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

Factors associated with anti-retroviral treatment failure among HIV/AIDS patients in Kibera slums, Nairobi county

Background: The introduction and scale up of anti-retroviral therapy (ART) has reduced HIV-related morbidity and mortality, this advantage will however be eroded if factors associated with anti-retroviral treatment failure are not identified and well addressed.Objective: To determine factors associated with anti-retroviral treatment failure among adult HIV/AIDS patients in Kibera slums, Nairobi county.Design: Descriptive cross-sectional studySetting: AMREF-Kibera community based Health CentreSubjects: Adult HIV/AIDS patients who have been on ART for six months and above.Results: It was clear that knowledge, attitudes and practices have a significant effect on anti-retroviral treatment failure with 86 % of the respondents agreeing that herbal medicine can be used as an alternative to ART while 75 % agreed that one does not need ART if they do not have AIDS. Poor adherence practices was also observed with the main reason of missing medication being due to stigma 81% followed by pill burden 78% and side effects 75%. The odds of ART failure were 1.09 times higher for those with poor knowledge about the purpose of ART drugs (ART Drugs are to Cure HIV AIDS). The odds of ART failure were 1.183 times higher for those with poor attitude (ART is a waste of Time). The odds of ART failure were 1.468 times higher for those with poor practices. The odds of ART Failure were 1.559 times higher for those with poor adherence practices as opposed to those with good adherence practices.Conclusion: Inadequate knowledge and poor attitudes towards ART in addition to poor adherence practices were associated with anti-retroviral treatment failure. The study therefore recommends that there is an urgent need to educate HIV/AIDS patients on ART and good adherence practices to avoid anti-retroviral treatment failure

Prevalence and factors associated with malaria parasitaemia in children under the age of five years in Malawi: A comparison study of the 2012 and 2014 Malaria Indicator Surveys (MISs)

© 2017 Zgambo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background Malaria is the main cause of morbidity and mortality among children under the age of five years in Malawi. The aim of this study was to compare the prevalence and factors associated with malaria parasitaemia among children under the age of five years in Malawi between the 2014 and 2012 Malaria Indicator Surveys (MISs). Methodology Data on demographic factors, vector control interventions, and blood for malaria test were collected from a representative sample of children under the age of five years in Malawi through multistage cluster sampling method. Data were analysed by chi-square test and logistic regression using complex samples analysis of the Statistical Package for the Social Sciences (SPSS) version 22.Results The prevalence of malaria parasitaemia among children under the age of five years increased from 28% in 2012 to 33% in 2014 (p > 0.05). Likewise, the proportion of children using long-lasting insecticide-treated net (LLIN) increased significantly from 54% in 2012 to 65% in 2014 MIS (p < 0.05). The proportion of households that had used indoor residual spraying (IRS) was 9% for both surveys. In multivariate analysis, use of LLIN significantly predicted for malaria parasitaemia in the 2012 MIS but not in the 2014 MIS. Older children and those coming from the poorest families were significantly associated with having malaria parasites in both surveys. Conclusion The increase in the use of LLIN among children in 2014, did not result in the reduction of malaria parasitaemia in children. The use of LLIN significantly predicted for malaria parasitaemia among children in the 2012 MIS but not in the 2014 MIS. The results of this study underscore the need to increase the coverage of IRS, mosquito repellents and larvicide alongside LLINs in order to reduce the burden of malaria among children in Malawi

Out-Patient Prescribing Practices at Mbagathi District Hospital-Nairobi County

Objective: To assess medicine use practices by using WHO prescribing and patient care indicators in Mbagathi Hospital outpatient department. Design: A hospital based retrospective study. Setting: Mbagathi District Hospital outpatient department between 1st January to 30th June 2012. Main outcome measures: Measures used in this study included, total number of medicines in a prescription, proportion of medicines in the essential drug list, proportion in generic names, proportion with injectables and antibiotics and percentage actually dispensed. Results: Total number of drugs prescribed was 1,506. On average, each patient was prescribed 3.85 types of drugs. A total of 835 drugs were prescribed by generic name, accounting for 25.6% of total number of drugs prescribed (1,506). Out of 391 sampled prescriptions, 266 had antibiotics accounting for (68.0%). A relatively small proportion of the prescriptions, 9.5% had an injection. A total of 1,087 drugs were prescribed according to the essential drugs list or formulary, accounting for 72.2% of total number of drugs prescribed (1,506). Only 55.2% of total medicines prescribed were actually dispensed and the rest were out of stock. Conclusion: The prescribing practices in this study are not satisfactory, as suggested by polypharmacy, over prescription of antibiotics, prescribing by brand names and lack of awareness of essential drugs list

Assessment of iron status among preschool children (6 to 59 months) with and without malaria in Western Province, Kenya

Introduction: Iron deficiency is a major public health concern. Globally, iron deficiency ranks number 9 and is responsible for about 60% of all anemia cases among preschool children. In Africa iron deficiency is 43-52% while in Kenya, children under 5 years constitute the largest burden with 69% of them being deficient. There is limited iron deficiency data in Kenya. This study determined haemoglobin levels, serum ferritin levels, nutritional status and P.falciparum malaria infection in preschool children. Methods: A household cross sectional study was undertaken among 125 preschoolers in Western province, drawn from 37 clusters. Systematic random sampling was used for sample selection. Data was collected using pretested structured questionnaires, entered in Microsoft package. Data analysis was done in Statistical package for social science (SPSS) version 20 using bivariate and multivariate logistic regression and differences were considered significant at P < 0.05. Results: The prevalence of iron deficiency (Serum ferritin <12mg/l), anaemia (Hb<110g/l) and plasmodium falciparum malaria were 20.8%, 25% and 6.8% respectively. There was a significant association between iron deficiency and anaemia (OR=3.43, 95% CI: 1.33-8.84, p=0.008). A preschool child with anaemia was 3.43 times likely to be iron deficient compared to a preschool child who was not anaemic. Conclusion: Iron deficiency, anaemia and plasmodium falciparum malaria was prevalent among preschool children. The findings revealed a significant association between iron deficiency and anaemia. Therefore effective interventions to improve iron status will have large health benefits by greatly reducing anaemia in preschool children.Keywords: Serum ferritin, haemoglobin, plasmodium falciparum malaria, preschool childre

Factors associated with road traffic accidents involving motorcyclists in Mwea Town, Kirinyaga County, Kenya

Introduction: Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and are a common cause of road traffic injuries. This study was carried out to determine factors associated with road traffic accidents involving motorcyclists in Mwea town, Kirinyaga County.Methodology: A cross sectional descriptive study design was used. The instrument of data collection was a semi-structured interviewer administered questionnaire. Data was analyzed using SPSS version 20. A total of 180 commercial motorcyclists participated.A total of 68 (38%) had been involved in road traffic accidents in the past one year at the time of the survey. Forty-seven (69.1%) of them had accidents once. Among those who were involved in accidents in the last one year, 18 (26.5%) attributed the occurrence of accident to poor visibility of the road, 16 (23.5%) to over speeding, 9 (13.2%) to careless motorists, and 6 (8.8%) to potholes.Conclusion: The extend of accidents was higher among those who drink alcohol, 34 (69.4%), than among those who don’t, 34(26.0%) (P= 0.00). Majority of the accidents, 43 (63.2%) occurred as a result of rolling after losing control. Excessive speed and alcohol use were identified as major factors. Lack of helmet use among those involved in accidents was 41.2% which should be of concern to the authority  to ensure that proper education and awareness is disseminate

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

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