Pan African Medical Journal最新文献

Introduction: cervical cancer is primarily driven by high-risk human papillomavirus infections. It is a leading cause of cancer-related deaths among women globally. The emergence of immunotherapeutic approaches, particularly programmed death ligand-1 (PD-L1) inhibitors, has shown promise in various cancers. This study aims to investigate the correlation between PD-L1 expression and HPV status in cervical carcinoma samples from a Nigerian tertiary hospital.

Methods: the study was conducted in the Department of Pathology of our hospital. The study materials were 101 cases of archival formalin-fixed paraffin-embedded (FFPE) tissue blocks that met the study criteria recruited retrospectively from January 2012 to December 2016. Immunohistochemistry for PD-L1 was done and real time PCR for HPV DNA was done using CFX96. The data were then analyzed using SPSS version 23. P < 0.05 was considered significant.

Results: high-risk HPV detection rate was 51%. The two most common genotypes were HPV 16 (84.3%) and HPV 35 (17.6%). The predominant infections were single genotypes occurring in 80.4% of the cases. There was no correlation of HPV status with PD-L1, histological grade or type of cervical carcinoma. High-risk HPV did not show any distribution pattern with age groups of patients.

Conclusion: human papillomavirus 16 is the most predominant cause of cervical carcinoma. There are some environmental variations in the frequency of other genotypes with HPV 35 being relatively more common than HPV 18 in this study. Programmed death ligand-1 was positive in 47% of the cases but did not show any correlation with the HPV infection status.

Introduction: the prevalence of Helicobacter pylori (H. pylori) infection in children is very high in Morocco. Eradication rates of H. pylori infection decrease due to the emergence of resistance to antibiotics. Data on the antimicrobial susceptibility of H. pylori in Moroccan children are not available. This study aims to assess the prevalence of H. pylori infection and the metronidazole resistance rate of H. pylori in Moroccan pediatric patients, and their association with epidemiologic factors.

Methods: a cross-sectional study was conducted on 132 pediatric patients who had an indication for upper gastrointestinal endoscopy and attended pediatric hospital Abderrahim Harouchi of the University Hospital Ibn Rochd, Casablanca, Morocco. Detection of H. pylori infection and the susceptibility to metronidazole was performed by classic PCR. Statistical analysis was performed using R Studio software.

Results: the overall prevalence of H. pylori infection was 80.3%. vomiting was significantly associated with H. pylori infection (p-value=0.01). Regarding the resistance rate of metronidazole, we found that the prevalence of H. pylori resistance to metronidazole was high (70.8%) and it significantly increased, especially in pediatric patients living in urban areas (p-value=0.01).

Conclusion: the prevalence of H. pylori infection and resistance rate of metronidazole were very high in Moroccan children. Therefore, triple therapy with metronidazole must be preceded by a study of the bacterium's susceptibility to the prescribed antibiotics, in particular to metronidazole.

Introduction: irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021).

Methods: this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s "AWaRe" categorization: "Access," "Watch," and "Reserve."

Results: a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively.

Conclusion: antibiotic use was high in the research setting. Over half of the antibiotic use was in the "Watch" group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.

Introduction: the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT.

Methods: this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses.

Results: the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001.

Conclusion: the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.

Introduction: visceral leishmaniasis (VL) represents the most serious and severe form of leishmaniasis in Northern Morocco. In this context, the objective of this study was to describe the epidemiological profile of VL in the Tangier Tetouan Al-Hoceima region from 2009 to 2018.

Methods: the epidemiologic data was collected from April 28^th, 2019 to February 2^nd, 2020 from files and investigation reports of cases. Additionally, annual reports for VL from the health services and provincial laboratories of parasitology were consulted. The analysis was conducted using statistical package for the social sciences (SPSS) v26 software.

Results: the study included 304 cases. Chefchaouen province was the highest endemic area (54.5%). The cases in the spring reached 36.5% and were characterized by age ≤5 years old (78.8%), male gender (M/F=1.3) and rural residents (91.4%). The number of inhabitants per household of cases was >5 persons (68.5%). A total of 94.3% and 98% had no suspect cases around or in their homes, respectively. Farmers accounted for 74.5% of cases. Signs of fever were present in 17.4% of cases, with 67.3% of these cases presenting these signs for a duration of more than 30 days. A total of 64.2% cases were diagnosed within a month. The serological test was used for diagnosis in 67.1% of cases and for the treatment, glunantime® was used in all cases (100%).

Conclusion: to eliminate the VL infection, it's necessary to monitor the entomological, mammalogical investigation. Also, to activate the Integrated Vector Control Management Committee at the most endemic province and to inform the community as well as the professionals of health about the VL control measures. A correlational study of the VL socio-economic and climate factors is recommended.

Introduction: the Bamenda, Santa and Tiko Health Districts are in the highest malaria transmission strata of Cameroon. The purpose of this study was to explore the indicators of ownership and utilisation as well as maintenance of Long-Lasting Insecticidal Nets (LLINs) in three health districts in Cameroon.

Methods: a cross-sectional household survey involving 1,251 households was conducted in the Tiko Health District (THD) in June and July 2017 and in Bamenda and Santa Health Districts in March to May 2018. A structured questionnaire was used to collect data on LLIN ownership, utilisation, and maintenance as well as demographic characteristics.

Results: the average number of LLINs per household was higher in the Bamenda Health District (BHD) compared to the THD (2.5, range; 0-6 vs. 2.4, range; 0-6) as well as the household ownership of at least one LLIN (93.3% vs. 89.0%). The proportion of the defacto population with universal utilisation was higher in BHD compared to THD (13.1% vs 0.2%). In the multinomial regression analysis, households in the SHD (p = 5.5x10-4, OR; 0.3, 95% C.I; 0.1-0.6), were less likely to own at least one LLIN compared to those in THD. Eighty-seven point one percent (87.1%) of household heads admitted that LLINs could be washed, while 50.1% affirmed the correct washing frequency.

Conclusion: ownership of LLINs was low in the THD in comparison to the goal of one for every two household members. Overall, LLINs coverage and accessibility was still low after the free mass distribution campaigns (MDCs), as only 14.6% of children 0-5 years and 16.1% of the entire population used LLIN the night before the survey.

According to the latest data, the majority of babies are delivered via cesarean section (C-section) in Türkiye. This is a medically unacceptable situation and reflects the highest rate in the world. Despite Türkiye enacting a law prohibiting elective C-sections, the rate has not decreased; rather increased. Therefore, this article and accompanying annex have been prepared to propose policy recommendations aimed at reducing the C-section rate. This article summarizes what has been done so far and outlines areas for improvement to reduce the C-section rate, offering a different perspective on policy. The C-section rate has reached such a critical level in Türkiye that a concerted effort involving the Turkish Ministry of Health, healthcare and obstetrics societies, physicians, midwives, healthcare professionals, public and the media is necessary. Health authorities in Türkiye should consider all policy recommendations in addressing this issue.

Introduction: Coronavirus disease (COVID-19) significantly impacted mental health and mental health services worldwide. We sought to explore the challenges faced by mental health services from the perspectives of service users, providers, and policymakers during the COVID-19 pandemic in Uganda and the strategies put in place to ensure the continuity of these services.

Methods: qualitative data were collected using semi-structured interviews with eight mental health service users, four mental health workers, four hospital administrators, four district mental health focal persons, and two policymakers. The data were analyzed using thematic analysis.

Results: the challenges reported by participants included human resource shortages, loss of space for service provision, low funding, drug shortages, changes in patient load, and lack of access to services due to restrictive measures. The adaptations included the use of innovative means like mobile phone technology, reorientation of health facility functioning to COVID-19 restrictions, using different methods to deliver medications, integration of mental health in general health services, and alternative financing for mental health services.

Conclusion: the COVID-19 pandemic posed significant challenges to mental health service provision. Nevertheless, the health system responded by implementing various measures to ensure continuity of care. Further research is needed to evaluate the effectiveness and scalability of these innovations in the long term.

Introduction: falls in the elderly are a neglected health problem in many societies, particularly in the developing world. Many health and social service providers are unprepared to prevent and manage falls and related injuries as they lack sufficient knowledge to identify their predisposing factors. For this reason, this study aims to identify the pattern of falls and its determinants among the elderly in northern Nigeria.

Methods: a cross-sectional study was conducted among 300 elderly patients, selected by systematic random sampling. An interviewer-administered questionnaire was used. Data was analyzed using SPSS version 20. Variables were summarised using percentages and measures of central tendency/dispersion. The chi-square test was used in assessing the significance of associations between categorical variables. A p-value of <0.05 was considered statistically significant. Binary logistic regression analysis was conducted to identify determinants of falls.

Results: the prevalence of falls and fall injuries was 41.4% and 25.4% respectively. The commonest pattern of fall injuries was swellings and pain (31.1%). Tripping was the commonest 60 (49.2%) cause of fall. Age (p<0.026, AOR=4.424, CI=1.192-16.424), presence of dizziness (p<0.015, AOR=0.334, CI=0.138-0.810), use of shoes with uneven (P<0.021, AOR=0.337, CI=0.133-0.851)/slippery soles (p<0.038, AOR=0.392 CI=0.162-0.948), having slippery mats (P<0.001, AOR=0.086, CI=0.039-0.192), wires/cords exposed (p=0.005, AOR=0.306 CI=0.132-0.705) on the pathways were the determinants.

Conclusion: the high prevalence of falls and fall injuries signifies its importance in health care. This implies that physicians should be proactive in asking, assessing, and assisting the elderly to provide targeted interventions to potentially prevent falls.

Mucinous cystadenoma of the caecum is an exceptionally rare occurrence, particularly in paediatric patients. They have been rarely reported in the appendix, ovary, pancreas, and liver. This is the first report of a mucinous cystadenoma of the caecum (to the best of the authors' knowledge) in a child. A mucinous cystadenoma of the caecum can serve as a pathological lead point in intussusception. We report a case of a 3-year-old boy with a mucinous cystadenoma of the caecum causing intussusception. The intussusception recurred after an initial successful hydrostatic reduction. He had a laparotomy which revealed a caecal mass for which a limited right hemicolectomy was done. The histological diagnosis of the caecal mass was a mucinous cystadenoma. In intussusception caused by a lead point like a mucinous cystadenoma, an enema reduction may be successful but the intussusception may recur. Physical examination may reveal pathological lead points not detected on ultrasound scans. This case report contributes to the limited literature on mucinous cystadenomas of the caecum and calls for the need for further research to better understand their aetiology, clinical manifestation, histopathological diagnosis, and management strategies.