HIV Preexposure Prophylaxis Training in Family Medicine Residencies: A National Survey

Background and Objectives: Preexposure prophylaxis (PrEP) reduces HIV transmission among high-risk individuals. Yet, the HIV epidemic continues to expand among marginalized populations and America’s Southeastern states. Various barriers remain to PrEP uptake, namely provider knowledge and education. We sought to investigate residency training, competency, and prescribing of PrEP among population size. Additionally, we asked program directors to identify barriers to PrEP. Methods: We surveyed family medicine program directors as part of the Council of Academic Family Medicine Educational Research Alliance survey from January 2018 through February 2018. Results: Our survey questions had a 52.9% (276/522) response rate. No programs in rural communities less than 30,000 population (0/27) reported significant PrEP training for their residents; those in nonrural communities of at least 30,000 reported this training more frequently (41/246, 16.7%). Compared to Fischer expected values, the finding was statistically significant (P=.019); using a 75,000 population demarcation lowered significance (P=.192). We found programs that identify significant PrEP training also cite more PrEP prescribing within their practice (OR 7.27, P<.001). Programs with significant training also report their residents graduate with greater PrEP competency (OR 18.33, P<.001). The largest barriers identified were faculty expertise, not having enough high-risk patients, inadequate screening, and resident knowledge/training. Conclusions: We identified natural associations between increased training in PrEP and perceived PrEP competencies. We identified a lack of significant PrEP training and associated PrEP competencies in rural residency programs. Barriers identified in this study can help inform curricular needs to improve primary care workforce capacity to lower HIV risk.

Real-Life Data on Total Vitamin D3 (25-Hydroxyvitamin D) Concentrations in Basrah, Iraq

Background: People from our region need a higher dose of vitamin D to maintain their serum 25(OH)D levels at concentrations greater than 20 ng/mL. This study aimed to obtain real data on vitamin D status in Basrah. Methods: Retrospective data analysis of patients seen over 2 years from May 2017 to the end of May 2019 at the Faiha Specialized Diabetes, Endocrine and Metabolism Centre (FDEMC) in Basrah, a tertiary referring center of southern Iraq. Results: The cohort included 3692 persons. Vitamin D deficiency was evident among 62.5% of the studied persons (66.5% of women and 48.7% of men). Univariate analysis for factors associated with vitamin D deficiency found it was significantly associated with female sex (OR, 2.095; 95% CI, 1.793 to 2.448; P<0.0001), age less than 44 years (OR, 2.6; 95% CI, 2.328 to 3.065; P<0.0001), nonmarried status (including single, widow and divorced) (OR, 0.768; 95% CI, 0.656 to 0.900; P<0.0001), nulliparous or unmarried status (OR, 0.684; 95% CI, 0.583 to 0.803; P<0.0001), housewife status (OR, 0.806; 95% CI, 0.673 to 0.967; P=0.020), and rural status (OR, 1.195; 95% CI, 1.034 to 1.382; P=0.016). No significant association was found between vitamin D deficiency and BMI. In multivariate logistic regression analyses, only female sex (OR, 0.513; 95% CI, 0.437 to 0.603; P<0.0001) and age less than 44 years (OR, 2.662; 95% CI, 2.252 to 3.147; P<0.0001), nulliparous or unmarried (OR, 0.814; 95% CI, 0.680 to 0.973; P=0.024) and rural residency (OR, 0.773; 95% CI, 0.647 to 0.924; P<0.0001) remained significantly associated. Conclusion: Women, a younger age, nulliparous, and a rural residency were associated with vitamin D deficiency.

Factors Influencing Decision Making Regarding the Acceptance of the COVID-19 Vaccination in Egypt: A Cross-Sectional Study in an Urban, Well-Educated Sample

Background: The COVID-19 pandemic has raised the necessity to rapidly develop safe and effective vaccines to limit the spread of infections. Meanwhile, vaccine hesitancy is a significant barrier to community vaccination strategies. Methods: An internet-based cross-sectional survey was conducted from March to April 2021 during the start of the vaccination campaigns. Results: A total of 1009 subjects participated, and the mean age (±SD) was 29.11 ± 8.2 years. Among them, 68.8% believed that vaccination is an effective method to control the spread of the disease, 81.2% indicated acceptance of the vaccine, and 87.09% reported that their doctor’s recommendation was essential for decision making. After adjusting for socioeconomic characteristics, rural residency (AOR 1.783, 95%CI: 1.256–2.531), working a part-time job (AOR 2.535, 95%CI: 1.202–5.343) or a full-time job (AOR 1.951, 95%CI: 1.056–3.604), being a student (AOR 3.516, 95%CI: 1.805–6.852) and having a partner (AOR 1.457, 95%CI: 1.062–2.00) were significant predictors for higher vaccine acceptance among the study participants. Believing in the vaccine’s efficacy showed the strongest correlation with vaccine acceptance (Spearman’s r = 0.309, p < 0.001). Conclusions: Although general vaccine acceptance is high (32.85%) in participants in our study, gender and geographic disparities were observed in the investigated urban population of young, well-educated Egyptians.

Trends and predictors of early initiation, exclusive, and continued breastfeeding in Bangladesh (2004-2018): a multilevel analysis of Demographic and Health Survey data

The early initiation of breastfeeding (EIBF) within one hour of birth, exclusive breastfeeding (EBF) to 6 months, and continued breastfeeding (CBF) to 2 years are key infant and young child feeding guidelines promoted globally for optimal child health and development. Using publicly available national survey data from the five most recent, consecutive Bangladesh Demographic and Health Surveys (2004, 2007, 2011, 2014, 2017-18), we assessed the trends in these key breastfeeding indicators. Multiple multilevel logistic regression models were built to assess sociodemographic predictors of breastfeeding using the latest 2017-18 dataset. Both EIBF and EBF have increased significantly between 2004 and 2017-18, from 26% to 60% and 36% to 68%, respectively and CBF decreased from 94% to 85%. Caesarean section delivery conferred lower EIBF practice (OR= 0.34, 95% CI: 0.27 to 0.42) compared to vaginal delivery. Women who were currently working had 32% lower odds of EBF (OR= 0.68, 95% CI: 0.48 to 0.95). Compared to delivery at home, women who delivered in a health facility had 81% higher odds of EBF (OR= 1.81, 95% CI: 1.25 to 2.34). Larger family size (≥5) also predicted EBF (OR= 1.70, 95% CI: 1.21 to 2.40). Rural residency was associated with 2.39 (95% CI 1.32 to 4.31) times of higher odds of CBF. Administrative region (division) was also predictive of the various breastfeeding indicators. Although Bangladesh currently exceeds the 2019 global prevalence rates for these three breastfeeding indicators, efforts should be made to continue improving EIBF and EBF, and to prevent future decreases in CBF.

Failed induction of labour and associated factors among women delivered in Jigjiga University Sheik Hassan Yabare Referral Hospital: a cross-sectional study

Introduction: Induction of labour is one component of comprehensive obstetrics care services that is increasing employed in modern day obstetrics to decrease the risk of maternal and neonatal morbidity and mortality. However, it has been strongly associated with poor maternal and perinatal outcomes. Therefore, his study was aimed to assess the magnitude of failed induction of labour and associated factors among mothers delivered at Jigjiga University Sheik Hassan Yabare referral Hospital, Eastern Ethiopia from June 1 to June 30, 2021.Methods: An institutional based cross-sectional study was carried out among 364 women’s delivered at Jigjiga University Sheik Hassan Yabare Referral Hospital from 2018 to 2021. A checklist was used to collect the data from the women’s chart. To isolate independent predictors related to failed induction of labour, multivariate logistic regression analyses were performed.Result: Our study participants were 364 women’s. The magnitude of failed induction of labour was 36.8% (95% CI: 31.8, 42.0). Age of the mother (<30 years) (AOR= 3.2; CI: 1.78, 5.75), rural residency (AOR=2.28; CI:1.29, 4.01), being primi-para (AOR= 2.76; CI: 1.55, 4.91), gestational age less than 37 or greater than 42 year (AOR= 2.65; CI: 1.44, 4.89) , multiple ton of pregnancy (AOR= 2.36; CI: 1.01, 5.55), premature rapture of membrane (AOR= 4.88; CI: 2.33, 10.21), pregnancy induced hypertension (AOR= 5.11; CI: 2.67, 9.79), and bishop score less than six (AOR= 1.95; CI: 1.15, 3.32) were significantly associated with failed induction of labour.Conclusion: The magnitude of failed induction of labour among mothers undergoing labor induction was relatively high in the study settings compared with previous studies in the country. Failed induction of labour was significantly associated with age of the mother (<30 years), rural residency, being primi-para, gestational age less than 37 or greater than 42 years, multiple ton of pregnancy, premature rapture of membrane, pregnancy induced hypertension, and bishop score less than six.

Clinical Non-adherence and Its Associated Factors Among HIV Positive Pediatrics Attending Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021

Background: The most important factor in the success of HIV treatment is clinical adherence. Inadequate clinical adherence is one of the factors that affect the adherence level of highly active antiretroviral treatment and its effect on suppressed viral replication. Even though data from different settings are necessary to tackle it, pieces of evidence are limited especially in the case of clinical adherence level of HIV-infected children. Hence, this study aimed to assess clinical non-adherence level and its associated factors among HIV-positive children on HAART. Methods: A multicenter cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children on ART in South Gondar Zone. Data were entered into Epi Data Version 4.6 and analysis was done using Statistical Package for Social Science (SPSS) Version 25. Binary logistic regression was implemented to assess the association of factors against the outcome variable and variables with p-values ≤ 0.25 in the bivariable analysis were entered into the multivariable analysis. Finally, variables with p-values less than 0.05 were considered statistically significant factors.Result-out of 384 study participants, 383 were included in this study with a response rate of 99.7%. Nearly half of the study participants 190(49.6%) were girls. The majority, 291 (76%) of caretakers were biological mothers, and 203(53%) did not have treatment supporters. One hundred seventy-nine (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9 %( 95% CI: 27.2-36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and comorbid illness were significantly associated with clinical non-adherence of HIV positive children.Conclusion-clinical non-adherence among children among HIV-positive children attending care in south Gondar zone health institutes is unacceptably high. Being rural residency, diagnostic status non-disclosure, no adherence supporter, having non-biological caretaker, and having comorbid illness were significantly associated with clinical non-adherence. Thus, attention shall be given to successful clinical adherence in HIV-positive children who uses the antiretroviral drug.

Prevalence and associated factors of premature discontinuation of antiplatelet therapy after ischemic stroke: a nationwide population-based study

Background We tried to evaluate the prevalence of premature discontinuation of antiplatelets and its affecting factors after ischemic stroke using large-sized representative national claims data. Methods Patients aged 20 years or older with newly confirmed ischemic stroke who started aspirin or clopidogrel for the first time were selected from 2003 to 2010 National Health Insurance Service-National Sample Cohort (NHIS-NSC) of South Korea (n = 4621), a randomly collected sample which accounts for 2.2% (n = 1,017,468) of total population (n = 46,605,433). The prevalence of discontinuation of antiplatelets was measured every 6 months until the 24 months since the first prescription. Then we classified the participants into 2 groups according to the discontinuation status at 12 months and assessed the factors influencing premature discontinuation of antiplatelets within 12 months. Results Among total participants, 35.5% (n = 1640) discontinued antiplatelets within 12 months and 58.5% (n = 2704) discontinued them within 24 months. The remaining 41.5% (n = 1917) continued them for 24 months or more. In the multivariate logistic regression analysis, initiating treatment with aspirin monotherapy [adjusted OR (aOR), 2.66, 95% CI 2.17–3.25] was the most prominent determinant of premature discontinuation within 12 months followed by CCI score ≥ 6 (aOR 1.50, 95% CI 1.31–1.98), and beginning treatment with clopidogrel monotherapy (aOR 1.41, 95% CI 1.15–1.72). Rural residency (aOR 1.36, 95% CI 1.14–1.62), < 4 total prescribed drugs (aOR 1.24, 95% CI 1.05–1.47), lower income (aOR 1.20, 95% CI 1.03–1.40 for middle income class and OR 1.21, 95% CI 1.02–1.45 for low income class), and ages ≥70 years (aOR 1.15, 95% CI 1.00–1.31) were also significantly associated with premature discontinuation of antiplatelets within 12 months. Conclusions The prevalence of premature discontinuation of antiplatelets after ischemic stroke was quite high. Thus, by understanding factors associated with premature discontinuation, a more strategic approach is required for the physicians to improve persistence with antiplatelets.

1312Population-attributable fraction estimates for factors of different types of anaemia among women: multilevel multinomial analysis

Background Anaemia is one indicator of poor health in women and responsible for substantial mortality. Assessing the relative impact of predictors for anaemia among women could help to prioritize targeted preventions strategies. This study aimed to quantify the attributable burden of modifiable factors for different severity levels of anaemia among Ethiopian women. Methods Adjusted odds ratio and exposure prevalence for selected factors were used to calculate population attributable fractions using the 2016 Ethiopian Demographic and Health Surveys data. Adjusted odds ratios (AOR) with 95% confidence intervals (CIs) were computed using multilevel multinomial regression models. Results In Ethiopia, an estimated 14.6% (95% confidence interval, CI: 3.4, 24.5) of mild anaemia was attributable to no formal education, 11.2% (95%CI: 1.2, 19.9) to high gravidity (≥ 4) and 5.2% (95%CI: 0, 10.7) to currently breastfeeding. Similarly, proportion of moderate-severe anaemia attributable to rural residence was 38.1% (95%CI: 15.9, 54.8), poorest wealth quantile was 12.6% (95%CI: 2.9, 24.6), previous five years birth was 10.5% (95%CI: 2.9, 18.2), and unimproved latrine was 17% (95% CI: 0, 32.5). Conclusions The result suggests that low education, low wealth status, high parity, rural residency, pregnancy and breastfeeding contribute substantially to the occurrence of anaemia among women. Key messages Mild anaemia could be reduced by setting intervention strategies targeting women with low education, multigravida women, and breastfeeding women, while preventing moderate-to-severe anaemia may require increasing income, and improving living environments like hygienic latrines.

Prevalence of Pneumonia Associated with Measles among Infants and Children

Objective: The aim of this study is to determine the prevalence of pneumonia associated with measles among children and infants. Study Design: Cross-sectional Place and Duration: Pediatrics department of Lady Reading Hospital, Peshawar and Sharif Medical and Dental College, Lahore for six months duration from February 2020 to July 2020. Methods: Total 150 patients i.e children and infants of both genders were included in this study. Children were aged <5years of age. Patients’ detailed demographics height and weight were recorded after taking informed written consent from the authorities. Patients’ diagnosed measles were presented. Symptoms and frequency of pneumonia among all patients were assessed. Complete data was analyzed by SPSS 22.0 version. Results: There were 90 (60%) children and 60 (40%) infants. Among 150 patients, 100 (66.7%) were males and 50 (33.3%) were females. 70 (46.7%) cases had birth weight > 3kg. 30 (20%) patients had high socioeconomic status, 50 (33.3%) had middle and 70 (46.6%) cases had poor. 85 (56.7%) patients had rural residency. According to severity of measles, 35 (23.3%) had mild,45 (30%) cases had moderate and severity was among 70 (46.7%) patients. Prevalence of pneumonia was found among 95 (63.3%) cases. 40 (26.75) cases had measles vaccination. Conclusion: We concluded in this study that prevalence of pneumonia among children of measles were significantly high. It was due to less number of vaccination status with poor socio economic status among patients. It can be controlled by providing awareness of vaccination to the parents of children. Keywords: Pneumonia, Measles, Children, Infants, Prevalence