Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country

Background: It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods: Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results: Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions: Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA

Cost-Effectiveness of a Chemoprophylactic Intervention with Single Dose Rifampicin in Contacts of New Leprosy Patients

In 2008, 249,007 new leprosy patients were detected in the world. It therefore remains necessary to develop new and effective interventions to interrupt the transmission of M. leprae. We assessed the economic benefits of single dose rifampicin (SDR) for contacts as chemoprophylactic intervention in the control of leprosy. The study is based on a large trial including 21,711 contacts of 1,037 patients with newly diagnosed leprosy. We gave a single dose of rifampicin or placebo to contacts and followed them up for four years. The main outcome measure was the development of clinical leprosy. The cost effectiveness was expressed in US dollars per prevented leprosy case. Chemoprophylaxis with SDR for preventing leprosy among contacts of leprosy patients is cost-effective at all contact levels and thereby a cost-effective prevention strategy. In total $6,009 was invested and 38 leprosy cases were prevented after 2 years, costing$158 per prevented leprosy case. Implementation studies are necessary to establish whether this intervention is acceptable and feasible in other leprosy endemic areas of the world

Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021

Background Anaemia is a major health problem worldwide. Global estimates of anaemia burden are crucial for developing appropriate interventions to meet current international targets for disease mitigation. We describe the prevalence, years lived with disability, and trends of anaemia and its underlying causes in 204 countries and territories. Methods We estimated population-level distributions of haemoglobin concentration by age and sex for each location from 1990 to 2021. We then calculated anaemia burden by severity and associated years lived with disability (YLDs). With data on prevalence of the causes of anaemia and associated cause-specific shifts in haemoglobin concentrations, we modelled the proportion of anaemia attributed to 37 underlying causes for all locations, years, and demographics in the Global Burden of Disease Study 2021. Findings In 2021, the global prevalence of anaemia across all ages was 24·3% (95% uncertainty interval [UI] 23·9–24·7), corresponding to 1·92 billion (1·89–1·95) prevalent cases, compared with a prevalence of 28·2% (27·8–28·5) and 1·50 billion (1·48–1·52) prevalent cases in 1990. Large variations were observed in anaemia burden by age, sex, and geography, with children younger than 5 years, women, and countries in sub-Saharan Africa and south Asia being particularly affected. Anaemia caused 52·0 million (35·1–75·1) YLDs in 2021, and the YLD rate due to anaemia declined with increasing Socio-demographic Index. The most common causes of anaemia YLDs in 2021 were dietary iron deficiency (cause-specific anaemia YLD rate per 100 000 population: 422·4 [95% UI 286·1–612·9]), haemoglobinopathies and haemolytic anaemias (89·0 [58·2–123·7]), and other neglected tropical diseases (36·3 [24·4–52·8]), collectively accounting for 84·7% (84·1–85·2) of anaemia YLDs. Interpretation Anaemia remains a substantial global health challenge, with persistent disparities according to age, sex, and geography. Estimates of cause-specific anaemia burden can be used to design locally relevant health interventions aimed at improving anaemia management and prevention. Funding Bill & Melinda Gates Foundation

Implementation Evaluation of HIV/AIDS Voluntary Counseling and Testing (VCT) Service at Public Health Facilities of Akaki Kality Sub-City, Addis Ababa, Ethiopia

Awoke Masrie,1 Samrawit Shawel,1 Aklilu Tamire,1 Miheret Mandefro,1 Tilaye Gebru,2 Meskerem Seboka Ergiba,3 Muluneh Getachew3 1School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 2School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia; 3Department of Health Policy and Management, Public Health Faculty, Institute of Health Jimma University, Jimma, Oromia, EthiopiaCorrespondence: Awoke Masrie, Email [email protected]: Voluntary Counseling and Testing (VCT) is widely acknowledged globally as an effective method for preventing and treating HIV/AIDS. It allows people to understand their HIV status, make informed choices about getting tested for it, evaluate their personal risk of contracting HIV, and create plans to reduce that risk. The study aimed to evaluate the process of VCT services in public health facilities of Akaki Kality sub-city, Addis Ababa, Ethiopia.Methods and Materials: A case study evaluation design with a mixed method was employed from May 12 to June 12, 2021. A total of 244 clients were interviewed during the study period. Furthermore, 12 direct observations, a review of documents from the past six months to the study period, and 12 key informant interviews were conducted. Quantitative data were entered into Epi data 4.6 and exported to SPSS version 25 for analysis. Univariate analysis was done and presented in tables and texts. Qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall service implementation process was measured on the basis of pre-determined judgmental criteria.Results: The overall level of VCT service implementation was 83.84%, to which the availability of resources (84.8%), compliance of service providers with the national guidelines (85.38%), and client satisfaction (76.93%) contributed. One facility had stock-outs of test kits in the last three months, and all VCT counseling and testing rooms lacked audio-visual privacy. Supportive supervision, the use of IEC materials during counseling, linking all HIV-positive clients to treatment and care services, and sending complete reports were practiced in a way that needs some improvement.Conclusion: Overall, the service implementation was deemed satisfactory, but further action is required to improve resource availability, ensure provider compliance with national guidelines, and enhance the status of the service. In addition, the Woreda Health Office and Addis Abeba Health Bureau should regularly supervise and provide feedback.Keywords: client satisfaction, availability, complianc

Do Health Sciences Students Have the Appropriate Knowledge and Attitude to Advance Organ Donation in Ethiopia? Cross-Sectional Study

Amare Desalegn Wolide,1 Kabaye Kumela Goro,2 Fantu Kerga Dibaba,2 Serkadis Debalke,2 Meskerem Seboka,3 Birtukan Edilu Tufa,2 Fanta Gashe Fufa,2 Eshetu Mulisa Bobasa2 1Department of Biomedical Sciences, Faculty of Medicine, Jimma University, Jimma, 378, Ethiopia; 2Faculty of Health Sciences Jimma University, Jimma 378, Ethiopia; 3Institute of Public Health, Jimma University, Jimma 378, EthiopiaCorrespondence: Amare Desalegn WolideJimma University, Jimma 378, EthiopiaTel +251 932445922Email [email protected]: Donated organs and tissues are necessary for transplantation to treat irreparable organ failure. This study aimed to assess the knowledge and attitude of undergraduate health science students’ toward organ donation at Jimma University.Methods: The study was conducted in Jimma University, College of Health Sciences from February 1, 2018 to April 25, 2018, Gregorian calendar. Data was entered into Epi-Data version 3.1 and exported to SPSS version 23 for analysis. A descriptive and generalized linear model was applied to present the results.Results: The overall knowledge and attitude scores of the students were 3.844 (2.98, 4.712) and 6.3914 (5.93, 6.85) respectively. The results showed that students had good knowledge of and a positive attitude toward organ donation. Male students had a higher mean knowledge score than female students, however, the difference was not significant. Dental medicine and medicine students had a higher mean knowledge score than any other health science students in the faculty. Students showed knowledge difference yearly. A significant number of students 290 (73.4%) and 313 (79.2%) knew the importance of live and cadaveric organ donation to treat permanently failed organs, respectively. Also, about 238 (60.3%) students had the awareness of disease transmission and 358 (90.6%) of them knew the involvement of tissue rejection when inappropriate organ transplantation is done to the recipients. Furthermore, likewise, more than half of the students expressed positive beliefs toward the different questions of organ donation-ethics, religion, and willingness for organ donation.Conclusion: Students showed good knowledge and a positive attitude toward organ donation and this should be translated to the public to increase the rate of organ donations.Keywords: organ donation, knowledge, attitude, Jimma Universit