Dyslipidemia among adult HIV patients on antiretroviral therapy and its association with age and body mass index in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Dyslipidemia is a common public health problem in people living with human immunodeficiency virus (HIV) who are receiving antiretroviral therapy and increases the risk of cardiovascular disease. Although evidence indicates that the prevalence of dyslipidemia is high, estimated pooled data are not well documented. Therefore, we aimed to estimate the pooled prevalence of dyslipidemia in adult people living with HIV receiving antiretroviral therapy in Ethiopia. METHOD: We conducted a systematic review and meta-analysis of the literature. The following databases and grey literature were searched: PubMed, WorldCat, ScienceDirect, DOAG, African Journals Online, Google Scholar, and African Index Medicine. We included all comparative epidemiological studies that reported the prevalence of high concentration of total cholesterol, triglycerides, and low density lipoprotein, and low concentration of high density lipoprotein cholesterol that were published between January 2003 and July 2023. The random effects model was used to pool the outcome of interest. Additionally, subgrouping, sensitivity analyses, and funnel plots were performed. R software Version 4.2.1 was used for statistical analysis. RESULT: Seventeen studies with a total of 3929 participants were included in the meta-analysis. The pooled prevalence of dyslipidemia, high total cholesterol, high triglyceride, elevated level of low density lipoprotein and low level of high density lipoprotein cholesterol were 69.32% (95% CI: 63.33, 74.72), 39.78% (95%CI: 32.12, 47.96), 40.32% (95%CI: 34.56, 46.36), 28.58% (95%CI: 21.81, 36.46), and 36.17% (95%CI: 28.82, 44.24), respectively. Age and body mass index were associated with high total cholesterol, triglyceride, and low-density lipoprotein cholesterol levels. CONCLUSION: The authors concluded that the prevalence of dyslipidemia in Ethiopia is high in people living with HIV receiving antiretroviral therapy. Early detection of dyslipidemia and its integration into treatment are essential for preventing cardiovascular disease. TRIAL REGISTRATION: Protocol registered with PROSPERO (CRD42023440125).

The effectiveness of short mobile phone text message reminders compared to usual care on medication adherence in patients with hypertension: a systematic review protocol.

BACKGROUND: Poor adherence to long-term medication increases the risk of morbidity and mortality and decreases the quality of life of patients with hypertension. One strategy to improve treatment adherence is to use a short text message reminder. Although evidence indicates that such programs increase medication adherence, the extent of their effectiveness and translation into clinical practice needs to be better documented. Our systematic review will collect and analyze the available evidence for clinical practice implementation. This systematic review aimed to evaluate the effectiveness of short mobile phone text message reminders versus usual/standard care for medication adherence in patients with hypertension. METHODS: This review will include and summarize evidence from randomized controlled trials. Adults (age > 18 years) with hypertension. The comparator group received either the usual care or standard care. It encompasses standard medical care for patients not participating in a structured and supervised intervention program such as a telemedicine program. We will include studies that assess the effectiveness of short mobile phone text message reminders in improving medication adherence in patients with hypertension compared to usual care. We will search the following databases: PubMed, EMBASE, CINAHL, SCOPUS, Web of Science, Cochrane Library Central Register of Controlled Trials, and Cochrane Library. We will include studies published in English. Furthermore, we will consider studies published from the inception of the database until April 20, 2024. At least two reviewers will independently conduct study selection, data extraction, and quality assessment. A third reviewer will determine and resolve discrepancies. We will conduct a quality assessment using the ROBIS 2 critical appraisal checklist. At least two independent reviewers will crosscheck the data synthesis. DISCUSSION: We expect this review to provide current evidence for future studies and clinical practice concerning the impact of mobile phone text message reminders on medication adherence issues. We will publish our results in a peer-reviewed journal for publication. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023391236.

Self-care practice and its barriers among diabetes patients in North East Ethiopia: A facility-based cross-sectional study.

Diabetes prevention and management through self-care practice is critical to reducing severe complications and death due to diabetes. Data on the prevalence of self-care practices will help us to design and implement prevention and management strategies to foster adherence and compliance with the interventions. This study was intended to assess self-care preparation and its barriers among diabetes patients in Northeast Ethiopia. A facility-based cross-sectional study was conducted among diabetes patients visiting Debre Berhan Town Public Health Institutions from March 10, 2021- April 10, 2021. A systematic random sampling technique was utilized to select 392 samples. Data were collected using a structured questionnaire adapted from Summary of Diabetes Self-Care Activities Measures. Reliability analysis was done using Cronbach's alpha test, and the Hosmer and Lemeshow test also checked for model fitness. Bivariate and multivariable binary logistic regression was done to identify the factors associated with dietary practices. For all statistically significant tests, p- a value < 0.05 was used as a cut-off point. The mean age of the respondents was 47.1 years, with a standard deviation (SD) of ± 13.4 years. The mean adherence to self-care practice was 29.00 ± 10.37 SD. More than half, 218 (61.1%) of the study subjects had poor self-care practices. In the multivariable logistic regression analysis, being a governmental worker (AOR = 7.06 (1.61-30.9) and having social support from partners (AOR = 5.83(3.01-11.3) showed a statistically significant association with good self-care practice. The current study showed that the overall level of self-care practice of study subjects was poor. Therefore, health facilities should provide adequate health education and promotion activities to enhance patients' level of adherence. In addition, families, partners, or friends of diabetes patients should be informed about their essential roles in patients' self-care practice.

Adverse reactions following COVID-19 vaccine among healthcare professionals working in Ethiopia: a facility-based cross-sectional study.

Background of the study: One of the best medical approaches for halting the spread of infectious diseases is vaccination. During the COVID-19 pandemic, healthcare workers (HCWs) were a high-risk population. Due to their susceptibility in terms of their working environment, front-line healthcare personnel should receive vaccinations before others. Objective: The purpose of this study was to assess the adverse reactions to COVID-19 vaccines among Ethiopian healthcare professionals in 2022. Methods: A facility-based cross-sectional study design was conducted in Addis Ababa Health Facilities, Ethiopia. A total of 290 health professionals who were vaccinated during the study period were involved. Data entry was done by Epidata (version 3.1) and analyzed using SPSS software version 26. Bivariable analysis was conducted and a p value of less than 0.25 was selected for further multivariable analysis. A p value of 0.05 was considered statistically significant at a 95% confidence level. Results: A total of 277 study participants were successfully involved in the study, yielding a response rate of 95.5%. The study participants comprised 123 (44.4%) women and 154 (55.6%) men. The majority of them (202, 72.9%) had received the Oxford AstraZeneca vaccine. Among the 277 study participants, 142 (51.3%) had developed adverse reactions associated with vaccination. Of these, 81 (29.2%) had moderate adverse reactions. Only 2 (0.7%) had developed adverse reactions that led to hospitalization. The most reported short-term adverse reactions were injection site pain (151, 54.5%), headache (114, 41.2%), fever (104, 37.5%), fatigability and tiredness (94, 33.9%), chills (92, 33.2%), muscle pain (79, 28.5%), and decreased sleep quality (34, 12.3%). The multivariable logistic regression showed that the odds of having an adverse reaction were 1.501 times higher among women than men (AOR = 1.501, 95% CI [1.08, 2.754]). Conclusion and recommendations: This study revealed that adverse effects following the COVID-19 vaccine were moderate in magnitude and minimal in severity. This study showed that adverse reactions that led to hospitalization were rare. Based on the findings of this study, it is recommended that national, multicenter, prospective, and randomized studies be conducted to assess the independent association of each vaccine.

What is the effect of mobile phone text message reminders on medication adherence among adult type 2 diabetes mellitus patients: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Globally, type 2 diabetes has become increasing. As little is known about the effect of educational intervention on this population, this systematic review and meta-analysis evaluated the effectiveness of mobile phone text message reminders versus usual care to improve medication adherence among type 2 diabetes mellitus patients. METHODS: PubMed, Google Scholar, Cochrane Library, Scopus, and African Journals Online, were searched. A random-effects model was employed to estimate combined effect sizes. Subgroup analyses were employed to investigate possible sources of heterogeneity between studies. The overall certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS: A total of 9 trials with 1,121 participants were included in the review. The pooled estimated impact of mobile phone text message reminders on medication adherence was (SMD: 0.36; 95%CI; 0.14, 0.59) compared to usual care groups among patients with type 2 diabetes mellitus. In addition, subgroup analyses revealed greater medication adherence levels in those studies with intervention durations of more than six months and with self-report/refill adherence scale measurement (SMD: 0.21; 95%CI: 0.02, 0.40) and (SMD: 0.45; 95%CI: 0.22, 0.68), respectively. CONCLUSION: Mobile phone text messages can potentially lead to improved medication adherence levels in patients with Type 2 diabetes despite heterogeneity across the studies. Therefore, mobile phone text messaging when delivered in addition to usual care, have the potential to produce significant improvements in medication adherence.

Prescribing pattern of anti-hypertensive medications among hypertensive outpatients at selected hospitals of South Gondar Zone, Amhara, Ethiopia: a hospital based cross sectional study.

BACKGROUND: Irrational prescription has a lion share for uncontrolled blood pressure. There is no study assessing prescription pattern among hypertensive patients at the study sites. Therefore, the objective of the current study was to evaluate prescription patterns for hypertension and blood pressure (BP) control at randomly selected hospitals of South Gondar Zone. METHODS: A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021. Hypertensive patients were selected by systematic random sampling proportionally from study hospitals. Structured questionnaires were used to collect socio-demographic chacteristics and adherence. Data abstraction form was used to collect prescription patterns, BP level and other necessary information. The association of prescription patterns and other variables with blood pressure control was determined by using binary logistic regression. RESULTS: All recruited 423 patients were included in data analysis. Among prescriptions for hypertension, on average 93.5% were found to be in line with WHO guideline. About 53% of prescriptions for hypertension were monotherapies. Patient level low medication regimen complexity, and monotherapy were associated with blood pressure control (Ajusted Odds Ratio [AOR] = 2.04, [1.07-3.91]; AOR = 3.83 [1.42-10.35], respectively). Patients with inappropriate drug selection, and non-adherence were less likely to have controlled BP (AOR = 0.47 [0.26-0.85]; AOR = 0.52 [0.34-0.85], respectively). Moreover, patients who didn't have health insurance and follow regular aerobic exercise were less likely to have controlled BP (AOR = 0.42 [0.26-0.68]; AOR = 0.53 [0.32-0.88], respectively). CONCLUSION: Diuretics were the most frequently prescribed drug in monotherapy and in combination with calcium channel blockers (CCBs) as dual therapy. On average, more than 90% of prescription was in accordance with WHO guideline and around one-third of participants experienced at least one moderate or major drug-drug interaction. Patient level low medication regimen complexity and monotherapy were positively associated with BP control whereas, non-adherence, inappropriate drug selection, having no health insurance, and didn't follow regular aerobic exercise were negatively associated with BP control. Clinicians should be adherent to treatment guidelines and focus on modifiable factors to improve BP control.

Incidence and predictors of loss to follow-up among adult HIV-infected patients taking antiretroviral therapy at North Shewa zone public Hospitals, Northeast Ethiopia: A retrospective follow-up study.

Background: Patients who are lost to follow-up while on treatment compromise their own health and the long-term success of antiretroviral therapy (ART) programs. Besides, loss to follow-up (LTFU) increases HIV-related morbidity and mortality. Therefore, this study aimed to determine the incidence of LTFU and its predictors among adult HIV positive patients on anti-retroviral therapy at North Shoa zone public hospitals, Northeast Ethiopia. Methods: A retrospective follow up study of 517 people living with HIV/AIDS and attending an ART clinic between 2015 and 2020 was conducted at North Shewa zone, public hospitals. Kaplan-Meier failure function together with log rank test was used to compare failure function. Multivariable Cox proportion hazards regression model was used to determine predictors of LTFU. Result: The incidence density rate of lost to follow up among HIV positive adult on ART was found to be 8.9 per 100 adult years observation (95%CI; 7.45, 10.68). In multivariable cox proportional regression analysis, WHO clinical stage-IV (AHR = 1.50; 95% CI: 1.08, 3.75), comorbidity disease (AHR = 0.54; 95% CI; 0.30, 0.97), body mass index less than 18kg/m2 (AHR = 1.60; 95% CI; 1.02, 2.51), cotrimoxazole preventive therapy (AHR = 1.57; 95% CI;1.09, 2.53), and a low CD4 count (AHR = 1.66; 95% CI; 1.29, 3.49) were found to be a significant predictors of lost to follow up. Conclusion: The current study showed that the incidence rate of loss to ART follow-up was high. Body mass index score less than 18kg/m2, advanced WHO clinical stage, CD4<200cell/mm3, had comorbidity disease, and cotrimoxazole therapy were a significant predictors of lost to ART follow up. Therefore, appropriate mitigation measures in the at-risk group need to be instigated to advance retention rate.

Distribution Width of Red Blood Cells and Related Factors Among Patients with End-Stage Renal Disease in Addis Ababa, Ethiopia.

Background: RDW is critical to the clinical diagnosis and progression of ESRD. There is currently little data on the relationship between RDW and ESRD in sub-Saharan Africa. Because of this, the present study evaluates RDW in patients with ESRD and associated factors in Addis Ababa, Ethiopia. Methods: The hospital-based cross-sectional study design was conducted on a total of 83 patients. RDW, MCV, SCR, BUN, GFR, FBS and serum albumin were determined. Blood pressure (mmHg), weight (kg), height (m), MUAC (cm) and BMI (kg/m2) were also measured. Data entry was via Epi-data version 3.4 and analyzed with SPSS version 26.0. A multivariate logistic regression analysis with a p-value < 0.05 at a 95% confidence interval was used to identify the associated factors of RDW. Results: A total of 83 ESRD patients participated, with a response rate of 95.4%. RDW ranged from 15.5% to 23.6% with a mean of 17.40% + 1.46%. Anisocytosis was present in 98.8% of patients. Of 83 patients, 66.3% were hypertensive, 20.5% had diabetes, and the remaining 13.3% had other conditions (glomerulonephritis and peripheral vascular disease). The mean GFR value was 5.20 mL/min/1.73 + 1.58. RDW showed a significant association with GFR (AOR: 4.6, 95% CI [1.27, 20.74], P = 0.047), alcohol consumption (AOR: 13.4, P = 0.012, 95% CI [1.97, 22.62]), recurrent kidney disease (AOR=25.6, P=0.016, 95% CI [1.85, 53.71]) and use of medication (AOR=00.2, P=0.044), 95% CI [0.03, 0.95]). Conclusion: RDW showed a significant association with GFR, recurrent kidney disease, alcohol consumption, and medication use in hemodialysis-dependent ESRD patients. The mechanisms of RDW disruption in ESRD patients need further investigation.

Red blood cell folate level and associated factors of folate insufficiency among pregnant women attending antenatal care during their first trimester of pregnancy in Addis Ababa, Ethiopia.

Objective: Folate is an essential vitamin for de novo DNA synthesis and cell proliferation. Folate insufficiency at the time of conception and during the first trimester of pregnancy is associated with unintended pregnancy and birth outcomes, particularly neural tube defects. Hence, this study aimed to assess folate status and associated factors of folate insufficiency among pregnant women attending antenatal care during their first trimester of pregnancy in Addis Ababa, Ethiopia. Materials and methods: A cross-sectional study was conducted from 8 August 2017 to 3 January 2018 in Addis Ababa. In this study, 160 participants were enrolled via the convenience sampling method. Red blood cell folate was measured by the electrochemiluminescence binding assay method. Data were entered into Epi-Data version 3.1 and analyzed by SPSS version 22.0. Descriptive statistics were used to describe demographic characteristics and to determine the magnitude of folate deficiency. Logistic regression was used to identify the risk factors for folate deficiency. A p-value of less than 0.05 was considered statistically significant. Results: In this study, 44/160 (27%) participants had red blood cell folate level <400 ng/mL, insufficient to prevent neural tube defect. Multivariate regression showed that regular vegetable consumption was an independent determinant factor for red blood cell folate level (adjusted odds ratio: 0.41, confidence interval: 0.18-0.93). Conclusion: This study shows that a large magnitude of the first-trimester pregnant women had red blood cell folate concentrations below levels that are maximally protective against neural tube defects. Folic acid supplementation and supplemental nutrition containing green leafy vegetables should be promoted during the periconceptional period. In addition, the policymakers should set rules for mandatory folic acid fortification.

Medication regimen complexity and its association with adherence and blood pressure control among hypertensive patients at selected hospitals of South Gondar Zone: A hospital based cross sectional study.

INTRODUCTION: Despite the availability of effective antihypertensive medications, blood pressure (BP) control is suboptimal. High medication regimen complexity index (MRCI) is known to reduce adherence and may be the reason for poor BP control. However, there is no data in the present study areas. Hence, the aim of this study was to assess MRCI and its association with adherence and BP control among hypertensive patients at selected hospitals of South Gondar Zone. METHODS: A hospital based cross sectional study was conducted from December 1, 2020 to February 30, 2021 at selected hospitals of South Gondar Zone. Medication regimen complexity and adherence was evaluated using 65-item validated tool called MRCI (Text removed at time of retraction. See retraction notice for more information.). Multivariable logistic regression analysis was done to determine the association between predictive and outcome variables. RESULTS: About 3.3% of participants were classified as having high HTN specific MRCI whereas 34.75% of participants were classified as having high patient level MRCI. (Text removed at time of retraction. See retraction notice for more information.) Being illiterate, and having low HTN MRCI were more likely to have controlled BP in adjusted analyses. On the contrary, (Text removed at time of retraction. See retraction notice for more information.) not having health insurance, and having lower monthly income were less likely to have controlled BP. CONCLUSION: A considerable proportion of patients had high MRCI. Having low HTN MRCI was more likely to have controlled BP. Simplification of a complex medication regimen for patients with HTN should be sought by physicians and pharmacists to improve BP control.

The Effect of Estrogen Receptor Status on Survival in Breast Cancer Patients in Ethiopia. Retrospective Cohort Study.

Background: There is wide global variance in survival from breast cancer, both in developed and developing country. However, the effect of estrogen receptor status has not been widely evaluated in Ethiopia where the incidence of breast cancer is rapidly increasing. Hence, the current study aimed to determine the effect of estrogen receptor status on the overall survival of breast cancer patients who were treated at Black Lion Specialized Hospital, Ethiopia. Methods: In this institution-based retrospective cohort study a total of 368 study participants were included with a one-to-one ratio of estrogen receptor negative to estrogen receptor positive. The main outcome of interest for this study was death due to breast cancer. The authors compared the women with estrogen receptor-positive and estrogen receptor-negative breast cancer for overall survival rate using log rank test. The incidence density rate of mortality was calculated for each exposed and non-exposed variable. The effect of estrogen receptor status on breast cancer mortality was estimated using the Cox proportional hazards model. Results: The incidence density rate of mortality among breast cancer patients for estrogen receptor positive were found to be 5.48 (95% CI=3.94-7.64) per 1,000 person years observation; while for estrogen negative receptor status the mortality rate was found to be 10.47 (95% CI=8.19-13.37) per 1,000 person years observation. In the Cox regression analysis after ful adjustments for confounder variables, the mortality event risk was 32% higher among estrogen receptor negative (HR=1.32; 95% CI=1.08-2.91) as compared to estrogen receptor positive breast cancer patients. Conclusion: We have found that the incidence density rate of mortality among breast cancer patients was significantly higher in the estrogen receptor negative groups. Therefore, clinicians should give careful attention to the impact of estrogen receptor negative status on the overall outcome of clients.

Prevalence of depression and associated factors among adult cancer patients receiving chemotherapy during the era of COVID-19 in Ethiopia. Hospital-based cross-sectional study.

BACKGROUND: Depression is a major public health problem among cancer patients undergoing chemotherapy. It compromises patient outcomes, resulting in higher rates of mortality. Currently, there are little data on the prevalence of depression in Sub-Sharan countries. Therefore, the current study was done to assess the prevalence of depression among adult cancer patients and its associated factors in Ethiopia. METHOD: An institutional based cross-sectional study was conducted among 420 adult cancer patients from 1st March to April 30, 2021. Systematic random sampling technique was used to recruit participants. Depression was assessed using the Patient Health Questionnaire-9. The collected data were coded and entered into Epi-data version 4.2 and exported to SPSS version 25 for analysis. Bivariate binary logistic regression was performed to select factors that will be included in multivariate analysis, and variables with a p-value < 0.05 were included in multivariate analysis. In multivariate analysis, odds ratios and their 95% confidence intervals were computed and variables with p-value < 0.05 were considered to declare a significant association. RESULTS: In this study, the prevalence of depression was 33.1% (95% CI = 0.2858, 0.3761). Minimal symptoms of depression, minor depression, moderate depression, moderate severe depression, and severe depression were found to be 272 (64.8%), 9 (2.1%), 104 (24.8%), 28 (6.7%), and 7 (1.7%), respectively. Those cancer patients who had unemployed status, sacked from jobs, and had stage IV cancer were most likely to develop depression, whereas patients who completed primary education, colon, prostate and cervical cancer were less likely to have depression. CONCLUSION: Depression is found to be a major public health concern for adult cancer patients in Ethiopia. To reduce the occurrence of depression among cancer patients, special attention is needed.

Chronic Kidney Disease and Associated Factors Among HIV Infected Patients Taking Tenofovir Disoproxil Fumarate Based Regimen in Ethiopia: A Hospital-Based Cross-Sectional Study.

BACKGROUND: Life expectancy of HIV patients has increased by the extensive use of antiretroviral therapies (ART), but ART predisposes patients to chronic non-communicable diseases including chronic kidney disease (CKD). Tenofovir disoproxil fumarate is one of the commonly used drugs in ART and is found to have more risk for developing CKD. In the study areas, there was no previous study addressing the prevalence of CKD, so the purpose of this study was to pinpoint the prevalence of CKD, and its associated factors. METHODS: A hospital-based cross-sectional study was employed at Tikur Anbessa Specialized Hospital (TASH) and Zewuditu Memorial Hospital (ZMH) from April 1 to June 30, 2019. The study participants were proportionally allocated to each hospital and a total of 243 eligible participants were selected conveniently from the two hospitals in the study period. Structured questionnaire and checklist were used to collect socio-demographic and clinical data of the participants. Blood samples (3-5 ml) were used to determine serum creatinine using calibrated fully automated Mind ray BS-200E, and glomerular filtration rate (GFR) was estimated using a chronic kidney disease epidemiology equation. Multivariate logistic regression was employed to identify factors associated with CKD, and a P-value of less than 0.05 was considered significant. RESULTS: In the present study, the prevalence of CKD (GFR <60 ml/min/1.73 m2) was 4.53% (95% CI = 2.3-8%). GFR was classified into stages, stage 5 (GFR <15), stage 4 (15-29.9), stage 3 (30-59.9), stage 2 (60-89.9), and stage 1 (≥90) were 0%, 0.4%, 4.1%, 38.3%, and 57.2%, respectively. In the multivariate logistic regression, age greater than 50 years old, and having cancer were significantly associated with CKD (AOR: 0.22, 95% CI = 0.05-0.88, P = 0.033, and AOR: 18.20, 95% CI = 122-271.77, P = 0.035, respectively). CONCLUSION: Chronic kidney disease in HIV-infected patients receiving a TDF-based regimen requires attention. Age >50 years old, and having cancer as comorbidity were significantly associated with chronic kidney disease. Patients should be regularly monitored for early diagnosis and management of chronic kidney disease in a TDF-based regimen.

Prevalence and Predictors of Hypovitaminosis D in Ethiopian HIV-Infected Adults.

BACKGROUND: Hypovitaminosis D is associated with bone fracture and cardiovascular disease in patients receiving antiretroviral therapy. Currently, there are few data on the magnitude of hypovitaminosis D in people living with HIV in Sub-Saharan country. Therefore, the present study determines the magnitude of hypovitaminosis D in people living with HIV and its associated factors in Ethiopia. METHODS: A cross-sectional study was conducted among 171 adult people living with HIV at Debre Berhan Specialized Hospital. Serum vitamin D was measured. Multivariate logistic regression analysis and p-value <0.05 was used to identify the associated factors of hypovitaminosis D. RESULTS: In the present study, the prevalence of hypovitaminosis D was 129/171 (75.4%), with 11/171 (6.4%) having vitamin D deficiency and 118/171 (69%) having vitamin D insufficiency. Female sex was significantly associated with hypovitaminosis D (AOR: 3.01, 95% CI = 1.381-6.561, P = 0.006). CONCLUSION: Our study found a high burden of hypovitaminosis D among adult people living with HIV on antiretroviral therapy. Female sex was associated with hypovitaminosis D.

Barriers and Strategies to Lifestyle and Dietary Pattern Interventions for Prevention and Management of TYPE-2 Diabetes in Africa, Systematic Review.

BACKGROUND: Diabetes mellitus is a major chronic illness in Africa that requires lifelong lifestyle interventions and pharmacological therapy. Lifestyle change is the most important aspect of diabetes care and includes diabetes self-management education and support, medical nutrition therapy, physical activity, smoking cessation counseling, and psychosocial care. PURPOSE: The purpose of this project was to review published articles that investigate lifestyle and dietary pattern interventions for diabetes prevention and management in Africa. Barriers to lifestyle interventions and strategies to overcome the barriers are also reviewed in this study. METHODS: The article search was conducted in an electronic database search of PubMed, Google Scholar, and Cochrane Library. Studies were included if they were published between 2011 and 2019, if they were conducted in an African country, and were written in the English language. RESULTS: Articles reviewed included several that examined the basic lifestyle and dietary pattern changes for all patients diagnosed with type 2 diabetes, on self-care behavior of type 2 diabetes patients, on the cost of diabetes in Africa, and on barriers for adherence to lifestyle and dietary changes in Africa, with strategies to address those barriers. CONCLUSION: Lifestyle interventions including regular physical exercise, weight management, and adherence to health care professionals' recommendations on a healthy diet are the cornerstone in the prevention and management of diabetes in Africa. The main barriers to adherence were both systemic (population changes, poor access, western cultural influences, and low-quality healthcare) and personal (poverty and cost, educational status, and perceptions about the disease) in nature. The strategies for the barriers include health education programs, advocacy, and capacity building.