Malaria treatment seeking behaviour and access to artemisinin combination therapy : a case of Mushin, Lagos, Nigeria

Includes bibliographical references.ACTs have been shown to be effective in treating malaria and are currently recommended as first-line drugs for the treatment of uncomplicated malaria in Nigeria because of resistance of malaria to chloroquine (CQ) and sulphadoxine pyrimethamine (SP). However, very little is known about malaria and treatment-seeking patterns and the use of ACTs since the adoption of the treatment policy more than 6 years ago in Nigeria

Citation classics in systematic reviews and meta-analyses : who wrote the top 100 most cited articles?

Background: Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. The aims of this study were to assess whether citation classics exist in published systematic review and meta-analysis (SRM), examine the characteristics of the most frequently cited SRM articles, and evaluate the contribution of different world regions. Methods: The 100 most cited SRM were identified in October 2012 using the Science Citation Index database of the Institute for Scientific Information. Data were extracted by one author. Spearman’s correlation was used to assess the association between years since publication, numbers of authors, article length, journal impact factor, and average citations per year. Results: Among the 100 citation classics, published between 1977 and 2008, the most cited article received 7308 citations and the least-cited 675 citations. The average citations per year ranged from 27.8 to 401.6. First authors from the USA produced the highest number of citation classics (n=46), followed by the UK (n=28) and Canada (n=15). The 100 articles were published in 42 journals led by the Journal of the American Medical Association (n=18), followed by the British Medical Journal (n=14) and The Lancet (n=13). There was a statistically significant positive correlation between number of authors (Spearman’s rho=0.320, p=0.001), journal impact factor (rho=0.240, p=0.016) and average citations per year. There was a statistically significant negative correlation between average citations per year and year since publication (rho = -0.636, p=0.0001). The most cited papers identified seminal contributions and originators of landmark methodological aspects of SRM and reflect major advances in the management of and predisposing factors for chronic diseases. Conclusions: Since the late 1970s, the USA, UK, and Canada have taken leadership in the production of citation classic papers. No first author from low or middle-income countries (LMIC) led one of the most cited 100 SRM

Interventions for improving adults' use of primary oral health care services

CITATION: Harris, R., et al. 2017. Interventions for improving adults’ use of primary oral health care services. Cochrane Database of Systematic Reviews, 8:1-18, Art. CD012771, doi:10.1002/14651858.CD012771.The original publication is available at https://www.cochranelibrary.comThis is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of interventions aimed at improving adults’ use of primary dental care services in order to improve their oral health and quality of life.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012771/fullPublisher's versio

Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns

CITATION: Okwundu, C. I., et al. 2017. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Cochrane Database of Systematic Reviews, 5:1-12, Art. CD012660, doi:10.1002/14651858.CD012660.The original publication is available at https://www.cochranelibrary.comThis is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: - To determine the diagnostic accuracy of TcB as: i) a diagnostic test for hyperbilirubinaemia in newborns suspected to have hyperbilirubinaemia on visual inspection; ii) a diagnostic test for monitoring bilirubin levels in newborns receiving treatment (e.g. phototherapy) for hyperbilirubinaemia. - To determine whether the gestational age, postnatal age, body weight, race and site of TcB measurement have any influence on the accuracy of TcB measurement for hyperbilirubinaemia in newborns.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012660/fullPublisher's versio

Transcutaneous bilirubin screening for hyperbilirubinemia in African newborns

Thesis (PhD)--Stellenbosch University, 2019.ENGLISH SUMMARY : Background: In many parts of the world, including African countries, apparently healthy newborns are usually discharged home early. Serum bilirubin levels usually peaks on postnatal days 3 to 5, by when many newborns have already been discharged home. Severe neonatal hyperbilirubinemia constitutes an important cause of neonatal mortality and morbidity in Africa. There is a need for ways of identifying newborns at risk of severe jaundice before hospital discharge especially in developing countries with poor health systems and inadequate follow-up procedures after discharge from hospital. Objectives: The objective of this combination of studies is to provide evidence for the use of transcutaneous bilirubin (TcB) screening in a population of indigenous African newborns. Methods: We summarized the available evidence on the accuracy and effectiveness of TcB screening in two Cochrane systematic reviews. In the first systematic review, we summarized the evidence on the effectiveness of TcB screening in newborns. The second review summarized the evidence on the accuracy of TcB measurement compared to total serum bilirubin (TsB) measurement. We also conducted research on the effects of TcB screening and on the accuracy of the TcB measurement in a population of South African newborns. Results: For our first systematic review, we did not identify any randomized controlled trial that assessed the effect of TcB screening on readmission for jaundice or on the incidence of severe hyperbilirubinemia in newborns. Findings from included observational studies from North America suggest that universal pre-discharge TcB screening in newborns reduces readmission for hyperbilirubinemia and also reduces the incidence of severe hyperbilirubinemia. We conducted a randomized controlled trial of TcB screening in an indigenous population of African newborns from South Africa. Findings from our trial confirmed that TcB screening reliably identified newborns at risk of severe hyperbilirubinemia and led to a 75% reduction in the readmission rate for hyperbilirubinemia and up to 73% decrease in the incidence of severe hyperbilirubinemia. However, the effect of TcB screening on kernicterus and bilirubin induced neurology dysfunction is not known. Findings from our second systematic review of accuracy of TcB measurement compared to TsB measurement in the laboratory, suggest a significant correlation coefficient of up to 0.98 between these two measurements. However, there are mixed findings from the included studies on the effect of various factors including: gestational age, race, postnatal age, TsB concentration, on the correlation. Also, there are limited studies in indigenous African newborns. Our cross-sectional study on the accuracy of the TcB measurement in a population of South African newborns showed a good correlation between TcB measurement and TsB measured in the laboratory. Conclusion: The TcB tool can be used to reliably estimate TsB in African newborns and can help identify newborns who need phototherapy before hospital discharge. We recommend that every newborn should be assessed for hyperbilirubinemia using objective means of measuring or estimating serum bilirubin measurement such as the TcB or TsB before discharge from hospital. This could go a long way in reducing hyperbilirubinemia related readmissions and incidence of severe hyperbilirubinemia. Pre-discharge TcB screening in newborns can therefore be used to identify newborns in need of phototherapy or those who are at risk of readmission for hyperbilirubinemia after discharge.AFRIKAANSE OPSOMMING : Agtergrond: In baie dele van die wêreld, insluitende Afrikalande, word oënskynlike gesonde pasgebore babas vroeg uit die hospitaal ontslaan. Serum bilirubienvlakke bereik gewoonlik ‘n hoogtepunt drie tot vyf dae na geboorte, teen die tyd wanneer baie babas alreeds ontslaan en by die huis is. Ernstige hiperbilirubinemie onder pasgeborenes is ‘n belangrike oorsaak van neonatale sterftes en morbiditeit in Afrika. Daar is behoefte aan maniere om pasgebore babas wat ‘n risiko vir ernstige geelsug het te identifiseer nog voordat hul uit die hospitaal ontslaan word, veral in ontwikkelende lande met swak gesondheidstelsels en onvoldoende opvolgprosedures na hospitaalontslag. Doelwitte: Die doelwit van hierdie kombinasie van studies is om navorsingsbewyse te verskaf vir die gebruik van bilirubien (“TcB”) sifting deur skandering van die vel, in ‘n bevolking van inheemse pasgebore babas in Afrika. Metodes: Ons het die beskikbare navorsingsbewyse met betrekking tot die akkuraatheid en effektiwiteit van TcB sifting opgesom in twee Cochrane stelselmatige oorsigte. In die eerste stelselmatige oorsig het ons die navorsingsbewyse rakende die effektiwiteit van TcB sifting in pasgeborenes opgesom. In die tweede oorsig het ons die navorsingsbewys rakende die akkuraatheid van TcB metings vergelyk met die totale serum bilirubien (“TsB”) meting. Ons het ook navorsing gedoen rakende die effek van TcB sifting asook die akkuraatheid van die TcB meting in ‘n bevolking van Suid-Afrikaanse pasgeborenes. Resultate: Vir ons eerste stelselmatige oorsig het ons nie enige ewekansige steekproewe geïdentifiseer wat die effek van heropname in die hospitaal vir hiperbilirubinemie ondersoek het nie, of wat die insidensie van pasgeborenes met ernstige hiperbilirubinemie wat TcB sifting ondergaan het, ondersoek het nie. Bevindinge van ingesluite waarnemingstudies van Noord-Amerika suggereer dat universele TcB sifting in pasgeborenes voor hospitaalontslag die heropname vir hiperbilirubinemie, asook die insidensie van ernstige hiperbilirubinemie, verlaag. Ons het ‘n ewekansige gekontroleerde proef uitgevoer van TcB sifting in ‘n inheemse Suid-Afrikaanse bevolking van pasgebore babas. Bevindings van ons proef het bevestig dat TcB sifting van pasgebore babas wat ‘n risiko het vir ernstige hiperbilirubinemie betroubaar is, en tot ‘n 75% afname in die heropnamekoers vir hiperbiliruminemie gelei het, asook tot en met ‘n 73% afname in die insidensie van hiperbilirubinemie. Die effek van TcB sifting op kernikterus en bilirubien-geïnduseerde neurologie is egter nie bekend nie. Bevindings van ons tweede stelselmatige oorsig oor die akkuraatheid van die TcB meting teenoor die TsB meting in die laboratorium suggereer ‘n beduidende korrelasie van tot 0.98 tussen hierdie twee metings. Die ingesluite studies het egter gemengde bevindinge getoon in terme van faktore soos swangerskapsouderdom, ras, postnatale ouderdom en TsB konsentrasie wat die effek op korrelasie kan beïnvloed. Daar is ook ‘n beperkte aantal studies oor inheemse pasgeborenes in Afrika. Ons deursnitstudie oor die TcB meting se akkuraatheid in ‘n Suid-Afrikaanse bevolking van pasgebore babas het ‘n goeie korrelasie getoon tussen TcB meting en TsB meting in die laboratorium. Gevolgtrekkings: Die TcB hulpmiddel is betroubaar en kan gebruik word om TsB in pasgebore babas in Afrika te skat. Dit kan ook pasgeborenes identifiseer wat fototerapie voor hospitaalontslag benodig. Ons beveel aan dat elke pasgebore baba getoets moet word vir hiperbilirubinemie deur middel van ‘n objektiewe meting of skatting van serum bilirubien, byvorbeeld TcB of TsB. Dit kan hiperbilirubinemie-verwante hertoelatings in hospitale en die insidensie van ernstige hiperbilirubinemie verlaag. TcB sifting in pasgeborenes voor ontslag uit die hospital kan dus gebruik word om babas te identifiseer wat fototerapie benodig, of wat ‘n risiko het vir heropname vir hiperbilirubinemie na hospitaalontslag

Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults

CITATION: Onwumeh, J., Okwundu, C. I. & Kredo, T. 2017. Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults. Cochrane Database of Systematic Reviews, 5:1-68, Art. CD009818, doi:10.1002/14651858.CD009818.pub2.The original publication is available at https://www.cochranelibrary.comBackground: Human immunodeficiency virus (HIV) continues to be a leading cause of morbidity and mortality, particularly in sub‐Saharan Africa. Although antiretroviral drugs have helped to improve the quality of life and life expectancy of HIV‐positive individuals, there is still a need to explore other interventions that will help to further reduce the disease burden. One potential strategy is the use of interleukin‐2 (IL‐2) in combination with antiretroviral therapy (ART). IL‐2 is a cytokine that regulates the proliferation and differentiation of lymphocytes and may help to boost the immune system. Objectives: To assess the effects of interleukin‐2 (IL‐2) as an adjunct to antiretroviral therapy for HIV‐positive adults. Search methods: We searched the following sources up to 26 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; the Web of Science; LILACS; the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP); and ClinicalTrials.gov. We also checked conference abstracts, contacted experts and relevant organizations in the field, and checked the reference list of all studies identified by the above methods for any other potentially eligible studies. Selection criteria: Randomized controlled trials (RCTs) that evaluated the effects of IL‐2 as an adjunct to ART in reducing the morbidity and mortality in HIV‐positive adults. Data collection and analysis:Two review authors independently screened records and selected trials that met the inclusion criteria, extracted data, and assessed the risk of bias in the included trials. Where possible, we compared the effects of interventions using risk ratios (RR), and presented them with 95% confidence intervals (CI). We assessed the overall certainty of the evidence using the GRADE approach. Main results: Following a comprehensive literature search up to 26 May 2016, we identified 25 eligible trials. The interventions involved the use of IL‐2 in combination with ART compared with ART alone. There was no difference in mortality apparent between the IL‐2 group and the ART alone group (RR 0.97, 95% CI 0.80 to 1.17; 6 trials, 6565 participants, high certainty evidence). Seventeen of 21 trials reported an increase in the CD4 cell count with the use of IL‐2 compared to control using different measures (21 trials, 7600 participants). Overall, there was little or no difference in the proportion of participants with a viral load of less than 50 cells/mL or less than 500 cells/mL by the end of the trials (RR 0.97, 95% CI 0.81 to 1.15; 5 trials, 805 participants, high certainty evidence) and (RR 0.96, 95% CI 0.82 to 1.12; 4 trials, 5929 participants, high certainty evidence) respectively. Overall there may be little or no difference in the occurrence of opportunistic infections (RR 0.79, 95% CI 0.55 to 1.13; 7 trials, 6141 participants, low certainty evidence). There was probably an increase in grade 3 or 4 adverse events (RR 1.47, 95% CI 1.10 to 1.96; 6 trials, 6291 participants, moderate certainty evidence). None of the included trials reported adherence. Authors' conclusions: There is high certainty evidence that IL‐2 in combination with ART increases the CD4 cell count in HIV‐positive adults. However, IL‐2 does not confer any significant benefit in mortality, there is probably no difference in the incidence of opportunistic infections, and there is probably an increase in grade 3 or 4 adverse effects. Our findings do not support the use of IL‐2 as an adjunct to ART in HIV‐positive adults. Based on our findings, further trials are not justified.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009818.pub2/fullPublisher's versio

Transcutaneous screening for hyperbilirubinemia in neonates (Protocol)

Description of the condition Hyperbilirubinemia is a term used to describe elevated levels of bilirubin in the blood. In newborns, hyperbilirubinemia becomes clinically apparent as jaundice, a yellow coloration of the skin and the sclera, at serum bilirubin levels > 5 mg/dL (Porter 2002). Hyperbilirubinemia is very common in both term and preterm newborn infants (occurring in around 60% of newborns) and results from a predisposition to produce bilirubin and the newborn’s limited ability to excrete it (Lauer 2011). Jaundice or hyperbilirubinemia is the most common cause of hospital readmission in the neonatal period (Soskolne 1996; Maisels 1998; Escobar 2005). Most cases of newborn jaundice are mild and self limited. However, in rare cases, infants can have very high levels of bilirubin that can lead to bilirubin encephalopathy and kernicterus (Newman 2006). The threshold concentration of bilirubin and/or the duration of hyperbilirubinemia responsible for causing kernicterus injury in newborn infants is not known (Dennery 2004). Low concentrations of bilirubin may have some antioxidant benefits, suggesting that bilirubin should not be completely eliminated. Studies from developed countries estimate the incidence of kernicterus to range from about 0.4 to 2 per 100,000 (Sgro 2006; Manning 2007; Burke 2009). However, studies from developing countries suggest that the incidence may be much higher (Nair 2003; Owa 2009). The acute phase signs of kernicterus are poor feeding, lethargy, high-pitched cry, hypertonia or hypotonia, opisthotonos and seizures. The chronic manifestations include athetoid cerebral palsy, motor delay, gaze palsy, dental dysplasia, mental retardation and sensorineural hearing loss (AAP 2004). Current treatments for hyperbilirubinemia include phototherapy and exchange transfusion (usually reserved for severe cases of hyperbilirubinemia) (NICE 2010)

Procalcitonin, C-reactive protein, and presepsin for the diagnosis of sepsis in adults and children

CITATION: Onyenekwu, C. P., Okwundu, C. I. & Ochodo, E. A. 2017. Procalcitonin, C-reactive protein, and presepsin for the diagnosis of sepsis in adults and children. Cochrane Database of Systematic Reviews, 4:1-15, Art. CD012627, doi:10.1002/14651858.CD012627.The original publication is available at https://www.cochranelibrary.comThis is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: The objectives of this review are: - To assess the diagnostic accuracy of PCT, CRP and presepsin for sepsis in adults and children. - To investigate sources of heterogeneity in the estimates of diagnostic accuracy. - To compare the performance of the above tests.https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012627/fullPublisher's versio

Antiretroviral pre-exposure prophylaxis (PrEP) for preventing HIV in high-risk individuals

Background: More than 30 years into the global HIV/AIDS epidemic, infection rates remain alarmingly high, with over 2.7 million people becoming infected every year. There is a need for HIV prevention strategies that are more effective. Oral antiretroviral pre-exposure prophylaxis (PrEP) in high-risk individuals may be a reliable tool in preventing the transmission of HIV. Objectives: To evaluate the effects of oral antiretroviral chemoprophylaxis in preventing HIV infection in HIV-uninfected high-risk individuals. Search methods: We revised the search strategy from the previous version of the review and conducted an updated search of MEDLINE, the Cochrane Central Register of Controlled Trials and EMBASE in April 2012. We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov for ongoing trials. Selection criteria: Randomised controlled trials that evaluated the effects of any antiretroviral agent or combination of antiretroviral agents in preventing HIV infection in high-risk individuals Data collection and analysis: Data concerning outcomes, details of the interventions, and other study characteristics were extracted by two independent authors using a standardized data extraction form. Relative risk with a 95% confidence interval (CI) was used as the measure of effect. Main results: We identified 12 randomised controlled trials that meet the criteria for the review. Six were ongoing trials, four had been completed and two had been terminated early. Six studies with a total of 9849 participants provided data for this review. The trials evaluated the following: daily oral tenofovir disoproxil fumarate (TDF) plus emtricitabine (FTC) versus placebo; TDF versus placebo and daily TDF-FTC versus intermittent TDF-FTC. One of the trials had three study arms: TDF, TDF-FTC and placebo arm. The studies were carried out amongst different risk groups, including HIV-uninfected men who have sex with men, serodiscordant couples and other high risk men and women. Overall results from the four trials that compared TDF-FTC versus placebo showed a reduction in the risk of acquiring HIV infection (RR 0.49; 95% CI 0.28 to 0.85; 8918 participants). Similarly, the overall results of the studies that compared TDF only versus placebo showed a significant reduction in the risk of acquiring HIV infection (RR 0.33; 95% CI 0.20 to 0.55, 4027 participants). There were no significant differences in the risk of adverse events across all the studies that reported on adverse events. Also, adherence and sexual behaviours were similar in both the intervention and control groups. Authors' conclusions:Finding from this review suggests that pre-exposure prophylaxis with TDF alone or TDF-FTC reduces the risk of acquiring HIV in high-risk individuals including people in serodiscordant relationships, men who have sex with men and other high risk men and women

Brief school-based interventions and behavioural outcomes for substance-using adolescents.

Key results: For outcomes that concern substance use, the studies assessed use of alcohol and cannabis. When compared to information provision, brief interventions are probably not more efficacious in reducing substance use or delinquent behaviour. When compared to assessment-only controls, the interventions may have some significant effects on substance use and behaviours. At short-term follow-up, brief interventions significantly reduced cannabis frequency in one study. At medium-term follow-up, brief interventions significantly reduced frequency of alcohol use, alcohol abuse and dependence symptoms, and cannabis abuse symptoms in one study. At long-term follow-up, brief interventions significantly reduced alcohol abuse, cannabis frequency, and cannabis abuse and dependence symptoms in one study. The pattern of results indicates that adolescents who received a brief intervention generally did better in reducing their alcohol and cannabis use than adolescents who received no intervention at all. However, adolescents who received a brief intervention did not seem to do better in reducing their alcohol and cannabis use than adolescents who received information-only interventions. It is therefore premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use