DESIGN: We included data on children initiating ART between 2004 and 2016 at less than 16 years old at 16 International Epidemiologic Databases to Evaluate AIDS Southern Africa cohorts. Children were classified as loss to follow up (LTFU) if they had not attended clinic for more than 180 days. Children had a care interruption if they were classified as LTFU, and subsequently returned to care. Children who died within 180 days of ART start were excluded.
METHODS: The main outcome was all cause mortality. Two exposed groups were considered: those with a first care interruption within the first 6 months on ART, and those with a first care interruption after 6 months on ART. Adjusted hazard ratios were determined using a Cox regression model.
RESULTS: Among 53 674 children included, 23 437 (44%) had a care interruption, of which 10 629 (20%) had a first care interruption within 6 months on ART and 12 808 (24%) had a first care interruption after 6 months on ART. Increased mortality was associated with a care interruption within 6 months on ART [adjusted hazard ratio (AHR) = 1.52, 95% CI 1.12-2.04] but not with a care interruption after 6 months on ART (AHR = 1.05, 95% CI 0.77-1.44).
CONCLUSION: The findings suggest that strengthening retention of children in care in the early period after ART initiation is critical to improving paediatric ART outcomes.
Objective: To estimate changes in the prevalence of current tobacco use and socioeconomic inequalities among male and female participants from 22 sub-Saharan African countries from 2003 to 2019.
Design, Setting, and Participants: Secondary data analyses were conducted of sequential Demographic and Health Surveys in 22 sub-Saharan African countries including male and female participants aged 15 to 49 years. The baseline surveys (2003-2011) and the most recent surveys (2011-2019) were pooled.
Exposures: Household wealth index and highest educational level were the markers of inequality.
Main Outcomes and Measures: Sex-specific absolute and relative changes in age-standardized prevalence of current tobacco use in each country and absolute and relative measures of inequality using pooled data.
Results: The survey samples included 428 197 individuals (303 232 female participants [70.8%]; mean [SD] age, 28.6 [9.8] years) in the baseline surveys and 493 032 participants (348 490 female participants [70.7%]; mean [SD] age, 28.5 [9.4] years) in the most recent surveys. Both sexes were educated up to primary (35.7%) or secondary school (40.0%). The prevalence of current tobacco use among male participants ranged from 6.1% (95% CI, 5.2%-6.9%) in Ghana to 38.3% (95% CI, 35.8%-40.8%) in Lesotho in the baseline surveys and from 4.5% (95% CI, 3.7%-5.3%) in Ghana to 46.0% (95% CI, 43.2%-48.9%) in Lesotho during the most recent surveys. The decrease in prevalence ranged from 1.5% (Ghana) to 9.6% (Sierra Leone). The World Health Organization target of a 30% decrease in smoking was achieved among male participants in 8 countries: Rwanda, Nigeria, Ethiopia, Benin, Liberia, Tanzania, Burundi, and Cameroon. For female participants, the number of countries having a prevalence of smoking less than 1% increased from 9 in baseline surveys to 16 in the most recent surveys. The World Health Organization target of a 30% decrease in smoking was achieved among female participants in 15 countries: Cameroon, Namibia, Mozambique, Mali, Liberia, Nigeria, Burundi, Tanzania, Malawi, Kenya, Rwanda, Zimbabwe, Ethiopia, Burkina Faso, and Zambia. For both sexes, the prevalence of tobacco use and the decrease in prevalence of tobacco use were higher among less-educated individuals and individuals with low income. In both groups, the magnitude of inequalities consistently decreased, and its direction remained the same. Absolute inequalities were 3-fold higher among male participants, while relative inequalities were nearly 2-fold higher among female participants.
Conclusions and Relevance: Contrary to a projected increase, tobacco use decreased in most sub-Saharan African countries. Persisting socioeconomic inequalities warrant the stricter implementation of tobacco control measures to reach less-educated individuals and individuals with low income.
OBJECTIVES: We aimed to identify study-level and individual-level modifiers of the effect of SQ-LNSs on child hemoglobin (Hb), anemia, and inflammation-adjusted micronutrient status outcomes.
METHODS: We conducted a 2-stage meta-analysis of individual participant data from 13 randomized controlled trials of SQ-LNSs provided to children 6-24 mo of age (n = 15,946). We generated study-specific and subgroup estimates of SQ-LNSs compared with control, and pooled the estimates using fixed-effects models. We used random-effects meta-regression to examine potential study-level effect modifiers.
RESULTS: SQ-LNS provision decreased the prevalence of anemia (Hb < 110 g/L) by 16% (relative reduction), iron deficiency (plasma ferritin < 12 µg/L) by 56%, and iron deficiency anemia (IDA; Hb < 110 g/L and plasma ferritin <12 µg/L) by 64%. We observed positive effects of SQ-LNSs on hematological and iron status outcomes within all subgroups of the study- and individual-level effect modifiers, but effects were larger in certain subgroups. For example, effects of SQ-LNSs on anemia and iron status were greater in trials that provided SQ-LNSs for >12 mo and provided 9 (as opposed to <9) mg Fe/d, and among later-born (than among first-born) children. There was no effect of SQ-LNSs on plasma zinc or retinol, but there was a 7% increase in plasma retinol-binding protein (RBP) and a 56% reduction in vitamin A deficiency (RBP
METHODS: A total of 1028 confirmed cases of COVID-19 from Africa with definite survival outcomes were identified retrospectively from an open-access individual-level worldwide COVID-19 database. The live version of the dataset is available at https://github.com/beoutbreakprepared/nCoV2019 . Multivariable logistic regression was conducted to determine the risk factors that independently predict mortality among patients with COVID-19 in Africa.
RESULTS: Of the 1028 cases included in study, 432 (42.0%) were females with a median (interquartile range, IQR) age of 50 (24) years. Older age (adjusted odds ratio {aOR} 1.06; [95% confidence intervals {95% CI}, 1.04-1.08]), presence of chronic disease (aOR 9.63; [95% CI, 3.84-24.15]), travel history (aOR 2.44; [95% CI, 1.26-4.72]), as well as locations of Central Africa (aOR 0.14; [95% CI, 0.03-0.72]) and West Africa (aOR 0.12; [95% CI, 0.04-0.32]) were identified as the independent risk factors significantly associated with increased mortality among the patients with COVID-19.
CONCLUSIONS: The COVID-19 pandemic is evolving gradually in Africa. Among patients with COVID-19 in Africa, older age, presence of chronic disease, travel history, and the locations of Central Africa and West Africa were associated with increased mortality. A regional response should prioritize strategies that will protect these populations. Also, conducting a further in-depth study could provide more insights into additional factors predictive of mortality in COVID-19 patients.
METHODS: PARACHUTE is a phase IV, prospective, non-interventional, observational study. Primary endpoint was the proportion of patients remaining progression free at 12 months. Secondary endpoints were ORR, PFS, safety and tolerability, and relative dose intensity (RDI).
RESULTS: Overall, 190 patients with a median age of 61 years (range: 22.0-96.0) were included. Most patients were Asian (70%), clear-cell type RCC was the most common (81%), with a favourable (9%), intermediate (47%), poor (10%), and unknown (34%) MSKCC risk score. At the end of the observational period, 78 patients completed the observational period and 112 discontinued the study; 60% of patients had the starting dose at 800 mg. Median RDI was 82%, with 52% of patients receiving 10%) TEAEs related to pazopanib included diarrhoea (30%), palmar-plantar erythrodysesthesia syndrome (15%), and hypertension (14%).
CONCLUSIONS: Results of the PARACHUTE study support the use of pazopanib in patients with advanced or mRCC who are naive to VEGF-TKI therapy. The safety profile is consistent with that previously reported by pivotal and real-world evidence studies.
METHODS: The developed app was tested in a large academic public hospital in a PPS in South Africa. During data collection, the app was evaluated for functionality on 35 variables and subsequently refined. After data collection, the app was evaluated in terms of its time-saving potential and ease of use.
RESULTS: 181 patient's files were surveyed across 13 wards in the hospital, with the antimicrobial usage findings similar to the previous paper-based study in the same hospital. The median age for males was 45.5 years and 42 years for females. Overall 80 out of 181 (44%) patients received antibiotics. Whilst 38% (12 out of 31) of patients in the adult surgical ward received antimicrobials, the prevalence was the highest (78%) in the pediatric medical wards. All the data collectors were confident in using the app after training and found the tool is not complex at all to use. In addition, the time taken to plan for the study and to collect data was considerably reduced. Reduced time spent in data collection and analysis is important for timely instigation of quality improvement programs in resource limited settings.
CONCLUSIONS: All data collectors would recommend the app for future PPSs. Several concerns with data entry were identified, which have now been addressed. The app development has been successful and is now being deployed across South Africa as part of a national PPS as well as wider.
METHODS: We analyzed the clinical, immunologic, and genetic data of IEI patients from 22 countries in the Middle East and North Africa (MENA) region. The data was collected from national registries and diverse databases such as the Asian Pacific Society for Immunodeficiencies (APSID) registry, African Society for Immunodeficiencies (ASID) registry, Jeffrey Modell Foundation (JMF) registry, J Project centers, and International Consortium on Immune Deficiency (ICID) centers.
RESULTS: We identified 17,120 patients with IEI, among which females represented 39.4%. Parental consanguinity was present in 60.5% of cases and 27.3% of the patients were from families with a confirmed previous family history of IEI. The median age of patients at the onset of disease was 36 months and the median delay in diagnosis was 41 months. The rate of registered IEI patients ranges between 0.02 and 7.58 per 100,000 population, and the lowest rates were in countries with the highest rates of disability-adjusted life years (DALY) and death rates for children. Predominantly antibody deficiencies were the most frequent IEI entities diagnosed in 41.2% of the cohort. Among 5871 patients genetically evaluated, the diagnostic yield was 83% with the majority (65.2%) having autosomal recessive defects. The mortality rate was the highest in patients with non-syndromic combined immunodeficiency (51.7%, median age: 3.5 years) and particularly in patients with mutations in specific genes associated with this phenotype (RFXANK, RAG1, and IL2RG).
CONCLUSIONS: This comprehensive registry highlights the importance of a detailed investigation of IEI patients in the MENA region. The high yield of genetic diagnosis of IEI in this region has important implications for prevention, prognosis, treatment, and resource allocation.
METHODS: We identified providers from 5 countries where national HPV vaccination programs were at various stages of implementation: Argentina, Malaysia, South Africa, South Korea, and Spain. Providers authorized to administer adolescent vaccines completed an in-depth survey, reporting perceptions of barriers and facilitators to initiating and completing HPV vaccination, and logistical challenges to HPV vaccination.
RESULTS: Among 151 providers, common barriers to HPV vaccination initiation across all countries were parents' lack of awareness (39%), concerns about vaccine safety or efficacy (33%), and cost to patients (30%). Vaccination education campaign (70%) was the most commonly cited facilitator of HPV vaccination initiation. Common barriers to series completion included no reminder system or dosing schedule (37%), loss to follow-up or forgetting appointment (29%), and cost to patients (25%). Cited facilitators to completing the vaccine series were education campaigns (45%), affordable vaccination (32%), and reminder/recall systems (22%). Among all countries, high cost of vaccination was the most common logistical challenge to offering vaccination to adolescents (33%).
CONCLUSIONS: Incorporating provider insights into future HPV vaccination programs could accelerate vaccine delivery to increase HPV vaccination rates globally.
AIM OF THE REVIEW: This review is an attempt to provide scientific information regarding the ethnopharmacology, phytochemistry, pharmacological and toxicological profiles of Gynura species along with the nomenclature, distribution, taxonomy and botanical features of the genus. A critical analysis has been undertaken to understand the current and future pharmaceutical prospects of the genus.
MATERIALS & METHODS: Several electronic databases, including Google scholar, PubMed, Web of Science, Scopus, ScienceDirect, SpringerLink, Semantic Scholar, MEDLINE and CNKI Scholar, were explored as information sources. The Plant List Index was used for taxonomical authentications. SciFinder and PubChem assisted in the verification of chemical structures.
RESULTS: A large number of phytochemical analyses on Gynura have revealed the presence of around 342 phytoconstituents including pyrrolizidine alkaloids, phenolic compounds, chromanones, phenylpropanoid glycosides, flavonoids, flavonoid glycosides, steroids, steroidal glycosides, cerebrosides, carotenoids, triterpenes, mono- and sesquiterpenes, norisoprenoids, oligosaccharides, polysaccharides and proteins. Several in vitro and in vivo studies have demonstrated the pharmacological potential of Gynura species, including antidiabetic, anti-oxidant, anti-inflammatory, antimicrobial, antihypertensive and anticancer activities. Although the presence of pyrrolizidine alkaloids within a few species has been associated with possible hepatotoxicity, most of the common species have a good safety profile.
CONCLUSIONS: The importance of the genus Gynura both as a prominent contributor in ethnomedicinal systems as well as a source of promising bioactive molecules is evident. Only about one fourth of Gynura species have been studied so far. This review aims to provide some scientific basis for future endeavors, including in-depth biological and chemical investigations into already studied species as well as other lesser known species of Gynura.