John E. Ehiri

Intimate partner violence and HIV infection among women: A systematic review and meta-analysis

To assess evidence of an association between intimate partner violence (IPV) and HIV infection among women.

Implementation of HACCP in food businesses: the way ahead

Abstract Food-borne diseases constitute an important public health problem in both developed and developing countries. Although their health and economic aspects are often obscured by insufficiency of data, available evidence on incidence and associated costs of medical care indicates that they are a major cause of morbidity, and a drain on resources. A joint WHO/FAO expert committee on food safety asserts that illness due to contaminated food is probably the most widespread health problem in the contemporary world, and an important cause of reduced economic productivity. Given the inadequacies of traditional approaches to food safety control, viz . inspection and end-product testing, there is a need to apply such other strategy of proven effectiveness as the Hazard Analysis Critical Control Points (HACCP) system which has been described as the most viable means for the prevention of food-borne diseases yet devised. While there is an extensive literature suggesting the effectiveness of HACCP in preventing food-borne diseases, food operators have yet to embrace it with the anticipated enthusiasm. This paper examines factors that are likely to hinder wider acceptance and practical implementation of HACCP in food operations and discusses measures to overcome them. It is concluded that HACCP training and education of food operators and food regulatory officials is a conditio sine qua non for the realization of the fullest benefits of the strategy.

Factors associated with patient, and diagnostic delays in Chinese TB patients: a systematic review and meta-analysis

BackgroundDelay in seeking care is a major impediment to effective management of tuberculosis (TB) in China. To elucidate factors that underpin patient and diagnostic delays in TB management, we conducted a systematic review and meta-analysis of factors that are associated with delays in TB care-seeking and diagnosis in the country.MethodsThis review was prepared following standard procedures of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. Relevant studies published up to November 2012 were identified from three major international and Chinese literature databases: Medline/PubMed, EMBASE and CNKI (China National Knowledge Infrastructure).ResultsWe included 29 studies involving 38,947 patients from 17 provinces in China. Qualitative analysis showed that key individual level determinants of delays included socio-demographic and economic factors, mostly poverty, rural residence, lack of health insurance, lower educational attainment, stigma and poor knowledge of TB. Health facility determinants included limited availability of resources to perform prompt diagnosis, lack of qualified health workers and geographical barriers.Quantitative meta-analysis indicated that living in rural areas was a risk factor for patient delays (pooled odds ratio (OR) (95% confidence interval (CI)): 1.79 (1.62, 1.98)) and diagnostic delays (pooled OR (95% CI): 1.40 (1.23, 1.59)). Female patients had higher risk of patient delay (pooled OR (95% CI): 1.94 (1.13, 3.33)). Low educational attainment (primary school and below) was also a risk factor for patient delay (pooled OR (95% CI): 2.14 (1.03, 4.47)). The practice of seeking care first from Traditional Chinese Medicine (TMC) providers was also identified as a risk factor for diagnostic delay (pooled OR (95% CI): 5.75 (3.03, 10.94)).ConclusionPatient and diagnostic delays in TB care are mediated by individual and health facility factors. Population-based interventions that seek to reduce TB stigma and raise awareness about the benefits of early diagnosis and prompt treatment are needed. Policies that remove patients’ financial barriers in access to TB care, and integration of the informal care sector into TB control in urban and rural settings are central factors in TB control.

Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women in Kumasi, Ghana

Objective  To investigate the association between birth outcomes and blood levels of aflatoxin B1 (AFB1)‐lysine adduct in pregnant women in Kumasi, Ghana.

Hygiene training and education of food handlers: Does it work?

In spite of improving knowledge and understanding of epidemiology of food‐borne diseases and illnesses, efforts to reduce their impact on health and the economy have proved inadequate, and their incidence continues to rise. Because most outbreaks result from faulty food handling practices, it is generally believed that hygiene training of food handlers could contribute significantly to prevention and control, but there is uncertainty about the effectiveness of such training in reducing the incidence of food‐borne diseases, and a need to reappraise current practice. This paper presents a critical review of the effectiveness of hygiene training for food handlers at all levels of the food chain in both developed and developing countries; examines methodological problems in evaluation; and suggests ways to assure the practical utility of such training for food handling personnel.

WHO Initiative to Estimate the Global Burden of Foodborne Diseases

Abstract Background The public health impact of foodborne diseases globally is unknown. The WHO Initiative to Estimate the Global Burden of Foodborne Diseases was launched out of the need to fill this data gap. It is anticipated that this effort will enable policy makers and other stakeholders to set appropriate, evidence-informed priorities in the area of food safety. Methods The Initiative aims to provide estimates on the global burden of foodborne diseases by age, sex, and region; strengthen country capacity for conducting burden of foodborne disease assessments in parallel with food safety policy analyses; increase awareness and commitment among Member States for the implementation of food safety policy and standards; and encourage countries to use burden of foodborne disease estimates for cost-effectiveness analyses of prevention, intervention, and control measures. To estimate the global burden (expressed in disability-adjusted life-years), the Foodborne Disease Burden Epidemiology Reference Group (FERG) focused on the contamination of food with enteric and parasitic pathogens, chemicals, and toxins. Findings Study findings will provide the technical background and challenges of assessing the burden of foodborne diseases, based on national and international studies. Systematic reviews to support estimates of the incidence and mortality of food-related diseases are being completed. Results will be used to update and refine global burden estimates for relevant food-related hazards, in the context of other international burden of disease studies. It is recognised that exposure to such hazards may also occur through other pathways including the environment (eg, water, air) and by direct transmission (eg, human-to-human and animal-to-human). Structured expert elicitation will be used to provide the basis for attribution of incidence and burden to food, and estimation of the most important food sources. Interpretation Estimating the global burden of foodborne diseases is highly complex because of the diversity of hazards that can be transmitted by food, the multitude of health outcomes they cause, and complex transmission pathways. WHO is planning to present a global estimate for the first time in 2014. Funding WHO.

HIV/AIDS-related stigma in Kumasi, Ghana

OBJECTIVE To assess HIV/AIDS-related stigma and discrimination of people living with HIV/AIDS (PLWHA) in Kumasi, Ghana. METHODS A cross-sectional survey of 104 adults from the four sub-districts in Kumasi was conducted. RESULTS Four stigma constructs, employment-based discrimination, screening and identification of HIV positive people, revelation of HIV status and social contact stigma were determined based on reliability measures from responses to the questionnaire. Regression analysis showed that participants with higher educational attainment were more likely to favor policies denying employment to PLWHA (p<0.05), but disapproved of revealing HIV sero-status (p<0.05). Muslims were more likely than Christians to agree with identifying PLWHA (p<0.05) and more likely to advocate revealing HIV sero-status (p<0.05). Males were more likely to favor revealing HIV status (p<0.05). Employed persons were more likely to have social contact with PLWHA (p<0.05). CONCLUSIONS These findings are useful in guiding the design of interventions against HIV/AIDS-related stigma in Kumasi.

Prenatal exposure to cannabis and maternal and child health outcomes: a systematic review and meta-analysis

Objective To assess the effects of use of cannabis during pregnancy on maternal and fetal outcomes. Data sources 7 electronic databases were searched from inception to 1 April 2014. Studies that investigated the effects of use of cannabis during pregnancy on maternal and fetal outcomes were included. Study selection Case–control studies, cross-sectional and cohort studies were included. Data extraction and synthesis Data synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted independently by 2 reviewers. Main outcomes and measures Maternal, fetal and neonatal outcomes up to 6 weeks postpartum after exposure to cannabis. Meta-analyses were conducted on variables that had 3 or more studies that measured an outcome in a consistent manner. Outcomes for which meta-analyses were conducted included: anaemia, birth weight, low birth weight, neonatal length, placement in the neonatal intensive care unit, gestational age, head circumference and preterm birth. Results 24 studies were included in the review. Results of the meta-analysis demonstrated that women who used cannabis during pregnancy had an increase in the odds of anaemia (pooled OR (pOR)=1.36: 95% CI 1.10 to 1.69) compared with women who did not use cannabis during pregnancy. Infants exposed to cannabis in utero had a decrease in birth weight (low birth weight pOR=1.77: 95% CI 1.04 to 3.01; pooled mean difference (pMD) for birth weight=109.42 g: 38.72 to 180.12) compared with infants whose mothers did not use cannabis during pregnancy. Infants exposed to cannabis in utero were also more likely to need placement in the neonatal intensive care unit compared with infants whose mothers did not use cannabis during pregnancy (pOR=2.02: 1.27 to 3.21). Conclusions and relevance Use of cannabis during pregnancy may increase adverse outcomes for women and their neonates. As use of cannabis gains social acceptance, pregnant women and their medical providers could benefit from health education on potential adverse effects of use of cannabis during pregnancy.

Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?

The objective of this study was to summarize and critically assess the effects of interventions to prevent HIV/AIDS among adolescents in less developed countries. Reports of studies that evaluated interventions for preventing HIV/AIDS/STDs among persons aged 11-25 years were obtained from online computer databases, by searching conference proceedings and relevant journals, and by following up references cited in published reports. Studies were included if they investigated any educational, behavioral, psychosocial or other intervention that aimed to prevent or reduce HIV/AIDS/STD among persons aged 11-25 years in a less developed country. Only studies that included a control group, and which involved pre- and post-intervention assessments were included. Outcome measures included: (i) changes in safe sex practices (abstinence, condom use, limitation of sexual partners, avoidance of casual sex), (ii) knowledge about HIV/AIDS transmission and prevention methods, (iii) perception of HIV/AIDS/STD risks, (iv) self-efficacy with regard to condom negotiation and refusal of sex, (v) uptake of voluntary counseling and testing (VCT), and (vi) reduction in incidence of HIV/AIDS/STDs. Studies were assessed in terms of intervention format (e.g., education, role-play, video), duration, and setting (school or community). Reported improvements in outcome measures in intervention versus control groups were assessed. Sixteen studies met the inclusion criteria. Thirteen of these were conducted in Africa and three in Latin America. Twelve of the sixteen studies were school-based, and four were community-based. The interventions reviewed were not resoundingly successful in achieving their goals of increasing knowledge of HIV/AIDS, altering attitudes, improving negotiation and communication skills, or in influencing positive behavior evidenced through consistent condom use, abstinence, or reducing the number of partners. Considering the importance of HIV/AIDS prevention among adolescents, design of evaluation studies of programs in less developed countries need to be improved. The use of randomized controlled trials or other rigorous approaches for evaluating population-based behavioral interventions (e.g., Solomon Four design) is recommended.

Reproductive health effects of aflatoxins: A review of the literature

CONTEXT Although it is known that aflatoxins have many adverse health effects, there is no systematic summary of how it affects the reproductive system or its reproductive health effects. OBJECTIVE Summarize evidence on the reproductive health effects of aflatoxins. RESULTS The search yielded 121 potential studies, of which 25 were retained. One study found a higher concentration of aflatoxins in the semen of infertile men (40% of cases compared to 8% of controls). Six studies found significant associations or correlations between low birth weight and aflatoxins while one study did not find any correlation. One study found maternal serum aflatoxin to be a risk factor for jaundice in infants (OR, 2.68; CI, 1.18-6.10). Overall, maternal breast milk in developing countries had higher rates of aflatoxin contamination than in high income countries. CONCLUSIONS Stakeholders in developing countries need to take steps to reduce exposure of vulnerable populations to the toxic effects of aflatoxins.