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The study set out to perform a systematic literature review of evidence-based interventions that target the reduction of secondary stroke risk in Africa. The review analyzed longitudinal intervention studies conducted in Sub-Saharan Africa, focusing on adult participants who had suffered a prior stroke. It encompassed publications and peer-reviewed papers sourced from reputable databases, including PubMed, Ovid, Cochrane, and Web of Science. Three randomized clinical trial (RCT) studies were included with sample sizes ranging from 16 to 400 participants, mean age ranged between 50 and 66 years, with 64.5% male participants. All studies applied multidisciplinary team interventions of enhanced patient follow-up involving care givers, nurse educators, physicians, and social workers. Interventions ranged from comprehensive patient education, tracking of medication adherence and enforcing healthy lifestyle behaviors (regular exercise, regular BP checks, and dietary changes). We found a decrease in Systolic Blood Pressure over time in 2 of 3 treatment groups, an improvement in medical adherence in all treatment groups, and a decrease in cholesterol levels in 1 treatment group. Evidence-based interventions involving multidisciplinary teams and comprehensive patient education were found to demonstrate promising results in reducing secondary stroke risk in Africa, leading to significant improvements in medical adherence and reductions in systolic blood pressure in the majority of treatment groups. However, more research is required to confirm the influence of these interventions on cholesterol levels and to establish their lasting advantages in preventing strokes among African communities. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa, many urban dwellers are at risk of faecal-orally transmitted diseases due to unplanned and growing urbanization with inadequate sanitation. Making it essential to understand the urban transmission of these diseases and the associated responses. This perspective paper discussed an approach to design a diagram of transmission dynamic from a combination of an urban exposome framework and transmission of faecal-oral diseases. The result is an exposome diagram displaying the interconnection of exposure components and potential barriers to stop the transmission of faecal-oral diseases in the urban area subdivided into public, domestic and individual. As an exposome diagram, it helps to follow the dynamics of exposure over time and to plan targeted surveillance and intervention. [ABSTRACT FROM AUTHOR]

Introduction: Ceftriaxone is the most frequently used antibiotic for the treatment of various bacterial infections in hospitalized and ambulatory patients. Despite this, inappropriate ceftriaxone use is common. Objective: The aim of this review is to assess the appropriate use of ceftriaxone in sub-Saharan African countries. Methods: A systematic search was done on PubMed, EMBASE, Cochrane Libraries and Google Scholar for papers published addressing the prescribing pattern and use of ceftriaxone in sub-Saharan Africa. The findings were reported in medians and quartiles. Results: A total of 15 articles met the inclusion criteria. Pneumonia and sepsis were the most frequently diagnosed infections in the included studies. The overall median prevalence of appropriate ceftriaxone use is 39.2% (IQR: 29.9– 60.9), showing that most of the included studies reported a higher prevalence of inappropriate ceftriaxone use. Although there are a higher number of patients with inappropriate use of ceftriaxone, a relatively higher number of patients got appropriate daily dose (79.8%, IQR: 45.7– 89.4) of ceftriaxone than appropriate duration of ceftriaxone (55%, IQR: 52.2– 80). Conclusion: The review revealed that three in five patients with ceftriaxone got inappropriate ceftriaxone's dose, frequency or duration. A relatively higher number of patients got appropriate daily dose of ceftriaxone. On the other hand, approximately more than half of the patients got inappropriate duration, too short or too long, of ceftriaxone. Hence, prescribers are recommended to adhere to their country-specific treatment guideline. Moreover, it is highly recommended to either commence or strengthen antimicrobial stewardship program effectively in their healthcare settings. [ABSTRACT FROM AUTHOR]

Purpose: An electronic health record (EHR) system known as the e-Tracker was introduced in community health facilities in Ghana and numerous advantages were expected for clinical staff, as evidenced by previous literature. However, little is known about public health officials' views, specifically in low-resource settings. This study aimed to investigate the perceptions of district health officers on data quality, use, and management following the adoption of tablet-based electronic health records in Ghana. Methods: A pre- and post-survey was conducted in two regions of Ghana that adopted the e-Tracker for the entire districts during the early stages of the national rollout. Sociodemographic information, internet connection environment, and perceptions on data quality, use, and management were measured. McNemar's test and Wilcoxon Signed-Rank test were performed to identify changes in perceptions. Chi-square test and Mann–Whitney U-test were used to find any statistical differences in demographic characteristics between the two regions. Results: Twenty-four out of 25 districts in Volta and 24 out of 26 districts in Eastern regions participated in both pre- and post-surveys, with a total of 73 participants. In terms of efficiency in data management, the district health officers reported reduced time commitment in data validation and aggregation. Within less than a year, however, no statistically significant improvement was found in data quality and the use of electronic data for relevant tasks. Conclusion: A new EHR system in low-resource settings can rapidly improve efficiency in data management from the public health officials' perspectives. Further impact evaluation is warranted to assess the long-term effect of the EHR system. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 caused significant negative damage to the health status of populations and health systems globally. In Uganda, our previous study revealed that the strict Public Health and Social measures (PHSMs) and the closure of Entebbe Regional Referral Hospital (ERRH) led to missed healthcare access among the citizens in the Entebbe municipality. Limited studies, however, exist on the impact of the response measures on the local health systems. This study aims to explore the impacts of these measures on the local health service provision from the views of health facilities in Entebbe. Methods: We used a thematic framework method, grounded by the health systems resilience framework consisting of five components: (1) health service delivery; (2) medical products and technology; (3) health workforce; (4) public health functions; and (5) governance and financing. Key informant interviews with eight representatives from four private hospitals and four health centers were conducted from September to October 2022. Results: Fifteen themes and 25 subthemes were identified. With the closure of the ERRH and the strict PHSMs, the citizens faced various difficulties in accessing the needed health services. The facilities received an overwhelming number of patients and faced various challenges, such as a lack of medicine, healthcare workers, facility capacity, and no means to transfer patients. Nevertheless, the facilities made efforts to maintain the required services. Moreover, mobilizing vertical and horizontal actors through a flexible network, from the district health office to community health volunteers, helped to coordinate the medicines, transportation for both patients and healthcare workers, conduct patient tracking, etc. Conclusion: Our study suggested the importance of an integrated system of public health and health service delivery systems, the formalization of a vertical cooperative mechanism, and the introduction of public health insurance for strengthening resilient health systems. These insights may benefit other sub-Saharan cities. [ABSTRACT FROM AUTHOR]

Introduction: Historically, antimicrobials have been used to treat microbial illnesses in humans and animals. But throughout this time, antibiotics that had been successful against particular microorganisms started to lose their effectiveness due to rising inappropriate use brought on by ignorance, negligent attitudes, and improper methods. Our goal in conducting this study was to ascertain the knowledge, attitudes, and practices of doctors with relation to the use of antibiotics in light of the growing global and Sub-Saharan African problem of antimicrobial resistance. Methods: In a tertiary hospital in Mogadishu, Somalia, a cross-sectional survey study was carried out to assess experts' and research assistants' knowledge, attitudes, behavior, awareness, and practices regarding the use of antibiotics and antibiotic resistance. A questionnaire consisting of 2 sections and 22 questions was applied to the participants on a voluntary basis. Results: Among the 202 doctors that participated in the study, 49 (24.3%) were specialists, and 153 (75.7%) were assistants. Prescriptions for one to ten antibiotic boxes per week on average were reported by 146 respondents (72.3%). Of the physicians, just 27 (13.4%) did not require assistance when prescribing an antibiotic. The most often accessed sources of support were experts in infectious diseases (43.1%) and national/international antimicrobial guidelines (32.2%). The top three factors contributing to antibiotic resistance in Somalia include misuse of antibiotics (61.4%), unnecessary prescriptions written by doctors (44.6%), and an absence of infectious disease specialists in most institutions (44.1%). Conclusion: As an alarming level of antimicrobial resistance has been observed globally in recent years, the results of our survey will help educate our doctors by gauging their perceptions, attitudes, and knowledge about rational antibiotic use in Sub-Saharan Africa. This will provide better patient outcomes. [ABSTRACT FROM AUTHOR]

Aim: To identify relevant and pertinent themes and interventions within the literature relating to childhood traumatic grief, in order to provide a sound background of evidence for further research and service development. Background: Childhood traumatic grief is caused when a significant person in a child's life dies under circumstances that they perceive to be traumatic. This can leave a child unable to return to the same level of physical and emotional functioning that he or she had prior to the death occurring. In Sub-Saharan Africa, there is an increased risk for childhood traumatic grief due to a high prevalence of orphanhood, environmental stressors, stigma, and abuse. This can have detrimental effects upon mental health. Methods: The review followed the York methodology: identifying the purpose and agreeing on the strategy beforehand; identifying relevant sources/studies; selecting the studies; charting the data; and collating, summarizing, and reporting results. Results and discussion: Interventions identified to prevent and/or manage traumatic grief included narrative exposure therapy, psychotherapy, mentoring, peer-group support, psychosocial support, a grief and loss therapy session, and memory boxes. Mental health remains neglected within service and policy development as well as in global health spending. The average amount expended on mental health services per person per year in low-income countries is less than $0.25. Only 36% of people in low income countries are covered by a mental health policy, compared with 92% in high income countries. Limitations: The sixth stage of the York methodology was omitted. Only papers written in English were included in the review. Conclusion: Childhood traumatic grief in young people is an important issue within Sub- Saharan Africa and has relevance to the global mental health agenda. Implications for nursing and health policy: With the HIV/AIDS pandemic continuing to threaten and the number of orphans estimated to rise, a number of recommendations developed from the literature are suggested. [ABSTRACT FROM AUTHOR]

Purpose: Evidence supporting secondary stroke in sub-Saharan Africa is scarce. This study describes the incidence of stroke recurrence and associated risk factors in sub-Saharan Africa. Methods and Materials: Scientific databases were systematically searched from January 2000 to December 2022 for population-based observational studies, case-control or cohort studies of recurrent stroke involving adults aged 18 years and above in sub-Saharan Africa (SSA). We assessed the quality of the eligible studies using the Critical Appraisal Skills Program (CASP) checklist for observational studies. Results: Six studies met the inclusion criteria and were included in this study. Stroke recurrence rates in SSA ranged from 9.4% to 25%. Majority of the studies were conducted from Western Africa and showed that stroke recurrence rates are high within sub-Saharan Africa ranging from 2% to 25%. The known stroke risk factors such as hypertension, chronic alcohol consumption, etc., remained the leading causes of stroke recurrence. The studies reported a higher mortality rate ranging from 20.5 − 23% among those with recurrent strokes compared to primary strokes. Conclusion: This systematic review is an update and summary of the available literature on stroke recurrence within sub-Saharan Africa. Further studies are warranted to assess the outcomes and burden of stroke recurrence in SSA. [ABSTRACT FROM AUTHOR]

Objective of this study was therefore to analyze the rational use of medicines in public and private not-for-profit health facilities, in five health districts in Mauritania. Methods: We conducted a cross-sectional study to assess the rational use of medicines. We used the standard indicators derived from the methodologies of the World Health Organization (WHO) and International Network for Rational Use of Drugs (INRUD). Data were prospectively collected from 1050 prescriptions/patients, in thirty-one public and private not-for-profit health posts/centers in 5 health districts. The data were analyzed using the Statistical Package for the Social Sciences. P value less than 0.05 at 95% confidence interval considered for significance of relationships for associations in statistical test. Results: The average number of medicines per prescription was 2.21; 83.1% (1931/2325) of medicines were prescribed by generic name, but only 54% (1253/2325) were on the National Essential Medicine List (NEML). Antibiotics were prescribed in 62.4% (655/1050) of the consultations, and injectable medicines were prescribed in 15.6% (164/1050) of the consultations. The average consultation time was 16.32 minutes, and the average dispensing time was 97 seconds. Dispensed medicines were correctly labeled, and 83% (871/1050) of patients met the correct administration schedule. The NEML, and the "restricted NEML" for 76 commonly-used medicines, were available in all surveyed health facilities, but the National Therapeutic Guidelines were available in only 60.26% of them. Conclusion: Our findings indicate a possible excess of antibiotics prescriptions, and a likely lack of knowledge of the National Therapeutic Guidelines. There is a need to investigate in more detail the prescription patterns versus disease-specific therapeutic guidelines, and to qualitatively investigate the factors that contribute to the observed irrational prescribing. Moreover, training local staff in the rational use of medicines seems important. [ABSTRACT FROM AUTHOR]

Relatively little has been written on Medical Education in Sub-Saharan Africa, although there are over 170 medical schools in the region. A number of initiatives have been started to support medical education in the region to improve quality and quantity of medical graduates. These initiatives have led to curricular changes in the region, one of which is the introduction of Competency-Based Medical Education (CBME). Institutional reviews: This paper presents two medical schools, Makerere University College of Health Sciences and College of Medicine, University of Ibadan, which successfully implemented CBME. The processes of curriculum revision are described and common themes are highlighted. Both schools used similar processes in developing their CBME curricula, with early and significant stakeholder involvement. Competencies were determined taking into consideration each country's health and education systems. Final competency domains were similar between the two schools. Both schools established medical education departments to support their new curricula. New teaching methodologies and assessment methods were needed to support CBME, requiring investments in faculty training. Both schools received external funding to support CBME development and implementation. Conclusion: CBME has emerged as an important change in medical education in Sub-Saharan Africa with schools adopting it as an approach to transformative medical education. Makerere University and the University of Ibadan have successfully adopted CBME and show that CBME can be implemented even for the low-resourced countries in Africa, supported by external investments to address the human resources gap. [ABSTRACT FROM AUTHOR]

Background: A pacemaker is a device implanted in the chest to help people with symptomatic bradycardia and life-threatening irregular rhythm. However, it is also associated with many complications. Therefore, this study evaluated pacemaker-related complications and factors associated with them, as there is little data on pacemaker-related complications in sub-Saharan Africa and Ethiopia.Methods: The study was conducted on 118 patients over 18 years old who had pacemakers implanted between 2017 and 2022 at Tikur Anbessa Comprehensive Specialized Hospital in Addis Ababa, Ethiopia who were reviewed by the authors from September 2022 to December 2022. Sociodemographic factors, clinical characteristics, and complications data were extracted using a structured questionnaire by retrospective review of patient records. The chi-square test or Fisher's exact test was performed to evaluate factors associated with complications.Results: The median age of patients was 60.5 years (IQR = 15 years), with men accounting for 50.8% of patients. Hypertension was the most common comorbidity (64.2%). Symptomatic grade 3 AV block was the most common indication (78.8%) for pacemaker implantation. With a mean follow-up of 3.92 ± 1.94 years, 15.3% of patients had complications. Pneumothorax, pocket site infection, and lead dislodgement were the most common complications occurring in 2.54% of patients each. Patient age during surgery (p-value = 0.02), patient gender (p-value = 0.04), pacemaker implanting team (p-value = 0.01), and adherence to follow-up (p-value = 0.04) are related to pacemakers-related complications.Conclusion: Pacemaker implantation is associated with many complications. Pneumothorax, pacemaker pocket infection, and lead dislodgement were the most common complications. Patient age at pacemaker implantation, patient gender, pacemaker implanting team, and follow-up compliance were factors associated with pacemaker-related complications. Skill development through specialized training and compliance counseling may improve outcomes for patients who have complications related to pacemaker implanting team and poor adherence to follow. [ABSTRACT FROM AUTHOR]

This review aims to map the burden of pulmonary TB among immigrants in the UK and investigate associated factors. It also reviews the TB management approaches among immigrants in the UK.Design: The study utilized PRISMA guidelines to search electronic databases (PubMed and EMBASE) for articles published from 2000 to 2022 on TB prevalence and factors in immigrants and explored government websites for TB management strategies.Results: Nineteen out of 530 initially identified articles were included. The included studies reported a prevalence rate of TB among immigrants ranging from 0.04 to 52.1%, showing a decrease in the burden over time. Additionally, a higher number of TB cases were observed among immigrants from the Asian region, particularly immigrants from South Asia, followed by those from sub-Saharan Africa. Stigma, misconception about the disease, language barrier, lack of confidentiality, and unfriendly healthcare system for immigrants were the main drivers of the TB burden among immigrants. The TB management approaches in the UK include pre-entry screening for active TB, LTBI testing for a specific population group, and antibacterial therapy for 3– 6 months for TB patients.Conclusion: The UK's control and prevention efforts in reducing tuberculosis prevalence among immigrants show optimism, but challenges persist. Key improvements include healthcare delivery, TB improvement programs, and policies addressing stigma and patient confidentiality. [ABSTRACT FROM AUTHOR]

This article discusses the burden of visual impairment caused by onchocerciasis infection in Central Africa from 1990 to 2019. Onchocerciasis, also known as river blindness, is a disease transmitted by black flies and caused by infection from a roundworm. The study used data from the Global Burden of Disease 2019 dataset to map the prevalence and years lived with disability (YLDs) of visual impairment attributable to onchocerciasis in the African region. The results showed a decrease in the prevalence and YLDs of onchocerciasis-related visual impairment over the past three decades, with the highest burden observed in the Western Sub-Saharan Africa region. The study highlights the importance of continued efforts to improve treatment coverage and raise public awareness to further reduce the burden of onchocerciasis-related visual impairment. [Extracted from the article]

Lack of awareness, access to insulin and diabetes care can result in high levels of morbidity and mortality for children with type 1 diabetes (T1DM) in sub-Saharan Africa (SSA). Improvements in access to insulin and diabetes management have improved outcomes in some settings. However, many people still present in diabetic ketoacidosis (DKA) in parallel to misdiagnosis of children with T1DM in contexts with high rates of communicable diseases. The aim of this study was to highlight the complexity of diagnosing pediatric T1DM in a healthcare environment dominated by infectious diseases and lack of adequate health system resources. This was done by developing clinical vignettes and recreating the hypothetico-deductive process of a clinician confronted with DKA in the absence of identification of pathognomonic elements of diabetes and with limited diagnostic tools. A non-systematic literature search for T1DM and DKA in SSA was conducted and used to construct clinical vignettes for children presenting in DKA. A broad differential diagnosis of the main conditions present in SSA was made, then used to construct a clinician's medical reasoning, and anticipate the results of different actions on the diagnostic process. An examination of the use of the digital based Integrated Management of Childhood Illness diagnostic algorithm was done, and an analysis of the software's efficiency in adequately diagnosing DKA was assessed. The main obstacles to diagnosis were low specificity of non-pathognomonic DKA symptoms and lack of tools to measure blood or urine glucose. Avenues for improvement include awareness of T1DM symptomatology in communities and health systems, and greater availability of diagnostic tests. Through this work clinical vignettes are shown to be a useful tool in analyzing the obstacles to underdiagnosis of diabetes, a technique that could be used for other pathologies in limited settings, for clinical teaching, research, and advocacy. [ABSTRACT FROM AUTHOR]

Introduction: Despite the high prevalence of age-associated comorbidities in HIV patients in sub-Saharan Africa, there is a lack of data on their influence on treatment outcomes in HIV patients. Therefore, this study aimed to assess the impact of age-associated comorbidities on responses to antiretroviral therapy (ART) among people living with HIV.Methods: A hospital-based nested case–control study was conducted among adult HIV-infected patients at the Jimma Medical Center from January 3 to June 2, 2022. Data were recorded by interviewing the patients and their medical chart and analyzed using The Statistical Package for Social Science (SPSS) v. 23, and at p < 0.05.The Results: The overall immunological and virologic failure rates were 13.8% and 13.4%, respectively. Being male [AOR = 3.079,95% CI (1.139– 8.327)], having age-associated comorbidity [AOR:10.57,95% CI (2.810– 39.779)], age ≥ 50 years [AOR = 2.855, 95% CI (1.023– 7.9650)], alcohol intake [AOR = 3.648,95% CI (1.118– 11.897)], and having a baseline CD4+ count of < 200 cells/uL [AOR:3.862, 95% CI (1.109– 13.456) were an independent predictor of immunological failure; Whereas Being alcoholic [AOR:3.11, 95% CI (1.044– 9.271)], having a baseline CD4+ count of < 200 cells/uL [AOR:5.11, 95% CI (1.547– 16.892)], a low medication adherence [AOR:5.92, 95% CI (1.81– 19.36)], bedridden baseline functional status [AOR:3.902, 95% CI (1.237– 12.307)], and lack of cotrimoxazole prophylaxis [AOR:2.735,95% CI (1.084– 6.902)] were found to be an independent predictor of virologic treatment failure, but being younger (age < 50 years) was protective for virologic failure.Conclusion: Out of the eight patients who were treated for HIV at least one patient had developed immunological and/or virological failure. Age-associated comorbid chronic non-communicable diseases highly influence immunological outcomes compared with virological outcomes. Health providers should pay attention to age-associated comorbidities, encourage lifestyle modifications, and counsel on medication adherence to improve clinical outcomes in patients with HIV. [ABSTRACT FROM AUTHOR]

Background: In sub-Saharan African countries (SSA), despite the efforts to enable adolescents to access sexual and reproductive health (SRH) services, there are limited systematic review studies that comprehensively synthesize barriers to accessing services using a social-ecological model. Therefore, this review was conducted to fill this gap. Methods: This study protocol was registered in the PROSPERO database (CRD42022259095). We followed PRISMA guideline to conduct this review. PubMed, Google Scholar, Embase and African Journal Online databases were used. Two authors individually screened articles. Only qualitative articles published in the English in last 10 years were included in this review. Results: From the total of 4890 studies, 23 qualitative studies fulfilled the eligibility criteria. Those studies were from 11 SSA countries. This review finding revealed that inadequate information about the services, the incorrect perception about services, low self-esteem, fear of being noticed by family members, and financial constraints are barriers at the intrapersonal level. Unsupportive families and lack of open communication between adolescent-parent about sexuality issues were interpersonal barriers to access. Lack of provider competency, provider attitude, an unsupportive environment, physical inaccessibility of services, and shortage of medicine, and supplies were identified as institutional-level barriers. Moreover, community-level barriers like community stigma, social, religious, and gender norms within the society were identified as the main barriers to accessing services for adolescents. Conclusion: This review finding reveals that the main barriers to access SRH services for adolescents living in SSA are misperception about services, low self-esteem to access services, financial constraints, unsupportive families, community stigma and social norms, unsupportive environments in health facilities, healthcare provider behavior, poor competency, being judgmental attitude, and breaking privacy and confidentiality. This study finding calls for new approach like a multi-pronged that works with service providers, with community, with families, and with adolescent to improve SRH services utilization of adolescent. [ABSTRACT FROM AUTHOR]

Sickle cell disease is caused by an abnormality of the β-globin gene and is characterised by sickling of the red blood cells. Globally, sub-Saharan African countries share the highest burden of the disease. This study aimed at critically reviewing studies focusing on challenges of sickle cell anaemia in sub-Saharan Africa. A literature search was carried out in five major databases. Articles that met the inclusion criteria were included in the bibliometric review and critical analysis. A majority of the studies were undertaken in the West African region (85.5%), followed by Central Africa (9.1%). Very few studies had been undertaken in East Africa (3.6%), whilst the Southern African region had the fewest studies (1.8%). Distribution in relation to country revealed that three quarters of the studies were carried out in Nigeria (74.5%), followed by the Democratic Republic of the Congo (9.1%). According to healthcare settings, a strong majority of the studies were undertaken in tertiary health care facilities (92.7%). Major themes that emerged from the review include interventions, cost of treatment, and knowledge about sickle cell disease. Public health awareness and promotion as well as improving the quality of sickle cell centers for prompt management of patients with sickle cell disorder was identified as a critical strategy towards reducing the burden of the disease in sub-Saharan Africa. To achieve this, governments in countries located in this region need to adopt a proactive strategy in addressing gaps that have been identified in this study, as well as instituting other relevant measures, such as continuous media engagement and public health interventions relating to genetic counselling. Reforms in other areas that can help reduce the disease burden, include training of practitioners and equipping sickle cell disease treatment centers according to World Health Organization specifications. [ABSTRACT FROM AUTHOR]

Objectives and indicators must be agreed, and regular audits undertaken. Conclusion: Antibiotic prescribing across Africa is characterised by high prevalence, usually empirical. Various prescribing and quality indicators are being employed to assess antibiotic use, and ASPs have shown to improve antibiotic prescribing providing direction to reduce AMR. [ABSTRACT FROM AUTHOR]

According to the International Diabetes Federation, sub-Saharan Africa is experiencing the highest anticipate increase in the prevalence of type 2 diabetes (T2D) in the world and has the highest percent of people living with T2D who are undiagnosed. Therefore, diagnosis and treatment need prioritization. However, pharmacological hypoglycemics are often unavailable and bariatric surgery is not an option. Therefore, the ability to induce T2D remission through lifestyle intervention alone (LSI-alone) needs assessment. This scoping review evaluated trials designed to induce T2D remission by LSI-alone. PubMed, Embase, Cochrane, and CINAHL databases were searched for trials designed to induce T2D remission through LSI-alone. Of the 928 identified, 63 duplicates were removed. With abstract review, 727 irrelevant articles were excluded. After full-text review, 112 inappropriate articles were removed. The remaining 26 articles described 16 trials. These trials were published between 1984 and 2021 and were conducted in 10 countries, none of which were in Africa. Remission rates varied across trials. Predictors of remission were 10% weight loss and higher BMI, lower A1C and shorter T2D duration at enrollment. However, LSI-alone regimens for newly diagnosed and established T2D were very different. In newly diagnosed T2D, LSI-alone were relatively low-cost and focused on exercise and dietary counseling with or without calorie restriction (~1500 kcal/d). Presumably due to differences in cost, LSI-alone trials in newly diagnosed T2D had higher enrollments and longer duration. For established T2D trials, the focus was on arduous phased dietary interventions; phase 1: low-calorie meal replacement (< 1000 kcal/day); phase 2: food re-introduction; phase 3: weight maintenance. In short, LSI-alone can induce remission in both newly diagnosed and established T2D. To demonstrate efficacy in Africa, initial trials could focus on newly diagnosed T2D. Insight gained could provide proof of concept and a foundation in Africa on which successful studies of LSI-alone in established T2D could be built. [ABSTRACT FROM AUTHOR]

Background: RDW is critical to the clinical diagnosis and progression of ESRD. There is currently little data on the relationship between RDW and ESRD in sub-Saharan Africa. Because of this, the present study evaluates RDW in patients with ESRD and associated factors in Addis Ababa, Ethiopia. Methods: The hospital-based cross-sectional study design was conducted on a total of 83 patients. RDW, MCV, SCR, BUN, GFR, FBS and serum albumin were determined. Blood pressure (mmHg), weight (kg), height (m), MUAC (cm) and BMI (kg/m2) were also measured. Data entry was via Epi-data version 3.4 and analyzed with SPSS version 26.0. A multivariate logistic regression analysis with a p-value < 0.05 at a 95% confidence interval was used to identify the associated factors of RDW. Results: A total of 83 ESRD patients participated, with a response rate of 95.4%. RDW ranged from 15.5% to 23.6% with a mean of 17.40% + 1.46%. Anisocytosis was present in 98.8% of patients. Of 83 patients, 66.3% were hypertensive, 20.5% had diabetes, and the remaining 13.3% had other conditions (glomerulonephritis and peripheral vascular disease). The mean GFR value was 5.20 mL/min/1.73 + 1.58. RDW showed a significant association with GFR (AOR: 4.6, 95% CI [1.27, 20.74], P = 0.047), alcohol consumption (AOR: 13.4, P = 0.012, 95% CI [1.97, 22.62]), recurrent kidney disease (AOR=25.6, P=0.016, 95% CI [1.85, 53.71]) and use of medication (AOR=00.2, P=0.044), 95% CI [0.03, 0.95]). Conclusion: RDW showed a significant association with GFR, recurrent kidney disease, alcohol consumption, and medication use in hemodialysis-dependent ESRD patients. The mechanisms of RDW disruption in ESRD patients need further investigation. [ABSTRACT FROM AUTHOR]

Seasonal Malaria Chemoprevention (SMC), which combines amodiaquine (AQ) with sulfadoxine-pyrimethamine (SP), is an effective and promising strategy, recommended by WHO, for controlling malaria morbidity and mortality in areas of intense seasonal transmission. Despite the effectiveness of this strategy, a number of controversies regarding the impact of the development of malaria-specific immunity and challenges of the strategy in the context of increasing and expanding antimalarial drugs resistance but also the limited coverage of the SMC in children make the relevance of the SMC questionable, especially in view of the financial and logistical investments. Indeed, the number of malaria cases in the target group, children under 5 years old, has increased while the implementation of SMC is been extended in several African countries. This ambivalence of the SMC strategy, the increase in the prevalence of malaria cases suggests the need to evaluate the SMC and understand some of the factors that may hinder the success of this strategy in the implementation areas. The present review discusses the impact of the SMC on malaria morbidity, parasite resistance to antimalarial drugs, molecular and the immunity affecting the incidence of malaria in children. This approach will contribute to improving the malaria control strategy in highly seasonal transmission areas where the SMC is implemented. [ABSTRACT FROM AUTHOR]

Introduction: Although antimicrobials have traditionally been used to treat infections and improve health outcomes, resistance to commonly used antimicrobials has posed a major challenge. An estimated 700,000 deaths occur globally every year as a result of infections caused by antimicrobial-resistant pathogens. Antimicrobial resistance (AMR) also contributes directly to the decline in the global economy. In 2019, sub-Saharan Africa (SSA) had the highest mortality rate (23.5 deaths per 100,000) attributable to AMR compared to other regions. Methods: We searched PubMed for articles relevant to AMR in pathogens in the WHO-GLASS list and in other infections of local importance in SSA. In this review, we focused on AMR rates and surveillance of AMR for these priority pathogens and some of the most encountered pathogens of public health significance. In addition, we reviewed the implementation of national action plans to mitigate against AMR in countries in SSA. Results and Discussion: The SSA region is disproportionately affected by AMR, in part owing to the prevailing high levels of poverty, which result in a high burden of infectious diseases, poor regulation of antimicrobial use, and a lack of alternatives to ineffective antimicrobials. The global action plan as a strategy for prevention and combating AMR has been adopted by most countries, but fewer countries are able to fully implement country-specific action plans, and several challenges exist in many settings. Conclusion: A concerted One Health approach will be required to ramp up implementation of action plans in the region. In addition to AMR surveillance, effective implementation of infection prevention and control, water, sanitation, and hygiene, and antimicrobial stewardship programs will be key cost-effective strategies in helping to tackle AMR. [ABSTRACT FROM AUTHOR]

Background: Depression among tuberculosis patients remains a significant public health concern. Its burden and severity is increasing in low-income countries, especially in sub-Saharan Africa. Although it has negative impacts on quality of life, depression among tuberculosis patients is rarely studied in Ethiopia, particularly in the study area. Therefore, this study aimed to determine the magnitude of depression and associated factors among tuberculosis patients in Eastern Ethiopia. Methods: A facility-based cross-sectional study was conducted from April 15 to May 15, 2021, among 213 tuberculosis patients in public health facilities of the Harari Regional State, Eastern Ethiopia. Study participants were selected using a systematic sampling technique. Data were collected using interviewer-administered questionnaire. Depression was assessed using Patients Health Questionnaire-9 (PHQ-9). Epi-data and SPSS were used for data processing and analysis. Bi-variable and multivariable logistic regressions were employed to determine the effects of predictors on depression. Statistical significance was considered at a p-value < 0.05. Results: The magnitude of depression among tuberculosis patients was 52.1% [95% CI (45.4, 58.8%)]. Patient's age of 25– 34 years [AOR = 0.31, 95% CI (0.128, 0.75)], female sex [AOR = 5.04; 95% CI (2.18, 11.62)], intensive phase of tuberculosis treatment [AOR = 2.56; 95% CI (1.118, 5.876)], HIV-positive status [AOR = 7.143; 95% CI (1.55, 32.93)], smoking history [AOR = 9.08; 95% CI (3.35, 24.61)] and having poor social support [AOR = 4.13; 95% CI (1.29, 13.22)] were factors statistically associated with depression. Conclusion: In this study, the magnitude of depression was relatively high as more than half of the participants had depression. Advanced age, female sex, intensive phase of tuberculosis treatment, HIV-positive status, smoking history, and poor social support were identified as associated factors with depression. Therefore, this result calls all stakeholders to give duly emphasis on incorporating and integrating mental health support programs as routine practice in tuberculosis follow-up clinics, as screening, early detection and treatment, and training for all health care providers are very crucial in tackling depression among tuberculosis patients. [ABSTRACT FROM AUTHOR]

Purpose: Sub-Saharan Africa suffers from a dual impact of communicable (CDs) and non-communicable diseases (NCDs). There is scarce data on causes, trends of admission, and deaths among patients in Sudan. We aimed to determine the causes, trends of admission, and mortality among adult patients admitted to Gadarif Hospital in Eastern Sudan. Patients and Methods: The medical records of adult patients admitted to Gadarif medical wards from January 2017 to December 2020 were reviewed for age, gender, causes of admission, and outcomes. Multivariate Cox regression analysis was used to analysis factors (age, sex, years, and disease) associated with the mortality. Results: Of the 7230 patients who were admitted, 2221 (34.7%) were females and 5009 (69.3%) were males. The median age (interquartile range, IQR) was 47.0 (35.0) years. Of these 7230 patients, 3167 (43.8%) and 4063 (56.2%) patients were admitted with CDs and NCDs, respectively. Cardiovascular diseases (18.4%), snakebites (12.9%), and visceral leishmaniasis (12.0%) were the most common causes of admission. The overall in-patient adult deaths were 674 (9.3%). Cardiovascular diseases (22.3%), neurological diseases (16.9%), sepsis (15.9%), renal diseases (13.9%), and snakebites (8.3%) were the most common causes of inpatient mortality. Malignancy (20.7%), sepsis (20.9%), neurological diseases (17.4%), and cardiovascular diseases (13.8%) comprised the highest case fatality rates among the admitted patients. Using a Cox regression model (adjusted), age (adjusted hazard ratio = 1.02, 95% confidence interval = 1.01‒1.03) was associated with increased mortality hazard. However, the gender and years of admission were not associated with increased mortality hazard. Conclusion: Admissions and mortality rates for CDs and NCDs are high compared with other African countries. Preventive measures are required to avert the high burden of these diseases. Health care systems in Sudan need to be prepared to deal with the dual burden of the diseases. [ABSTRACT FROM AUTHOR]

Introduction: The first documented case of COVID-19 in Kenya was recorded March of 2020. Co-morbidities including hypertension and diabetes have been associated with increased morbidity, hospitalization, and mortality among COVID-19 patients. This retrospective study describes the clinical characteristics, disease severity, and outcomes among the patient population at a tertiary hospital in Kenya. Methods: This was a retrospective descriptive study of COVID-19 patients who were admitted between March 2020 and December 2020 at the Aga Khan University Hospital in Nairobi, Kenya. Data collected include patient demographic and baseline characteristics. Differences between patients who were known to have diabetes and hypertension during admission were compared for statistical significance. Difference between those who survived and those who died were also compared for statistical significance. Results: A total of 913 records of patients were studied with a mean age of 51.2 years (SD = 16.7), 66.5% were male and 80.8% were of African origin. History of diabetes, hypertension, and HIV status were at 27.3%, 33.1%, and 2.3%, respectively. At presentation, 33.1% (302/913) of patients had known hypertension by history, and following admission, this proportion increased to 37.7% (344/913). At presentation, 27.3% (249/913) of patients had known diabetes. During hospital stay, 20.8% (190) more patients were found to have diabetes, raising the overall percent to 48.1% (439/913). When comparing diabetes and hypertension at baseline versus at the end of admission, diabetes increased by 20.8% (p < 0.001) and hypertension by 4.6% (p = 0.049). HIV co-infection was 2.3%, and no patient had tuberculosis. Conclusion: This study showed a high incidence of co-morbidities in patients infected with COVID-19. Diabetes was most common, followed by hypertension. All patients admitted with COVID-19 infection should routinely be tested for diabetes with HbA1c and have regular blood pressure monitoring in order to diagnose occult diabetes and hypertension. Adverse outcomes were found in patients with these co-morbidities and should be monitored and treated appropriately. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is one of the commonest coinfections and leading causes of death among people living with HIV in resource-limited countries. There is limited evidence on the short- and long-term mortality rate in people receiving antiretroviral therapy and coinfected by tuberculosis in sub-Saharan Africa, where the burden of coinfection is highest. Purpose: This study aimed to compare mortality among HIV positives with and without tuberculosis coinfection receiving antiretroviral therapy in Addis Ababa, Ethiopia. Methods: HIV positives' medical records were reviewed between 2011 to 2018 and identified 7038 HIV-positive adults enrolled for antiretroviral therapy in Addis Ababa. The outcome of interest for this study was death. A parametric Gompertz regression model was applied to compare mortality between HIV with tuberculosis coinfection versus HIV without tuberculosis. Results: Overall, 1123 (15.96%, 95% CI: 15.11– 16.83%) individuals with HIV had tuberculosis coinfection at antiretroviral therapy enrollment. After adjusting for age, sex, education, marital status, cotrimoxazole therapy, body mass index, baseline CD4 cell count, and year in ART enrollment, HIV positives with tuberculosis coinfection had more than twice a higher overall mortality risk than HIV positives without tuberculosis coinfection (AHR: 2.53; 95% CI 1.63– 3.91, p < 0.001). Conclusion: This large retrospective cohort study reveals significantly higher mortality in HIV and tuberculosis coinfected group. This suggests the need for enhanced utility of integrated HIV and tuberculosis health services in sub-Saharan Africa where tuberculosis prevalence is highest. [ABSTRACT FROM AUTHOR]

While typhoid fever has largely been eliminated in high-income regions which have developed modern water, sanitation, and hygiene facilities, it remains a significant public health burden resulting in morbidity and mortality among millions of individuals in resource-constrained settings. Prevention and control efforts are needed that integrate several high-impact interventions targeting facilities and infrastructure, including those addressing improvements in sanitation, access to safe water, and planned urbanization, together with parallel efforts directed at effective strategies for use of typhoid conjugate vaccines (TCV). The use of TCVs is a critical tool with the potential of having a rapid impact on typhoid fever disease burden; their introduction will also serve as an important strategy to combat evolving antimicrobial resistance to currently available typhoid fever treatments. Well-designed epidemiological surveillance studies play a critical role in establishing the need for, and monitoring the impact of, typhoid fever control and prevention strategies implemented by public health authorities. Here, we present a perspective based on a narrative review of the impact of typhoid fever on morbidity and mortality in sub-Saharan Africa and discuss ongoing surveillance activities and the role of vaccination in prevention and control efforts. [ABSTRACT FROM AUTHOR]

Background: Many people with undiagnosed HIV live in sub-Saharan Africa and vulnerable laboratory systems undermine testing services. Methods: A facility-based mixed-approach cross-sectional study was conducted from January 1 to February 1, 2020. A total of 23 health facilities were included in the study which stratified into hospitals and health centers. Six months of bin card records and request and resupply forms (RRFs) were reviewed. Data were collected through physical inventory, observation, and document review. After the data was imported into the MS Excel 2016 spreadsheet, it was analyzed using SPSS | Version 20 | Software. In addition, 12 semi-structured in-depth interviews were conducted and responses were analysed using a thematic approach. Results: The entire health facility had RRF reports and bin card records while the availability of HIV rapid test kits was 75%. More than half, 38 (55.1%) of the bin card records were updated and the average data accuracy of bin cards was 84.1%. The data quality of the RRF reports was determined accurate 18 (78.3%), complete 15 (65.22%), and on-time 7 (30.3%). Sixteen (69.6%) health facilities experienced at least one stock out with an average daily stock out of 4%. The wastage rate was 0.0083%. Only 9 (39.1%) health facilities have fulfilled acceptable storage conditions. Conclusion: Most of the health facilities did no longer fulfilled acceptable storage conditions. Similarly, the data quality of most bin card records and RRF reports was poor. This deprived inventory management practice was likely related to supply, staff, and documentation challenges. [ABSTRACT FROM AUTHOR]

Background: The prognostic values of the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in predicting the in-hospital mortality of Black African patients with advanced hepatocellular carcinoma (HCC) in palliative treatment is unknown. Aim: To determine the prognostic value of NLR and PLR compared with that of Child–Turcotte–Pugh (CTP), model for end-stage liver disease (MELD) scores and the Barcelona clinic liver cancer staging system (BCLC). Methods: The cutoffs, accuracies and association with the mortality of these prognostic scores were determined using a time-dependent area under receiver operating characteristic curves (AUC), the log rank test and Cox proportional hazards ratio. Results: A total of 104 patients with advanced HCC (median age=49.5 years, males=58.7%) were enrolled. All were hospitalized for an enlarged liver mass of at least 15.4 cm in size in the right thoracic quadrant. Overall, 46 (44.2%) patients died in hospital during follow-up. Patients with NLR > 2.5 (log rank test=7.11, p=0.01) or PLR > 92 (log rank test=5.63, p=0.02) had poor survival. Factors associated with the in-hospital mortality were the MELD score (p=0.01), NLR (p=0.03) and hemoglobin level (p=0.02). NLR exhibits better and stable accuracy in predicting the in hospital mortality at time points of 30 (AUC=0.618), 60 (AUC=0.680) and 90 (AUC=0.613) days of follow-up, compared with CTP, MELD scores, BCLC and PLR. However, PLR displayed an enhanced accuracy over 90 days of follow up (AUC=0.688). Conclusion: NLR is useful in predicting the in-hospital mortality in Black African patients with advanced stage HCC in clinical practice. NLR and PLR may be used concomitantly for long-term follow-up. [ABSTRACT FROM AUTHOR]

Introduction: Improvements in physical, mental, and overall quality of life are well documented in younger HIV populations who exercise. Exercise guidelines exist for younger HIV populations, but none for older people living with HIV (OPLWH), especially 50 years of age and older. Our aim was to map the existing literature on the effects of exercise and physical activity prescriptions for OPLWH. Methods: We conducted a scoping review using the methodological framework proposed by the Joanna Briggs Institute. Online searches on five research databases yielded 503 published articles. Fifteen studies met the study's inclusion criteria. Results: The most commonly used parameters of exercise included aerobic and strength training, as well as a combination of both. The physical, psychological and Quality of Life (QoL) impact of physical activity and its effect on OPLWH is evidently beneficial. Overall, a positive correlation between exercise and physical, mental and functional status was observed. No adverse side effects, or safety and efficacy concerns, during the use of exercise were reported. Conclusion: This review confirms the dearth of evidence on physical activity and exercise in the context of OPLWH. Of greater concern is the fact that there were no studies conducted in sub-Saharan Africa, the global region with by far the highest HIV burden. [ABSTRACT FROM AUTHOR]

Introduction: Intestinal parasites are the most common infectious gastrointestinal parasites in developing countries including Ethiopia. Globally, it remains a public health problem by affecting 3.2 billion people, of which 10% were pregnant women. In Sub-Saharan Africa, pregnant women are the risky group next to children for this infection. This study aimed to assess the magnitude and associated factors of intestinal parasite infection among pregnant women. Methods: Facility-based cross-sectional study was conducted among 365 pregnant women attending antenatal care service in Shewarobit town health facilities, North Shoa Zone, Amhara Region, Ethiopia. Data were collected using an interview questionnaire and laboratory microscopic stool examination from February 1, 2020, to March 30, 2020. Descriptive statistics and multivariable analyses were used to characterize the data and to identify the associated factors with the outcome variable at a p-value < 0.05, respectively. Results: A total of 347 (95.1%) pregnant women participated in this study. The magnitude of intestinal parasite infection was 27.7% during the study period. Among the parasites, G. lamblia and S. mansoni were the most prevalent identified parasites. Pregnant mother, who did not have handwashing practice after using the toilet [AOR: 3.89, 95% CI (1.86– 8.13)], had a habit of walking on barefoot [AOR: 5.65, 95% CI (1.72, 18.56)], had uncooked food meal habit [AOR: 5.12, 95% CI (1.24, 21.14)], use of water in unimproved water source [AOR: 3.20, 95% CI (1.11– 9.24)], lack of health education [AOR: 4.08, 95% CI (2.01– 8.27)], and not dewormed [AOR: 3.09, 95% CI (2.01– 7.94)] were predictors for parasitic infection. Conclusion: High prevalence of intestinal parasite infection is observed in pregnant women. Personal hygiene practice, health education, and water quality were factors identified as contributors to intestinal parasite infection in pregnant women. Public health measures on water and environmental sanitation, health education for intestinal parasite infection and personal hygiene practices, and early deworming are vital to reduce the intestinal parasites' infection and assure safe pregnancy. [ABSTRACT FROM AUTHOR]

Background: Human immune deficiency virus (HIV) remains one of the leading causes of infectious disease mortality and morbidity in Sub-Saharan Africa. Although remarkable progress has been made in prevention and treatment of HIV, there is a higher rate of loss to follow-up in HIV-infected children than in adults, once they enter care. Objective: To determine the incidence and identify predictors of loss to follow-up among HIV-infected children on anti-retroviral treatment in Sidama Zone, Ethiopia. Methods: A retrospective cohort study was done among children that were enrolled in ART care in Sidama Zone from September 2014 to August 2018. A total of 143 eligible children were included in this study. A structured checklist was used to extract data from patients' medical records such as patient intake forms, electronic database, and registers. Data were entered, cleaned, coded, and analyzed by STATA version 12. Cox proportional hazards models were fitted to investigate predictors of loss to follow-up. Results: Of the 143 participants, 76 (53.15%) were female children with a median age of 7 years and interquartile range of 4– 9. The incidence rate was 5 per 100 person-years and the cumulative incidence 12.59%. The median follow-up time was 2.46 years and the total time at risk was 356.06 person-years. Furthermore, 55.56% and 72.22% of those lost to follow-up were within the first and the second years of follow-up, respectively. In multivariable Cox proportional model, only the TB status of the children was significantly associated with loss to follow-up with hazard ratio 3.348 [1.174831, 9.543494] and p-value of 0.024. Conclusion: In this study, TB status of children was the significant determinant of loss to follow-up. However, the overall retention was 87.4% and a substantially higher proportion of loss was observed within the first and second years of follow-up. [ABSTRACT FROM AUTHOR]

Background: The burden of substance use disorders is increasing in most countries in sub-Saharan Africa. Individuals with substance use disorders (eg, alcohol use disorder) are at high risk of manifesting extrapyramidal side effects or extrapyramidal symptoms (EPS) during treatment of alcohol-induced mental illness symptoms especially psychosis. EPS management poses a challenge since some of the drugs used for treating EPS have addictive properties. The knowledge about EPS diagnosis and treatment is not well distributed across the health system, with health workers at lower health facilities having least awareness. The present case gives details of a patient who developed EPS during the management of alcohol withdrawal symptoms. Case Details: Following cessation of alcohol use, a 54-year-old man with alcohol use disorder presented with a one-week history of visual, auditory and tactile hallucinations, illusions, insomnia, extreme fear and irritability. He was managed with several daily doses of intramuscular chlorpromazine 100 mg, whenever he woke up aggressive from sedation from a peripheral health facility. Four days after his admission, he became mute, stiff, immobile, triple-flexed, tremulous and was drooling saliva. He was referred to a secondary facility for further management while on antipsychotic medication. Finally, he was referred to a tertiary facility, managed with tablets of benzhexol 5 mg twice daily and intravenous diazepam 20 mg per day. Daily follow-up was done using the extrapyramidal symptom rating scale (ESRS) for EPS. EPS symptoms resolved ten days after initiation of treatment. Conclusion: EPS among individuals with addictive disorders poses a challenge in its management, especially in countries where the mental health care system is not well developed at lower-level health facilities. The mental health system has to prepare sustainable interventions to properly manage EPS among the growing population of individuals with addictive disorders through strengthening the mental health policy by training and equipping all health providers with knowledge and skills in managing EPS, increasing finances allocated for mental health and controlling the production and use of addictive substances. [ABSTRACT FROM AUTHOR]

Purpose: The metabolic syndrome (MetS) is on the rise in Sub-Saharan Africa, attributed to increased and uncontrollable urbanization accompanied by its lifestyle changes. Non-communicable diseases, such as hypertension, diabetes, and obesity, which are components of the (MetS) are also on the increase in Botswana. To date, no study has determined the prevalence of the MetS in the apparently healthy Batswana adults. The objective of the study was to determine the prevalence of the MetS among the 25– 65-year-old Batswana residing in urban and neighboring semi-urban areas of Gaborone. Participants and Methods: A cross-sectional study was used to collect data from N=794 participants, n=383 men and n=411 women, residing in Gaborone and two surrounding semi-urban areas. Data collected included demographic, anthropometric measurements, blood pressure (BP), blood glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C) and total cholesterol. Results: A high prevalence of 26.8% was reported, with women mostly afflicted (35.0% vs 18.0%). The MetS risk factors found to be common in women were low HDL-C at (50% vs 48.7%) compared to men, while proportions with elevated BP (50.3% vs 39.4%) were prominent in men. The prevalence increased with age, with the oldest age group showing a higher prevalence in both women and men, respectively (55– 65 years; 38.5% vs 41.2%). Conclusion: An unprecedented high MetS prevalence was revealed among perceived to be healthy Batswana adults, with women at a higher risk. This public health concern creates an opportunity to establish evidence of risk factors, develop guidelines and strategies with appropriate public health measures to prevent and control the MetS. [ABSTRACT FROM AUTHOR]

Auto-immune N-methyl-D-aspartate receptor encephalitis (NMDARE) is a relatively recently described cause of acute encephalopathy with very few reports from sub-Saharan Africa (SSA). We report a case of NMDARE in a young Kenyan female who was transferred to our facility with headaches, insomnia, behaviour changes and latterly pathognomonic orofacial dyskinesias. We comprehensively ruled out infectious and other inflammatory/auto-immune causes. She was diagnosed with NMDARE by positive antibody testing in serum and cerebrospinal fluid and changes on brain magnetic resonance imaging. She was immunosuppressed with high-dose steroids, intravenous immunoglobulins, plasma exchange and rituximab, and showed signs of neurological improvement clinically and radiologically. Unfortunately, she succumbed to septic shock from prolonged intensive care. This is the first report of NMDARE in an indigenous patient from the eastern SSA. The majority (> 80%) of patients are either left with mild disability or make a full recovery after NMDARE, but some factors – which comprise the NMDARE One-Year Functional Status (NEOS) prognostication score – can adversely affect outcome, as was the case in our patient. [ABSTRACT FROM AUTHOR]

Purpose: An earlier adoption of contraceptive methods during the postpartum period could help women to extend the inter-pregnancy interval. This article aimed to determine and compare the timing of long-acting reversible contraceptives (LARC) use (ie, intrauterine device and implant) in Burkina Faso (BF) and DR Congo (DRC) between the intervention and control groups. Patients and Methods: A total of 1120 postpartum women were enrolled and followed up to 12 months postpartum. We used Yam-Daabo trial data which was a multi-intervention, single-blinded, cluster-randomised controlled trial done in primary health-care centres (clusters) in both countries. Centres were randomly allocated to receive the six-component intervention or standard antenatal and postnatal care in matched pairs (1:1). We did a secondary analysis using Royston-Parmar's semi-parametric model to estimate the effect of the interventions on the median time of LARC uptake. Results: Our analysis included 567 postpartum women in BF (284 in the intervention group and 283 in the control group) and 553 in the DRC (274 in the intervention group and 279 in the control group). After showing an increase in family planning use in these two African countries, Yam Daabo's interventions showed a reduction of the median time of LARCs adoption in the intervention group compared to the control group in both countries (difference of 39 days in Burkina Faso; difference of 86 days in the DR Congo). Conclusion: The Yam Daabo intervention package resulted in increased and earlier adoption of LARC in rural settings in Burkina Faso and urban settings in DR Congo. Such an intervention could be relevant in similar contexts in Sub-Saharan Africa with very high fertility rates and high unmet needs for contraception. [ABSTRACT FROM AUTHOR]

Background: HIV/AIDS is a global pandemic. Sub-Saharan Africa accounts for two-thirds of the newly HIV-infected cases in the world. Similarly, the prevalence of HIV infections among Ethiopian university students has also increased as HIV prevention was not sufficiently prioritized. In order to decrease the surge of the HIV pandemic, prevention messages that encourage individuals to reduce sexual and risk behaviors still remain a key intervention strategy. Besides this, the behavioral response to HIV prevention messages among Ethiopian universities is not well studied. Objective: To assess students' behavioral response to HIV/AIDS prevention messages in selected universities of the Amhara region using an extended parallel process model (EPPM), in 2019. Methods: A facility-based cross-sectional study was employed among 423 eligible students from January to February, 2019 using a stratified sampling technique. The dependent variable is response to HIV/AIDS prevention messages (danger control and fear control) which is addressed by EPPM. The model explains the components of threat (perceived susceptibility and perceived severity) and efficacy (response efficacy and self-efficacy). Subtracting wings of threat component score from efficacy wings score gives the critical value. If the critical value had positive scores, it showed responses of danger control; if the critical value was negative, it showed response of fear control. A logistic regression model was fitted to assess the association between the dependent and independent variables. Results: The response rate of this study was 94.6%. Among 400 respondents, 263 (65.8%; 95%CI: 61– 70) of them were in the danger control response whereas 137 (34.2%; 95%CI: 30– 39) were in fear control response. Moreover, 200 (50%) of the participants had adequate knowledge and 180 (45%) had a favorable attitude towards HIV/AIDS prevention messages. Danger control response for HIV prevention messages was higher among first-year students (AOR=5.5; 95%CI: 1.5– 19) and third-year students (AOR=3.9; 95%CI: 2– 14) compared with fifth-year students. Similarly, those students who reside on the campus were 60% times less likely to develop danger control when compared with students who live with their family (AOR=0.4; 95%CI: 0.2– 0.9). Besides this, students who had adequate knowledge (AOR=2.6; 95%CI: 1.5– 4.5) and students who receive fear-inducer messages (AOR=4.5; 95%CI: 3– 25] were more likely to develop danger control responses. Conclusion and Recommendation: Nearly two-thirds of the participants were in the danger control response. Year of study, with whom students currently live, type of message they received, and the knowledge level of respondents were the factors associated with students' response to HIV/AIDS prevention messages. Therefore, the messages must aim at enhancing threat component perception with appropriate efficacy messages to control danger and promote behavioral change. [ABSTRACT FROM AUTHOR]

Background: Human Immunodeficiency Virus-1/AIDS and Schistosoma mansoni are widely spread in sub-Saharan Africa including Ethiopia and the co-infection is also prevalent, occurs commonly. Schistosoma mansoni infection has been suggested to be a risk factor for HIV transmission and progression. This study aims to assess the prevalence and intensity of Schistosoma mansoni infection and associated risk factors among individuals with and without human immunodeficiency virus (HIV) at Chuahit Health Center, West Dembia, Northwest Ethiopia. Methods: Institutional based cross-sectional study was conducted from March to April 2019. Two hundred sixty-six study subjects were included in the study by using a systemic and convenient sampling technique. Pretested structured questionnaire was employed to collect data. Single stool samples were collected and examined for S. mansoni eggs. Finger prick and venous blood samples were collected for HIV-1 screening and viral load count. Data were analyzed using SPSS version 20. Independent t-test and one-way ANOVA were used to compare the mean of egg counts with HIV status and viral load counts, respectively. A P-value of less than 0.05 was taken as statistically significant. Results: The overall prevalence and intensity of S. mansoni infection was 41 (15.4%) and 162.24 egg per gram of faeces (EPG), respectively. Prevalence of S. mansoni was higher in seronegative study participants though the difference is statistically insignificant. Higher intensity of infection was observed among seropositive study participants with high viral load counts (> 1000 copies/mL). Conclusion: Relatively higher prevalence and intensity of S. mansoni infection were found. Study participants' occupation was identified as potential risk factor to S. mansoni infection. Further studies are needed to know the impact of HIV on the prevalence and intensity of S. mansoni infection in the study area. [ABSTRACT FROM AUTHOR]

Primary liver cancer has the sixth highest incidence and fourth highest cancer mortality worldwide. Hepatitis B is the leading cause of liver cancer, though its incidence is decreasing with vaccination. Alcohol is the leading cause of liver transplant, cirrhosis, and cancer in the developed world, and is projected to surpass hepatitis B as the leading hepatic cancer etiology worldwide. Tobacco smoking has shown a positive association with liver cancer in a majority of studies, though not all. Aflatoxin, a mycotoxin produced by Aspergillus, is estimated to account for 3– 20% of global liver cancer cases, 40% of which occur in sub-Saharan Africa. These statistics are confounded by the prevalence of hepatitis B, which may have a synergistic effect on hepatic carcinogenesis. Aflatoxin is ingested and likely inhaled from agricultural products, placing farmers, food processors, and textile workers in developing nations at risk. Vinyl-chloride is used in the production of PVC plastics and causes rare liver angiosarcoma, hepatocellular carcinoma, and other neoplasms. Arsenic and cadmium are naturally-occurring, hepatocarcinogenic metals with high occupational exposure in industries involving coal, metals, plastics, and batteries. Millions of laborers in waste-disposal and manufacturing are exposed to organic solvents and N-nitrosamines, which vary from carcinogenic (group 1) to possibly carcinogenic (group 2B) in their IARC designation. Insecticide DDT is possibly hepatocarcinogenic (group 2B), though continues to be used for malaria control in the developing world. While suggested by case reports, anabolic steroids and oral contraceptives have not been shown to increase liver cancer risk in large studies. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a major risk factor for cardiovascular morbidity and mortality. Increasingly, evidence suggests that 24-hour ambulatory blood pressure (BP) monitoring (ABPM) is more accurate than clinic BP in predicting cardiovascular risk. However, this association has not been widely studied in subSaharan Africa, especially in Tanzania. Aim: To explore the relationship between 24-hour ABPM profiles and cardiovascular risk factors in comparison with clinic BP among Muhimbili University of Health and Allied Sciences (MUHAS) employees. Methods: A descriptive cross-sectional study was conducted from October 2018 to February 2019. Socio-demographic and cardiovascular risk information was gathered. We used an automated ABPM device to record 24-hour ambulatory BP. Correlation between BP profiles and cardiovascular risk factors was done using Pearson's correlation coefficient, and independent factors for hypertension were determined using logistic regression analysis. P-value of < 0.05 was considered statistically significant. Results: In total, 390 employees participated. Their mean age was 40.5 ± 8.9 years, and 53.6% were men. The mean office systolic and diastolic BP were 126± 12 mmHg and 78± 13 mmHg, respectively, while the corresponding values for mean 24-hour ABPM were 122± 14 and 75± 10 mmHg. The prevalence of hypertension was 23.1%. The prevalence of white coat hypertension was 16.2%, while masked hypertension and nocturnal non-dipping were present in 11.5 and 66.7%, respectively. Overall, the mean 24-hour systolic BP showed the strongest correlations with cardiovascular risk factors while mean office systolic BP showed least. Independent associated factors of hypertension were male gender, age ≥ 40 years, family history of hypertension, central obesity, raised cholesterol and uric acid levels, all p< 0.01. Conclusion: Compared to office BP, ABPM measurements had stronger correlations with cardiovascular risk factors in this population, and therefore likely to reflect true BP. ABPM has revealed high proportion of masked, white coat and nocturnal non-dipping, supporting use of ABPM to detect these clinically important BP profiles. [ABSTRACT FROM AUTHOR]

Background: Voluntary counseling and testing (VCT) is a vital response to human immunodeficiency virus (HIV) infection among adolescents in sub-Saharan Africa. Determining the status of VCT services is important to link HIV care and antiretroviral therapy. Methods: An institutional cross-sectional study design was conducted among 841 young students at Gondar College of Teachers' Education. A self-administered questionnaire was used to gather the data. Descriptive statistics were performed. Bivariate and multivariable binary logistic regressions were used to identify factors associated with the use of VCTs. The adjusted odds ratio (AOR) with 95% confidence was used to report statistical significance. Results: The majority (71%) were aware of VCT services. More than one-third (37.8%, 95% CI: 34.6– 41.2) participants had used VCT services. Having peer groups used VCT (AOR=2.04, 95% CI: 1.31– 3.20), having partner (AOR: =1.6, 95% CI: 1.04– 2.45), desiring to have VCT in the future (AOR=3.58, 95% CI: 1.98– 6.50), being aware of VCT (AOR= 1.98, 95% CI: 1.20– 3.34), knew infected/dead individuals with HIV/AIDS (AOR=1.67, 95% CI: 1.07– 2.61), know test sites (AOR=2.01, 95% CI: 1.29– 3.13) were positively associated, whereas being married (AOR=0.36, 95% CI: 0.20– 0.63) and fear of confidentiality (AOR=0.23, 95% CI: 0.10– 0.52) were major barriers to use. Conclusion: Low use of VCTs, which was far away from the 90:90:90 WHO goal, has been noted. The use of VCT services was associated with having peer groups that used VCT, having a partner, wanting to have VCT in the future, knowing the infected/dead individual with HIV/AIDS, fear of confidentiality of results, knowing the test sites, and having awareness of VCT. Efforts are needed to strengthen the health system that also needs to pay attention to education about HIV and VCT. [ABSTRACT FROM AUTHOR]

Background: The estimated burden of maternal morbidities in lower-income countries, such as Madagascar, is high. However, there is still a lack of data on maternal morbidities, in part due to an absence of standardized assessment tools. This cross-sectional study aims to report maternal morbidities among 1015 women in the district of Ambanja, Madagascar, and to describe the advantages and limitations of a mHealth system. Methods: Data were collected using the PANDA (pregnancy and newborn diagnosis assessment) system, an mHealth device that incorporates the WHO recommendations for antenatal care (ANC). Data, including personal and medical information, but also clinical data such as hypertension, anemia or HIV were collected from more than 1000 women attending ANC. Results: A total of 1015 pregnant women were recruited from January 2015 to August 2018. The average age was 24.6 years old, and most women were married (82.3%). The majority lived in urban areas and were unemployed. Prevalence of hypertension and gestational diabetes was relatively low (4% vs 2.2%). Malaria infection was diagnosed in 2.2% and HIV was diagnosed in 1.2% of pregnant women. The most common morbidity was anemia (68.4%) and the only significant factor associated was being single compared to being married (OR 1.68, 95% CI 1.05– 2.70, p-value 0.032). Discussion: The prevalence of anemia in our study population was much higher than previously reported in Sub-Saharan Africa. This finding highlights the need for regular iron supplementation during pregnancy, especially in vulnerable (eg, single) women. The PANDA mHealth system provides unique opportunities due to its standardization of ANC and creation of a digital database accessible from a distance. However, one of the main challenges was that even a mHealth system such as the PANDA remains dependent on the local procurement chain. Therefore, future studies need to access opportunities of mHealth systems to support health service delivery. Trial Registration: Registered on ISRCTN on 14th October 2015, number ISRCTN18270380. Retrospectively registered. [ABSTRACT FROM AUTHOR]

Urolithiasis is a global pathology with increasing prevalence rate. The lifetime recurrence of urolithiasis ranges from 10– 75% creating a public health crisis in affected regions. The epidemiology of urolithiasis in most parts of Africa and Asia remains poorly documented as incidence and prevalence rates in these settings are extrapolated from hospital admissions. The surgical management of kidney and ureteral stones is based on the stone location, size, the patient's preference and the institutional capacity. To date, the available modalities in the management of urolithiasis includes external shock wave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL), ureterorenoscopy (URS) including flexible and semirigid ureteroscopy. However, regarding the lack of endourological equipment and expertise in most parts of Sub-Saharan Africa (SSA), most urological centers in these regions still consider open surgery for kidney and ureteral stones. This review explores the current trend and surgical management of upper tract urolithiasis in SSA with insight on the available clinical guidelines. [ABSTRACT FROM AUTHOR]

Background: Neonatal resuscitation is a means to restore life to a baby from the state of asphyxia. It is a single intervention of birth asphyxia. Over 1.2 million African babies are supposed to die in the first four weeks of their life and many of them in the first 24 hours of birth in Sub-Saharan Africa. The major cause of early neonatal death is neonatal asphyxia, which can be prevented by neonatal resuscitation. However, there is limited evidence on midwives' and nurses' knowledge of neonatal resuscitation in the study area. Therefore, this study aimed to assess the knowledge of midwives and nurses about neonatal resuscitation and its associated factors. Methods: This facility-based cross-sectional study was done on 427 midwives and nurses, who were selected using simple random sampling technique. Data were collected on facility type, availability of essential equipment, socio-demographic characteristics, working unit, professional experience, in-service training, and knowledge of neonatal resuscitation. First-degree holder midwives collected the data using a pre-tested face-to-face interviewer-administered questionnaire. Bivariate and multivariate logistic regression was used to analyze the association between the dependent and independent variables. Results: The study showed that 9.8% of the study participants had good knowledge about neonatal resuscitation. Factors significantly associated with knowledge of neonatal resuscitation were being trained on newborn resuscitation (AOR = 3.79, 95% CI: 1.73, 8.32), being unmarried (AOR = 2.36, 95% CI: 1.11, 5.02), holding bachelor sciences degree or above (AOR = 2.67, 95% CI: 1.11, 6.47), and working under West Hararghe health institutions (AOR = 0.30, 95% CI: 0.10, 0.88). Conclusion: The study participants had low knowledge of neonatal resuscitation. Being unmarried, holding bachelor sciences degree or above, being trained on neonatal resuscitation, and working under West Hararghe health institutions were factors associated with the knowledge of the study participants on neonatal resuscitation. [ABSTRACT FROM AUTHOR]

Background: Trypanosome infections still pose severe health and economic consequences, especially in the endemic regions of Sub-Saharan Africa. Trypanosome differentiation to the procyclic forms which lack the immune evasion mechanisms for survival in the bloodstream is prevented by tyrosine dephosphorylation which is catalyzed by protein-tyrosine phosphatase; thereby promoting survival of the parasites in the host. Inhibition of Protein-tyrosine phosphatase is a strategic therapeutic target that could attenuate trypanosomiasis. This study investigated the in vitro inhibitory effect of stem bark extracts of Khaya senegalensis and Tamarindus indica on the enzymatic activity of protein-tyrosine phosphatase. Methods: All determinations were carried out following standard procedures for analytical experiments. The analogues of myristic acid that inhibited the enzymatic activity of protein-tyrosine phosphatase were isolated by bioassay-guided fractionation of stem bark extracts of Khaya senegalensis and Tamarindus indica. Results: Analogues of myristic acid proved to be potent inhibitors of protein-tyrosine phosphatase. Double reciprocal (Lineweaver–Burk) plots of the initial velocity data indicated non-competitive inhibition with Ki of 0.67 mg/mL for Khaya senegalensis and 2.17 mg/mL for Tamarindus indica. The kinetic parameters for the cleavage of para-nitrophenylphosphate by the enzyme showed a KM of 3.44 mM and Vmax of 0.19 μmol/min. Sodium orthovanadate, the enzymes' specific inhibitor, inhibited the enzyme competitively with Ki of 0.20 mg/mL. Gas chromatography-mass spectrometry analysis of the stem bark bioactive fractions of Khaya senegalensis and Tamarindus indica revealed the presence of myristic acid analogues. Conclusion: Analogues of myristic acid are potent inhibitors of protein-tyrosine phosphatase that could be developed as trypanocide to inhibit the enzymatic activity of protein-tyrosine phosphatase in order to prevent transmission of trypanosomes. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its cross-cutting nature, impacting multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. We argue that by synergizing disease-specific vertical programs with system-specific horizontal programs through an integrated disease-system diagonal approach, we can improve access, quality, and safety of diabetes care programs while also supporting other chronic diseases. We recommend utilizing the six World Health Organization (WHO) health system building blocks – 1) leadership and governance, 2) financing, 3) health workforce, 4) health information systems, 5) supply chains, and 6) service delivery – as a framework to design a diagonal approach with a focus on health system strengthening and integration to implement and scale quality diabetes care. We discuss the successes and challenges of this approach, outline opportunities for future care programming and research, and highlight how this approach can lead to the improvement in the quality of care for diabetes and other chronic diseases across SSA. [ABSTRACT FROM AUTHOR]

Background: Nigeria has the second largest HIV epidemic in the world and one of the highest rates of new infection in sub-Saharan Africa. Within the last three decades, majority of HIV programs in Nigeria were treatment strategies with few prevention approaches. The persistence of HIV prevalence despite the treatment blueprint has led to a concerted call to HIV Prevention Cascade (HPC) theory which ensures continuous sophisticated interrelationship that stretches beyond the biomedical interventions of treatment. To our knowledge, there is no previous review on HPC theory in Nigerian context. Objectives: The aim of this review was to explore and outline the HIV/AIDS prevention cascade theory in relation to the achievement of the global 90-90-90 target set by the United Nations Programme on HIV and AIDS and suggest possible avenues to maximize on strengths and weaknesses of HPC in Nigeria. Methods: In this mini-review, the authors utilized standardized search measures in the review of published articles in credible domains across the HPC in PubMed, Research gate, Google Scholar, Mendeley Reference Manager and Cochrane Library from January 1980 to December 2018. Referenced sections of the articles identified were used to hand-search additional references not retrieved by the initial search engines. The authors performed an evaluation of selected studies on three cascade theories: epidemiological, behavioral and social science with an integration of the supply, demand and adherence sides. Results: We included nine review articles reporting three different cascade theories. Only one included study applied the cascade theories exclusively in Nigerian context. We could only conduct narrative synthesis. Conclusion: There is scarceness of currently published evidence on HPC in Nigerian context. HPC allows for a paradigm shift and sequential process of events to eliminate the epidemic of HIV using HIV prevention perspectives in Nigerian settings. Since data are sparse, more research is needed on HPC theory. [ABSTRACT FROM AUTHOR]

Purpose: Out-of-pocket expenses associated with facility-based deliveries are a well-known barrier to health care access. However, there is extremely limited contemporary information on delivery-related household out-of-pocket expenditure in sub-Saharan Africa. We assess the financial burden of delivery for the most remote Zambian women and compare differences between delivery locations (primary health center, hospital, or home). Methods: We conducted household surveys and in-depth interviews among randomly selected remote Zambian women who delivered a baby within the last 13 months. Women reported expenditures for their most-recent delivery for delivery supplies, transportation, and baby clothes, among others. Expenditures were converted to US dollars for analysis. Results: Of 2280 women sampled, 2223 (97.5%) reported spending money on their delivery. Nearly all respondents in the sample (95.9%) spent money on baby clothes/blanket, while over 80% purchased delivery supplies such as disinfectant or cord clamps, and a third spent on transportation. Women reported spending a mean of USD28.76 on their delivery, with baby clothes/blanket (USD21.46) being the main expenditure and delivery supplies (USD3.81) making up much of the remainder. Compared to women who delivered at home, women who delivered at a primary health center spent nearly USD4 (p<0.001) more for their delivery, while women who delivered at a level 1 or level 2 hospital spent over USD7.50 (p<0.001) more for delivery. Conclusion: These expenses account for approximately one third of the monthly household income of the poorest Zambian households. While the abolition of user fees has reduced the direct costs of delivering at a health facility for the poorest members of society, remote Zambian women still face high out-of-pocket expenses in the form of delivery supplies that facilities should provide as well as unofficial policies/norms requiring women to bring new baby clothes/blanket to a facility-based delivery. Future programs that target these expenses may increase access to facility-based delivery. [ABSTRACT FROM AUTHOR]

Introduction: Hypertension is among the first five causes of mortality, globally contributing more than 40% to cardiac related deaths worldwide, with almost 70% cardiovascular deaths in the low- and middle-income countries. Its burden is projected to be 150 million by 2025 based on epidemiological data within the Sub-Saharan Africa regions, with Ghana experiencing 505,180 increases in 2007. It is currently among the leading cause of death in the country, with prevalence ranging from 19% to 48%. There is limited data concerning hypertension on Ghanaian youth. Particularly, on those at the Senior High School (SHS) level that represents the immediate workforce of the country on the depth of prevalence, knowledge as well as the risk factors that may predispose them into having prehypertension and hypertension for proper records and interventional measures and that is what this study pursues to do. Materials and methods: A cross-sectional study was employed in five different SHSs in the Ashanti region of Ghana from December 2018 to February 2019 with structured questionnaires and physical screening of participants. Logistic regression analysis was performed to test for relation knowledge and riskfactors on HTN. Results: The overall prevalence of pre-HTN within the group was 33.8%, with stages 1 and 2 HTN prevalence of 5.4%. Sixty-three percent do not have an idea of what HTN is, and positive associations were found between no physical exercises, no addition of extra salt, type of food often eaten and family history. Conclusion: This study establishes prevalence in pre-HTN within students at the SHS level with low knowledge and high risk factors on the disease. This indication is beneficial to target the interventional programs on this population at this early stage by inculcating education on HTN prevalence and its risks in the educational curricular by the government. [ABSTRACT FROM AUTHOR]

Cesarean section (CS) is the most common operative procedure performed in sub-Saharan Africa (SSA), accounting for as much as 80% of the surgical workload. In contrast to CSs performed in high-income countries, CSs performed in SSA are accompanied by high morbidity and mortality rates. This operation is the most important known variable associated with an increased probability of postpartum bacterial infection. The objective of this review was to assess surgical outcomes related to CS in SSA. PubMed (including Medline), CINAHL, Embase, and the World Health Organization's Global Health Library were searched without date or language restrictions. A total of 26 studies reporting surgical site–infection rates after CS were identified, representing 14,063 women from 14 countries. The vast majority (76.7%) of CSs performed were emergency operations. The overall CS rate for women included in this review was 12.4% (range: 1.0%–41.9%). Only 17 of 26 total studies reported a significant proportion of women receiving antimicrobials of any kind. The surgical site–infection rate was 15.6% and the wound-infection rate 10.3%. [ABSTRACT FROM AUTHOR]