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61. Undernutrition increased the risk of loss to follow-up among adults living with HIV on ART in Northwest Ethiopia: a retrospective cohort study.

Author

Alebel, A, Sibbritt, D, Petrucka, P, Demant, D, Alebel, A, Sibbritt, D, Petrucka, P, and Demant, D

Abstract

This study aims to examine the effect of undernutrition on loss to follow-up (LTFU) in adults living with human immunodeficiency virus (HIV) receiving antiretroviral therapy (ART) in Ethiopia. We conducted an institution-based retrospective cohort study using medical records of 844 adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital (Northwest Ethiopia). The effect of undernutrition on LTFU was examined using a proportional hazards regression model after adjusting potential confounders. The significance level was set at p < 0.05. At the end of the study period, 109 (12.9%) participants were considered LTFU, with an overall LTFU incidence of 5.3 per 100 person-years (95% CI 4.4, 6.4). The incidence of LTFU was higher in undernourished participants (8.2 per 100 person-years) compared to well-nourished participants (4.3 per 100 person-years). After adjusting for potential confounders, the adjusted risk of LTFU among undernourished participants was two times higher than in their well-nourished counterparts (AHR [adjusted hazard ratio]: 2.1, 95% CI 1.4, 3.2). This study found that undernutrition significantly increased the risk of LTFU among adults living with HIV on ART.

Published
2022

62. Effects of undernutrition on opportunistic infections among adults living with HIV on ART in Northwest Ethiopia: Using inverse-probability weighting

Author

Alebel, A, Demant, D, Petrucka, P, Sibbritt, D, Alebel, A, Demant, D, Petrucka, P, and Sibbritt, D

Abstract

Background Opportunistic infections (OIs) are the leading causes of hospitalization, morbidity, and mortality (accounting for 94.1% of all deaths) in people living with human immunodeficiency virus (PLHIV). Despite evidence suggested that undernutrition significantly increases the risk of OIs in PLHIV, to our knowledge, no study has examined the actual effects of undernutrition on OIs in this population, particularly in low-income countries. Thus, this study examined the effects of undernutrition on OIs in adults living with HIV receiving antiretroviral therapy (ART). Methods We conducted a retrospective cohort study among 841adults living with HIV receiving ART between June 2014 and June 2020 at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. Study participants were selected using a simple random sampling technique. Data from participants’ medical records were extracted using a project-specific data extraction checklist. The Kaplan Meier survival curve estimated the OIs free survival time. The effects of undernutrition on time to develop OIs was estimated using inverse-probability weighting. Finally, regression coefficients with 95% confidence intervals (95% CIs) were reported, with a statistical significance of p < 0.05. Results Of 841 study participants, 262 (31.2%) developed OIs, and the overall incidence rate was 16.7 (95% CI: 14.8, 18.8) per 100 person-years. The incWidence of OIs in undernourished participants (21/100 person-years, 95% CI: 17.8, 27.4) was higher than well-nourished participants (15.0/100 person-years, 95% CI: 12.9, 17.4). When everyone in the population of interest is well-nourished, average time to develop OIs is estimated as 26.5 (coefficient: 26.5, 95% CI: 20.6, 32.4, p < 0.001) months. When everyone in the

Published
2022

63. Association Between Body Mass Index Variation and Early Mortality Among 834 Ethiopian Adults Living with HIV on ART: A Joint Modelling Approach.

Author

Alebel, A, Sibbritt, D, Petrucka, P, Demant, D, Alebel, A, Sibbritt, D, Petrucka, P, and Demant, D

Abstract

INTRODUCTION: Body mass index (BMI) is a simple and cost-effective tool for monitoring the clinical responses of patients living with human immunodeficiency virus (HIV) after antiretroviral therapy (ART) initiation, especially in resource-limited settings where access to laboratory tests are limited. Current evidence on the association between longitudinal BMI variation and clinical outcomes among adults living with HIV receiving ART is essential to inform clinical guidelines. Therefore, this study examines the association between BMI variation and premature mortality in adults living with HIV on ART. METHODS: An institution-based retrospective cohort study was conducted among 834 adults living with HIV receiving ART from June 2014 to June 2020 at Debre Markos Comprehensive Specialized Hospital in Northwest Ethiopia. We first identified predictors of mortality and BMI variation using proportional hazards regression and linear mixed models, respectively. Then, the two models were combined to form an advanced joint model to examine the effect of longitudinal BMI variation on mortality. RESULTS: Of the 834 participants, 49 (5.9%) died, with a mortality rate of 4.1 (95% CI 3.1, 5.4) per 100 person-years. A unit increase in BMI after ART initiation corresponded to an 18% reduction in mortality risk. Patients taking tuberculosis preventive therapy (TPT), mild clinical disease stage, and changing ART regimens were at lower risk of death. However, patients with ambulatory/bedridden functional status were at higher risk of death. Regarding BMI variation over time, patients presenting with opportunistic infections (OIs), underweight patients, patients who started a Dolutegravir (DGT)-based ART regimen, and those with severe immunodeficiency had a higher BMI increase over time. However, patients from rural areas and overweight/obese patients experienced a lower BMI increase over time. CONCLUSION: BMI improvement after ART initiation was strongly associated with a lower mortali

Published
2022

65. Awareness and screening practices for gestational diabetes mellitus among pregnant women in Arusha Urban, Tanzania

Author

Msollo, S.S., Martin, H.D., Mwanri, A.W., and Petrucka, P.

Subjects
Gestational diabetes mellitus, awareness, Screening, pregnant women, Tanzania
Abstract

Awareness is an important aspect for seeking self-prevention, diagnosis, and management of gestational diabetes mellitus. This study aimed to assess awareness and history of screening practices for gestational diabetes mellitus among pregnant women in Arusha Urban District of Arusha City Council, Tanzania. A cross-sectional study was conducted in 2018, among 468 randomly selected pregnant women attending antenatal clinics at Ngarenaro and Kaloleni Health Centers in urban areas of Arusha District. Data collection was done through face-to-face interviews using a structured questionnaire and analyzed using SPSSTM version 20. Almost 60% of the participants completed primary school and were self-employed (55.8%) basically in small business. Few women were aware of the existence of gestational diabetes mellitus (10.7%). Among the aware women, 36, 23, 26 and 30% knew the meaning, effects, symptoms and risk factors for gestational diabetes mellitus respectively. Twelve (24%) of these women, obtained this information from the antenatal clinic while 38(76%) from different media. Awareness was positively associated with post-secondary (AOR 13.7, 95% CI: 4.07-46.15) and secondary education levels (AOR 5.5, 95% CI: 1.78-16.76). About 8.2% of the women were screened for gestational diabetes mellitus in their previous pregnancy in urine whereby 13.2% reported to have high urine glucose and provided with nutrition counselling without further follow up from the antenatal care. Therefore, awareness and screening practices for gestational diabetes mellitus are insufficient in the study area which may be attributed to low prioritization and limited resources.

Published
2021

66. Spirituality and COVID-19 pandemic: A qualitative inquiry of real time experiences in Pakistan

Author

Barolia, Rubina, Ajani, Khairulnissa, Iqbal, Sajid, Abdullah, Muhammad, Danish, Sumera, Sajjad, Sehrish, Gowani, Ambreen, Barolia, Mehak, and Petrucka, Pammla

Abstract

ABSTRACTMany individuals are now reflecting on spirituality and religiosity being essential parts of their life that helped them cope and overcome the fears associated with COVID-19 during the quarantine period. Although medical interventions remained vital in managing the COVID-19 outbreak, little attention was given to the contributions of spirituality as a personal coping mechanism in South Asian culture. Through a qualitative descriptive exploratory approach, we explored the roles which spirituality and faith played in lives of COVID-19 patients and their families during the quarantine period in Karachi, Pakistan. Twenty-two dyads of COVID-19 patients and their family members were purposively selected and interviewed via telephone or Zoom. Quarantine was a reflective opportunity to focus on one’s inner-self and make spiritual connection or re-connection with God. Participants felt the pandemic reminded them that humanity must come closer, act as one household, and extend help to each other. However, there were conflicting views regarding the impacts of spirituality and religiosity during the restrictions and quarantine period.

Published
2023
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67. Are 20th-Century Methods of Teaching Applicable in the 21st Century?

Author

Bassendowski, Sandra Leigh and Petrucka, Pammla

Abstract

The image of students passively absorbing information from an educator who is lecturing from behind a podium does not reflect the current scope and dimension of higher education. There are now tools of technology that can be used to create learning experiences to actively and meaningfully "pull" students into course content. The author started to think about the idea of push-pull whereby in the past, educators (the experts) usually passed the information from them to the students (push). Today, the literature is replete with articles about the need for collaboration, cooperation, communities of learners and engagement with students (pull). Education has garnered the same attention as the arts to "open up" over the years and allow exploration of the history and possibilities through the wide array of media and technology that is available to transform ideas, processes, and strategies. Pull approaches are exemplified by constructivist and connectivist approaches, which are cocreated by students as in virtual and socially shared spaces. In educational contexts, pull models view students as active participants in the sharing of their learning by working alongside the educators in both traditional, online settings, and blended environments. The delivery of information ("push"), along with student-centered activities ("pull"), enhances collaborative learning experiences and the positive effects of shared learning spaces. In these types of learning spaces, students can communicate their thoughts and feelings with others in a safe environment and explore different aspects of expected learning outcomes. The theory of "push and pull" from the art world influences contemporary thinking about teaching and learning in current contexts. The theory can be used to explore current educational pedagogy and support an adapted model of teaching. A wide array of media and technology is available to create new hybrid forms of teaching.The integration of technology enables educators to create learning experiences that actively and meaningfully "pull" students into course content. (Contains 1 figure.)

Published
2013
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69. Incidence and predictors of surgical site infection following cesarean section in North-west Ethiopia: a prospective cohort study

Author

Ketema, DB, Wagnew, F, Assemie, MA, Ferede, A, Alamneh, AA, Leshargie, CT, Kibret, GD, Petrucka, P, Telayneh, AT, and Alebel, A

Subjects
Adult, Adolescent, Cesarean Section, Incidence, Middle Aged, Microbiology, Young Adult, Risk Factors, Pregnancy, Surveys and Questionnaires, Humans, Surgical Wound Infection, Female, Prospective Studies, Ethiopia, Referral and Consultation, 0605 Microbiology, 1103 Clinical Sciences, 1108 Medical Microbiology, Proportional Hazards Models
Abstract

BackgroundFollowing delivery by caesarean section, surgical site infection is the most common infectious complication. Despite a large number of caesarean sections performed at Debre Markos Referral Hospital, there was no study documenting the incidence of surgical site infection after caesarean section. Therefore, this study aimed to estimate the incidence of surgical site infection following caesarean section at Debre-Markos Referral Hospital in Amhara region, North-west Ethiopia.MethodsA prospective cohort study was conducted among 520 pregnant women who had a caesarean section between March 28, 2019 and August 31, 2019. Preoperative, intraoperative, and postoperative data were collected using a standardized questionnaire. Data was entered using EpiData™ Entry Version 4.1 software and analyzed using R Version 3.6.1 software. A descriptive analysis was conducted using tables, interquartile ranges and median. The time to development of surgical site infection was estimated using Kaplan-Meier method. The Cox regression model for bivariable and multivariable analyses was done. Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to show the strength of association.ResultThe mean age of the study cohort was 27.4 ± 4.8 years. The overall cumulative incidence of surgical site infection was 25.4% with an incidence of 11.7 (95% CI:9.8,13.9) per 1000 person/days. Not able to read and write (AHR = 1.30,95% CI:1.19,2.11), no antenatal care (AHR = 2.16, 95%CI:1.05,4.53), previous history of CS (AHR = 1.21, 95% CI:1.11,2.31), HIV positive (AHR = 1.39, 95% CI:1.21,2.57), emergency procedure (AHR = 1.13, 95% CI:1.11,2.43), vertical type of incision (AHR = 2.60, 95% CI:1.05,6.44), rupture of membrane (AHR = 1.50, 95% CI:1.31,1.64), multiple vaginal examination (AHR = 1.88, 95% CI: 1.71, 3.20) were significant predictors of surgical site infection in this study.ConclusionThis study concluded that the incidence of surgical site infection following caesarean section was relatively high compared to previous studies. Not able to read and write, have no ante natal care, previous history of caesarean section, HIV, emergency surgery, vertical type of incision, rupture of membranes before caesarean section, and multiple vaginal examinations were significant predictors of surgical site infection in this study. Therefore, intervention programs should focus on and address the identified factors to minimize and prevent the infection rate after caesarean section.

Published
2020

70. Time to sputum culture conversion and its associated factors among multidrug-resistant tuberculosis patients in Eastern Africa: A systematic review and meta-analysis

Author

Assemie, MA, Alene, M, Petrucka, P, Leshargie, CT, and Ketema, DB

Subjects
Adult, Male, Antitubercular Agents, Sputum, Mycobacterium tuberculosis, Africa, Eastern, Microbiology, Young Adult, Treatment Outcome, Tuberculosis, Multidrug-Resistant, 0605 Microbiology, 1108 Medical Microbiology, 1117 Public Health and Health Services, Humans, Female, Data Management
Abstract

ObjectiveThis study aimed to consider the estimated time to multi-resistant tuberculosis culture conversion, and associated factors, in order to enhance evidence utilization in eastern Africa.MethodsWe systematically identified available articles on multidrug-resistant tuberculosis culture conversion using PubMed, Scopus, Cochrane Library, Web of Science core collection, and Science Direct databases. A random-effects model was employed using the R 3.6.1 version and Stata/se 14 software.ResultsNine articles with a sample size of 2458 multidrug-resistant tuberculosis patients were included. The two-month culture conversion rate was 75.4%, with a median time of 61.2 days (interquartile range: 48.6-73.8). In the included studies, favorable treatment outcomes of MDR-TB patients were seen in 75% of the cases, while unfavorable treatment outcomes were seen in 18% (10% deaths, 7% defaulted, and 1% treatment failure) of the cases. The independent factor for delayed sputum culture conversion was body mass index below 18.5kg/m2 (HR=3.1, 95% CI: 2.0, 6.7).ConclusionThe median time to sputum culture conversion was 61.2 days, which is a reasonably short time. Body mass index was the identified associated factor leading to delayed culture conversion. Therefore, there is a need for awareness of how to improve the nutritional status of multidrug-resistant tuberculosis patients through appropriate nutritional supports.

Published
2020

71. Neonatal mortality in the neonatal intensive care unit of Debre Markos referral hospital, Northwest Ethiopia: a prospective cohort study

Author

Alebel, A, Wagnew, F, Petrucka, P, Tesema, C, Moges, NA, Ketema, DB, Yismaw, L, Melkamu, MW, Hibstie, YT, Temesgen, B, Bitew, ZW, Tadesse, AA, and Kibret, GD

Subjects
Male, Cesarean Section, Infant, Newborn, Infant, Pediatrics, Hospitals, Cohort Studies, Pregnancy, Risk Factors, Intensive Care Units, Neonatal, Infant Mortality, 1114 Paediatrics and Reproductive Medicine, Humans, Female, Ethiopia, Prospective Studies, Referral and Consultation, Retrospective Studies
Abstract

BackgroundNeonatal mortality remains a serious global public health problem, but Sub-Saharan Africa (SSA), in particular, is largely affected. Current evidence on neonatal mortality is essential to inform programs and policies, yet there is a scarcity of information concerning neonatal mortality in our study area. Therefore, we conducted this prospective cohort study to determine the incidence and predictors of neonatal mortality at Debre Markos Referral Hospital, Northwest Ethiopia.MethodsThis institutionally-based prospective cohort study was undertaken among 513 neonates admitted to the neonatal intensive care unit of Debre Markos Referral Hospital between December 1st, 2017 and May 30th, 2018. All newborns consecutively admitted to the neonatal intensive care unit during the study period were included. An interviewer administered a questionnaire with the respective mothers. Data were entered using Epi-data™ Version 3.1 and analyzed using STATA™ Version 14. The neonatal survival time was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables were compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of neonatal mortality.ResultsAmong a cohort of 513 neonates at Debre Markos Referral Hospital, 109 (21.3%) died during the follow-up time. The overall neonatal mortality rate was 25.8 deaths per 1, 000 neonate-days (95% CI: 21.4, 31.1). In this study, most (83.5%) of the neonatal deaths occurred in the early phase of neonatal period (ConclusionIn this study, we found a high rate of early neonatal mortality. Factors significantly linked with increased risk of neonatal mortality included: unemployed mothers, not attending ANC, not initiating exclusive breastfeeding, neonates admitted due to respiratory distress syndrome, and first minute Apgar score classified as severe.

Published
2020

72. Does undernutrition increase the risk of lost to follow-up in adults living with HIV in sub-Saharan Africa? Protocol for a systematic review and meta-analysis.

Author

Alebel, A, Demant, D, Petrucka, P, Sibbritt, D, Alebel, A, Demant, D, Petrucka, P, and Sibbritt, D

Abstract

INTRODUCTION:Undernutrition is considered a marker for poor prognosis among people living with HIV (PLHIV), particularly in sub-Saharan Africa (SSA), where undernutrition and HIV are both highly prevalent. Evidence suggests that undernutrition (body mass index <18.5 kg/m2) is one of the main factors that significantly increases the risk of lost to follow-up (LTFU) in PLHIV. However, primary studies in SSA have reported inconsistent findings on the relationship between undernutrition and LTFU among adults living with HIV. To the best of our knowledge, no systematic review which aimed to summarise the available evidence. Hence, this review aims to determine the pooled effect of undernutrition on LTFU among adults living with HIV in SSA. METHODS AND ANALYSIS:PubMed, EMBASE, Web of Science, Scopus, and, for grey literature, Google Scholar will be systematically searched to include relevant articles published since 2005. Studies reporting the effect of undernutrition on LTFU in adults living with HIV in SSA will be included. The Newcastle-Ottawa Scale will be used for quality assessment. Data from eligible studies will be extracted using a standardised data extraction tool. Heterogeneity between included studies will be assessed using Cochrane Q-test and I2 statistics. The Egger's and Begg's tests at a 5% significance level will be used to evaluate publication bias. As heterogeneity is anticipated, the pooled effect size will be estimated using a random-effects model. The final effect size will be reported using the adjusted HR with a 95% CI. ETHICS AND DISSEMINATION:Ethical approval is not required for a protocol for a systematic review. The results of this systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER:CRD42021277741.

Published
2021

73. Effects of undernutrition on mortality and morbidity among adults living with HIV in sub-Saharan Africa: a systematic review and meta-analysis.

Author

Alebel, A, Demant, D, Petrucka, P, Sibbritt, D, Alebel, A, Demant, D, Petrucka, P, and Sibbritt, D

Abstract

Background

Undernutrition is one of the most common problems among people living with HIV, contributing to premature death and the development of comorbidities within this population. In Sub-Saharan Africa (SSA), the impacts of these often inter-related conditions appear in a series of fragmented and inconclusive studies. Thus, this review examines the pooled effects of undernutrition on mortality and morbidities among adults living with HIV in SSA.

Methods

A systematic literature search was conducted from PubMed, EMBASE, CINAHL, and Scopus databases. All observational studies reporting the effects of undernutrition on mortality and morbidity among adults living with HIV in SSA were included. Heterogeneity between the included studies was assessed using the Cochrane Q-test and I2 statistics. Publication bias was assessed using Egger's and Begg's tests at a 5% significance level. Finally, a random-effects meta-analysis model was employed to estimate the overall adjusted hazard ratio.

Results

Of 4309 identified studies, 53 articles met the inclusion criteria and were included in this review. Of these, 40 studies were available for the meta-analysis. A meta-analysis of 23 cohort studies indicated that undernutrition significantly (AHR: 2.1, 95% CI: 1.8, 2.4) increased the risk of mortality among adults living with HIV, while severely undernourished adults living with HIV were at higher risk of death (AHR: 2.3, 95% CI: 1.9, 2.8) as compared to mildly undernourished adults living with HIV. Furthermore, the pooled estimates of ten cohort studies revealed that undernutrition significantly increased the risk of developing tuberculosis (AHR: 2.1, 95% CI: 1.6, 2.7) among adults living with HIV.

Conclusion

This review found that undernutrition has significant effects on mortality and morbidity among adults living with HIV. As the degree of undernutrition became more severe, mortality rate also increased. Therefore, findings from this rev

Published
2021

74. Undernutrition among Ethiopian adults living with HIV: a meta-analysis

Author

Alebel, A, Kibret, GD, Petrucka, P, Tesema, C, Moges, NA, Wagnew, F, Asmare, G, Kumera, G, Bitew, ZW, Ketema, DB, Tiruneh, T, Melkamu, MW, Hibstie, YT, Temesgen, B, and Eshetie, S

Abstract

BackgroundMalnutrition and human immunodeficiency virus (HIV) are interlaced in a vicious cycle and worsened in low and middle-income countries. In Ethiopia, even though individuals are dually affected by both malnutrition and HIV, there is no a nationwide study showing the proportion of malnutrition among HIV-positive adults. Consequently, this review addressed the pooled burden of undernutrition among HIV-positive adults in Ethiopia.MethodsWe searched for potentially relevant studies through manual and electronic searches. An electronic search was carried out using the database of PubMed, Google Scholar, and Google for gray literature and reference lists of previous studies. A standardized data extraction checklist was used to extract the data from each original study. STATA Version 13 statistical software was used for our analysis. Descriptive summaries were presented in tables, and the quantitative result was presented in a forest plot. Heterogeneity within the included studies was examined using the Cochrane Q test statistics and I 2 test. Finally, a random-effects meta-analysis model was computed to estimate the pooled proportion of undernutrition among HIV-positive adults.ResultsAfter reviewing 418 studies, 15 studies met the inclusion criteria and were included in the meta-analysis. Findings from 15 studies revealed that the pooled percentage of undernutrition among HIV-positive adults in Ethiopia was 26% (95% CI: 22, 30%). The highest percentage of undernutrition (46.8%) was reported from Jimma University specialized hospital, whereas the lowest proportion of undernutrition (12.3%) was reported from Dilla Hospital. The subgroup analyses of this study also indicated that the percentage of undernourishment among HIV-positive adults is slightly higher in the Northern and Central parts of Ethiopia (27.5%) as compared to the Southern parts of Ethiopia (25%).ConclusionThis study noted that undernutrition among HIV-positive adults in Ethiopia was quite common. This study also revealed that undernutrition is more common among HIV-positive adults with advanced disease stage, anemia, diarrhea, CD4 count less than 200 cells/mm3, and living in rural areas. Based on our findings, we suggested that all HIV-positive adults should be assessed for nutritional status at the time of ART commencement.

Published
2020

75. Incidence of common opportunistic infections among HIV-infected children on ART at Debre Markos referral hospital, Northwest Ethiopia: a retrospective cohort study.

Author

Melkamu, MW, Gebeyehu, MT, Afenigus, AD, Hibstie, YT, Temesgen, B, Petrucka, P, Alebel, A, Melkamu, MW, Gebeyehu, MT, Afenigus, AD, Hibstie, YT, Temesgen, B, Petrucka, P, and Alebel, A

Abstract

BACKGROUND:Opportunistic infections (OIs) are the leading cause of morbidity and mortality among children living with human immunodeficiency virus (HIV). For better treatments and interventions, current and up-to-date information concerning occurrence of opportunistic infections in HIV-infected children is crucial. However, studies regarding the incidence of common opportunistic infections in HIV-infected children in Ethiopia are very limited. Hence, this study aimed to determine the incidence of opportunistic infections among HIV-infected children on antiretroviral therapy (ART) at Debre Markos Referral Hospital. METHODS:A facility-based retrospective cohort study was undertaken at Debre Markos Referral Hospital for the period of January 1, 2005 to March 31, 2019. A total of 408 HIV-infected children receiving ART were included. Data from HIV-infected children charts were extracted using a data extraction form adapted from ART entry and follow-up forms. Data were entered using Epi-data™ Version 3.1 and analyzed using Stata™ Version 14. The Kaplan Meier survival curve was used to estimate the opportunistic infections free survival time. Both bi-variable and multivariable Cox proportional hazard models were fitted to identify the predictors of opportunistic infections. RESULTS:This study included the records of 408 HIV-infected children-initiated ART between the periods of January 1, 2005 to March 31, 2019. The overall incidence rate of opportunistic infections during the follow-up time was 9.7 (95% CI: 8.13, 11.48) per 100 child-years of observation. Tuberculosis at 29.8% was the most commonly encountered OI at follow-up. Children presenting with advanced disease stage (III and IV) (AHR: 1.8, 95% CI: 1.2, 2.7), having "fair" or "poor" ART adherence (AHR: 2.6, 95% CI: 1.8, 3.8), not taking OI prophylaxis (AHR:1.6, 95% CI: 1.1, 2.4), and CD4 count or % below the threshold (AHR:1.7, 95% CI: 1.1, 2.6) were at a higher risk of developing opportunistic infections. CONCLUS

Published
2020

76. Mortality rate among HIV-positive children on ART in Northwest Ethiopia: a historical cohort study.

Author

Alebel, A, Engeda, EH, Kelkay, MM, Petrucka, P, Kibret, GD, Wagnew, F, Asmare, G, Bitew, ZW, Ketema, DB, Gedif, G, Temesgen, B, Hibstie, YT, Melkamu, MW, Eshetie, S, Alebel, A, Engeda, EH, Kelkay, MM, Petrucka, P, Kibret, GD, Wagnew, F, Asmare, G, Bitew, ZW, Ketema, DB, Gedif, G, Temesgen, B, Hibstie, YT, Melkamu, MW, and Eshetie, S

Abstract

Background

Though highly active antiretroviral therapy (HAART) has been available for more than a decade in Ethiopia, information regarding mortality rates of human immunodeficiency virus (HIV)-positive children after antiretroviral therapy antiretroviral therapy (ART) initiation is very scarce. Thus, this study intends to determine the predictors of mortality among HIV-positive children receiving ART in Amhara Region.

Methods

A multicenter facility-based historical cohort study was conducted in 538 HIV-positive children on ART from January 2012 to February 2017. We employed a standardized data extraction tool, adapted from ART entry and follow-up forms. Descriptive analyses were summarized using the Kaplan-Meier survival curve and log rank test. Then, the Cox-proportional hazard regression model was employed to estimate the hazard of death up to five-years after ART initiation. Variables with p-values ≤0.25 in bivariable analysis were candidates to the multivariable analysis. Finally, variables with p-values < 0.05 were considered as significant variables.

Results

The cohort contributed a total follow-up time of 14,600 child-months, with an overall mortality rate of 3.2 (95% CI: 2.3, 4.3) per 100 child-years. This study also indicated that HIV-infected children presenting with opportunistic infections (OIs) (AHR: 2.5, 95% CI: 1.04, 5.9), anemia (AHR: 3.1, 95% CI: 1.4, 6.7), severe immunodeficiency (AHR: 4.4, 95% CI: 1.7, 11.7), severe stunting (AHR: 3.3, 95% CI: 1.4, 8.0), severe wasting (AHR: 3.1, 95% CI: 1.3, 7.3), and advanced disease staging (III and IV) (AHR: 3.0, 95% CI: 1.2, 7.1) were at higher risk of mortality.

Conclusion

A higher rate of mortality was observed in our study as compared to previous Ethiopian studies. HIV-positive children presenting with anemia, OIs, severe immunodeficiency, advanced disease staging (III and IV), severe stunting, and severe wasting were at higher risk of mortality.

Published
2020

77. Effects of maternal education on birth preparedness and complication readiness among Ethiopian pregnant women: a systematic review and meta-analysis.

Author

Ketema, DB, Leshargie, CT, Kibret, GD, Assemie, MA, Petrucka, P, Alebel, A, Ketema, DB, Leshargie, CT, Kibret, GD, Assemie, MA, Petrucka, P, and Alebel, A

Abstract

Background

Birth preparedness and complication readiness are broadly endorsed by governments and international agencies to reduce maternal and neonatal health threats in low income countries. Maternal education is broadly positioned to positively affect the mother's and her children's health and nutrition in low income countries. Thus, this systematic review and meta-analysis aims to estimate the effect of maternal education on birth preparedness and complication readiness.

Methods

This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We conducted an electronic based search using data bases of PubMed /MEDLINE, Science direct and google scholar. STATA™ Version 14.1 was used to analyze the data, and forest plots were used to present the findings. I2 test statistics and Egger's test were used to assess heterogeneity and publication bias. Pooled prevalence and pooled odd ratios with 95% confidence intervals were computed. Finally, Duval and Tweedie's nonparametric trim and fill analysis using random-effects meta-analysis was conducted to account for publication bias.

Results

In this meta-analysis, 20 studies involving 13,744 pregnant women meeting the inclusion criteria were included, of which 15 studies reported effects of maternal education on birth preparedness and complication readiness. Overall estimated level of birth preparedness and complication readiness was 25.2% (95% CI 20.0, 30.6%). This meta-analysis found that maternal education and level of birth preparedness and complication readiness were positively associated. Pregnant mothers whose level of education was primary and above were more likely to prepare for birth and obstetric emergencies (OR = 2.4, 95% CI: 1.9, 3.1) than non-educated mothers.

Conclusion

In Ethiopia, the proportion of women prepared for birth and related complications remained low. Maternal education has a positive effect on the level of birth

Published
2020

78. Antiseizure medication nonadherence and its associated factors among Epileptic patients in Ethiopia, a systematic review and meta-analysis.

Author

Amha, Haile, Memiah, Peter, Getnet, Asmamaw, Mengist, Belayneh, Gedfew, Mihretie, Ayenew, Temesgen, Akalu, Tadesse Yirga, Mulugeta, Henok, Bewket, Bekalu, Kebede, Bekalu, and Petrucka, Pammla

Abstract

Background: The majority of patients with epilepsy in resource-poor countries never receive proper treatment, and those who are started on anti-seizure medications quickly discontinue them. Medication noncompliance is extremely common, with estimates ranging from 26 to 79 percent. Non-adherence to antiseizure medications is associated with poor seizure control, increased morbidity, increased hospitalization time, poor quality of life, increased health care costs, and increased mortality in adults.Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 guideline was used for this systematic review and meta-analysis. The databases Pub Med, Cochrane Library, Scopus Online, and Google Scholar were all searched. STATA™ version 11 software was used for the meta-analysis. The I2 test and Egger's tests were used to assess heterogeneity and publication bias. The random-effects method was used to estimate the pooled adherence level with a 95 percent confidence interval.Results: This meta-analysis included twelve Ethiopian studies involving a total of 3416 epileptic patients. The national pooled prevalence of antiseizure medication non-adherence was 41.96%. Patients who paid for their medications, took them for more than a year, had co-morbidity, and felt stigmatized were more likely to be non-adherent than their counterparts.Conclusion: According to this systematic review and meta-analysis, more than two out of every five epileptic patients did not take their antiseizure medications as prescribed. Clinicians must educate epileptic patients about the importance of medication adherence.Systematic Review Registration: The review has been registered on an International Prospective Register of Systematic Review with registration number CRD42019142905. [ABSTRACT FROM AUTHOR]

Published
2021
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80. Glycated hemoglobin A1C level and the risk of diabetic retinopathy in Africa: A systematic review and meta-analysis.

Author

Shiferaw, Wondimeneh Shibabaw, Akalu, Tadesse Yirga, Desta, Melaku, Kassie, Ayelign Mengesha, Petrucka, Pammla Margaret, Assefa, Hilina Ketema, and Aynalem, Yared Asmare

Abstract

Diabetic retinopathy is a frequent cause of acquired blindness worldwide. Various studies have reported the effects of glycemic control on the risk of diabetic retinopathy, but the results remain inconclusive. Therefore, this meta-analysis was performed to determine the association between glycated hemoglobin A1C levels and diabetic retinopathy in Africa. A systematic search was performed using the PubMed, African Journals Online, Google Scholar, Scopus, and Wiley Online Library from inception to June 11, 2020, for observational studies addressing the association of hemoglobin A1c levels with diabetic retinopathy. The I2 statistic was used to check heterogeneity across the included studies. A random-effects model was applied to estimate the pooled effect size (OR) and respective 95% confidence interval across studies. A funnel plot and Egger's regression test were used to determine the presence of publication bias. Sensitivity analysis was used to determine the effect of a single study on the overall estimation. All statistical analyses were performed using STATA™ Version 14 software. A total of 23 articles with 18,099 study participants were included in this meta-analysis. In the present review, when HbA1c was analyzed as a categorical variable, poor glycemic control (HbA1c >7%) was associated with an increased risk of diabetic retinopathy when compared with good glycemic control (OR = 1.25; 95% CI; 1.14, 1.38). Similarly, when HbA1c was analyzed as a continuous variable, a higher HbA1c was associated with an increased risk of diabetic retinopathy (MD: 0.42, 95% CI; 0.11, 0.98). Our meta-analysis indicated evidence for poor glycemic control as an independent risk factor for the development of diabetic retinopathy in patients with diabetes mellitus. Therefore, the authors suggest that clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range. • Poor glycemic control (HbA1c >7%) is associated with an increased risk of diabetic retinopathy. • The pooled odds ratio of 12 cross-sectional studies and 4 cohort studies showed an increased risk of DR. • Clinicians should advise their patients with diabetes to maintain their HbA1c levels within the normal range. [ABSTRACT FROM AUTHOR]

Published
2020
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83. The COVID-19 pandemic: a catalyst for creativity and collaboration for online learning and work-based higher education systems and processes

Author

Khamis, Tashmin, Naseem, Azra, Khamis, Anil, and Petrucka, Pammla

Abstract

Purpose: The purpose of this research is to focus on work-based problems catalysed by the COVID-19 global pandemic, based on a case study of a multi-continental, multi-campus university distributed across Kenya, Tanzania, Uganda and Pakistan. Higher education institutions (HEIs) in developing countries lacked pre-existing infrastructure to support online education and/or policy and regulatory frameworks during the pandemic. The university's programmes in Pakistan and East Africa provide lessons to other developing countries' HEIs. The university's focus on teaching and learning and staff development has had a transformational organisational effect. Design/methodology/approach: Case study with participatory approaches aimed at co-production of responsive systems and co-creation of effective curriculum and faculty training is used. Findings: Systems and processes developed across the university in the effort to ensure educational continuity. From the disruption to all educational programmes and the disarray of regulatory bodies' responses, collaboration emerged as a key driver of positive change. The findings reiterate the value of trust and provision of opportunities for those with the requisite competencies to lead in a participatory and distributive manner whilst addressing limited human and financial resources. The findings reflect on previous work respecting organisational change recast in the digital age. Originality/value: This paper reflects the authors' work in real-time as they led and managed changes encountered during the COVID-19 pandemic. The paper will be of value to management and leadership cadres, particularly in developing contexts, responsible for recovery and sustainability of the higher education sector.

Published
2021
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87. Scanning resources to build an international nursing knowledge network

Author

Zanchetta, Margareth Santos, Fredericks, Suzanne, Metersky, Kateryna, Martorella, Geraldine, Petrucka, Pammla, Clune, Laurie, Vedana, Kelly Graziani Giacchero, Baixinho, Cristina Rosa Soares Lavareda, Rocha, Cristianne Maria Famer, Campagna, Sara, He, Sally Zhang, Gouveia, Márcia Teles de Oliveira, Medeiros, Marcelo, Munari, Denize Bouttelet, Albarracin, Daniel Gonzalo Eslava, Aguilera-Serrano, Carlos, and Santos, Walterlânia Silva

Abstract

This paper reports the gathered information from an international environmental scan of university-baseline information for the creation of a Nursing Knowledge Network. An online environment scan of organizational context (February to October 2021) explored the identification of research areas, existing resources, expected benefits, innovations in teaching research, barriers to knowledge dissemination, and prospective contributions of the Network. Target informants were 200 nursing faculty affiliated to 63 universities located in 13 countries, as well as nursing networks in the Ibero-American context. One informant per university was asked to respond to the questionnaire. The participation rate was nearly 70% (42/63). The informants’ universities per country included Brazil (n = 21); Canada (n = 4); Portugal and Spain (n = 3 each); Colombia, Mexico, Peru, and USA (n = 2 each); Chile, Italy, and Paraguay (n = 1 each). Nursing faculty provided rich information and shared knowledge confirming a strong commitment to global co-creation of innovations and research partnership capacities through collaboration, cooperation, and knowledge exchange among nursing higher education institutions. Seldom researched areas are a potential focus for the Network to generate appropriate evidence to inform local scientific practices. The gathered information will inform further review of nursing and governmental policies and programs related to the application and dissemination of nursing evidence across local, regional, and global levels.

Published
2024
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90. Using Two-Eyed Seeing to Explore Interagency Collaboration

Author

Whiting, Cheryl, Cavers, Stephanie, Bassendowski, Sandra, and Petrucka, Pammla

Abstract

Background Health-care environments influence service delivery; approaches need to be more wholistic and culturally competent requiring effective interagency collaboration to bridge traditional Indigenous and mainstream health services. Despite considerable research on collaboration, the concept remains misunderstood, at worst, and formative, at best. Within the nexus of these two diverse health services, there is limited information on how collaborations could be created and sustained effectively.Purpose To explore the perspectives/experiences of collaboration of select Saskatchewan health professionals practicing across these diverse services to understand the concept from their perspectives.Methods This qualitative study explored collaboration through observation and interviews to elicit perspectives (two-eyed seeing) of health professionals working within the context of a traditional–mainstream health services partnership.Results Individual- and system-level factors and accountabilities are needed for successful cross-cultural collaboration and can be enabled by embedding the virtues of Indigenous and values of mainstream health services along with building and maintaining relationships, valuing difference, creating supportive environments and wholistic approaches, having the right people at the table, and making a change for impactful outcomes.Conclusion Findings support the need for implementing contextually relevant collaborative practice models for productive, wholistic health services. Two-eyed seeing provides the ability to capture and catalyze the tremendous value and strengths of both worlds, potentiating complementary aspects to meet the needs of clients and communities.

Published
2018
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91. Factors associated with low antiretroviral therapy enrollment of children in the Simiyu region: A cross-sectional Creswell mixed-methods sequential explanatory design

Author

Mageda, Kihulya, Kulemba, Khamis, Kapologwe, Ntuli, Katalambula, Leonard, and Petrucka, Pammla

Abstract

Despite substantial antiretroviral therapy (ART) coverage in other groups with the human immunodeficiency virus (HIV) in Tanzania, there is a progressive decline in ART enrollment among HIV-infected children. This study aimed to determine the factors affecting the enrollment of children with HIV in ART and to identify an effective, sustainable intervention to address children’s ART care enrollment. To achieve this, we conducted a cross-sectional study using a mixed-method sequential explanatory design, including children with HIV aged 2 to 14 years in the Simiyu region. Stata™ and NVIVO™ software were used to perform quantitative and qualitative data analyses, respectively. In the quantitative analyses, we considered 427 children, with a mean age of 8.54 ± 3.54 years and a median age of 3 years (interquartile range: 1–6 years). The mean length of ART initiation delay was 3.71 ± 3.21 years. Additionally, independent child enrollment predictors included distance to the facility (adjusted odds ratio [AOR]: 3.31; 95% confidence interval [CI]:1.14–9.58), caregivers’ income (AOR: 0.17; 95% CI: 0.07–0.43), and fear of stigma (AOR: 3.43; 95% CI: 1.14–10.35). In qualitative analyses, 36 respondents reported that stigma, distance, and lack of HIV-positive status disclosure to their fathers were causes for low enrollment in ART. Overall, this study demonstrated that a caregiver’s income, distance to obtain HIV care services, HIV-positive status non-disclosure to the father, and fear of stigma played a significant role in children’s enrollment in HIV care. As such, HIV/acquired immunodeficiency syndrome programs would benefit from having intensive interventions to address distance, such as scaling up care and treatment centers, as well as techniques to reduce stigma in the population.

Published
2023
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92. Re-Visioning the Winter Count

Author

Bickford, Deanna and Petrucka, Pammla

Abstract

According to Greene (2005), “history is written by the victor – meaning that the voices of the defeated are often muted in the historical record, overwritten by the perspectives of the more powerful” (p. 1). However, winter counts (waniyetu wówapi), traditional pictographic calendars on animal hide, challenge this historical recount through their simple symbolic representation that captures history from the perspective of Indigenous communities. This paper proposes the re-visioning of winter counts in achieving their traditional roles of facilitating Elder and community discussions, preserving and passing on history (Burke, 2007a), assisting the “People” to know and understand their history (Scott, 2006), and acting as a “medium of moral and social instruction” (Risch, 2000). Our contention is that re-visioning of winter counts as a sound Indigenous methodology is decolonizing.

Published
2016
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93. Enhancing decolonization and knowledge transfer in nursing research with non-western populations: examining the congruence between primary healthcare and postcolonial feminist approaches.

Author

Racine L and Petrucka P

Subjects
*CULTURE, *FEMINISM, *THEORY of knowledge, *NURSING, *NURSING research, *PHILOSOPHY, *PHOTOGRAPHY, *PRIMARY health care
Abstract

RACINE L and PETRUCKA P. Nursing Inquiry 2011; : 12-20 This article is a call for reflection from two distinct programs of research which converge on common interests pertaining to issues of health, social justice, and globalization. One of the authors has developed a research program related to the health and well-being of non-western populations, while the other author has expanded the field of Aboriginal and international research in Canada and abroad. Based on examples drawn from our respective programs of research, we suggest conciliating the philosophy of primary healthcare to postcolonial feminism for decolonizing research and enhancing knowledge transfer with non-western populations. We contend that applying the theoretical and methodological strengths of these two approaches is a means to decolonize nursing research and to avoid western neocolonization. In conciliating primary health care and postcolonial feminism, the goal is to enhance the pragmatic relevance of postcolonial feminism to generate resistance through transformative research for achieving social justice. In tapping into the synergistic and complementary epistemological assumptions of the philosophy of primary health care and postcolonial 'feminisms', nurse researchers reinforce the anti-oppresive goals of postcolonial feminist research. Consequently, this approach may enhance both decolonization and knowledge transfer through strategies like photovoice. [ABSTRACT FROM AUTHOR]

Published
2011
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95. CAPACITY BUILDING WITH REGINA MÉTIS SPORTS AND CULTURE CENTRE.

Author

Petrucka, Pammla, Bassendowski, Sandra, Bourassa, Carrie, LaRocque, Karen, Smadu, Marlene, Ramsden, Vivian, Whitehead-Poulin, Holly, McBeth, Bev, and Wessel, Floralyn

Abstract

A team comprised of members from Regina Métis Sports and Culture Centre (RMSCC), First Nations University of Canada, Regina Qu'Appelle Health Region, Saskatchewan Institute of Applied Science and Technology, and University of Saskatchewan have established a community-based participatory research relationship. This article reflects on the early formation and capacity building of the RMSCC. It will provide an overview of the community, the project intent, and findings of a series of public consultations. It will also highlight the ongoing efforts to build capacity and share knowledge across community, provider, and academic sectors. [ABSTRACT FROM AUTHOR]

Published
2009

98. Puzzle patterns: Research day interactive strategy.

Author

Bassendowski, Sandra L. and Petrucka, Pammla M.

Abstract

Summary: The article describes the planning, implementation, and assessment of an interactive strategy designed for a research day at the College of Nursing, University of Saskatchewan. A decision was made to use a creative, interactive strategy involving the use of large, blank jigsaw puzzles to generate a visual depiction of research interests and challenges faced by participants who represented graduate and undergraduate nursing students, faculty, and invited guests from government, health regions, and professional associations. Participants were asked the following questions – “What are you curious about in nursing and health care,” and “What situations or questions in nursing need answers”? The strategy demonstrated the comprehensiveness of information that can be obtained through a short-turn around interactive strategy. Further, it also attests to the broad spectrum of interests within a single nursing education program and posits the potential for educators to undertake further thematic analysis to synthesize the data to inform research agendas. [Copyright &y& Elsevier]

Published
2006
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99. Copper Induced Cyclization of α,β-Unsaturated Carbonyl Compounds to Isoxazoles

Author

C. Browder, Cindy, B. Moss, Christopher, B. Kraft, Matthew, L. Petrucka, Paige, S. Morey, Tara, W. Leach, Christopher, and C. Gearhart, Nicholas

Abstract

An unusual synthesis of isoxazoles from α,β-unsaturated ketoximes is reported. Using very inexpensive reagents, isoxazoles are isolated in good yields. Notably, a mixture of E and Z oxime isomers is employed. Initial studies indicate the oxidative cyclization reaction does not proceed via radical route; a copper insertion/elimation route is proposed.

Published
2011

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