A longitudinal data analysis on risk factors for developing type-2 diabetes mellitus at the university of Gondar comprehensive specialized hospital, Gondar, Ethiopia

Diabetes mellitus is a group of metabolic chronic diseases characterized by high blood sugar levels with multi-system complications. The objective of this study was to assess the risk factors for developing type-2 diabetes mellitus over time in their random blood sugar and to obtain better predictive model for type 2 diabetes patients' random blood sugar (RBS) level in the University of Gondar Comprehensive Specialized Hospital. A retrospective cohort study with a total of 330 diabetic patients who have been active in the follow-up treatment for at least 3 times in three month interval in the hospital from February 2014 to February 2016 was conducted. Linear mixed effects model for longitudinal data were employed to measure the changes in RBS level. The results revealed that the linear distribution trend in the mean RBS level accounted for 79% of the variability in the data and the mean RBS level decreased over time. Age, residence, family history, alcohol intake, dietary type, BMI, treatment, exercise and education status were the significant factors for the change in mean RBS level of the diabetes patients over time. The study also confirmed that among the factors of RBS level included in the study, meat dietary type, patients who do not perform exercise, and body mass index (BMI) were positively correlated with the RBS level while the rest were negatively correlated. It was significant for the patients to do daily self-care activities to prevent long term complications. The government should also contribute to the education of communities to spread awareness creation and enhance prevention mechanisms of diabetes

Daily tobacco use and problem drinking among urban adults in South Africa: a longitudinal study

Introduction: there is a lack of longitudinal studies investigating daily tobacco use and problem drinking in Africa. The aim of this study was to explore the prevalence of daily tobacco use and problem drinking and to determine the factors associated with daily tobacco use and problem drinking among urban dwellers in a longitudinal study in South Africa.Methods: electronic interview data were collected from 2213 adults (mean age 45.7 years, SD=15.1; range 20-97) at time 1 (baseline assessment) and Time 2 (12 months follow-up assessment) from one urban centre in South Africa.Results: daily tobacco use only, was at time 1 24.0% and at time 2 23.4%, a decrease of 0.5%. Problem drinking only was at time 1 19.6% and at time 2 21.1%, an increase of 1.5%. Concurrent daily tobacco use and problem drinking increased from time 1 9.5% to 10.3% at time 2, an increase of 0.8%. In longitudinal regression analyses, being male and being born in current city were significantly associated with all three substance use indicators (daily tobacco use; problem drinking; and concurrent daily tobacco use and problem drinking). In addition, older age, not currently married, lower education, underweight and higher levels of perceived stress were associated with daily tobacco use and younger age was associated with problem drinking.Conclusion: high prevalence of daily tobacco use and problem drinking were found among urban dwellers and several socio-demographic (being male, being born in the city, not married and lower education) and health variables (being underweight and perceived stress) were identified which can guide substance use intervention programmes for this population

Longitudinal analysis of HIV risk behaviour patterns and their predictors among public primary care patients with tuberculosis in South Africa

The goal of this study was to identify various HIV risk behaviours among tuberculosis (TB) patients in a longitudinal study design in South Africa. In 42 public primary healthcare facilities in three districts in three provinces, adult new TB and TB retreatment patients with hazardous or harmful alcohol use were interviewed within 1 month of initiation of anti-TB treatment and were followed up at 6 months. The total sample with a complete 6-month follow-up assessment was 853. At the follow-up assessment, several HIV risk behaviours significantly reduced from baseline to follow-up. In multivariate Generalized Estimating Equations logistic regression analyses, high poverty (odds ratio (OR): 2.68, 95% confidence interval (CI): 1.56­4.62),Posttraumatic Stress Disorder (PTSD) symptoms (OR = 1.55, 95% CI = 1.03­2.36), and sexual partner on antiretroviral therapy(ART) (OR = 1.84, 95% CI = 1.09­3.10) were associated with a higher odds, and excellent/very good perceived health status (OR:0.61, 95% CI: 0.37­0.98), severe psychological stress (OR = 0.51, 95% CI = 0.34­0.77), and HIV non-disclosure to most recent sexual partner (OR = 0.40, 95% CI = 0.25­0.65) were associated with a lower odds of inconsistent condom use. Being HIV positive (OR = 4.18, 95% CI = 2.68­6.53) and excellent/very subjective health status (OR = 2.98, 95% CI = 1.73­5.13) were associated with a higher odds, and having PTSD symptoms (OR = 0.60, 95% CI = 0.36­0.99), being on ART (OR = 0.48, 95% CI= 0.25­0.95), having a sexual partner on ART (OR = 0.41, 95% CI = 0.18­0.96), and HIV status non-disclosure (OR = 0.25, 95%CI = 0.15­0.41) were associated with a lower odds of having sex with an HIV-positive or HIV status unknown person. High poverty index (OR = 1.97, 95% CI = 1.19­3.25) and having a sexual partner on ART (OR = 4.37, 95% CI = 1.82­10.48) were associated with a higher odds, and having a partner with HIV-negative status (OR = 0.29, 95% CI = 0.16­0.51) and inconsistent condom use (OR = 0.39, 95% CI = 0.24­0.64) were associated with a lower odds of HIV status non-disclosure at last sex. The study found that among TB patients with problem drinking over a 6-month TB treatment period, the frequency of some HIV risk behaviours (inconsistent condom use) declined (OR = 0.64, 95% CI = 0.41­0.98), but also persisted at a high-level calling for a strengthening and integration of HIV prevention into TB management

Birth Weight Recovery among very Low Birth Weight Infants Surviving to Discharge from Charlotte Maxeke Johannesburg Academic Hospital; Neonatal unit

Background. The recommended growth velocity (GV) of very low birth weight (VLBW) infants is 15 g/kg/day. Several factors have been associated with poor postnatal weight gain. Objective. To provide current information on the postnatal growth of VLBW infants at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).Methods. This was a longitudinal study of VLBW infants surviving to discharge from CMJAH neonatal unit from August to October 2013.Results. Sixty-nine infants were included in the study. The mean GV was 13.2 g/kg/day; the median weight loss was 7.69 and the median time for regaining birth weight was 16 days. Fifty-one infants (73.9) regained their birth weight at or before 21 days. There was a decrease in mean z-scores for weight (ZSWs) from -0.32 (standard deviation 1.25) at birth to -1.94 (1.35) at discharge. A multiple linear regression showed a negative association between ZSW at discharge and number of days nil per os without parenteral nutrition (PN). Antenatal steroids were associated with poor GV. There were no factors associated with regaining birth weight after 21 days on multiple logistic regression.Conclusion. This study showed a GV in VLBW infants approaching recommended standards. Number of days without PN and use of antenatal steroids were associated with poor postnatal growth

Antiretrovirals and the use of traditional, complementary and alternative medicine by HIV patients in Kwazulu-Natal, South Africa: a longitudinal study

Abstract: The aim of this prospective study (20 months) was to assess HIV patients' use of Traditional, Complementary and Alternative Medicine (TCAM) and its effect on ARV adherence at three public hospitals in KwaZulu-Natal, South Africa. Seven hundred and thirty-five (29.8% male and 70.2% female) patients who consecutively attended three HIV clinics completed assessments prior to ARV initiation, 519 after 6 months, 557 after 12 and 499 after 20 months on antiretroviral therapy (ART). Results indicate that following initiation of ARV therapy the use of herbal therapies for HIV declined significantly from 36.6% prior to ARV therapy to 8.0% after 6 months, 4.1% after 12 months and 0.6% after 20 months on ARVs. Faith healing methods (including spiritual practices and prayer) declined from 35.8% to 22.1%, 20.8% and 15.5%, respectively. In contrast, the use of micronutrients (vitamins, etc.) significantly increased from 42.6% to 78.2%. The major herbal remedies that were used prior to ART were unnamed traditional medicine, followed by imbiza (Scilla natalensis planch), canova (immune booster), izifozonke (essential vitamins mixed with herbs), African potato (Hypoxis hemerocallidea), stametta (aloe mixed with vitamins and herbs) and ingwe (tonic). Herbal remedies were mainly used for pain relief, as immune booster and for stopping diarrhea. As herbal treatment for HIV was associated with reduced ARV adherence, patient's use of TCAM should be considered in ARV adherence management

Evaluation of vaginal pessary use by South African gynaecologists

Introduction:The use of vaginal pessaries for conservative management of pelvic organ prolapse (POP) is well established. However; there is limited data on current clinical practice among gynaecologists; and thus the aim of this survey was to evaluate vaginal pessary use among South African gynaecologists. Methods: An anonymous self administered one page questionnaire was designed by the author and administered to South African gynaecologists at an Obstetrics and Gynaecology Update meeting in 2009. Results: The response rate was 32(133 out of 420). 24(29 out of 123) offered vaginal pessaries as first line treatment for pelvic organ prolapse in their clinical practice. The ring pessary was the commonest pessary for all compartmental defects. The two most favored reasons for pessary use was surgical or anaesthetic risk (64) (85 out of 133) and patient declining surgery (50) (66 out of 133). Recurrent involuntary expulsion (52) (69 out of 133); discomfort (41) (55 out of 133); opting for surgery (39) (52 out of 133) were the three top reasons for pessary discontinuation. 88(92 out of 105) responded that they would have reviewed patients within 6 weeks after initial pessary insertion; and thereafter 46(44 out of 96) reviewed patients on 3-6 monthly interval. Conclusion: When compared to other surveys fewer South African gynaecologists offer vaginal pessaries as first line treatment to patients with symptomatic pelvic organ prolapse. Similar practice trends included the choice of pessary; follow up interval and reasons for pessary discontinuation

In vivo efficacy study of quinine sulphate in the treatment of uncomplicated P. Falciparum malaria in patients from southwestern Cameroon

Objective: To evaluate clinical, parasitological and haematological responses to quinine sulphate therapy in patients with uncomplicated malaria using the 14-day WHO protocol. Design: Longitudinal study.Setting: The Buea Provincial hospital annex located in South Western Cameroon. Subjects: The study participants consisted of children (≥8 months) and adults (≤50 years) with acute malaria attending the outpatient division of health institutions within Fako Division.Results: Quinine sulphate failure was found in 42% of the patients. Of these 10% were resistant at the RI while 32% were at the RII level. Clinically, the overall success rate (ACR) was 94.2% while therapeutic failures (ETF and LTF) were observed in four patients (5.8%). 27.4% and 17.4% of the patients were anaemic at enrolment and day 14 respectively. The mean PCV levels of the patients increased during the follow-up period except on day three when mean PCV levels dropped. The difference in the mean PCV levels during the follow-up was significant (F=60.29; P=0.0001).Conclusion: The relatively high resistance of quinine sulphate observed in this study suggests the need to monitor the spread of resistance to this drug in the study region

HIV risk factors in three geographic strata of rural Rakai District; Uganda

OBJECTIVES: To examine risk factors for HIV-1 infection in three geographic strata (main road trading centers that service local and international traffic; small trading villages on secondary dirt roads that serve as foci for local communications; and agricultural villages off main and secondary roads) in Rakai District; Uganda. DESIGN AND METHODS: Serological; sociodemographic; knowledge/behaviors and health survey conducted in 21 randomly selected community clusters; complete data were collected for 1292 consenting adults. RESULTS: Fifteen per cent of the men and 24pc of the women were HIV-1-positive. On univariate analysis; several sociodemographic and behavioral factors were significantly associated with risk of HIV infection; including age; place of residence; travel; occupation; marital status; number of sex partners; sex for money or gifts; history of sexually transmitted disease (STD); and history of injections. On multivariate analysis; age; residence and number of sex partners remained significantly associated with HIV infection in both sexes; a history of STD and not having been circumcised were significant in men. There was a significant interaction between place of residence and reported number of sex partners: for any given level of sexual activity; the risk of HIV infection was markedly increased if the background community prevalence was high. CONCLUSION: Sexual transmission appears to be the primary behavioral risk factor for infection; but the risks associated with this factor vary substantially between the three geographic strata. These data can be used to design targeted interventions

Plasmodium falciparum and P. malariae epidemiology in a West African village

Transmission of Plasmodium falciparum and P. malariae was studied in a village in Burkina Faso. Consecutive captures of mosquitos were organized twice a month over a year and the species of the mosquitos identified. Also, the prevalences and densities of Plasmodium spp. were determined every 2 months in a sample of children who lived in the village. Anopheles gambiae, A. funestus, and A. nili were the local vectors, but only the first two played a predominant role in both P. falciparum and P. malariae transmission. The parasitological sporozoite index (SI) was 4.48% for A. gambiae and 4.22% for A. funestus. The immunological SIs were higher: 5.82% of A. gambiae were infected with P. falciparum and only 0.16% with P. malariae; the corresponding proportions for A. funestus were 6.45% and 0.41%. Transmission of Plasmodium spp. by A. gambiae was important during the rainy season (July-October) and by A. funestus at the beginning of the dry season (September-November). Each child in the study village could receive about 396 P. falciparum-infected bites per year but only 22 of P. malariae. The P. falciparum parasite indices were maximum during the middle of the rainy season (August), while those for P. malariae reached a peak during the dry season (February)