Search

Problem Many national child health guidelines In Malawi, Nigeria and South Africa are outdated and score poorly on rigorous methods and stakeholder participation. Approach In line with the World Health Organization's (WHO) emphasis on local guideline contextualization, the Global Evidence-Local Adaptation (GELA) project supported multistakeholder processes to adapt evidence-informed recommendations for child health in Malawi, Nigeria and South Africa. The GELA project team convened national steering groups, which conducted structured, iterative priority-setting exercises to identify priority topics. We identified appropriate source guidelines by systematically searching and screening available guidelines. We then matched recommendations in potential source guidelines to the relevant questions, and assessed the guidelines for timeliness and quality. Drawing on WHO's guideline process, we applied the GRADE-ADOLOPMENT process to develop contextualized recommendations from existing guidelines. If no source guideline or reviews were identified, we conducted new evidence syntheses. Local setting Malawi, Nigeria and South Africa are countries with varying health priorities and systems, all transitioning to universal health coverage. Guideline structures differ between countries, with processes largely led from national health ministries. Relevant changes National guideline groups, supported by GELA researchers and government-academic partners, developed five contextually-tailored child health recommendations. For most of these recommendations, additional evidence was required to inform contextually appropriate national decision-making. Formal capacity-building and on-the-job learning enhanced the competencies of national contributors and researchers in evidence-informed decision-making. Lessons learnt Developing context-relevant recommendations requires considerable resources and time. Further investment in strengthening local capacity is needed for sustainable national guideline development. [phrase omitted] Probleme En Afrique du Sud, au Malawi et au Nigeria, de nombreuses lignes directrices nationales relatives a la sante infantile sont obsoletes et affichent de pietres resultats en termes de rigueur des methodes et d'implication des parties prenantes. Approche S'alignant sur l'importance accordee par l'Organisation mondiale de la Sante (OMS) a la contextualisation des lignes directrices locales, le projet Global Evidence - Local Adaptation (GELA) a apporte son soutien a divers processus de collaboration multilaterale afin d'adapter des recommandations sur la sante infantile etayees par des faits en Afrique du Sud, au Malawi et au Nigeria. L'equipe du projet GELA a constitue des groupes de pilotage nationaux, charges d'effectuer des exercices iteratifs et structures de definition des priorites afin de repertorier les principaux themes. Nous avons identifie des lignes directrices de reference en procedant a une recherche et une selection parmi celles disponibles. Ensuite, nous avons compare les recommandations de ces potentielles lignes directrices de reference avec les questions pertinentes, puis nous avons evalue leur qualite et leur actualite. En nous fondant sur le processus d'elaboration de lignes directrices de l'OMS, nous avons applique la methodologie GRADEADOLOPMENT pour formuler des recommandations contextualisees a partir de lignes directrices existantes. Si aucune analyse ni ligne directrice de reference n'avait pu etre degagee, nous etablissions de nouvelles syntheses de preuves. Environnement local L'Afrique du Sud, le Malawi et le Nigeria sont des pays aux priorites et systemes de sante variables, qui operent tous trois une transition vers une couverture sanitaire universelle. Les structures des lignes directrices different d'un pays a l'autre, les processus etant generalement menes par les Ministeres nationaux de la Sante. Changements significatifs Les groupes charges d'elaborer des lignes directrices nationales, avec l'aide des chercheurs GELA et des partenaires gouvernementaux et universitaires, ont emis cinq recommandations adaptees au contexte en matiere de sante infantile. Dans la plupart des cas, la prise de decisions nationales contextualisees necessitait des preuves supplementaires. Le programme de renforcement des capacites et l'apprentissage sur le terrain ont permis d'ameliorer les competences des chercheurs et contributeurs nationaux dans les processus decisionnels etayes par des faits. Lecons tirees Mettre au point des recommandations propres a chaque contexte demande du temps et des ressources considerables. D'autres investissements dans le renforcement des capacites locales sont indispensables pour perenniser le developpement national de lignes directrices. [phrase omitted] Situacion Muchas directrices nacionales de salud infantil en Malawi, Nigeria y Sudafrica estan obsoletas y obtienen una puntuacion baja respecto a los metodos rigurosos y la participacion de las partes interesadas. Enfoque En consonancia con el enfasis de la Organizacion Mundial de la Salud (OMS) en la contextualizacion local de las directrices, el proyecto Global Evidence-Local Adaptation (GELA) apoyo procesos multisectoriales para adaptar las recomendaciones basadas en la evidencia a la salud infantil en Malawi, Nigeria y Sudafrica. El equipo del proyecto GELA convoco a grupos directivos nacionales, que realizaron ejercicios estructurados e iterativos de fijacion de prioridades para identificar los temas prioritarios. Se identificaron las directrices fuente apropiadas mediante la busqueda sistematica y el analisis de las directrices disponibles. A continuacion, se compararon las recomendaciones de las posibles directrices fuente con las preguntas pertinentes y se evaluo la oportunidad y la calidad de las directrices. A partir del proceso de elaboracion de directrices de la OMS, se aplico el proceso GRADE-ADOLOPMENT para desarrollar recomendaciones contextualizadas partiendo de las directrices existentes. Si no se identificaba ninguna directriz o revision fuente, se realizaban nuevas sintesis de la evidencia. Marco regional Malawi, Nigeria y Sudafrica son paises con prioridades y sistemas sanitarios diversos, todos ellos en transicion hacia la cobertura sanitaria universal. Las estructuras de las directrices difieren de un pais a otro, y los procesos se dirigen en gran medida desde los ministerios de sanidad nacionales. Cambios importantes Los grupos nacionales de directrices, apoyados por investigadores del GELA y socios gubernamentales y academicos, elaboraron cinco recomendaciones de salud infantil adaptadas a cada contexto. Para la mayoria de estas recomendaciones, se necesitaron pruebas adicionales para fundamentar una toma de decisiones nacional adecuada al contexto. La capacitacion formal y el aprendizaje en el lugar de trabajo mejoraron las competencias de los colaboradores e investigadores nacionales en la toma de decisiones basada en evidencias. Lecciones aprendidas La elaboracion de recomendaciones adaptadas al contexto requiere recursos y tiempo considerables. Se necesita una mayor inversion en el fortalecimiento de la capacidad local para el desarrollo sostenible de directrices nacionales., Introduction Implementation of evidence-informed health guidelines tailored to the health system contexts of low- and middle-income countries is needed to improve health outcomes. Evidence-informed health guidelines are documents containing clinical, [...]

Objective To identify and summarize the evidence about the extent of overuse of medications in low- and middle- income countries, its drivers, consequences and potential solutions. Methods We conducted a scoping review by searching the databases PubMed[R], Embase[R], APA PsycINFO[R] and Global Index Medicus using a combination of MeSH terms and free text words around overuse of medications and overtreatment. We included studies in any language published before 25 October 2021 that reported on the extent of overuse, its drivers, consequences and solutions. Findings We screened 3489 unique records and included 367 studies reporting on over 5.1 million prescriptions across 80 low- and middle-income countries--with studies from 58.6% (17/29) of all low-, 62.0% (31/50) of all lower-middle- and 60.0% (33/55) of all upper-middle-income countries. Of the included studies, 307 (83.7%) reported on the extent of overuse of medications, with estimates ranging from 7.3% to 98.2% (interquartile range: 30.2-64.5). Commonly overused classes included antimicrobials, psychotropic drugs, proton pump inhibitors and antihypertensive drugs. Drivers included limited knowledge of harms of overuse, polypharmacy, poor regulation and financial influences. Consequences were patient harm and cost. Only 11.4% (42/367) of studies evaluated solutions, which included regulatory reforms, educational, deprescribing and audit-feedback initiatives. Conclusion Growing evidence suggests overuse of medications is widespread within low- and middle-income countries, across multiple drug classes, with few data of solutions from randomized trials. Opportunities exist to build collaborations to rigorously develop and evaluate potential solutions to reduce overuse of medications. Objectif Identifier et resumer les donnees demontrant l'ampleur de la surconsommation de medicaments dans les pays a revenu faible et intermediaire, mais aussi les causes de cette surconsommation, ses consequences et les pistes de solution. Methodes Nous avons mene une analyse exploratoire en effectuant une recherche dans les bases de donnees PubMed[R], Embase[R], APA PsycINFO[R] et l'Index Medicus mondial a l'aide d'une combinaison de termes MeSH et de mots en texte libre lies a la surconsommation de medicaments et aux surtraitements. Nous avons inclus des etudes redigees dans toutes les langues et publiees avant le 25 octobre 2021, qui mentionnaient l'ampleur de la surconsommation, ses causes, ses consequences et les pistes de solution. Resultats Nous avons passe en revue 3489 documents uniques et conserve 367 etudes faisant etat de plus de 5,1 millions d'ordonnances dans 80 pays a revenu faible et intermediaire--ces etudes concernaient 58,6% (17/29) des pays a revenu faible, 62,0 % (31/50) de ceux a revenu intermediaire de la tranche inferieure et 60,0% (33/55) de ceux a revenu intermediaire de la tranche superieure. Sur l'ensemble des etudes reprises, 307 (83,7%) signalaient l'ampleur de la surconsommation de medicaments, avec des estimations comprises entre 7,3% et 98,2% (ecart interquartile: 30,2-64,5). Cette surconsommation s'observait principalement dans des categories telles que les antimicrobiens, les substances psychotropes, les inhibiteurs de la pompe a protons et les antihypertenseurs. Plusieurs causes etaient evoquees: meconnaissance des degats lies a une surconsommation, polypharmacie, mauvaise reglementation et influences economiques. Les consequences etaient surtout nefastes pour la sante des patients et les couts engendres. A peine 11,4% (42/367) des etudes examinaient des solutions, parmi lesquelles des reformes reglementaires, ainsi que des initiatives de sensibilisation, de deprescription et d'audit-feedback. Conclusion Un faisceau croissant de preuves indique que la surconsommation de medicaments est largement repandue dans les pays a revenu faible et intermediaire, dans de nombreuses categories de substances, et peu d'informations circulent quant aux solutions issues des essais randomises. Il existe neanmoins des opportunites de collaboration qui permettraient de developper et d'evaluer rigoureusement des pistes de solution pour lutter contre la surconsommation de medicaments. Objetivo Identificar y resumir la evidencia sobre el grado del uso excesivo de medicamentos en los paises de ingresos bajos y medios, sus causas, consecuencias y posibles soluciones. Metodos Se realizo una revision exploratoria mediante busquedas en las bases de datos PubMed[R], Embase[R], APA PsycINFO[R] y Global Index Medicus a partir de una combinacion de terminos MeSH y palabras de texto libre sobre el uso excesivo de medicamentos y el sobretratamiento. Se incluyeron estudios en cualquier idioma publicados antes del 25 de octubre de 2021 y que informaran sobre el grado del uso excesivo, sus causas, consecuencias y soluciones. Resultados Se examinaron 3489 registros unicos y se incluyeron 367 estudios que informaron sobre mas de 5,1 millones de recetas en 80 paises de ingresos bajos y medios, con estudios del 58,6 % (17/29) de todos los paises de ingresos bajos, el 62,0 % (31/50) de todos los paises de ingresos medios bajos y el 60,0 % (33/55) de los paises de ingresos medios altos. De los estudios incluidos, 307 (83,7 %) informaron sobre el grado de uso excesivo de medicamentos, con estimaciones que oscilaban entre el 7,3 % y el 98,2 % (rango intercuartil: 30,2-64,5). Las clases mas usadas en exceso incluian los antimicrobianos, los psicofarmacos, los inhibidores de la bomba de protones y los antihipertensores. Los factores causantes incluyeron el conocimiento limitado de los danos del uso excesivo, la polifarmacia, la falta de regulacion y las influencias financieras. Las consecuencias incluian el dano a los pacientes y el coste. Solo el 11,4 % (42/367) de los estudios evaluaron las soluciones, entre las que se encontraban las reformas normativas, las iniciativas de educacion, de desprescripcion y de retroalimentacion de auditorias. Conclusion Cada vez hay mas evidencias de que el uso excesivo de medicamentos esta muy extendido en los paises de ingresos bajos y medios, en multiples clases de medicamentos, y se dispone de datos insuficientes sobre soluciones procedentes de ensayos aleatorizados. Hay oportunidades de crear colaboraciones para desarrollar y evaluar con rigor posibles soluciones para reducir el uso excesivo de los medicamentos., Introduction Overuse in health care is broadly defined as tests or treatments that are inappropriate, unnecessary or of low value and are likely to cause people more harm than benefit. [...]

Introduction: The objective of this study was to evaluate quality indicators of secondary health care in chronic kidney disease (CKD). Methods: This retrospective longitudinal study was conducted in an outpatient medical nephrology clinic of the Brazilian Unified Health System (UHS) and a multidisciplinary outpatient clinic of a private health plan (PHP). The inclusion criteria were age ≥ 18 years, ≥ 3 medical appointments, and follow‐up time ≥ 6 months. Results: Compared to PHP patients (n = 183), UHS patients (n = 276) were older (63.4 vs. 59.7 years, p = 0.04), had more arterial hypertension (AH) (91.7% vs. 84.7%, p = 0.02) and dyslipidemia (58.3 vs. 38.3%, p < 0.01), and had a lower estimated baseline glomerular filtration rate (eGFR) (29.9 [21.5–42.0] vs. 39.1 [28.6–54.8] mL/min/1.73 m2, p < 0.01). Compared to PHP patients, UHS patients had a lower percentage of diabetics with glycated hemoglobin < 7.5% (46.1% vs. 61.2%, p = 0.03), fewer people with potassium < 5.5 mEq/L (90.4% vs. 95.6%, p = 0.04), and fewer referrals for hemodialysis with functioning arteriovenous fistula (AVF) (9.1% vs. 54.3%, p < 0.01). The percentages of people with hypertension and blood pressure < 140 × 90 mmHg were similar between the UHS and PHP groups (59.7% vs. 66.7%; p = 0.17), as was the percentage of people with parathyroid hormone control (85.6% vs. 84.8%; p = 0.83), dyslipidemia and LDL‐cholesterol < 100 mg/dL (38.3% vs. 49.3%; p = 0.13), phosphorus < 4.5 mg/dL (78.5% vs. 72.0%; p = 0.16), and 25‐OH‐vitamin‐D > 30 ng/mL (28.4% vs. 36.5%; p = 0.11). The crude reduction in eGFR was greater in the UHS group than in PHP (2.3 [−0.1; 5.9] vs. 1.1 [−1.9; 4.6] mL/min/1.73 m2; p < 0.01). In the multivariate linear mixed‐effects model, UHS patients also showed faster CKD progression over time than PHS ones (group effect, p < 0.01; time effect, p < 0.01; interaction, p < 0.01). Conclusions: Quality of care for patients with CKD can be improved through both services, and multidisciplinary care may have a positive impact on the control of comorbidities, the progression of CKD, and the planning of the initiation of hemodialysis. [ABSTRACT FROM AUTHOR]

Among all nephropathies, diabetic kidney disease (DKD) is the most common cause of kidney impairment advancement to end-stage renal disease (ESRD). Although DKD has no cure, the disease is commonly managed by strict control of blood glucose and blood pressure, and in most of these cases, kidney function often deteriorates, resulting in dialysis, kidney replacement therapy, and high mortality. The difficulties in finding a cure for DKD are mainly due to a poor understanding of the underpinning complex cellular mechanisms that could be identified as druggable targets for the treatment of this disease. The review is thus aimed at giving insight into the interconnection between chronic hyperglycaemia and cellular mechanistic perturbations of nephropathy in diabetes. A comprehensive literature review of observational studies on DKD published within the past ten years, with 57 percent published within the past three years was carried out. The article search focused on original research studies and reviews published in English. The articles were explored using Google Scholar, Medline, Web of Science, and PubMed databases based on keywords, titles, and abstracts related to the topic. This article provides a detailed relationship between hyperglycaemia, oxidative stress, and various cellular mechanisms that underlie the onset and progression of the disease. Moreover, it also shows how these mechanisms affect organelle dysfunction, resulting in fibrosis and podocyte impairment. The advances in understanding the complexity of DKD mechanisms discussed in this review will expedite opportunities to develop new interventions for treating the disease. [ABSTRACT FROM AUTHOR]

Cassava (Manihot esculenta Crantz) is an important staple crop, especially for resource-poor populations. Cassava-based diets are rich in calories but grossly deficient in essential mineral elements. A field study in southeastern Nigeria aimed at increasing yields and concentrations of bioavailable mineral elements in a β-carotene cassava variety, UMUCASS 38 (TMS 01/1371), through agronomic biofortification. A randomized complete block design experiment in triplicate, with foliar application of Zn (3.0 kg ha−1 Zn as ZnSO4), I (4.0 kg ha−1 I as KI), Se (0.25 kg ha−1 Se as Na2SeO3) and Zn + Se + I in combination at vegetative, tuber initiation and bulking stages of cassava. Results indicated neither phytotoxicity nor altered physical and chemical soil properties. Application of Zn or Zn + Se + I at the vegetative stage significantly increased cassava tuber yields. More Zn, Se, and I accumulated in fresh and processed cassava tuber products (gari, lafun), especially when Zn + Se + I was applied at tuber initiation stage. The combined application of Zn + Se + I consistently outperformed sole applications indicating a synergistic interaction effect between the three elements. It is concluded that in the Zn-deficient soils of southeast Nigeria, yield of cassava root tubers can be significantly increased by foliar application of Zn-containing fertilizer at the vegetative stage, but for optimal accumulation of elemental Zn, Se, and I, a combined Zn + Se + I fertilizer be applied at the tuber initiation stage. [ABSTRACT FROM AUTHOR]

Urbanization, armed conflict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health., Author(s): Akaninyene Otu [sup.1] [sup.2] , Emmanuel Effa [sup.2] , Clement Meseko [sup.3] , Simeon Cadmus [sup.4] , Chinwe Ochu [sup.5] , Rauna Athingo [sup.6] , Eve Namisango [sup.7] , [...]

IgG4‐related disease (IgG4‐RD) is an immune‐mediated disorder marked by fibro‐inflammatory masses that can infiltrate multiple organ systems. Due to its relatively recent discovery and limited understanding of its pathophysiology, IgG4‐related disease may be difficult to recognize and is consequently potentially underdiagnosed. Renal involvement is becoming regarded as one of the key features of this disease. To date, the most well‐recognized renal complication of IgG4‐related disease is tubulointerstitial nephritis, but membranous glomerulonephritis, renal masses, and retroperitoneal fibrosis have also been reported. This concise review has two objectives. First, it will briefly encapsulate the history, epidemiology, and presentation of IgG4‐related disease. Second, it will examine the reported renal manifestations of IgG4‐related disease, exploring the relevant histology, imaging, clinical features, and treatment considerations. This synthesis will be highly relevant for nephrologists, rheumatologists, general internists, and renal pathologists to raise awareness and help improve early recognition of IgG4‐related kidney disease (IgG4‐RKD). [ABSTRACT FROM AUTHOR]

A review on the role of biochar in agricultural productivity revealed the importance of biochar as a soil amendment system for sustainable agriculture. There is a growing interest in its use, as a fertilizing material or as incorporation into farming systems for amending soils. It is a fact that biochar is fast assuming the status of a quick fix solution to all soil degradation problems associated with the sustainable management of plant nutrients for strategic increases in crop yields. These call for a careful examination of the benefits and definite drawbacks of biochar. To avoid the abuse of biochar, there is need to quantitatively and qualitatively study its application and deployment for soil amelioration and nutrient boost for crop production. This involves field studies and extensive review of available literatures, to clear any doubt that may exist in the use of biochar. A well-established knowledge based on its beneficial potentials will inform both scientists and farm practitioners how best to engage biochar. This review essentially seeks to highlight the usefulness of biochar and its possible applications and drawbacks as a tool in sustainable agriculture. [ABSTRACT FROM AUTHOR]

Background: Community screening for chronic kidney disease has often been based on single measurements of markers of kidney damage worldwide. The evaluation of kidney dysfunction and related risk factors may be facilitated by the deployment of telehealth services such as short message service. Methodology: Cross-sectional study for screening participants for CKD and risk factors during a world kidney event at two communities in Calabar, Cross River State. Short message service (SMS) was used to remind and invite participants to attend a kidney clinic to recheck their kidney functions and subsequently adjust initial point prevalence estimates based on this outcome. Chronic Kidney disease was defined as eGFR less than 60ml/min/1.73m2 and/or proteinuria. Results: A total of 230 consenting participants were screened with an overall mean age of 36.43 ±11.69 years. 145 (62.7%) were either obese or overweight, while 25 (10.9%), 10 (4.3%) and 1 (0.4%) had a history of hypertension, diabetes, and CKD, respectively. Various degrees of proteinuria were found in 50 (21.74%) participants. Eleven participants had low eGFR <60mL/min. The point prevalence of CKD at the first screening was 24.3% (95%CI 18.9 - 30.4). Of those with either proteinuria or low eGFR, only 12(24%) and 5(45.4%) respectively represented themselves for recheck following the text messages. The adjusted point prevalence was 20.1%. Conclusion: There is a low level of response to recall for rescreening for urinary and blood markers of kidney disease using mobile phone short message service in our population. The determinants and drivers of response will need to be studied. [ABSTRACT FROM AUTHOR]