scholarly journals Comparative Assessment of the Prevalence, Practices and Factors Associated with Self-medication with Antibiotics in Africa: A Systematic Review and Meta-analysis

Author(s):  
Eugene Vernyuy Yeika ◽  
Brecht Ingelbeen ◽  
Ben-Lawrence Kemah ◽  
Frankline Sevidzem Wirsiy ◽  
Joseph Nkeangu Fomengia ◽  
...  

AbstractBackgroundSelf-medication with antibiotics (SMA) is a common practise in many parts of Africa, but its magnitude and drivers are not well-known. This systematic review evaluated and compared the prevalence, reasons, sources, and factors associated with of SMA within African sub-regions.MethodsAn electronic search of PubMed and Google Scholar databases was performed for observational studies conducted between January 2005 and February 2020. Two reviewers independently screened the abstracts and full texts using the PRISMA flowchart and equally performed quality assessment. Both quantitative and qualitative syntheses of selected studies were carried out.ResultsA total of 40 studies from 19 countries were selected for qualitative synthesis. The prevalence of SMA in Africa ranged from 12.1% to 93.9% with a median prevalence of 55.7% (IQR 41%-75%). Western Africa was the sub-region with the highest prevalence 70.1% (IQR 48.3%-82.1%), followed by Northern Africa with 48.1% (IQR 41.1-64.3%). We identified 27 different antibiotics used for self-medication from 13 different antibiotic classes. Penicillins were the most frequently used antibiotics followed by Tetracyclines and Fluoroquinolones. The most frequent indications for SMA were upper respiratory tract symptoms/infections (27 studies). Common sources of antibiotics used for self-medication were community pharmacies (31 studies), family/friends (20 studies), leftover antibiotics from previous treatments (19 studies), and patent medicine stores (18 studies). Commonly reported factors associated with SMA were no education/ low educational status (9 studies), male gender (5 studies), and low income / unemployment (2 studies).ConclusionsThe prevalence of SMA in Africa is high and varies across sub-regions with Western Africa having the highest prevalence. Drivers of SMA are complex comprising of socio-economic factors, limited access to healthcare coupled with absence or poorly implemented policies regulating antibiotic sales.

2020 ◽  
Author(s):  
Roberto Ariel Abeldano Zuniga ◽  
Silvia Coca ◽  
Giuliana Abeldano ◽  
Ruth Ana Maria Gonzalez Villoria

Objective. The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. Method. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events. Results. A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. Conclusions. Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. Significance of results. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. Keywords: Drugs; Antivirals; Clinical improvement; Mortality; COVID-19; SARS-CoV2.


2020 ◽  
Author(s):  
Roberto Ariel Abeldaño ◽  
Silvia Mercedes Coca ◽  
Giuliana Florencia Abeldaño ◽  
Ruth Ana María González Villoria

Abstract Objective: The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection.Method: We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization), virological clearance, and severe adverse events.Results: A total of 48 studies were retrieved from the databases. Ten articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir.Conclusions: Dexamethasone would have a better result in hospitalized patients, especially in low-resources settings.Significance of results: The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries; since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources.


2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S336-S336
Author(s):  
Aaron Richterman ◽  
Duarxy Rodcnel Sainvilien ◽  
Lauren Eberly ◽  
Louise C Ivers

Abstract Background Cholera has caused seven global pandemics, including the current one which has been ongoing since 1961. A systematic review of risk factors for symptomatic cholera infection has not been previously published. Methods In accordance with PRISMA guidelines, we performed a systematic review and meta-analysis of individual and household risk factors for symptomatic cholera infection. Results We identified 110 studies eligible for inclusion in qualitative synthesis. Factors associated with symptomatic cholera that were eligible for meta-analysis included education less than secondary level (summary OR 2.64, 95% CI 1.41–4.92, I2 = 8%), unimproved water source (summary OR 4.78, 95% CI 3.02–7.57, I2 = 49%), open container water storage (summary OR 2.51, 95% CI 1.57–4.01, I2 = 33%), consumption of food outside the home (summary OR 5.02, 95% CI 2.34–10.76, I2 = 61%), household contact with cholera (summary OR 3.99, 95% CI 2.03–7.87, I2 = 89%), water treatment (summary OR 0.22, 95% CI 0.13–0.36, I2 = 37%), and handwashing (summary OR 0.17, 95% CI 0.10–0.30, I2 = 37%). Other notable associations with symptomatic infection included income/wealth, blood group, gastric acidity, infant breastfeeding status, and HIV infection. Conclusion We identified potential risk factors for symptomatic cholera infection including environmental characteristics, socioeconomic factors, and intrinsic patient factors. Ultimately, a combination of interventional approaches targeting various groups with risk-adapted intensities may prove to be the optimal strategy for cholera control. Disclosures All authors: No reported disclosures.


2021 ◽  
Vol 15 ◽  
pp. 175346662110072
Author(s):  
Roberto Ariel Abeldaño Zuñiga ◽  
Silvia Mercedes Coca ◽  
Giuliana Florencia Abeldaño ◽  
Ruth Ana María González-Villoria

The aim was to assess the clinical effectiveness of drugs used in hospitalized patients with COVID-19 infection. We conducted a systematic review of randomized clinical trials assessing treatment with remdesivir, chloroquine, hydroxychloroquine, lopinavir, ritonavir, dexamethasone, and convalescent plasma, for hospitalized patients with a diagnosis of SARS-CoV-2 infection. The outcomes were mortality, clinical improvement, duration of ventilation, duration of oxygen support, duration of hospitalization, virological clearance, and severe adverse events. A total of 48 studies were retrieved from the databases. Eleven articles were finally included in the data extraction and qualitative synthesis of results. The meta-analysis suggests a benefit of dexamethasone versus standard care in the reduction of risk of mortality at day 28; and the clinical improvement at days 14 and 28 in patients treated with remdesivir. We can conclude that dexamethasone would have a better result in hospitalized patients, especially in low-resources settings. The analysis of the main treatments proposed for hospitalized patients is of vital importance to reduce mortality in low-income countries, since the COVID-19 pandemic had an economic impact worldwide with the loss of jobs and economic decline in countries with scarce resources. The reviews of this paper are available via the supplemental material section.


BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047283
Author(s):  
Rosalind Gittins ◽  
Louise Missen ◽  
Ian Maidment

IntroductionThere is a growing concern about the misuse of over the counter (OTC) and prescription only medication (POM) because of the impact on physical and mental health, drug interactions, overdoses and drug-related deaths. These medicines include opioid analgesics, anxiolytics such as pregabalin and diazepam and antidepressants. This protocol outlines how a systematic review will be undertaken (during June 2021), which aims to examine the literature on the pattern of OTC and POM misuse among adults who are accessing substance misuse treatment services. It will include the types of medication being taken, prevalence and demographic characteristics of people who access treatment services.Methods and analysisAn electronic search will be conducted on the Cochrane, OVID Medline, Pubmed, Scopus and Web of Science databases as well as grey literature. Two independent reviewers will conduct the initial title and abstract screenings, using predetermined criteria for inclusion and exclusion. If selected for inclusion, full-text data extraction will be conducted using a pilot-tested data extraction form. A third reviewer will resolve disagreements if consensus cannot be reached. Quality and risk of bias assessment will be conducted for all included studies. A qualitative synthesis and summary of the data will be provided. If possible, a meta-analysis with heterogeneity calculation will be conducted; otherwise, Synthesis Without Meta-analysis will be undertaken for quantitative data. The reporting of this protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationEthical approval is not required. Findings will be peer reviewed, published and shared verbally, electronically and in print, with interested clinicians and policymakers.PROSPERO registration numberCRD42020135216.


Author(s):  
Jacqueline Corcoran ◽  
Anao Zhang ◽  
Lydia Watson-Lewis ◽  
Tatiana Johnson

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Shaoyu Zhu ◽  
N Patrik Brodin ◽  
Madhur K Garg ◽  
Patrick A LaSala ◽  
Wolfgang A Tomé

ABSTRACT BACKGROUND Intracranial arteriovenous malformation (AVM) is a congenital lesion that can potentially lead to devastating consequences if not treated. Many institutional cohort studies have reported on the outcomes after radiosurgery and factors associated with successful obliteration in the last few decades. OBJECTIVE To quantitatively assess the dose-response relationship and risk factors associated with AVM obliteration using a systematic review and meta-analysis approach. METHODS Data were extracted from reports published within the last 20 yr. The dose-response fit for obliteration as a function of marginal dose was performed using inverse-variance weighting. Risk factors for AVM obliteration were assessed by combining odds ratios from individual studies using inverse-variance weighting. RESULTS The logistic model fit showed a clear association between higher marginal dose and higher rates of obliteration. There appeared to be a difference in the steepness in dose-response when comparing studies with patients treated using Gamma Knife radiosurgery (Elekta), compared to linear accelerators (LINACs), and when stratifying studies based on the size of treated AVMs. In the risk-factor analysis, AVM obliteration rate decreases with larger AVM volume or AVM diameter, higher AVM score or Spetzler-Martin (SM) grade, and prior embolization, and increases with compact AVM nidus. No statistically significant associations were found between obliteration rate and age, sex, prior hemorrhage, prior aneurysm, and location eloquence. CONCLUSION A marginal dose above 18 Gy was generally associated with AVM obliteration rates greater than 60%, although lesion size, AVM score, SM grade, prior embolization, and nidus compactness all have significant impact on AVM obliteration rate.


Oral Diseases ◽  
2021 ◽  
Author(s):  
Amanda de Farias Gabriel ◽  
Felipe Martins Silveira ◽  
Marina Curra ◽  
Lauren Frenzel Schuch ◽  
Vivian Petersen Wagner ◽  
...  

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