ABSTRACT
Introduction: holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention. Methods: we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019). Results: the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general. Conclusion: the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.
Subject(s)
Insecticides , Malaria , Pregnancy , Child , Humans , Female , Incidence , Democratic Republic of the Congo/epidemiology , Electronic Health Records , Malaria/epidemiology , Malaria/prevention & controlABSTRACT
IntroductionIt remains unclear if the development of health services, clinical management, and scientific evidence, during the pandemic is associated with better medical outcomes, sustained in the long term, for Covid-19 patients of each gender. This study presents the trends in mortality associated with Covid-19 for women and men during the first year of the pandemic. MethodsThis study was based in 17 Spanish hospitals. Sociodemographic, clinical, and mortality data from all patients with Covid-19, who had been discharged alive, or had died after being admitted, between March 2020 and February 2021, were used. The association between time of admission and mortality was examined with multivariate logistic regression models. Results3390 Covid-19 patients were included in the study, of which 1330 were women, the age was M(SD): 66.55(16.55) Death was reported for 451 patients. There was a significant decreasing trend in mortality by time of admission for the whole year with an OR: 0.86(0.77-0.96) p=0.005. No significant trend in mortality for women was observed OR: 1.00(0.85-1.19) p=0.959, while there was a significant decreasing trend for men OR: 0.78 (0.68-0.90) p=0.001 DiscussionThe health policies put in place, the scientific evidence developed by researchers, and the experienced acquired by clinicians, are likely to explain this improvement in mortality. More epidemiological and clinical studies addressing trends of mortality in patients with different sociodemographic and clinical profile and the improvement of clinical outcomes are required. Future research may address the safety and efficacy of interventions specifically in female patients.
ABSTRACT
BackgroundAzithromycin (AZM) has been widely used in the management of Covid-19. However, the evidence on its actual effects remains disperse and difficult to apply in clinical settings. This systematic review and metanalysis summarizes the available evidence to date on the beneficial and adverse effect of AZM in patients with Covid-19. MethodsThe PRISMA 2020 statement criteria were followed. Randomized controlled trials (RCTs) and observational studies comparing clinical outcomes of patients treated, and not treated, with AZM, indexed until the 5th of July 2021, were searched in PubMed, Embase, The Web of Science, Scopus, The Cochrane Central Register of Controlled Trials, and MedRXivs. We used Random-effects models to estimate pooled effect size from aggregate data. ResultsThe initial search produced 4950 results. Finally, 16 studies, five RCTs and 11 with an observational design, with a total of 22984 patients, were included. The metanalysis showed no difference in mortality for those treated, or not, with AZM, OR: 0.95 (0.79-1.13). There was also no significant difference for those treated, and not, with AZM in need for hospital admission or time to admission from ambulatory settings, clinical severity, need for intensive care, or adverse effects. ConclusionsThese results presented in this review do not support the use of AZM in the management of Covid-19. They also show that any harm caused to the patient who received it is unlikely. Future research on treatment for patients with Covid-19 may need to focus on other drugs.
ABSTRACT
ObjectivesThis study investigates the association between the treatment with heparin and mortality in patients admitted with Covid-19. MethodsRoutinely recorded, clinical data, up to the 24th of April 2020, from the 2075 patients with Covid-19, admitted in 17 hospitals in Spain between the 1st of March and the 20th of April 2020 were used. The following variables were extracted for this study: age, gender, temperature, and saturation of oxygen on admission, treatment with heparin, hydroxychloroquine, azithromycin, steroids, tocilizumab, a combination of lopinavir with ritonavir, and oseltamivir, together with data on mortality. Multivariable logistic regression models were used to investigate the associations. ResultsAt the time of collecting the data, 301 patients had died, 1447 had been discharged home from the hospitals, 201 were still admitted, and 126 had been transferred to hospitals not included in the study. Median follow up time was 8 (IQR:5-12) days. Heparin had been used in 1734 patients. Heparin was associated with lower mortality when the model was adjusted for age and gender, with OR (95%CI): 0.55 (0.37-0.82) p=0.003. This association remained significant when saturation of oxygen <90%, and temperature >37C were added to de model with OR: 0.54(0.36-0.82) p=0.003, and also when all the other drugs were included as covariates OR: 0.42 (0.26-0.66) p<0.001. ConclusionsThe association between heparin and lower mortality observed in this study can be acknowledged by clinicians in hospitals and in the community. Randomized controlled trials to assess the causal effects of heparin in different therapeutic regimes are required. - The administration of heparin was associated with lower mortality in patients admitted with Covid-19. - Our findings support that there is a thrombotic component in the development of respiratory distress for these patients. - The positive effect of heparin seems consistent and its use, when indicated, could be considered in clinical settings. - Randomized controlled trials are necessary to complement observational studies, and assess the causal associations between heparin, in different therapeutic regimes, and clinical outcomes. - Heparin is easy to administer, its use in ambulatory patients, to prevent admissions, or reduce their duration, could also be considered by clinicians and future researchers.
ABSTRACT
No disponible
