviral Therapy at a referral hospital, Northwest Ethiopia: A retrospective follow up study

<p>Abstract</p> <p>Background</p> <p>An estimated 2.5 million children were living with HIV/AIDS at the end of 2009, 2.3 million (92%) in sub-Saharan Africa. Without treatment, a third of children with HIV will die of AIDS before their first birthday, half dying before two years of age. Hence, this study aimed to assess magnitude and predictors of mortality among children on Antiretroviral Therapy (ART) at a referral hospital in North-West Ethiopia.</p> <p>Methods</p> <p>Institution based retrospective follow up study was carried out among HIV-positive children from January 1^st, 2006 - March 31^st, 2011. Information on relevant variables was collected from patients’ charts and registries. Life table was used to estimate the cumulative survival of children. Log rank tests were employed to compare survival between the different categories of the explanatory variables. Multivariate Cox proportional hazards model was fitted to identify predictors of mortality.</p> <p>Results</p> <p>A total of 549 records were included in the analysis. The mean age at initiation of treatment was 6.35 ±3.78 SD years. The median follow up period was 22 months. At the end of the follow up, 41(7.5%) were dead and 384(69.9%) were alive. Mortality was 4.0 deaths per 100 child-years of follow-up period. The cumulative probabilities of survival at 3, 6, 12, 24, and 60 months of ART were 0.96, 0.94, 0.93, 0.92 and 0.83 respectively. Majority (90.2%) of the deaths occurred within the first year of treatment. Absence of cotrimoxazole preventive therapy (adjusted hazard ratio [AHR] = 4.74, 95% CI: 2.17, 10.34), anaemia (haemoglobin level < 10gm/dl) (AHR=2.44, 95% CI: 1.26, 4.73), absolute CD4 cell count below the threshold for severe immunodeficiency (AHR=2.24, 95% CI: 1.07, 4.69) and delayed or regressing developmental milestones at baseline (AHR=6.31, 95% CI: 2.52, 15.83) were predictors of mortality.</p> <p>Conclusions</p> <p>There was a high rate of early mortality. Hence, starting ART very early reduces disease progression and early mortality; close follow up of all children of HIV-positive mothers is recommended to make the diagnosis and start treatment at an earlier time before they develop severe immunodeficiency.</p