Incidence and Prevalence of Opportunistic and Other Infections and the Impact of Antiretroviral Therapy Among HIV-infected Children in Low- and Middle-income Countries: A Systematic Review and Meta-analysis.

BACKGROUND: We conducted a systematic review and meta-analysis to evaluate the incidence and prevalence of 14 opportunistic infections (OIs) and other infections as well as the impact of antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected children (aged 161 000 OIs (2013 UNAIDS data) with estimated cost savings of at least US$17 million per year. CONCLUSIONS: There is a decrease in the risk of most OIs with ART use in HIV-infected children in LMICs, and estimated large potential cost savings in OIs averted with ART use, although there are greater uncertainties in pediatric data compared with that of adults

Incidence of Opportunistic Infections and the Impact of Antiretroviral Therapy Among HIV-Infected Adults in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis.

BACKGROUND: To understand regional burdens and inform delivery of health services, we conducted a systematic review and meta-analysis to evaluate the effect of antiretroviral therapy (ART) on incidence of key opportunistic infections (OIs) in human immunodeficiency virus (HIV)-infected adults in low- and middle-income countries (LMICs). METHODS: Eligible studies describing the cumulative incidence of OIs and proportion on ART from 1990 to November 2013 were identified using multiple databases. Summary incident risks for the ART-naive period, and during and after the first year of ART, were calculated using random-effects meta-analyses. Summary estimates from ART subgroups were compared using meta-regression. The number of OI cases and associated costs averted if ART was initiated at a CD4 count ≥200 cells/µL were estimated using Joint United Nations Programme on HIV/AIDS (UNAIDS) country estimates and global average OI treatment cost per case. RESULTS: We identified 7965 citations, and included 126 studies describing 491 608 HIV-infected persons. In ART-naive patients, summary risk was highest (>5%) for oral candidiasis, tuberculosis, herpes zoster, and bacterial pneumonia. The reduction in incidence was greatest for all OIs during the first 12 months of ART (range, 57%-91%) except for tuberculosis, and was largest for oral candidiasis, Pneumocystis pneumonia, and toxoplasmosis. Earlier ART was estimated to have averted 857 828 cases in 2013 (95% confidence interval [CI], 828 032-874 853), with cost savings of $46.7 million (95$43.8-$49.4 million). CONCLUSIONS: There was a major reduction in risk for most OIs with ART use in LMICs, with the greatest effect seen in the first year of treatment. ART has resulted in substantial cost savings from OIs averted

Global, regional, and national estimates of pneumonia burden in HIV-infected children in 2010: a meta-analysis and modelling study

Background: Globally, pneumonia is a leading cause of mortality and morbidity in children younger than 5 years. Underlying HIV infection is an important risk factor for pneumonia morbidity and mortality in children. There are, however, no global or country level estimates of pneumonia burden in HIV-infected children. We assessed the role of HIV in pneumonia incidence and mortality and estimated the number of pneumonia cases and deaths in HIV-infected children younger than 5 years in 133 high pneumonia-burden countries in 2010. Methods: We estimated the risk of hospital admission and case fatality rate caused by pneumonia in HIV-infected children compared with HIV-uninfected children from a systematic review of studies published in Medline, Embase, and Global Health between Jan 1, 1980, and Aug 31, 2013. We estimated nationwide pneumonia incidence and mortality with two different models that incorporated several risk factors for paediatric pneumonia hospital admission and mortality (including HIV infection). We then estimated the number of pneumonia episodes and deaths that occurred in HIV-infected children in 2010. Findings: The odds ratio (OR) for hospital admission for all-cause pneumonia in HIV-infected children compared with HIV-uninfected children was 6·5 (95% CI 5·9–7·2). The risk of death was higher in children with pneumonia and HIV compared with those with pneumonia only (OR 5·9, 95% CI 2·7–12·7). In 2010, 1·4 million pneumonia episodes (uncertainty range [UR] 0·6 million to 3·3 million) and 88 000 pneumonia deaths (UR 47 400–153 000) occurred in HIV-infected children in low-income countries. Of these, 1·2 million pneumonia episodes (UR 0·5 million–2·7 million) and 85 400 deaths (UR 46 000–147 300) were directly attributable to HIV. 1·3 million (90%) pneumonia episodes and 82 400 (93%) pneumonia deaths in HIV-infected children aged younger than 5 years occurred in the WHO African region. Interpretation: Globally, a small proportion of pneumonia episodes and pneumonia deaths occur in HIV-infected children. However, in the highest HIV-burden countries in sub-Saharan Africa (ie, Swaziland, Lesotho, and Zimbabwe) up to a fifth of all pneumonia cases and 60% of pneumonia deaths occur in HIV-infected children. In these countries, major reductions in child pneumonia mortality can be achieved only if the systemic challenges plaguing the health system (poor coverage of early infant testing for HIV, of antiretroviral drugs in pregnant women and young children, of co-trimoxazole prophylaxis, and of pneumococcal vaccination) can be overcome

Prevalence of Obesity and Overweight among Public Primary School Students in Kirkuk City

Background: The prevalence of childhood obesity is increasing in both developed and developing countries. The purpose  of this study was to identify the prevalence of overweight and obesity among public primary school student's and to find out the relationship between BMI and some socio-demographical characteristics for the child and his family in Kirkuk city.Methodology: A cross sectional study (multistage) random sample, were carried out for a period from the 1st of November ,2013 to the 1st of March ,2014, it consisted of (566); (306) boys and (260) girls. The sample age ranged between (6 -12) years. A constructed questionnaire conducted for data collection. Height and weight were measured by the researchers in the school. The data was analyzed through the application of descriptive statistical analysis (Frequency, Percentage %) and inferential statistic (chi-square).Results: The prevalence of overweight and obesity among public primary students was 24.2%, (18%) for overweight, (6.2%) for obese. A significant association was found between BMI category and some demographical characteristics for the child such as, age, grade, and being the only child in the family.Conclusions and Recommendations: The total prevalence of overweight and obese was (24.2%) among public primary school students. Further study needed to find out the association between body mass index and eating patterns among primary school students in Kirkuk city Keywords: Prevalence, BMI, Public Primary School, Overweight, Obesit

Pattern of skin diseases in children attending the dermatology clinic in Alert referral hospital, Addis Ababa, Ethiopia: a retrospective study

Background: A Skin disease, which is estimated to affect between 21 and 87% of children, are the reason for up to a third of outpatient visits to pediatricians and dermatologists. It can possibly re-sult in considerable anxiety, parental worry, and embarrassment to the child and lead to loss of confidence, disruption of social relations, and feeling of stigmatization. This study aimed to assess the pattern of skin diseases in children attending at ALERT referral hospital.Methods: The study setting is ALERT referral hospital, Addis Ababa, Ethiopia. A hospital-based, retrospective, cross-sectional descriptive study was carried out between July and August 2020. All children younger than 12 years, who were diagnosed for skin diseases from May 2018 to May 2020, were included. Four hundred twenty-three children were sampled using a random sampling method. SPSS Version 20 software was used for data analysis.Results: The results showed that 385(91%) of patients had one skin disease and the remaining 38(9%) had two or more skin diseases. Fungal infections were present in30.1% of the cases fol-lowed by eczema, which accounted for 27.4%. Among fungal infections, Tinea Capitis (106/116), 91.4% followed by Tinea Corporis and Tinea Pedis were the most common in ALERT dermatology clinic. Among eczema cases, family atopic dermatitis (82/106), 77% was the most common. The result showed seasonal variation in some diseases.Conclusion: Skin fungal infections were the most common followed by eczema, pigmentary dis-order, infestation, viral infection, urticaria, bacterial infection, and others. There was some sea-sonal variation in some diseases

MRC Clinical Trials Unit, UK

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Effectiveness of Project-Based Online Learning on 21st Century Thinking Skills of Indonesian Students: A Meta-Analysis Research from 2018-2023

Online learning plays an important role in supporting learning activities between students and teachers. However, there has been no quantitative meta-analysis of the overall effectiveness of Project-Based Learning online-based learning on students' 21st century thinking skills. The purpose of the study was to investigate the effectiveness of project-based learning online learning on the thinking skills of 21st century students in Indonesia.  This type of research is a meta-analysis. The meta-analysis analyzed 16 articles published from 201 8-2023. The results of the analysis concluded that project-based online learning has a significant effect on students' 21st century thinking skills with a summary effect or mean effect size (rE = 1.04 High criteria). Furthermore, these findings conclude that the project-based online learning model effectively encourages students' 21st century thinking skills compared to conventional learning models

Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring.

OBJECTIVE: Verbal autopsy (VA) is a systematic approach for determining causes of death (CoD) in populations without routine medical certification. It has mainly been used in research contexts and involved relatively lengthy interviews. Our objective here is to describe the process used to shorten, simplify, and standardise the VA process to make it feasible for application on a larger scale such as in routine civil registration and vital statistics (CRVS) systems. METHODS: A literature review of existing VA instruments was undertaken. The World Health Organization (WHO) then facilitated an international consultation process to review experiences with existing VA instruments, including those from WHO, the Demographic Evaluation of Populations and their Health in Developing Countries (INDEPTH) Network, InterVA, and the Population Health Metrics Research Consortium (PHMRC). In an expert meeting, consideration was given to formulating a workable VA CoD list [with mapping to the International Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) CoD] and to the viability and utility of existing VA interview questions, with a view to undertaking systematic simplification. FINDINGS: A revised VA CoD list was compiled enabling mapping of all ICD-10 CoD onto 62 VA cause categories, chosen on the grounds of public health significance as well as potential for ascertainment from VA. A set of 221 indicators for inclusion in the revised VA instrument was developed on the basis of accumulated experience, with appropriate skip patterns for various population sub-groups. The duration of a VA interview was reduced by about 40% with this new approach. CONCLUSIONS: The revised VA instrument resulting from this consultation process is presented here as a means of making it available for widespread use and evaluation. It is envisaged that this will be used in conjunction with automated models for assigning CoD from VA data, rather than involving physicians

The pattern of childhood tuberculosis at the Ethio Swedish-Children's Hospital

Abstract: Tuberculosis (TB) still remains a major public health problem in the developing world. Ninety five percent of the cases and 99% of deaths due to TB occur in the developing countries. TB is one of the major health problems in Ethiopia. The objective of the study is to outline the pattern of TB among Ethiopian children. Three hundred and seventy five children fulfilling the clinical criteria for TB were enrolled in the study at the ESCH, Addis Ababa, over a period of one year, from May 1993 to April 1994. Their ages ranged from one month to 14 years. The M:F ratio was 1.03:1 . Most children were from families with low socio-economic status, who lived in a one or two-roomed houses. More than five people live in a house in about 80% of the families. Symptom complex of TB and compatible X-ray were the two commonest findings followed by positive Mantoux test. Sputum examination for acid fast bacilli was done in 37 patients and was positive in 27% of them. Opacity was the commonest chest X-ray finding followed by infiltrations and hilar/paratracheal lymphadenopathy. There were nine patients with cavitary tuberculosis. Cervical lymph nodes were mostly affected (55.5%) followed by axillary nodes (24.0%). Thoracic vertebrae were common sites for spondylitis. Forty four and half percent had pulmonary TB, 27.5% had extra pulmonary TB, and 28% of the patients had two or more systems involved. Forty four percent of the patients were lost to follow up and 52.3% of the patients completed their treatment. Only three had signs of drug toxicity and one had treatment failure. Thirteen patients (3.5%) died at the hospital. The study showed that the lung is the most commonly affected organ, the commonest site of affection for extra pulmonary tuberculosis being the lymph nodes. Early diagnosis and close follow up are needed for better outcome in all cases of TB in children. [Ethiop. J. Health Dev. 1998;12(3):245-251