Morankar Sudhakar

Malaria and under-nutrition: a community based study among under-five children at risk of malaria, south-west Ethiopia.

Background The interaction between malaria and under-nutrition is not well elucidated in Ethiopia. The objective of this study was to assess the magnitude of under-nutrition and its correlation with malaria among under-five children in south-west Ethiopia. Methods This cross-sectional study was undertaken during March–February, 2009 as part of the baseline assessment of a cluster randomized trial around Gilgel Gibe Hydroelectric dam, south-west Ethiopia. A total of 2410 under-five children were included for anthropometric measurement and blood investigation for the diagnosis of malaria and anemia. The nutritional status of children was determined using the International Reference Population defined by the U.S National Center for Health Statistics (NCHS). Blood film was used to identify malaria parasite and haemoglobin concentration was determined by Hemo Cue analyzer (HemoCue Hb 301, Sweden). Results Significant proportion (40.4%) of under-five children were stunted (height-for-age<−2SD). The prevalence of under-weight was 34.2%. One third and one tenth of the children had anemia and malaria parasite respectively. Older children were more likely to have under-nutrition. There was no association between malaria and under-nutrition. Children who had malaria parasite were 1.5 times more likely to become anaemic compare to children who had no malaria parasite, [OR = 1.5, (95% CI: 1.1–2.0)]. Conclusion In this study, there is no association between malaria and under-nutrition. Children who have malaria are more likely to be anaemic. Malaria prevention and control program should consider nutrition interventions particularly anemia.

The effect of household heads training on long- lasting insecticide-treated bed nets utilization: a cluster randomized controlled trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated significant impact in reducing malaria-related childhood morbidity and mortality. However, utilization of LLITN by under-five children is not satisfactory in many sub-Saharan African countries due to behavioural barriers. Previous studies had focused on the coverage and ownership of LLITN. The effect of skill-based training for household heads on LLITN utilization had not yet been investigated. A cluster-randomized trial on the effect of training of household heads on the use of LLITN was done in Ethiopia to fill this knowledge gap.MethodsThe study included 22 (11 intervention and 11 control) villages in southwest Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. All households in each group received free LLITN. Data were collected at baseline, six and 12 months of the follow up periods. Utilization of LLITN in the control and intervention villages was compared at baseline and follow up periods.ResultsA total of 21,673; 14,735 and 13,758 individuals were included at baseline, sixth and twelfth months of the project period. At the baseline survey, 47.9% of individuals in the intervention villages and 68.4% in the control villages reported that they had utilized LLITN the night before the survey. At the six month, 81.0% of individuals in the intervention villages and 79.3% in the control villages had utilized LLITN. The utilization of LLITN in all age groups in the intervention villages was increased by 17.7 percentage point (95% CI 9.7-25.6) at sixth month and by 31.0 percentage point (95% CI 16.9-45.1) at the twelfth month. Among under-five children, the LLITN utilization increased by 31.6 percentage point (95% CI 17.3-45.8) at the sixth month and 38.4 percentage point (95% CI 12.1-64.7) at the twelfth months of the project period.ConclusionHousehold level skill-based training has demonstrated a marked positive effect in the utilization of LLITN. The effect of the intervention steadily increased overtime. Therefore, distribution of LLITN should be accompanied by a skill-based training of household heads to improve its utilization.Trail registrationAustralian New Zealand Clinical Trials Registry (ACTR number: ACTRN12610000035022).

The effect of household heads training about the use of treated bed nets on the burden of malaria and anaemia in under-five children: a cluster randomized trial in Ethiopia

BackgroundLong-lasting insecticide-treated bed nets (LLITN) have demonstrated a significant effect in reducing malaria-related morbidity and mortality. However, barriers on the utilization of LLITN have hampered the desired outcomes. The aim of this study was to assess the effect of community empowerment on the burden of malaria and anaemia in under-five children in Ethiopia.MethodsA cluster randomized trial was done in 22 (11 intervention and 11 control) villages in south-west Ethiopia. The intervention consisted of tailored training of household heads about the proper use of LLITN and community network system. The burden of malaria and anaemia in under-five children was determined through mass blood investigation at baseline, six and 12 months of the project period. Cases of malaria and anaemia were treated based on the national protocol. The burden of malaria and anaemia between the intervention and control villages was compared using the complex logistic regression model by taking into account the clustering effect. Eight Focus group discussions were conducted to complement the quantitative findings.ResultsA total of 2,105 household heads received the intervention and the prevalence of malaria and anaemia was assessed among 2410, 2037 and 2612 under-five children at baseline, six and 12 months of the project period respectively. During the high transmission/epidemic season, children in the intervention arm were less likely to have malaria as compared to children in the control arm (OR = 0.42; 95%CI: 0.32, 0.57). Symptomatic malaria also steadily declined in the intervention villages compared to the control villages in the follow up periods. Children in the intervention arm were less likely to be anaemic compared to those in the control arm both at the high (OR = 0.84; 95%CI: 0.71, 0.99)) and low (OR = 0.73; 95%CI: 0.60, 0.89) transmission seasons.ConclusionTraining of household heads on the utilization of LLITN significantly reduces the burden of malaria in under-five children. The Ministry of Health of Ethiopia in collaboration with other partners should design similar strategies in high-risk areas to control malaria in Ethiopia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12610000035022

Significant association between perceived HIV related stigma and late presentation for HIV/AIDS care in low and middle-income countries: A systematic review and meta-analysis

Background Late presentation for human immunodeficiency virus (HIV) care is a major impediment for the success of antiretroviral therapy (ART) outcomes. The role that stigma plays as a potential barrier to timely diagnosis and treatment of HIV among people living with HIV/AIDS (acquired immunodeficiency syndrome) is ambivalent. This review aimed to assess the best available evidence regarding the association between perceived HIV related stigma and time to present for HIV/AIDS care. Methods Quantitative studies conducted in English language between 2002 and 2016 that evaluated the association between HIV related stigma and late presentation for HIV care were sought across four major databases. This review considered studies that included the following outcome: ‘late HIV testing’, ‘late HIV diagnosis’ and ‘late presentation for HIV care after testing’. Data were extracted using a standardized Joanna Briggs Institute (JBI) data extraction tool. Meta- analysis was undertaken using Revman-5 software. I2 and chi-square test were used to assess heterogeneity. Summary statistics were expressed as pooled odds ratio with 95% confidence intervals and corresponding p-value. Results Ten studies from low- and middle- income countries met the search criteria, including six (6) and four (4) case control studies and cross-sectional studies respectively. The total sample size in the included studies was 3,788 participants. Half (5) of the studies reported a significant association between stigma and late presentation for HIV care. The meta-analytical association showed that people who perceived high HIV related stigma had two times more probability of late presentation for HIV care than who perceived low stigma (pooled odds ratio = 2.4; 95%CI: 1.6–3.6, I2 = 79%). Conclusions High perceptions of HIV related stigma influenced timely presentation for HIV care. In order to avoid late HIV care presentation due the fear of stigma among patients, health professionals should play a key role in informing and counselling patients on the benefits of early HIV testing or early entry to HIV care. Additionally, linking the systems and positive case tracing after HIV testing should be strengthened.

Khat as risk factor for hypertension: A systematic review

BACKGROUND Studies suggest possible newer risk factors for hypertension including Khat chewing, a plant which grows wild in countries bordering the Red Sea and along the east coast of Africa and the Arabian Peninsula. OBJECTIVES The objective was to synthesise the best available evidence on the epidemiological association between Khat chewing as exposure (potential risk factor) and hypertension. INCLUSION CRITERIA Subjects aged 16 years old or older regardless of gender and ethnicity, country of residence, Khat dose, frequency, duration of chewing or other characteristics of Khat exposure and co-presence of other known risk factors for hypertension.The focus of interest of this review was the epidemiological association between Khat chewing as exposure (potential risk factor) and hypertension as an outcome.Observational analytical studies (cohort studies, case-control studies and cross-sectional studies) were considered for inclusion. SEARCH STRATEGY Three staged search strategy was used to identify all relevant published and grey literature in English language from 1988 to 2011. Databases searched were PubMed, CINAHL, PopLine, LILACS, MedNar and Embase. METHODOLOGICAL QUALITY All papers selected for inclusion in the review were subjected to a rigorous, independent appraisal by the two reviewers prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA COLLECTION AND SYNTHESIS Due to poor internet service in our setting we were unable to use the Joanna Briggs Institute -software for data extraction and synthesis as approved in the protocol. Quantitative papers were pooled in statistical meta-analysis using the Review Manager Software. Odds ratios and their 95% confidence intervals were calculated for analysis. RESULTS Two studies from Ethiopia and one from Saudi Arabia were identified. In the study done by Getahun et al. 44 of the chewers (n=324) and 34 of the non chewers (n=319) were found to have hypertension. Analysis of this study showed no statistically significant association between Khat chewing and hypertension (OR=1.29, 95% CI =0.80-2.08). In the second study done by Mossie, 29 of the chewers (n=277) and 73 of the non chewers (n=621) were found to have hypertension and there was no statistically significant association between Khat chewing and hypertension (OR=0.88, 95% CI =0.56-1.38). Seventy seven of the chewers (n=568) and 160 of the non chewers (n=1207) were found to have hypertension) in the third study done by Ibrahim, similarly there was no statistically significant association between Khat chewing and prevalence of hypertension (OR=1.03, 95% CI =0.77-1.37 in this study.On meta analysis, a total of 3321 subjects were involved. Of the Khat chewers (1174), 150 were found to have hypertension. On contrary, 267 of non chewers (2147) were found to have hypertension. Finding of the analysis showed no statistically significant association between Khat chewing and hypertension (Odds ratio=1.04, 95% Confidence Interval= 0.84, 1.29). The studies were homogenous, Heterogeneity test: Chi = 1.35, df = 2, (P = 0.51). The test for overall effect also showed no statistical significance at conventional levels (P>0.05). CONCLUSIONS We did not find sufficient evidence to conclude that Khat as epidemiologic risk factor for hypertension.The present systematic review did not identify a statistically significant association of Khat chewing as epidemiologic risk factor for hypertension. IMPLICATIONS FOR RESEARCH This review identifies the need for further studies on Khat as an epidemiologic risk factor for hypertension considering further aspects of chewing, like dose-response, duration of chewing and co-existence of other co-morbid factors of hypertension.

Family planning counseling during antenatal care and postpartum contraceptive uptake in Africa: a systematic review protocol.

REVIEW QUESTION/OBJECTIVE The objective of this review is to systematically identify, appraise and synthesize the best available evidence on the effect of family planning counseling during antenatal care attendance on postpartum contraceptive uptake.The review question is, what is the effect of family planning counseling during antenatal care attendance on postpartum contraceptive uptake in Africa?

Determinants of help seeking and treatment seeking behavior of Tuberculosis patients – Gender perspective: A systematic review

Background Help and treatment seeking behavior of men and women suffering from tuberculosis is largely determined by how he/she and those around them perceive the causes, regard the diagnosis, accept the treatment, and adhere to the treatment. Objectives To critically appraise and synthesize the best available evidence on gender‐based determinants of help and treatment seeking behavior of tuberculosis patients. Inclusion criteria Male and female tuberculosis patients (>=15 years) living in developed and developing countries were included. Quantitative studies examining gender differences in help and treatment seeking among tuberculosis patients with cross‐sectional, retrospective and prospective cohort were included. Types of primary outcomes Outcomes related to determinants of help seeking: pattern of distress, perceived cause of tuberculosis and stigma related to tuberculosis patients and determinants of treatment seeking: delay in diagnosis, health service utilization, and consequence of treatment seeking; treatment outcomes. Search strategy The review considered both published and unpublished studies in the English language published between January 1990 and December 2010. Databases of the Joanna Briggs Institute, PubMed, Popline, Cochrane Library, CINAHL and MedNar were searched. The search focused on key elements of objectives (participants, comparator, and outcome) and a thorough search was undertaken utilizing a standardized three step approach. Methodological quality Considered papers were critically appraised by two independent reviewers using standardized Joanna Briggs Institute tools. Data was extracted using the Joanna Briggs Institute Meta Analysis of Statistical Assessment and Review Instrument data extraction tool. Data was analyzed using Revman 5.1 software from the Cochrane collaboration. Results Nine cross‐sectional, two retrospective and one prospective cohort studies were included in the review. Males were 49% less likely to have psychological distress than females (OR=0.51, 95% CI=0.32‐0.83). Males were 46% less likely to perceive health, illness and injuries as a cause of tuberculosis infection than females (OR=0.54, 95% CI=0.31‐0.96). Males were 78% less likely to use a traditional healer as health service utilization than females (OR=0.22, 95% CI=0.07‐0.66). Males were almost twice more likely to be diagnosed within 30 days in a health institution than females (OR=1.76, 95% CI=1.09‐2.84) however, they were 23% less likely to successfully complete tuberculosis treatment (OR=0.77, 95% CI=0.68‐0.87). Conclusions Gender differences were observed on determinants of help seeking such as distress, perceived causes of tuberculosis infection and stigma components. Determinants of treatment seeking that showed significant gender differences were utilization of health services for diagnosis and treatment, patient delay in seeking health service and treatment outcome of tuberculosis. Implications for Practice Gender specific strategies for behavioral change should be implemented by health professionals on causes of tuberculosis, early treatment seeking, signs/symptoms, related stigma and adherence of treatment to raise awareness in the community. Practitioners should suspect tuberculosis among women at early stages of their visits to health facilities and screen for tuberculosis. Special efforts should be made by practitioners for male tuberculosis patients to complete the treatment. Implications for Research Further research with gender perspective should be conducted using behavioral change models on screening of patients and sensitizing communities to uptake of tuberculosis facilities for tuberculosis control.

Risk factors for Tuberculosis after highly active anti retro viral treatment (HAART) initiation: A systematic review

Review question/objective The objective of this review is to systematically search, appraise and synthesize the best available evidence on risk factors for developing Tuberculosis (TB) after highly active antiretroviral treatment initiation among HIV patients More specifically, the objectives are to identify: 1. The socio demographic risk factors for developing Tuberculosis after highly active anti retro viral treatment initiation 2. Clinical risk factors for developing Tuberculosis after highly active anti retroviral treatment initiation Inclusion criteria Types of participants This review will consider studies that include HIV patients who have initiated highly active anti retro viral treatment (HAART) who is above 15 years of age. Focus of the review This review will consider studies that evaluate risk factors for developing active tuberculosis among HIV patients after initiation of highly active anti retro viral treatment (HAART). Types of outcomes This review will consider studies that include socio demographic, clinical and behavioral variables as risk factors for developing tuberculosis after highly active anti retro viral treatment initiation such as but not limited to: baseline CD4 count, highly active anti retroviral treatment (HAART) type, WHO clinical stage of HIV, previous history of TB, age, gender, race.

The Differential Effects of an Opt-Out HIV Testing Policy for Pregnant Women in Ethiopia When Accounting for Stigma: Secondary Analysis of DHS Data

Individual factors associated with HIV testing have been studied across multiple populations; however, testing is not just an individual-level phenomenon. This secondary analysis of 2005 and 2011 Ethiopia Demographic and Health Survey data was conducted to determine the extent to which the 2007 institution of an opt-out policy of HIV testing during antenatal care increased testing among women, and whether effects differed by women’s stigmatizing beliefs about HIV. A logit model with interaction between pre-/post-policy year and policy exposure (birth in the past year) was used to estimate the increased probability of past-year testing, which may be attributable to the policy. Results suggested the policy contributed to a nine-point increase in the probability of testing (95% CI 0.06–0.13, p < 0.0001). A three-way interaction was used to compare the effects of exposure to the policy among women holding higher and lower HIV stigmatizing beliefs. The increase in the probability of past-year testing was 16 percentage points greater among women with lower stigmatizing beliefs (95% CI 0.06–0.27, p = 0.002). Women with higher stigmatizing beliefs were less likely to report attending antenatal care (ANC), testing at their last ANC visit, or being offered a test at their last ANC visit. We encourage researchers and practitioners to explore interventions that operate at multiple levels of socio-ecological spheres of influence, addressing both stigma and structural barriers to testing, in order to achieve the greatest results in preventing HIV.

Effectiveness of training on standard precautions to prevent needle stick injuries among health professionals: A Systematic Review.

Review objectives The main objective of this systematic review is to critically appraise, synthesise and present the best available evidence on the effectiveness of training on standard precautions to prevent needle stick injuries among health professionals. More specifically, the objectives of this systematic review are to provide summarised evidence on: 1. The impact of standard precautions training on the frequency of needle stick injury among health professionals 2. Knowledge and practice change after training on standard precautions by health professionals 3. Needle stick injury morbidity, mortality and complications change after training on standard precautions among health professionals Inclusion criteria Types of participants This review will consider studies that include health professionals involved in clinical practices at different departments of private and governmental health institutions in both developed and developing countries. Specifically, the review will consider studies where the populations of interest are medical doctors, nurses/midwifes, auxiliary nurses, laboratory technicians, medical doctor students. There will be no restriction by age, gender or time in clinical practice among health professionals. Types of intervention The type of intervention for this systematic review will be training on standard precautions to prevent needle stick injuries among health professionals. Training in this case is the pre-service and/or in-service training given to health professionals on using and how to use protective devices to prevent needle stick injury. Comparators The comparators for this review will be health professionals who follow the standard precautions and who do not follow standard precautions. Types of outcomes The outcomes of interest for this systematic review will include: 1. Frequency of needle stick injury among health professionals 2. Knowledge and practices of standard precautions by health professionals 3. Morbidity, mortality and complications related with needle stick injury among health professionals