Conectar
Both dermatological and neurological manifestations characterise neurocutaneous syndromes (NCSs). Although individually rare, collectively they impose a substantial clinical, humanitarian and economic burden, often contributing to barriers in healthcare access. This scoping review aims to map global evidence on healthcare access and service utilisation in NCSs and identify barriers, facilitators and gaps in care.
This scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Bibliographic databases and hand searches will be used to identify relevant studies. Published and grey literature addressing healthcare access will be included while non-English studies will be excluded. Two independent reviewers will perform study selection and data extraction. Quality assessment will be conducted for full-text studies using the Joanna Briggs Institute tools. Findings will be mapped to evidence on healthcare access, service utilisation, treatment patterns, barriers and facilitators and will be presented using tables and geographic mapping.
This scoping review will use publicly available data and therefore does not require ethical approval. The findings will be published in a peer-reviewed journal.
This study assessed the spatial distribution of HIV test non-uptake among pregnant women who attended antenatal care (ANC) in sub-Saharan Africa.
Cross-sectional study design.
Sub-Saharan Africa (SSA) region. 24 SSA countries were included in this study.
Demographic and Health Survey (DHS), 2016–2024.
82 397 women who were pregnant in the last 2 years preceding the survey.
HIV test non-uptake, which is a legacy indicator of HIV test among pregnant women.
The HIV test non-uptake among ANC attending pregnant women was 39.6% (95% CI 39.27% to 39.93%). The spatial autocorrelation test revealed that HIV testing non-uptake among pregnant women was clustered. The global Moran’s I value was 0.48 with a p value
There was a significant geographical variation in HIV test non-uptake among pregnant women attending antenatal care (ANC) in sub-Saharan Africa. Prioritising hotspot areas with high rates of HIV test non-uptake for spatially targeted interventions is essential. Policymakers, health professionals, and other stakeholders should focus on improving women’s formal education, expanding health insurance coverage, and increasing ANC contacts to ensure that each visit includes HIV screening. Moreover, special attention should be given to younger women to enhance HIV testing uptake among those attending ANC in sub-Saharan Africa.
by Ligabaw Worku, Amha Kebede, Ayalew Jejaw Zeleke, Saron Fekadu, Melat Abdo, Tigist Atele, Netsanet Worku, Mulugeta Aemero
BackgroundAnopheles mosquitoes are the main vectors of malaria. Effective vector control depends on understanding their species composition, behavior, distribution, and insecticide resistance. This study investigated Anopheles species composition, susceptibility to deltamethrin, and the frequency of knockdown resistance (kdr) mutations in Maksegnit and Gendawuha, Northwest Ethiopia.
MethodsAnopheles larvae and pupae were collected from breeding sites during the rainy and post-rainy seasons and reared to adults under field insectary conditions following WHO guidelines. In addition, adult mosquitoes were collected from houses near larval habitats. Only field-derived mosquito populations were used in this study. Adult females (3–5 days old) reared from field-collected larvae were tested for susceptibility to 0.05% deltamethrin using WHO bioassays. Based on bioassay outcomes, mosquitoes were classified as phenotypically susceptible (died after exposure) or resistant (survived exposure), while field-collected adults represented an unexposed group. A total of 480 mosquitoes (160 resistant, 160 susceptible, and 160 field-collected unexposed adults) were subjected to genomic DNA extraction. Species identification and detection of knockdown resistance (kdr) mutations (L1014F and L1014S) were performed using PCR.
ResultsWHO bioassays conducted on 776 mosquitoes revealed confirmed resistance to deltamethrin, with mortality rates ranging from 48.5% to 72.5% (overall resistance: 37.5%). Resistance intensity exhibited significant variation, peaking after the rainy season and showing a higher prevalence in Maksegnit compared to Gendawuha (p Anopheles arabiensis was the predominant species (93%, 446/480), followed by An. pharoensis (6%, 29/480) and An. stephensi (1%, z/480), with the latter detected for the first time in Gendawuha. Regarding kdr mutation status, genotypic analysis showed that the L1014F mutation was the predominant allele, particularly among phenotypically resistant mosquitoes (67.8%), while lower frequencies were observed in susceptible (45.8%) and unexposed field-collected groups (61.4%). Conversely, the L1014S mutation was detected at low frequency (≤12.3%) and was restricted exclusively to the Maksegnit population.
ConclusionAnopheles arabiensis predominated, with confirmed resistance to deltamethrin, particularly in the post-rainy season. The L1014F kdr mutation was prevalent, while L1014S kdr mutation was rare. Detection of Anopheles stephensi highlights emerging risks, underscoring the need for season-specific resistance monitoring and integrated control strategies.
by Abebe Fenta, Tebelay Dilnessa, Destaw Kebede, Mekuriaw Belayneh, Zigale Hibstu Teffera, Bewket Mesganaw, Adane Adugna, Wubetu Yihunie Belay, Habtamu Belew, Desalegn Abebaw, Bantayehu Addis Tegegne, Zelalem Dejazmach, Fassikaw Kebede, Gashaw Azanaw Amare
BackgroundCo-infection with the human immunodeficiency virus (HIV) and tuberculosis (TB) is a primary cause of death and morbidity. The rate of morbidity and death from TB-HIV is still Ethiopia’s top health issue.
ObjectiveThis study aimed to assess the incidence and predictors of mortality among TB-HIV co-infected individuals on anti-TB and anti-retroviral dual Therapy at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia.
MethodsA retrospective cohort study was conducted at the Debre Markos Comprehensive Specialized Hospital among 436 TB-HIV co-infected individuals. A computer-generated random sampling technique was used to select patient charts registered from September 1st, 2011, and August 31st, 2020. Epi-Data version 3.1 was used for data entry, and STATA version 13 was used for the analysis. The Kaplan-Meier survival curve was applied to estimate the cumulative survival time of the TB-HIV patients. Log-rank tests were utilized to compare the survival time across various categories of explanatory variables. Bi-variable and multivariable Cox proportional hazard models were fitted to find predictors of TB-HIV mortality.
ResultsThe mortality rate of TB-HIV co-infected individuals was 15.6%, with a median survival time of 42 months. Being male (Adjusted hazard Ratio (AHR)1.914;95%CI: 1.022–3.584), having CD4 count Conclusion and recommendation
The mortality rate among TB-HIV co-infected patients at Debre Markos Comprehensive Specialized Hospital was high. Being male gender, having a CD4 count below 50 cells/mm³, being ambulatory and bedridden, having low baseline weight, and having low hemoglobin were the important predictors of mortality. To reduce mortality, it is crucial to focus on the early identification and management of high-risk patients, particularly those with low CD4 counts, poor functional status, and low hemoglobin. Strengthening integrated TB and HIV care services is recommended to improve patient survival outcomes.
by Mesay Milkias, Semagn Mekonnen, Hailemariam Getachew, Hailemariam Mulugeta, Siraj Ahmed, Melkamu Kebede, Belete Destaw, Medhanit Melese, Zemedu Aweke
BackgroundPost-operative pain is among the major post-cesarean problems, with an incidence ranging from 25.5% to 80%. Despite its simplicity, the effectiveness of wound infiltration with a mixture of bupivacaine and tramadol is still unknown. Therefore, this study aims to compare the analgesic effectiveness of wound infiltration with bupivacaine versus a combination of bupivacaine and tramadol for postoperative pain management among parturients undergoing cesarean section under spinal anesthesia.
MethodologyA double-blind, parallel, randomized controlled trial was conducted on 60 parturients. Parturients were randomized to take either bupivacaine (B = 30) or a combination of bupivacaine and tramadol (BT = 30). The homogeneity of variance was assessed using Levene’s test, and normality was assessed using the Shapiro-Wilk test. A numeric rating scale was used to measure pain severity. The independent t-test and the Mann-Whitney U test were used, respectively, for parametric and non-parametric data. A generalized estimating equation was used to assess repeated measurements.
ResultIn total, 60 parturients were analyzed with no dropouts. The severity of pain at the 6th hour was six times greater in the B group compared to the BT group (OR = 6.289, CI, 2.097–18.858, P = 0.001). The mean tramadol consumption was lower in the BT group (140.00 ± 48.066 mg) than in the B group (175.00 ± 34.114 mg), with a statistically significant mean difference of 10.761 (95% CI, 13.459 to 56.541), t (58) = 3.252, P = 0.002, (d = 0.839). The mean first analgesia request time was higher in the mixture of the BT group (367.33 ± 50.099 min) than in the B group (216.33 ± 68.744 min), with a statistically significant difference of 15.530 (95% CI, −182.087 to −119.913), t (58) = 5.6553, P = 0.001.
ConclusionWound infiltration with a combination of bupivacaine and tramadol is more effective than bupivacaine alone for postoperative analgesia in pregnant patients who underwent cesarean section under spinal anesthesia. This clinical trial study was registered at the Pan African Clinical Trial Registry with a unique trial registration number of PACTR202310525672884 (13/10/2023).
Assess the magnitude of adverse pregnancy outcomes and associated factors among mothers who had operative vaginal delivery in Amhara Region Comprehensive Specialized Hospitals, 2024.
A cross-sectional study was conducted from 1 November 2024 to 20 February 2025.
Seven comprehensive specialised hospitals were included in the study.
The study was employed on 389 mothers who had operative vaginal delivery.
Systematic sampling was used. Data were collected via questionnaires, chart reviews and observation. Data were entered into Epi Data V.4.6 and analysed using V.25 statistical package of social sciences. Variables with p
Adverse pregnancy outcomes of operative vaginal delivery.
Adverse pregnancy outcomes of operative vaginal delivery were 42.2%. Among them, 46 (11.8%) had only maternal complications, 55 (14.1%) had only neonatal complications and 63 (16.2%) had both maternal and neonatal complications. Perineal tear 29 (7.5%) and episiotomy extension 31 (8%) were the most common maternal complications, while caput succedaneum 45 (11.6%) was the most neonatal complication. The most common indication of operative vaginal delivery was prolonged second stage 203 (52.2%). Vacuum-assisted delivery (AOR 0.53; 95% CI 0.29 to 0.96), two tractions (AOR 2.19; 95% CI 1.23 to 3.90), birth weight less than 2.5 kg (AOR 1.85; 95% CI 1.21 to 2.83) and mid fetal station (AOR 2.9; 95% CI 1.49 to 5.64) were significantly associated with adverse pregnancy outcomes.
Adverse pregnancy outcomes following operative vaginal delivery were high. Type of instrumental vaginal delivery, number of tractions, fetal birth weight and fetal station were significantly increased risks. Therefore, operators should minimise traction attempts during operative vaginal delivery to reduce adverse outcomes.
FreshRSS 