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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262411
Author(s):  
Adugnaw Zeleke Alem ◽  
Yigizie Yeshaw ◽  
Alemneh Mekuriaw Liyew ◽  
Getayeneh Antehunegn Tesema ◽  
Tesfa Sewunet Alamneh ◽  
...  

Background Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries. Methods The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15–49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). Results In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8–38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25–34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely. Conclusion Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.


2022 ◽  
Vol 5 (2) ◽  
pp. 01-05
Author(s):  
Amin Bojdy ◽  
Yeganeh Ahrari ◽  
Mona Najafi ◽  
Mahnaz Arian ◽  
Nasrin khosravi Zeenyani

Background and aim: candidemia is a state that usually happens in immunocompromised patients. Thus it is more prevalent in ICU patients. This status brings mortality and morbidity; however, the outcome is various in different ICU care settings. The aim of this study is to assess epidemiology of outcome of candidemia in ICU in Mashhad during a 6-year period. Method: in a cross-sectional study between 2012 and 2018 in different ICU centers affiliating with Mashhad University of Medical Sciences, data of candidemia patients were extracted from hospital information system. These data were demographic, past medical history, result of the culture, and antifungal treatment. Result: totally, 55 patients (22 men and 33 women) were included in the study. The mean age of the patients was 45.9±1.9 years. Furthermore, the mean duration of hospitalization and the mean duration of ICU care were 43 and 37 days, respectively. Five patients had a history of immunosuppressive treatment and four patients were prescribed antifungal treatment in their past medical history (all with fluconazole and none with Itraconazole). Eighteen patients received caspofungin, eleven Amphotericin B treatment, and two fluconazole with no significant difference in outcome of the patients regarding antifungal type. In case of coincident antibiotic treatment, Carbapenems were prescribed in 43 patients, Glycopeptides in 48 patients, 25 patients had Cephalosporin treatment, and 13 patients had Fluoroquinolone treatment with no significant difference regarding the antibiotic type. Conclusion: The mortality percent of candidemia in ICU was 69.1 within mean time of 37 days. Furthermore, there was no significant difference in outcome of the patients regarding using Caspofungin or Amphotericin. Timely initiation of antifungal regarding to the culture result may bring better outcomes.


Author(s):  
Akitada Ichinose ◽  
Tsukasa Osaki ◽  
Masayoshi Souri

AbstractCoagulation factor V (or FV for the purpose of medical safety) is an essential cofactor of coagulation factor X in the common pathway of coagulation; severe FV deficiency leads to a bleeding tendency. Although both congenital and acquired FV deficiencies are widely recognized, FV deficiency also presents as an autoimmune disorder. A nationwide survey on autoimmune coagulation factor deficiencies (AiCFDs) conducted in Japan by our Japanese Collaborative Research Group identified 24 new patients with autoimmune FV deficiency (AiFVD) in the past 5 years. Furthermore, our extensive literature search confirmed that 177 AiFVD cases have been reported in previous articles published from Japan. Patients with AiFVD in Japan were predominantly men, with age similar to those with other AiCFDs. AiFVD was confirmed as a relatively mild type of bleeding diathesis, associated with lower mortality rate than that for AiFVD and other AiCFDs reported in previous studies. Patients with AiFVD had variable FV inhibitor titers and both neutralizing anti-FV autoantibodies and nonneutralizing counterparts. Although spontaneous resolution occurs in some patients, timely initiation of hemostatic and immunosuppressive therapies helps arrest the bleeding and eliminate anti-FV antibodies, resulting in a high cumulative recovery rate. Immunological anti-FV antibody detection is recommended to avoid missing AiFVD cases for the presence of nonneutralizing anti-FV autoantibodies. Further investigation is necessary to clarify the long-term prognosis and optimal management of AiFVD.


Nursing Open ◽  
2021 ◽  
Author(s):  
Azimeraw Arega Tesfu ◽  
Amlaku Mulat Aweke ◽  
Getahun Belay Gela ◽  
Kihinetu Gelaye Wudineh ◽  
Fentahun Yenealem Beyene

2021 ◽  
Author(s):  
Quraish Sserwanja ◽  
Linet M. Mutisya ◽  
Lilian Nuwabaine ◽  
Kassim Kamara ◽  
Ronald K Mutebi ◽  
...  

Abstract IntroductionGlobally, Sierra Leone has some of the worst maternal and child health indicators. The situation is worsened by a dearth of evidence about the level of continuum of care, an evidence-based intervention aimed at reducing maternal and perinatal morbidity and mortality. Hence this study aimed to fill this gap in evidence in the level of and factors associated with continuum of maternal and newborn care.MethodThe study employed data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Analysis was restricted to women who had a live birth in the five years preceding the survey (n = 7,326). Bi-variable and multivariable logistic regression were performed using SPSS software version 25.ResultsOnly 17.9% (95% CI: 17.4-19.1) of the women utilized complete continuum of care (CoC) for maternal and newborn health services in Sierra Leone. About 22% (95% CI: 21.3-23.1) utilized 8 or more antenatal care (ANC) contacts, 88% (95% CI: 87.9-89.4) had skilled birth attendance (SBA) while 90.7% (95% CI: 90.2-91.5) and 90.4% (95% CI: 89.9-91.2) of mothers and neonates utilized postnatal care (PNC) respectively. Having started ANC within first trimester (aOR 1.71, 95% CI: 1.46-2.00), belonging to the Southern region (aOR 1.85, 95% CI: 1.23-2.80), belonging to richer wealth quintile (aOR 1.76, 95% CI: 1.27-2.44), using internet (aOR 1.49, 95% CI: 1.12-1.98) and having no big problems seeking permission to access healthcare (aOR 1.34, 95% CI: 1.06-1.69) were significantly associated with utilization of CoC.ConclusionThe overall completion of continuum of maternal care is low, with ANC being the lowest utilized component of continuum of care. The study findings further call for urgent attention for maternal health stakeholders to develop and implement tailored interventions prioritizing women empowerment, access to affordable internet services, timely initiation of ANC contacts, women in developed regions such as the Western and those from poor households.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261301
Author(s):  
Nabin Adhikari ◽  
Kiran Acharya ◽  
Dipak Prasad Upadhya ◽  
Sumita Pathak ◽  
Sachin Pokharel ◽  
...  

Infant and young child feeding is a key area to improve child survival and promote healthy growth and development. Nepal government has developed and implemented different programs to improve infant and young child feeding practice. However, the practice remains poor and is a major cause of malnutrition in Nepal. This study aims to identify infant and young child feeding practices and its associated factors among mothers of children aged less than two years in western hilly region of Nepal. A descriptive cross-sectional study was carried out among 360 mothers of under two years’ children in Syangja district. A semi structural questionnaire was used. Data was entered in EpiData and analyzed using IBM SPSS version 21. Descriptive statistics were used to report the feeding practices and other independent variables. Bivariate and multivariate logistic regression model was used to establish the factors associated with infant and young child feeding practices. The prevalence of breastfeeding, timely initiation of breastfeeding, exclusive breastfeeding, timely initiation of complementary feeding, minimum dietary diversity, minimum meal frequency and minimum acceptable diet (MAD) were 95.6%, 69.2%, 47.6%, 53.3%, 61.5%, 67.3% and 49.9% respectively. Normal delivery (AOR 6.1, 95% CI 1.2–31.3) and higher maternal autonomy (AOR 5.2, 95% CI 1.8–14.6) were significantly associated with exclusive breastfeeding. Similarly, crop production and food security (AOR 3.8, 95% CI 1.9–7.7), maternal knowledge on MAD (AOR 2.5, 95% CI 1.0–6.2) and maternal autonomy (AOR 4.2, 95% CI 2.1–8.4) were significantly associated with minimum acceptable diet. Factors such as maternal education, maternal health services utilization, maternal knowledge, and maternal autonomy were associated with infant and young child feeding practices, which warrants further attention to these factors to reduce malnutrition.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261329
Author(s):  
S. M. Mazidur Rahman ◽  
Rumana Nasrin ◽  
Arfatur Rahman ◽  
Shahriar Ahmed ◽  
Razia Khatun ◽  
...  

Background Rapid and early detection of drug susceptibility among multidrug-resistant tuberculosis (MDR-TB) patients could guide the timely initiation of effective treatment and reduce transmission of drug-resistant TB. In the current study, we evaluated the diagnostic performance of GenoType MTBDRsl (MTBDRsl) ver1.0 assay for detection of resistance to ofloxacin (OFL), kanamycin (KAN) and ethambutol (EMB), and additionally the XDR-TB among MDR-TB patients in Bangladesh. Methods The MTBDRsl assay was performed directly on 218 smear-positive sputum specimens collected from MDR-TB patients and the results were compared with the phenotypic drug susceptibility testing (DST) performed on solid Lowenstein-Jensen (L-J) media. We also analyzed the mutation patterns of gyrA, rrs, and embB genes for detection of resistance to OFL, KAN and EMB, respectively. Results The sensitivity and specificity of the MTBDRsl compared to phenotypic L-J DST were 81.8% (95% CI, 69.1–90.9) and 98.8% (95% CI, 95.6–99.8), respectively for OFL (PPV: 95.7% & NPV: 94.1%); 65.1% (95% CI, 57.5–72.2) and 86.7% (95% CI, 73.2–94.9), respectively for EMB (PPV: 94.9% & NPV: 39.4%); and 100% for KAN. The diagnostic accuracy of KAN, OFL and EMB were 100, 94.5 and 69.6%, respectively. Moreover, the sensitivity, specificity and diagnostic accuracy of MtBDRsl for detection of XDR-TB was 100%. The most frequently observed mutations were at codon D94G (46.8%) of gyrA gene, A1401G (83.3%) of rrs gene, and M306V (41.5%) of the embB gene. Conclusion Considering the excellent performance in this study we suggest that MTBDRsl assay can be used as an initial rapid test for detection of KAN and OFL susceptibility, as well as XDR-TB directly from smear-positive sputum specimens of MDR-TB patients in Bangladesh.


Author(s):  
D. R. Sabirova ◽  
A. R. Shakirova ◽  
I. I. Ramazanova ◽  
N. V. Shakurova

This article describes a clinical case of a rare Schwachman–Diamond syndrome. It covers the features of the clinical picture of the disease and the laboratory examinations. A multidisciplinary approach for the purpose of early diagnosis, timely initiation of complex treatment, including nutritional therapy, prescription of enzyme preparations and granulocyte colony-stimulating factor, makes it possible to improve the quality of life and prognosis in such patients.


2021 ◽  
pp. bmjspcare-2021-003066
Author(s):  
Mila Petrova ◽  
Geoff Wong ◽  
Isla Kuhn ◽  
Ian Wellwood ◽  
Stephen Barclay

BackgroundCommunity-based and home-based palliative and end-of-life care (PEoLC) services, often underpinned by primary care provision, are becoming increasingly popular. One of the key challenges associated with them is their timely initiation. The latter requires an accurate enough prediction of how close to death a patient is.MethodsUsing ‘realist synthesis’ tools, this review sought to develop explanations of how primary care and community PEoLC programmes generate their outcomes, with the explanations presented as context–mechanism–outcome configurations. Medline, Embase, CINAHL, PsycINFO, Web of Science, ASSIA, Sociological Abstracts and SCIE Social Care Online were originally searched. A multistage process of focusing the review was employed, with timely identification of the EoL stage and timely initiation of associated services representing the final review focus. Synthesised sources included 21 full-text documents and 324 coded abstracts, with 253 ‘core contents’ abstracts generating >800 codes.ResultsNumerous PEoLC policies and programmes are embedded in a framework of Preparation and Planning for Death and Dying, with identification of the dying stage setting in motion key systems and services. This is challenged by: (1) accumulated evidence demonstrating low accuracy of prognostic judgements; (2) many individuals’ orientation towards Living and Hope; (3) expanding grey zones between palliative and curative care; (4) the complexity of referral decisions; (5) the loss of pertinent information in hierarchical relationships and (6) the ambiguous value of having ‘more time’.ConclusionPrioritising temporal criteria in initiating PEoLC services is not sufficiently supported by current evidence and can have significant unintended consequences.PROSPERO registration numberCRD42018097218.


2021 ◽  
pp. 1-6
Author(s):  
Rebecca Ronsley ◽  
Eric Bouffet ◽  
Peter Dirks ◽  
James Drake ◽  
Abhaya Kulkarni ◽  
...  

OBJECTIVE The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma. METHODS The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor location, CSF diversion procedure (external ventricular drain [EVD], endoscopic third ventriculostomy [ETV], ventriculoperitoneal [VP] shunt) and outcomes. The frontooccipital horn ratio (FOR) method was used to determine the presence of ventriculomegaly. RESULTS Of 39 patients with germinoma, 22 (73% male) had symptomatic hydrocephalus at diagnosis (11 pineal, 4 suprasellar, and 7 bifocal). Management of hydrocephalus included EVD (n = 5, 22.7%), ETV (n = 5, 22.7%), and combination ETV and EVD (n = 7, 31.8%), whereas 5 patients (22.7%) did not undergo surgical intervention. The median FOR at diagnosis was 0.42 (range 0.38–0.58), which correlated with moderate to severe ventriculomegaly. Carboplatin and etoposide–based chemotherapy induced fast tumor shrinkage, avoiding CSF diversion (n = 5) and resolving hydrocephalus with a transient EVD (n = 5). The median duration until EVD removal was 7 days (range 2–10 days). Two of 12 patients with EVD ultimately required a VP shunt. Kaplan-Meier overall survival was 100% and progression-free survival was 96.4% at a median follow-up of 10.4 years. CONCLUSIONS Timely initiation of chemotherapy is imperative to rapidly reduce tumor bulk in children with germinoma and limits the need for VP shunt insertions. In children in whom CSF diversion is required, hydrocephalus may be successfully managed with a temporary EVD ± ETV.


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