Background:Three bodies involved in the training of health professionals in South Africa, the Health Professions Council of South Africa, Council for Higher Education and the Department of Health, are expected to align and meet the quality education, training and practice standards of health professions, including clinical training and practice of optometry students at public health facilities. Objectives:To review documents related to optometric student clinical training standards in South Africa, to determine their alignment and ascertain whether they serve their intended purpose. Methods:A qualitative documentation review study using content analysis to collect, explore and compare data from purposively sampled documents, apraised using the international centre for allied health evidence instrument. Results:Two themes emerged from the review, namely; the required optometry knowledge, skills and conduct and the required optometry processes and procedures. However, the frameworks of the reviewed documents vary vastly in terms of quality, transparency and core content. Conclusion:There is general alignment of the defined clinical training and supervision standards amongst universities offering optometric education and the regulatory authorities within the public health facilities in South Africa. There is still a need to standardise the documents guiding optometry student clinical training and practice, with clear, consistent, referenced, accurate and evidence-based recommendations.
Background:Smallholder farmers in Uganda are commonly exposed to high levels of pesticides. Improper handling of these chemicals can cause numerous health risks. Hence, this study assessed the knowledge and risk perception of pesticide exposure among smallholder farmers of Sembabule district, Uganda. Methods:A cross-sectional study among 278 smallholder farmers was conducted, using a researcher administered questionnaire. Participants were selected using systematic sampling with an interval of each 8th household. A generalized linear model with modified Poisson regression was used to estimate prevalence ratios (PRs) and corresponding 95% confidence intervals (Cls) for factors associated with low-risk perception of pesticide exposure, including sociodemographic and knowledge related-variables were adjusted for in the multivariable model. Results:Overall, 66.19% (184/278) of the participants had poor knowledge of pesticide exposure, and 54.68% (152/278) had a low-risk perception of pesticide exposure. Low-risk perception of pesticide exposure was associated with lack of concern about negative impacts of pesticide exposure [Adjusted Prevalence Ratio, aPR = 4.96, 95% Cl: 2.13-11.56] and with the perception that pesticides do not affect the environment [aPR = 1.85, 95% Cl:1.22-2.81]. Conclusion:Smallholder farmers had low-risk perception of pesticide exposure. This underscores the need for national farmer-trainings by agricultural extension workers on safe pesticide use, and improvement of existent government pesticide sale regulations.
Background:Sickle cell disease (SCD) is the most common inherited blood disorder worldwide. Although monogenic, it presents substantial clinical heterogeneity influenced by genetic modifiers, including haplotypes and fetal hemoglobin (HbF) levels. Objectives:This pilot cross-sectional study aimed to characterize, for the first time, the βS gene haplotype distribution among Moroccan patients with sickle cell anemia and evaluate its impact on hematological parameters, particularly HbF levels. Methods:Eight polymorphic sites within the β-globin gene cluster were analyzed using PCR-RFLP in 334 chromosomes from SCD patients in northern Morocco. Associations between haplotypes and HbF levels were evaluated. Results:PCR RFLP showed that the Benin haplotype was the most common (61.1%), followed by Bantu (14.1%), Atypical A1 (11.7%), Senegal (10.5%), and Arab-Indian (2.7%). The most frequent genotypes were Ben/Ben (41.3%), Ben/CAR (15%), and Ben/Sen (10.2%). HbF levels varied significantly across haplotypes (p < 0.005), with Senegal and Arab-Indian showing the highest levels and Benin and Bantu the lowest. Conclusions:This study highlights both the genetic and anthropological diversity of SCD in Morocco, likely reflecting historical African gene flow. Haplotype profiling enhances understanding of genotype-phenotype correlations, offering valuable insights for prognosis and individualized care strategies to improve patients' outcomes.
Background:Cardiovascular diseases are a leading cause of mortality globally. Community pharmacists can improve the impact of cardiovascular diseases by early identification of risk factors and provision of health promotion. However, patients' perceptions of community pharmacists are not well understood. Objective:To understand how patients perceive the involvement of community pharmacists in preventing and controlling cardiovascular diseases. Methods:Semi-structured interviews were conducted with 10 (n = 10) cardiovascular disease patients who utilise community pharmacy services in Maseru and Berea districts. Convenience sampling method was used to select participants. The questionnaire comprised questions to uncover patients' experiences, utilisation, and expectations of community pharmacists' services. Thematic analysis was employed. Results:Four themes were identified, namely 1) perceived role of a community pharmacist, 2) patient healthcare-seeking behaviour, 3) perceived community pharmacist care outcomes, and 4) future expectations. Generally, cardiovascular disease patients visited community pharmacists every month for medication refills and were less aware of other services. Overall, patients were appreciative of and were willing to support future community pharmacists' services. The patients expect community pharmacists to lead initiatives that educate people about cardiovascular diseases and standardise services across all pharmacy outlets. Conclusions:Patients had limited awareness of other services provided by community pharmacists beyond dispensing medication, such as disease detection and health promotion. However, they valued the services provided by community pharmacists and were willing to utilise expanded services. This presents an opportunity for community pharmacists to raise awareness of their current scope of work and expansion of care.
Aim:Primary spontaneous pneumothorax (PSP) predominantly affects young individuals and presents with variable treatment outcomes and considerable recurrence rates. Understanding the relationship between treatment approach and recurrence is essential for guiding clinical decision-making. The aim of this study was to evaluate demographic characteristics, treatment modalities, and recurrence rates in patients with PSP. Methods:This single-center, retrospective study included patients diagnosed with PSP between January 2014 and December 2023. Recurrence rates following treatment were analyzed. Results:A total of 314 patients (median age 28 years; 93.0% male) were included. Tube thoracostomy was the initial treatment in 250 patients (79.6%). Recurrence occurred in 78 patients (24.8%), with higher rates following tube thoracostomy (28.0%) compared to oxygen therapy (17.8%). No recurrence was observed after initial video-assisted thoracoscopic surgery (VATS). In recurrent cases, 44.9% underwent VATS, 25.6% tube thoracostomy, and 29.5% oxygen therapy. Treatment choice and smoking status showed significant associations (p<0.001 for the first episode and p=0.007 for the second episode). Notably, all patients who underwent VATS were smokers. Conclusions:VATS performed during the first pneumothorax episode in selected patients prevents recurrence. The feasibility of VATS as the first treatment option in selected patients should be further investigated in larger series.
Background:Vasomotor symptoms during menopause can be affected by many biological, psychological and environmental factors. Coffee consumption may also be one of these factors. Purpose:This study aims to investigate the relationship between coffee consumption habits and the severity of vasomotor symptoms in postmenopausal women in Turkey. Method:A cross-sectional, descriptive study was conducted with 169 postmenopausal women. Data on participants' sociodemographic characteristics, coffee consumption habits, and vasomotor symptom severity were collected. ordinal regression analyses were performed to examine the effects on symptom severity; the significance level was set at p < 0.05. Results:The mean age of participants was 57.76 ± 5.27 years, and the mean age at menopause was 49.44 ± 3.25 years. The majority of women (78.1%) consumed mainly Turkish coffee; approximately half drank 0-1 cups of coffee per day. Regression analyses revealed that coffee type and consumption temperature were significantly associated with some vasomotor symptoms. Conclusion:Coffee type and consumption temperature may be associated with the severity of some vasomotor symptoms in the postmenopausal period. Future, larger-scale studies are needed to further clarify these relationships.
Background:Hypocholesterolaemia in pulmonary tuberculosis(TB) patients is disregarded but is a predictor of poor survival. Objectives:To determine serum lipid profile differences at diagnosis and various times of medication based on sex, HIV(human immune virus) and wasting status and factors associated with hypocholesterolaemia. Methods:A repeated cross-sectional study was conducted to assess triglyceride(TG), total cholesterol (TC), high-density lipoprotein(HDL) and low-density lipoprotein(LDL) among 414 participants. Results:Majority of the participants were males(239/414)(58%), with a median age of 28years. TB patients showed significantly lower lipid profile at diagnosis regardless of HIV-status and sex. Presence of anaemia among HIV-seropositive participants with TB, prevalence ratio(PR):2.6, 95%confidence interval(CI):1.0-7.1, p<0.05) and HIV-seronegative participants with TB(PR:2.5, 95%CI:1.1-5.5, p<0.05), moderate/severe TB(PR:2.5,95%CI:1.1-5.5, p<0.05) and CD4 cells>200(PR:0.3 95%CI:0.1-0.8, p<0.05) among HIV-seropositive participants with TB were associated with HDL-hypocholesterolaemia. Male sex, moderate/severe TB, body wasting, dyspnoea and chest pain were independently associated with TC-hypocholesterolaemia. Regardless of sex and wasting status, the pattern of cholesterol recovery was similar at varying times. Conclusion:We envisage that hypocholesterolemia is a marker of clinical TB-disease severity and its recovery indicates treatment response.
Background:The coverage of completeness of immunization is still an important problem in many countries, including Indonesia. Objectives:The aims of this study were to determine factors related to get incomplete immunization in Indonesia. Methods:The data were collected from the Indonesian Family Life Survey (IFLS) 5 with a sample of 782 women childbearing age (15-49 years) who had children aged 1-5 years old in Indonesia. The data was analyzed by using multiple logistic regressions. Results:Mother with lower education had 1.91 times greater odds for having incomplete immunization status compared with higher education (AOR=1.91, 95%CI 1.11-3.28). Mother who working contributed to improving incomplete immunizations compared with respondent who did not work (AOR=1.60, 95%CI 1.12-2.29). Mothers who lived in urban area had 1.48 higher odds to have incomplete immunization status in children compared to mother who lived in rural area (AOR=1.48, 95%CI 1.09-2.02). Husbands and both partners who have the power to make health decisions have lower odds of having a child whose immunizations are incomplete compared to only the mother who makes health decisions (AOR father =0.39, 95%CI=0.21-0.73; AOR both=0.62, 95%CI=0.42-0.92). Conclusion:Children's age, mothers' education and occupation, and health decision maker were related to incomplete immunization status.
Background:The treatment needs of elderly people can be complex because of reduced mobility, compromised physical and mental states amongst others. These complexities can be pronounced in those with systemic diseases and those on medications that compound oral conditions e.g. Xerostomia. This makes oral hygiene and treatment more difficult. Despite their increased need, the uptake of dental care by elderly people is characteristically poor and unmet needs may be high6. Barriers to the uptake of care include a lack of perceived need, concerns about availability, cost and fear of cost, fear of treatment and anxiety about Dentist characteristics. Materials and Method:This cross-sectional study sampled 500 elderly patients, aged 65 to 91, attending clinics in selected healthcare centers in Oyo State, Nigeria. A multistage sampling technique was used, and data was gathered through structured interviewer-administered questionnaires and a modified WHO clinical assessment form to assess oral health status. Data was analyzed using SPSS version 23, with summary statistics like frequency tables and means. Chi-square tests were employed to examine associations between variables, with significance set at P < 0.05.Data collection was conducted daily, with verification and supervision to ensure accuracy. Occasional re-examination of random patients was done to maintain consistency among examiners. Result:The results showed a mean age of 74 ± 10 years, with 51% female participants. A mean DMFT score of 5 and a CPITN score of 2 indicated significant dental care needs. However, only 8.6% of the elderly participants had accessed dental care in the past 12 months. Financial constraints, fear of pain, and anxiety about dental instruments were some of the major factors preventing the elderly from seeking care. Conclusion:The study concluded that despite available public-sector dental services, financial and personal barriers contributed to unmet oral health needs among the elderly.
Background:Chronic kidney disease (CKD) is a major global health concern affecting over 850 million people. Among military personnel, CKD poses unique operational and occupational challenges, yet information on awareness, prevention, and service delivery within the Nigerian Navy (NN) is limited. Objectives:To map existing evidence on CKD knowledge, prevention practices, healthcare services, and policy frameworks relevant to the NN, identify service and evidence gaps, and propose feasible interventions. Methods:A scoping review guided by the PRISMA-ScR framework was conducted. Literature published between 2000 and April 2024 was searched across PubMed, African Journals Online, and Google Scholar, complemented by grey literature from the Nigerian Navy Medical Services and the Ministry of Defence. Studies were selected using the Population-Concept-Context (PCC) framework and thematically synthesized across five domains: epidemiology, screening, workforce capacity, dialysis access, and governance. Results:Eight studies met the inclusion criteria. Evidence showed fragmented CKD prevention, low awareness, absence of a renal registry, gaps in workforce capacity, and restricted dialysis services confined to the Naval Medical Centre Victoria Island, and the Nigerian Navy Reference Hospital Ojo. No dedicated CKD or NCD policy exists. Conclusion:Strengthening screening, establishing a Navy CKD registry, and expanding tele-nephrology could enhance early detection, coordination, and operational readiness.
Background:Polycystic ovary syndrome is a prevalent endocrine disorder among reproductive-age women, significantly impacting their quality of life and increasing the risk of chronic diseases. Objectives:This study aimed to determine adherence levels and main barriers to adherence to prescribed treatment regimens among women with PCOS in Lahore, Pakistan. Methods:A cross-sectional study was conducted at hospitals (government and private) in Lahore, Pakistan, enrolling 401 women diagnosed with PCOS. Data were collected using structured questionnaires. Results:Only 21.4% of participants reported full adherence to their treatment regimens, while 50.6% were partially adherent, and 27.9% were non-adherent. Significant associations were found between adherence and socioeconomic status (SES) (χ2 = 8.98, p = 0.030) and body mass index (BMI) (χ2 = 8.28, p = 0.041). Logistic regression revealed women from upper-middle-class backgrounds had significantly lower odds of adherence compared to upper-class women (OR = 0.55, 95% CI: 0.33-0.92; p = 0.022). Conclusion:Treatment adherence among women with PCOS in Pakistan is suboptimal. Socioeconomic status and body mass index were significant predictors of adherence, while major barriers included limited knowledge, medication side effects, and treatment cost. Targeted interventions involving patient education, socioeconomic support, and healthcare system improvements are necessary to enhance treatment adherence and outcomes in this population.
Background:In Uganda, 1 in 4 girls has been pregnant by 18 years. This was worse during the COVID 19 pandemic. We determined risk factors for pregnancy among rural and urban dwelling adolescents in Uganda. Methods:We conducted a mixed-methods study among girls aged 13 to 19 years in a rural and urban district in Uganda. Quantitatively, we used an unmatched case control design involving 200 adolescents with pregnancy experience and 400 controls with no pregnancy experience. Quantitative data was analyzed using STATA version 14. Qualitative methods included 17 focus group discussions, 10 in-depth interviews and 20 key informant interviews with key stakeholders. Transcribed audio recordings were analyzed using a content thematic approach using Nvivo. Results:Of the 600 girls, mean age was 16.9 years (SD 3.84). Independent risk factors for pregnancy were age, out-of-school, a friend with teenage pregnancy, cigarette smoking, working for money and correct contraceptive knowledge. Protective factors included positive personal attitudes, father's education and larger household size. Qualitatively, inadequate information on sexual and reproductive health, early sexual debut, alcohol and drug abuse, absence of parental supervision, negative peer influence and poverty were reported. Conclusion:Overall, individual characteristics, behaviors and inadequate information increased the risk of pregnancy.
Background:Sickle cell anaemia (SCA) significantly contributes to skeletal morbidity in Nigeria, with bone complications like pain crises and avascular necrosis prevalent. Osteocalcin (OC) and bone-specific alkaline phosphatase (BALP) are potential markers of bone formation, yet their diagnostic utility in SCA is underexplored in African populations. Objective:To assess serum OC and BALP levels in Nigerian SCA patients during bone pain crises (BPC), steady state, and in healthy controls, evaluating their diagnostic relevance for bone turnover. Methods:This cross-sectional study at Ahmadu Bello University Teaching Hospital, Zaria, enrolled 180 adults (60 SCA in BPC, 60 steady state, 60 HbAA controls). Serum OC and BALP were measured via ELISA. Data were analyzed using Kruskal-Wallis tests, Spearman's correlation, and ROC curves (p≤0.05). Results:Median OC and BALP levels were significantly higher in SCA BPC (26.53 ng/mL, 23.51 µg/L) and steady state (24.40 ng/mL, 14.42 µg/L) compared to controls (16.07 ng/mL, 9.95 µg/L; p=0.022, p<0.001). BALP showed superior diagnostic accuracy (AUC=0.789, sensitivity=98.3%) compared to OC (AUC=0.592). OC correlated with BMI (p=0.020), but not age or gender. Conclusion:BALP is a more reliable marker than OC for detecting bone turnover alterations in SCA, particularly during BPC, supporting its use in resource-limited settings.
Background:The period during pregnancy to postnatal is vital for developing of mother-infant bond. A mother suffering from depression may have issues with forming effective bonding. An evaluation of whether perinatal depression influences mother-infant bonding has scarcely been studied in Kenya. Objectives:This study aimed to evaluate the relationship between perinatal depression and impaired maternal bonding among postpartum mothers. Methodology:A total of 225 postpartum mothers aged between 18-49 years at 6-12 weeks postpartum at a ratio of 1:2 (cases: controls) were selected. Women who had MIBD were enrolled as cases while mothers without MIBD were controls. Two self-report scale tools; the Postpartum Bonding Questionnaire scale and the Edinburg Postnatal Depression scale were used at 6-12 weeks postpartum to obtain data on depression and bonding. A semi-structured questionnaire collected information on specific risk factors. Results:The proportion of women with perinatal depression was 40% in the case group and 9.3% in the control group. The odds of having perinatal depression were 6.48 more in the cases than the controls (OR: 6.48, (95% C.I: 3.16, 13.28) and P-value <0.001. Conclusion:Perinatal depression is associated with impaired maternal bonding at 6-12 weeks postpartum.
Background:The prevalence of first-line ART failure in Bulawayo City, Zimbabwe's second-largest city for the year 2016 was 6.6% higher than the national average of 3.3%. We assessed the association between non-adherence and first-line ART failure persons on ART in Bulawayo City. Methods:A 1:1 case-control study was done to measure the association between adherence and other risk factors for treatment failure among 169 cases and 169 controls. The Morisky Medication adherence 8-item scale was used to assess self-reported adherence, and non-adherence was defined as having a self-reported score of 1 to 8. Epi info 7 was used for univariate, bivariate, and multivariate analysis. Results:Persons who were non-adherent to ART were 5 times more likely to experience treatment failure than those who adhered association between non-adherence and treatment failure (OR=5.1, 95% CI 2.9-8.9). The study established that 58% of the cases had good knowledge of adherence to ART compared to 85% of the controls. Stopping medication when feeling worse (AOR=3.5, 95% CI 1.8-7.0) was the most significant independent risk factor for treatment failure. Conclusions:The study found a strong association between non-adherence and treatment failure. Routine monitoring at every clinic visit of clients on ART should be done to monitor the client's adherence to medication.
Background:Diabetes and pre-diabetes are significant risk factors for acute coronary syndrome (ACS) and acute primary stroke (APS). Dysglycemia in any context is under-diagnosed or identified late in resource-poor countries such as in sub-Saharan Africa (SSA), especially when the patient is not known to have pre-morbid diabetes. Materials and methods:We conducted a prospective cross-sectional study at the Aga Khan University Hospital, Nairobi. Inclusion criteria: consenting adults ≥18 years admitted with ACS/APS during the period April 2021-February 2022 inclusive. HbA1C was used to determine the glycemic status. Definition of diabetes and pre-diabetes was based on the American Diabetes Association guidelines. Results:From a total of 211 patients [144 (81.2%) of African race], the median age of the patients was 58 (49-68) years with a male to female ratio of 2.5:1. 47.4% (n = 100) had ACS and 52.6% (n=111) had APS. The prevalence of dysglycemia was 68.2% (95% CI: 61.5%-74.5%) with the prevalence of pre-diabetes being 30.3% (64/211) and type 2 diabetes 37.9% (80/211). Of the patients with dysglycemia, 47.9% (69/144) had a new diagnosis. Conclusion:This study shows a remarkably high prevalence of dysglycemia in patients with ACS/APS. The new diagnosis of pre-diabetes prevalence was comparable to diabetes in these patients, adding to the evidence that prediabetes portends significant cardiometabolic consequences and effects over and above the development of type 2 diabetes.
Background:Vancomycin-resistant Enterococcus faecium is classified among World Health Organization priority pathogens for Research and development of new antibiotics. This study presents the results of 13-year surveillance of antibiotic resistance in E. faecium, with a specific focus on vancomycin and linezolid resistance in thirteen university hospitals across various regions of Tunisia. Methods:All participating laboratories followed a standardized methodology for clinical sample culture, bacterial identification, antibiotic susceptibility testing according to CA-SFM guidelines, result interpretation, epidemiological data collection. Additionally, they implemented quality controls. Findings:During the surveillance period, 2,931 E. faecium isolates were collected, predominantly from urine (49.1%) and blood cultures (24%), with high prevalence in Surgery Departments (30.3%) and Intensive Care Units (23.6%). Resistance rates were high for ampicillin (87.1%), erythromycin (93.6%), gentamicin (62.8%) and vancomycin (26%). Since 2019, six linezolid-resistant isolates have been isolated and only one isolate resistant to tigecycline was identified in 2021. Vancomycin resistance had significant upward trend since 2012, peaking at 38.1% in 2017. It was significantly associated to gentamicin (84.9% vs. 53.8%) (p<0.0001) and erythromycin95.8% vs. 89.6%) (p=0.0001) in a five year period (2018 - 2022). Conclusion:This worrying situation requires deeper investigations to develop adapted strategies with targeted measures in high-risk departments.
Background:Non-adherence is a complex challenge to global tuberculosis control because it arises from the interaction of multiple factors, and yet, there are few studies that have evaluated beyond patient factors into the organization and processes of tuberculosis service delivery. We examined the relationship between patient satisfaction and adherence among adult TB patients. Methods:In a cross-sectional study, we hypothesized that patients with high satisfaction scores were more likely to adhere to prescribed tuberculosis treatment than patients with lower satisfaction scores. 469 new TB cases aged 18 years and older were consecutively recruited from the National TB & Leprosy program-Uganda. The outcome variable was adherence (high was ≥90% Morisky scores) to TB treatment. The exposure variable was patient satisfaction (PS) scores. Results:Of the 469 patients, 29% (135/469) were non adherent). Patients satisfaction scores on the responsiveness to patients' preferences were higher among the adherent compared to the non-adherent, 62.1 ± 8.8 versus 63.8 ± 7.3 (p=0.014), respectively. Patients were very satisfied with the technical quality of care and management of patient's preferences, and were least satisfied with the amount of information about action usage, and effects of tuberculosis medication, regardless of adherence levels. For every unit increase in patient satisfaction scoes for the clinic structure, there was an associated decrease in the level of non-adherence. Conclusion:Patients' satisfaction with the organization and processes of the clinic was associated with non-adherence to tuberculosis medication. The satisfaction scores for information about action usage, and effects of tuberculosis medication were low.
