Conectar
Neonatal haemochromatosis, considered to be a gestational alloimmune liver disease (NH-GALD), is a rare but serious disease that results in fulminant hepatic failure. The recurrence rate of NH-GALD in a subsequent infant of a mother with an affected infant is 70%–90%. Recently, antenatal maternal high-dose intravenous immunoglobulin (IVIG) therapy has been reported as being effective for preventing recurrence of NH-GALD in a subsequent infant. However, no clinical trial has been conducted to date.
This is a multicentre open-label, single-arm study of antenatal maternal high-dose IVIG therapy in pregnant women with a history of documented NH in a previous offspring. The objective of this study is to evaluate the efficacy and safety of antenatal maternal high-dose IVIG therapy in preventing or reducing the severity of alloimmune injury to the fetal liver.
The clinical trial is being performed in accordance with the Declaration of Helsinki. The trial protocol was approved by the Clinical Research Review Board at four hospitals. Before enrolment, written informed consent would be obtained from eligible pregnant women. The results are expected to be published in a scientific journal.
28 October 2024, V.8.0.
jRCT1091220353.
by Muluken Chanie Agimas, Mekuriaw Nibret Aweke, Berhanu Mengistu, Lemlem Daniel Baffa, Elsa Awoke Fentie, Ever Siyoum Shewarega, Aysheshim Kassahun Belew, Esmael Ali Muhammad
IntroductionMalaria is a global public health problem, particularly in sub-Saharan African countries. It is responsible for 90% of all deaths worldwide. To reduce the impact and complications associated with delayed treatment of malaria among children under five, comprehensive evidence about the magnitude and determinants of delayed treatment for malaria could be the solution. But there are no national-level studies in the Horn of Africa for decision-makers.
ObjectiveTo assess the prevalence and associated factors of delay in seeking malaria treatment among under-five children in the Horn of Africa.
MethodPublished and unpublished papers were searched on Google, Google Scholar, PubMed/Medline, EMBASE, SCOPUS, and the published articles’ reference list. The search mechanism was established using Medical Subject Heading (MeSH) terms by combining the key terms of the title. Joana Brigg’s Institute critical appraisal checklist was used to assess the quality of articles. A sensitivity test was conducted to evaluate the heterogeneity of the studies. The visual funnel plot test and Egger’s and Begg’s statistics in the random effect model were done to evaluate the publication bias and small study effect. The I2 statistics were also used to quantify the amount of heterogeneity between the included studies.
ResultsThe pooled prevalence of delayed treatment for malaria among under-five children in the Horn of Africa was 48% (95% CI: 34%–63%). History of child death (OR =2.5, 95% CI: 1.73–3.59), distance >3000 meters (OR = 2.59, 95% CI: 2.03–3.3), drug side effect (OR = 2.94, 95% CI: 1.86–4.67), formal education (OR = 0.69, 95% CI: 0.49–0.96), middle income (OR = 0.42, 95% CI: 0.28–0.63), expensiveness (OR = 4.39, 95% CI: 2.49–7.76), and affordable cost (OR = 2.13, 95% CI: 1.41–3.2) for transport were factors associated with malaria treatment delay among children.
Conclusion and recommendationsAbout one out of two parents in the Horn of Africa put off getting their kids treated for malaria. High transportation expenses, long travel times (greater than 3,000 meters) to medical facilities, and anxiety about drug side effects were major risk factors that contributed to this delay. On the other hand, a middle-class income was found to be protective of treatment delays. These results highlight how crucial it is to improve access to healthcare services, both financially and physically, to minimize delays in treating malaria in the area’s children.
The gig economy is a promising arena to reduce unemployment and provide other benefits such as the opportunity to earn supplemental income. Like all other forms of work, the gig space also presents occupational health issues for those working in it. This proposed review is aimed at identifying and describing the common occupational health outcomes reported within this workforce; second, to examine the risk factors that contribute to the development of these health issues; and third, to assess the interventions and support systems currently in place to promote the occupational health of gig workers.
A systematic review will be undertaken according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (2009). A search from 2015 to 2025 will be conducted on four global databases (Web of Science, SCOPUS, Academic Source Complete and Business Source Complete). Only records in English, full text and peer-reviewed journal articles will be included. Book chapters, thesis, reports and systematic reviews will be excluded. The Joanna Briggs Institute Critical Appraisal Tools will be used to assess the methodological rigour of various studies prior to inclusion for the final analysis. The extracted data will be synthesised using a narrative synthesis approach, integrating findings from both quantitative and qualitative studies.
This research is exempt from ethics approval because the work will be carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.
CRD420250654059.
by Pornkamol Tiranaprakij, Sahaphume Srisuma, Krongtong Putthipokin, Sirasa Ruangritchankul
BackgroundAnticholinergic medication use is associated with adverse clinical outcomes, especially in older adults. However, few studies have assessed the anticholinergic burden in the Thai geriatric population. Hence, we aimed to evaluate the impact of anticholinergic burden on clinical outcomes in older patients after discharge from the hospital.
MethodsA prospective cohort study was conducted between January 1 to December 31, 2023. The prescribed medications were assessed at admission and discharge to determine the anticholinergic cognitive burden (ACB) scores. Participants were classified into three groups according to the ACB score at discharge: none (score 0), moderate (score 1–2), and severe (score ≥ 3) anticholinergic burden. The Cox proportional hazard model was used to determine the marker risk of high anticholinergic burden to adverse outcomes.
ResultsThis study involved 290 older patients admitted to general internal medicine wards. At discharge, 37.9% (n = 110) of the patients had a high anticholinergic burden (ACB score ≥ 3), and 50% (n = 145) had a higher ACB score than at admission. The three most commonly prescribed anticholinergics at discharge were benzodiazepines (20.3%), corticosteroids (20.0%), and antihistamines (15.9%). During the one-year follow-up period, 16.6% (n = 48) of the patients died. The incidence rate of all-cause mortality in hospitalized older patients with an ACB score ≥ 3 was 0.65 cases per 1000-person day during a one-year follow-up period. After adjusting for potential factors, an ACB score of ≥ 3 at discharge was marginally associated with one-year mortality post discharge [hazard ratio: 2.98, 95% confidence interval (0.96–9.28)].
ConclusionsThe exposure to high anticholinergic burden (ACB scores ≥ 3) at discharge was slightly associated with an increased risk of one-year mortality post discharge. The cautious use of benzodiazepines may assist to reduce the anticholinergic burden in this vulnerable population.
Early and balanced replacement of blood products appears to be the key factor in improving outcomes of major bleeding patients including acute trauma, cardiac, obstetric and transplant surgery patients. Definitive clinical guidance regarding the optimal ratio of blood products, including those containing fibrinogen, is still lacking. Therefore, we tested the hypothesis that increasing the fibrinogen content to erythrocyte suspension ratio improves the mortality and functional outcomes of patients undergoing surgeries with expected major bleeding.
The Approximate Dose-Equivalent of Fibrinogen-to-Erythrocyte Suspension (ADEFES) ratio is a multicentre, prospective, observational, cohort study of patients undergoing major surgical procedures with expected major perioperative bleeding (ie, requiring packed red blood cells (PRBC)>4U/24 hours). For 5U of cryoprecipitate and 1.5 U of fresh frozen plasma (FFP), the approximate dose-equivalent for fibrinogen is considered as 1 gram of fibrinogen. Association of the ADEFES ratio at 24 hours will be assessed on the primary objective, which will consist of the composite of 30-day all-cause mortality, 30-day bleeding-specific mortality and the ‘highly-dependent scores’ of Katz index of independence in activities of daily living.
The study protocol was approved by the Ethics Committee of Ankara Bilkent City Hospital (approval no. E2-23-4265, dated 07 June 2023; Chair: Prof. Dr. F.E. Canpolat) and by the institutional review boards of all participating centres. The study will be conducted in accordance with the principles of the Declaration of Helsinki and the Strengthening the Reporting of Observational Studies in Epidemiology guidelines, as well as in compliance with national regulations on data protection and Good Clinical Practice standards. Written informed consent will be obtained from all participants prior to inclusion in the study.
The results of this study will be disseminated through peer-reviewed scientific journals, presentations at national and international conferences, and communication with relevant stakeholders including clinical practitioners and healthcare institutions. If applicable, study outcomes will also be shared via institutional newsletters and digital platforms to reach a broader audience in the medical community.
Drug–drug interactions (DDIs) are a significant concern for patients on complex therapeutic regimens, especially involving cardiovascular medications, which are frequently implicated in these interactions.
This study used a standardised interaction database to determine the frequency, severity and risk factors associated with potential DDIs (pDDIs) among cardiovascular disease (CVD) in-patients.
The prospective cross-sectional study was conducted at a tertiary care hospital in Nepal from April 2024 to October 2024. A total of 106 eligible CVD in-patients were evaluated for pDDIs using the Lexicomp DDI checker database, and the interactions were categorised based on severity and risk rating. Binary logistic regression identified factors associated with pDDIs.
The study identified 621 pDDIs using the Lexicomp database, with median values of 8 pDDIs per patient. Patients with at least one pDDI comprised 64.2% of the sample. Most pDDIs were of moderate severity (77.3%) with risk ratings of C (65.7%). The most common cardiovascular medications involved in the detected DDI pairs were diuretics (31.2%), antiplatelets and anticoagulants (23.8%) and calcium channel blockers (12.2%). Multivariate binary logistic regression revealed that patients who stayed longer (adjusted OR (AOR) 9.08, 95% CI 1.027 to 80.216, p=0.047), those receiving more medications (AOR 18.85, 95% CI 2.975 to 119.370, p=0.002) and those who were admitted to the intensive cardiac care unit (AOR 16.31, 95% CI 2.728 to 97.461, p=0.002) were significantly more likely to experience pDDIs.
This study found a higher prevalence of pDDIs. It is advisable to incorporate medication reviews into routine cardiac care and use a drug interaction checker to identify pDDIs.
Alzheimer’s disease (AD) impacts over 55 million individuals worldwide and remains the leading cause of dementia (60–70% of cases). By 2050, South and Southeast Asia are projected to have an older adult population more than double, bearing a major share of Alzheimer’s disease burden. This will exert a heavy strain on healthcare systems, particularly in resource-limited countries where support and infrastructure are already stretched. Despite this, no review has yet explored the regional epidemiology and associated risk factors in this context. Thus, this study protocol outlines to synthesise prevailing evidence from these densely populated regions, particularly low- and middle-income nations within South and Southeast Asia.
This review will include studies that reported epidemiological characteristics including prevalence, age of onset, mortality, and risk factors of AD and related dementias comprising in South and Southeast Asian regions. Studies published in any language from inception to date will be extracted from PubMed, Scopus, CINAHL, EMBASE and APA PsycNet, following Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. We will also search grey literature sources and screen the reference lists of the articles selected for full-text review to identify additional relevant studies. Observational studies including case–control, cohort, and cross-sectional designs reporting desired outcomes will be included and appraised for quality assessment with the modified Newcastle-Ottawa Scale (mNOS). The included articles will be appraised by two independent reviewers, with a third resolving any conflicts. Pooled estimates of prevalence, age of onset and mortality will be analysed using random effect meta-analysis (REML) model. Associated risk factors, including modifiable and non-modifiable will be narratively synthesised. Forest plots will be used to visualise the findings, and heterogeneity across the included studies will be assessed using the I² and Cochrane’s Q statistics. Potential publication bias will be assessed using a funnel plot along with the Begg’s and Egger’s tests. Sensitivity and subgroup analyses will also be conducted to assess the robustness of pooled estimates and to explore potential sources of heterogeneity. Statistical analysis will be conducted using Rstudio (v.4.3.2) and GraphPad Prism V.9.0.2.
The systematic review is focused on the analysis of secondary data from published literature; thus, no ethical approval will be needed. The protocol will follow international standard guidelines, findings will be reported in a reputed journal and disseminated through (inter)national conferences, webinars and key stakeholders to inform policy, research and AD management strategies.
CRD 420251047105.
There is evidence for significant inequalities in morbidity and mortality due to cancer and other major non-communicable diseases (NCDs) both within and between European countries. Up-to-date evidence highlighting best practices for future policies is needed to reduce these inequalities.
The objective is to map and summarise published evidence on the impact of national and/or supranational policies on social inequalities in cancer and other NCDs, and their risk factors in Europe, and explore the nature and characteristics of these policies. The criteria for studies to be included are Population: any population group(s), whole population(s) or supranational population in Europe. Concept: any national or supranational policy directly targeting social inequalities in NCDs and/or their risk factors, or NCDs or their risk factors in general, while reporting effects on inequalities or targeting root causes of social inequality. Context: policies implemented by one or more governments or authorities in the WHO European region, in one or more sectors, and applied in a primordial, primary, secondary or tertiary prevention context. The policies may be universal, targeted or proportionate universal. The review will follow the Johanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. We will search 13 databases from 2008 up to present for eligible experimental or quasi-experimental studies in any language, and reference lists of relevant reviews and included studies. The databases for the main search will include MEDLINE, Embase, Cochrane CENTRAL, Global Health, American Psychological Association (APA) PsycInfo, Cumulated Index in Nursing and Allied Health Literature (CINAHL), Education Resources Information Center (ERIC), Web of Science Core Collection, Sociological Abstracts, Scopus, EconLit, The Social Interventions Research and Evaluation Network and FRANCIS. Study quality will be assessed using the Effective Practice and Organisation of Care (EPOC) risk of bias tool or the Risk of Bias in Non-Randomised studies of Interventions (ROBINS-I) tool depending on study design. Results will be synthesised narratively using descriptive statistics and visuals.
Ethical approval will not be sought as scoping reviews do not involve primary data collection or direct interaction with human participants. The results of this review, which is part of the JA-PreventNCD project, funded by the European Commission, and involving 25 European countries, will feed into one of the project’s deliverables, which comprises recommendations for policymakers based on the best available knowledge. We will also aim to present the results of the review at international conferences and publish the full review in an international peer-reviewed journal.
This protocol is registered on Open Science Framework (https://doi.org/10.17605/OSF.IO/H7MUW).
To provide expert consensus recommendations to support health systems in England to improve prioritisation and implementation of cardiovascular and renal risk-based type 2 diabetes (T2D) care, achieving quality improvement in line with the National Institute for Health and Care Excellence (NICE) NG28 guideline.
A two-round modified Delphi panel was conducted.
Participants represented health system leadership from a cross-section of integrated care systems across England. Delphi panel statements were relevant to both primary and secondary care.
A panel of 28 participants took part in the Delphi panel (10.7% drop-off rate between rounds). Statement development was guided by a separate committee of 11 topic experts, forming the Implementing NICE NG28 by harnessing Opportunities for adVanced integrated cAre Transformation and Excellence (INNOVATE)-28 Working Group.
In total, 84% (n=32/38) statements reached consensus across both Delphi rounds. There was agreement that health systems need to prioritise prevention of cardiovascular and renal complications in T2D, particularly for those at ‘high’ or at ‘rising’ cardiovascular and renal risk. Consensus was also reached that quality improvement should be incentivised based on local population needs, with investment into digital systems and supporting roles to aid this. Panellists further agreed that investment should be channelled into community-led resources to reinforce a preventative approach and help to ensure people living with T2D receive care in the most appropriate setting. Finally, collaboration between health and social care, health innovation networks and industry partners was highlighted as an opportunity to leverage support for the delivery of risk-based T2D care.
The recommendations from this Delphi panel are intended to support health systems to consistently implement the NG28 guideline and facilitate quality improvement to deliver equitable T2D care and mitigate cardiovascular and renal risk. By being innovative and bold with commissioning and ways of working, and leveraging partnerships, health system leaders can enact the transformational and sustainable change needed to improve outcomes for people living with T2D, tackle healthcare inequalities and optimise system resilience.
The WHO’s Integrated Management of Childhood Illness (IMCI) in young infants
We will create a dataset that integrates data from population-based studies globally with similar designs that have examined the presence of signs of PSBI identified by frontline health workers throughout the young infant period (days 0 to
All prior studies incorporated into our pooled analysis were approved by the independent local ethics committee/institutional review board (IRB) at each study site in each country, and all study participants provided informed consent. This project was approved by the Stanford University School of Medicine IRB protocol 74456. Study findings will be disseminated through publications in peer-reviewed journals, WHO documents, and presentations at maternal and child health meetings.
by Stephen Mensah Arhin, Kwesi Boadu Mensah, Isaac Tabiri Henneh, Felix Yirdong, Evans Kofi Agbeno, Charles Ansah, Martins Ekor
BackgroundPsychological distress and social burdens associated with infertility among couples have been well-documented. However, little is known about the specific coping strategies employed by couples in low-middle-income countries such as Ghana, in the aftermath of unsuccessful infertility treatment attempts. In this qualitative study, we explored specific coping strategies patients adopt to address psychological distress related to unsuccessful treatment for infertility.
MethodsA semi-structured interview approach was used to elicit qualitative responses from 18 fertility clients after unsuccessful treatment at four fertility clinics in Ghana. Thematic analysis (TA) was used to examine the coping strategies adopted by participants in response to psychological distress associated with infertility treatment failures. This allowed us to explore potential culturally specific coping strategies employed by participants in response to infertility-related psychological distress.
ResultsThe themes that emerged as coping strategies in response to infertility-related psychological distress were diversional activities, intrapersonal cognitive reframing, social isolation, familial support, religious coping, avoidance-focused coping strategies, seeking encouragement, and professional help.
ConclusionThe findings from this study indicate that coping strategies that involve isolating oneself may not provide lasting emotional relief for individuals experiencing infertility. Relational activities contribute positively to coping. This is relevant in helping health professionals in the management of infertility treatment failures, which may include setting up support groups of similar experiences to draw strength from each. Furthermore, the results underscore the need to integrate psychological interventions into the counseling of couples following an unsuccessful infertility treatment. The clinical and research implications of these findings are discussed.
Antenatal corticosteroid (ACS) regimens have remained unchanged since the initial trials in 1972, with the optimal regimen still undetermined. The WHO ACTION (Antenatal CorticosTeroids for Improving Outcomes in preterm Newborns)-III trial is a three-arm individually randomised double-blind trial evaluating the efficacy and safety of two different ACS dosing regimens (currently used and lower-dose ACS regimens vs placebo) in women with a high probability of having a late preterm birth. This study protocol nested within this trial aims to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) effects of two different ACS dosing regimens in pregnant women in the late preterm period (34–36 weeks) to help inform an optimal dosing regimen.
The study will be conducted in two of the five countries participating in the WHO ACTION-III trial—India (Delhi, Belagavi) and Nigeria (Ibadan and Ile-Ife). We will use a population PK approach using sparse sampling to study the PK effects of the two ACS regimens, that is, 6 mg dexamethasone phosphate (DEXp) or 2 mg betamethasone phosphate (BETp), administered intramuscularly every 12 hours for a maximum of four doses or till birth, whichever is earlier, compared with placebo. We will also ascertain the fetal–maternal ratio of DEXp and BETp at birth.
Maternal venous blood samples will be collected at 0, 1–4 hours, 8–12 hours after the first dose, and at 24–36 hours, 48–60 hours, 72–96 hours after the last dose, and immediately after birth, along with cord blood. Concentrations of DEXp and BETp will be measured at set time points using a validated liquid chromatography mass spectroscopy assay. PD parameters measured will include total and differential white blood cell count (by automated analysers using electrical impedance), plasma glucose (hexokinase method) and serum cortisol (using a validated electrochemiluminescence immunoassay), at predefined time points. PK models will be developed for each drug using non-linear mixed effects methods. Optimal dosing will be investigated using Monte Carlo simulations.
The study has been approved by the WHO Ethics Review Committee and the site-specific ethics committees of the participating leading institutions. Written informed consent will be obtained from all participants. The study results will be published in a peer-reviewed journal and presented at scientific conferences.
This study explored the burdens and motivations of family caregivers (FCs) for patients with end-stage liver disease (ESLD) in a tertiary hospital in Ghana.
A qualitative exploratory, descriptive approach with a purposive sampling technique was adopted. Data were collected through face-to-face semi-structured interviews. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis.
Participants were recruited from a tertiary hospital in the Northern Region of Ghana.
15 FCs aged between 18 and 50 years caring for patients with ESLD were recruited.
The study’s findings revealed that FCs of individuals with ESLD encountered considerable challenges, including sleep deprivation, physical exhaustion, family conflicts, financial difficulties and social restrictions. These difficulties contributed to a sense of being overwhelmed as caregivers strived to fulfil their duties. Family bonds, reciprocal relationships and religious obligations were the motivation/driving force for FCs caring for relatives with ESLD.
Integrating palliative care services in tertiary health facilities will reduce the burdens FCs of patients with ESLD face. Relevant stakeholders in the health sector need to develop culturally sensitive interventions to support FCs caring for patients with ESLD in Ghana.
by Masayoshi Terayama, Yu Imamura, Toru Kitazawa, Naoki Miyazaki, Misuzu Ishii, Kumi Takagi, Kengo Kuriyama, Naoki Takahashi, Masahiro Tamura, Akihiko Okamura, Jun Kanamori, Masayuki Watanabe
BackgroundPostoperative hyperglycemia in diabetic patients is a widely known risk factor for postoperative infectious complications (PICs) after esophagectomy; however, the significance of glycemic control in non-diabetic patients is less clear. In diabetic patients, early postoperative management of esophagectomy favors low-carbohydrate enteral nutrition (EN) over standard EN to suppress the risk of glycemic spike. Our single-center, randomized phase II trial seeks to test the hypothesis that low-carbohydrate EN can suppress hyperglycemia in non-diabetic patients who undergo esophagectomy. Herewith we present the study protocol.
MethodsA total of 50 patients will be enrolled and randomly assigned (1:1 ratio) to standard or low-carbohydrate EN. Randomization will be stratified by operation time (≥560 vs. blood glucose level of 180 mg/dL), and is indicative of the frequency and duration of hyperglycemia. AUC, which identifies periods of hyperglycemia and provides a comprehensive picture of glucose variability and control in diabetes management, is defined as the area under the curve over blood glucose level of 180 mg/dL on CGM monitoring.
DiscussionThis study is the first to investigate the impact of a low-carbohydrate EN formula on hyperglycemic control during perioperative nutritional management of esophageal cancer. These results will help to outline whether glycemic control should be also considered for non-diabetic patients during hospital care.
Trial registrationThis trial has been registered in the Japanese Registry of Clinical Trials (jRCTs031240081).
by Ebenezer Assoah, Denis Dekugmen Yar, Papa Kofi Amissah-Reynolds, Gadafi Iddrisu Balali, Rockson Addy, Joshua Kpieonuma Zineyele
This study assessed the prevalence of co-infections (human immunodeficiency virus, hepatitis B, and syphilis) and associated risk factors for Toxoplasma gondii infection among pregnant women in Mampong Municipality, Ghana. A cross-sectional design was used to recruit 201 pregnant women from six health facilities conveniently. Participants’ socio-demographics, clinical and environmental data were collected using a structured questionnaire. Using 2 ml of blood, T. gondii seroprevalence was determined by the TOXO IgG/IgM Rapid Test Cassette. Data was analyzed using descriptive and logistic regression analysis with SPSS version 27 to determine the prevalence and associations of T. gondii infection with other variables, respectively. The seroprevalence of T. gondii was 49.75%, of which 40.30%, 2.49%, and 6.97% tested positive for IgG, IgM, and IgG/IgM, respectively. Co-infection of toxoplasmosis with viral hepatitis B, human immunodeficiency virus (HIV), and syphilis rates were 15%, 1%, and 4%, respectively and were not risk factors for T. gondii transmission. Educational level and residential status were associated with toxoplasmosis [p T. gondii infections compared to a lower level of education [AOR = 0.39 (0.13, 0.99) p = 0.049]. Similarly, the risk of T. gondii infection was significantly lower among individuals residing in peri-urban [AOR = 0.13 (0.02–0.70), p = 0.02] and urban areas [AOR = 0.10 (0.02–0.78), p = 0.03] compared to those in rural areas. Backyard animals with extensive and semi-intensive systems, without veterinary care, and contact with animal droppings and water sources were significant risk factors for T. gondii infection [p T. gondii infection [p T. gondii infection was high among the study population, posing a risk of mother-to-child transmission. Key risk factors included low education, rural residence, backyard animal exposure, poor hygiene, and unsafe water sources. Toxoplasmosis was associated with miscarriage; thus, integrating it into routine antenatal screening could improve pregnancy outcomes. Health promotion interventions such as education on zoonotic risks, improved sanitation, safe water practices, and veterinary care for domestic animals are recommended to reduce infection risk among pregnant women.Poor menstrual health and unmet menstrual needs influence several aspects of adolescent girls’ lives, including their educational outcomes. However, evidence on menstrual health needs and educational outcomes among these vulnerable girls living in countries across sub-Saharan Africa (SSA) is fragmented and inconclusive. The systematic review aims to explore the association between menstrual health needs and educational outcomes among adolescent girls (10–19 years) living in SSA.
Studies (published and unpublished) will be identified from relevant electronic databases including PubMed, CINAHL, ScienceDirect, Google Scholar and LILACS without language restriction from January 2012 to December 2024. A comprehensive set of search terms and their alternate terms, together with the names of countries in sub-Saharan Africa, will be used for running the searches. We will also search Scopus, Web of Science, African Index Medicus, HINARI, African Journals Online, Academic Search Premier, MedRXIV, ProQuest, EBSCO Open Dissertations and reference lists of relevant studies. We will contact experts, identified through authorship of key publications in menstrual health research and recommendations from established research networks, for potentially relevant unpublished studies. All retrieved articles from the electronic databases and grey literature will be collated and deduplicated using Endnote and exported to Rayyan QCRI. The pre-defined eligibility criteria will be followed to screen papers for inclusion in the review. The flow of studies will be reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Given the anticipated volume of literature to be reviewed, at least two reviewers will independently select studies, extract data and assess the quality of the included studies for risk of bias using the Robbins-E risk of bias assessment tool. Any disagreements will be resolved through discussion between the reviewers. The Joanna Briggs Institute’s Sumari Software will be used for citation management. Binary outcomes will be estimated using pooled proportions (for non-comparative studies) and odds ratio (OR) or risk ratio (RR) (for comparative studies), reported with their 95% CIs. The mean difference (MD) will be used for reporting continuous outcomes with their 95% CIs. In the case where different instruments have been used to report means, we will employ standardised mean difference (SMD). Heterogeneity will be assessed graphically for overlapping CIs and statistically using the I2 statistic, and if heterogeneity is detected to be high (>50%), subgroup analysis will be performed to assess the impact of such variation.
While ethical approval is not required for the systematic review methodology itself, appropriate data sharing agreements and confidentiality protocols will be followed when collecting unpublished data from experts. The findings from this review will be published in a peer-reviewed journal and presented at relevant conferences. Also, the findings will be communicated to local stakeholders (eg, adolescent girls, parents/guardians, school authorities) in appropriate formats and languages to support translation into policy and practice to improve menstrual health and hygiene and education for adolescent girls in sub-Saharan Africa.
CRD42024565296.
Trauma and orthopaedic surgery (TOS) can result in surgical site infections (SSIs), and the repercussions include prolonged and increased cost of treatment. This study investigated the incidence and risk factors of SSI following TOS. A prospective cohort study was conducted at the Tamale Teaching Hospital from September 2023 to May 2024. Data on demographics, comorbidities, preoperative, intra-operative and postoperative parameters were collected from patients, medical records and the operation report. SSI was defined following the Centers for Disease Control and Prevention criteria. The incidence of SSI during the study period was determined, and univariate and multivariate logistic regression analyses were used to identify the independent risk factors of SSI. A total of 210 patients were enrolled of which 6.7% (14) developed SSIs, including 1.0% (2) deep and 5.7% (12) superficial SSIs. The incidence of open fractures and closed fractures in this study was 3.3% (7) and 2.9% (6), respectively. According to multivariate regression analysis, blood transfusion before surgery (p = 0.034; OR = 3.53; 1.10–11.33) was identified as an independent risk factor of SSI following TOS. However, there was a significant association between the type of dressing used on the surgical site after surgery (p = 0.035; OR = 4.08; 1.10–15.08) and SSI. The study reported the overall incidence rate of SSI after TOS to be 6.7% (67 per 1000 surgical operations). Blood transfusion before surgery was an independent risk factor of SSI following TOS. Local and global measures that limit the rates of SSI after TOS should be adopted especially in managing high-risk patients such as those who require pre-operative blood transfusion.
by Khomsan Ruangrit, Kittiya Phinyo, Sahassawat Chailungka, Kritsana Duangjan, Apitchaya Naree, Jearanai Thasana, Wassana Kamopas, Senoch Seanpong, Jeeraporn Pekkoh, Nuttapol Noirungsee
This study investigates the effectiveness of biochar immobilized with algicidal Bacillus sp. AK3 and denitrifying Alcaligenes sp. M3 in mitigating harmful algal blooms (HABs) and reducing nitrate pollution in aquatic environments. Over a six-day period, we analyzed changes in algal bloom-forming Microcystis density, chlorophyll-a levels (indicative of algal biomass), nitrate concentration, and microbial community composition in water treated with biochar and Bacillus sp. AK3 and Alcaligenes sp. M3-immobilized biochar. In water treatment using the AK3 and M3-immobilized biochar, Microcystis density decreased from 600,000 cells/mL to 80,000 cells/mL, and chlorophyll-a concentrations also substantially reduced, from 85.7 µg/L initially to 42.8 µg/L. Nitrate concentrations in the AK3 and M3-immobilized biochar treatment significantly decreased from approximately 23 mg/L to around 14 mg/L by Day 6, demonstrating the enhanced denitrification capabilities of the immobilized Alcaligenes sp. M3 and associated bacterial communities. The results also showed significant shifts in bacterial communities, with a decrease in Microcystis, highlighting the specific algicidal activity of Bacillus sp. AK3. The study underscores the potential of biochar-based treatments as a sustainable and effective approach for improving water quality and mitigating the environmental impacts of nutrient pollution and HABs.by Ahmad Sofi-Mahmudi, Erfan Shamsoddin, Sahar Khademioore, Yeganeh Khazaei, Amin Vahdati, Marcos Roberto Tovani-Palone
BackgroundOrofacial clefts are the most common craniofacial anomalies that include a variety of conditions affecting the lips and oral cavity. They remain a significant global public health challenge. Despite this, the quality of care for orofacial clefts has not been investigated at global and country levels.
ObjectiveWe aimed to measure the quality-of-care index (QCI) for orofacial clefts worldwide.
MethodsWe used the 2019 Global Burden of Disease data to create a multifactorial index (QCI) to assess orofacial clefts globally and nationally. By utilizing data on incidence, prevalence, years of life lost, and years lived with disability, we defined four ratios to indirectly reflect the quality of healthcare. Subsequently, we conducted a principal component analysis to identify the most critical variables that could account for the observed variability. The outcome of this analysis was defined as the QCI for orofacial clefts. Following this, we tracked the QCI trends among males and females worldwide across various regions and countries, considering factors such as the socio-demographic index and World Bank classifications.
ResultsGlobally, the QCI for orofacial clefts exhibited a consistent upward trend from 1990 to 2019 (66.4 to 90.2) overall and for females (82.9 to 94.3) and males (72.8 to 93.6). In the year 2019, the top five countries with the highest QCI scores were as follows: Norway (QCI = 99.9), Ireland (99.4), France (99.4), Germany (99.3), the Netherlands (99.3), and Malta (99.3). Conversely, the five countries with the lowest QCI scores on a global scale in 2019 were Somalia (59.1), Niger (67.6), Burkina Faso (72.6), Ethiopia (73.0), and Mali (74.4). Gender difference showed a converging trend from 1990 to 2019 (optimal gender disparity ratio (GDR): 123 vs. 163 countries), and the GDR showed a move toward optimization (between 0.95 and 1.05) in the better and worse parts of the world.
ConclusionDespite the positive results regarding the QCI for orofacial clefts worldwide, some countries showed a slight negative trend.
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