| 1. |
- Uthman, Muhammed Mubashir B., et al.
(författare)
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Interventions for the prevention of mycobacterium avium complex in adults and children with HIV
- 2013
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Ingår i: Cochrane Database of Systematic Reviews. - 1469-493X .- 1469-493X. ; :4, s. Art. no. CD007191-
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Forskningsöversikt (refereegranskat)abstract
- Background Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and is an independent predictor of mortality and shortened survival. Objectives To determine the effectiveness and safety of interventions aimed at preventing MAC infection in adults and children with HIV infection. Search methods We searched MEDLINE, EMBASE, and The Cochrane Library (search date December 2012). Selection criteria Randomised controlled trials comparing different strategies for preventing MAC infection in HIV-infected individuals. Data collection and analysis Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details. Development of MAC infection and survival were compared using risk ratios (RR) and 95% confidence intervals (CI). The quality of evidence has been assessed using the GRADE methodology. Main results Eight studies met the inclusion criteria. Placebo-controlled trials There was no statistically significant difference between clofazimine and no treatment groups in the number of patients that developed MAC infection (RR 1.01; 95% CI 0.37 to 2.80). Rifabutin (one study; RR 0.48; 95% CI 0.35 to 0.67), azithromycin (three studies; RR 0.37; 95% CI 0.19 to 0.74) and clarithromycin (one study; RR 0.35; 95% CI 0.21 to 0.58) were more effective than placebo in preventing the development of MAC infection. There was no statistically significant difference between those treated with clofazimine (one study; RR 0.98; 95% CI 0.41 to 2.32), rifabutin (one study RR 0.91; 95% CI 0.78 to 1.05), azithromycin (three studies, pooled RR 0.96; 95% CI 0.69 to 1.32) and placebo in number of reported deaths. One study found that the risk of death was reduced by 22% in patients treated with clarithromycin compared to those treated with placebo (RR 0.78; 95% CI 0.64 to 0.96). Monotherapy vs. monotherapy Patients treated with clarithromycin (RR 0.60; 95% CI 0.41 to 0.89) and azithromycin (RR 0.60; 95% CI 0.40 to 0.89) were 40% less likely to develop MAC infection than those treated with rifabutin. There was no statistically significant difference between those treated with clarithromycin (RR 0.98; 95% CI 0.83 to 1.15), azithromycin (RR 0.98; 95% CI 0.77 to 1.24) and rifabutin in the number of reported deaths Combination therapy versus monotherapy There was no statistically significant difference between patients treated with a combination of rifabutin and clarithromycin and those treated with clarithromycin alone (RR 0.74; 95% CI 0.46 to 1.20); and those treated with combination of rifabutin and azithromycin and those treated with azithromycin alone (RR 0.59; 95% CI 1.03). Patients treated with a combination of rifabutin plus clarithromycin were 56% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.44; 95% CI 0.29 to 0.69). Patients treated with a combination of rifabutin plus azithromycin were 65% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.35; 95% CI 0.21 to 0.59). There was no statistically significant difference in the number of reported deaths in all the four different comparisons of prophylactic agents. Authors' conclusions Based on limited data, azithromycin or clarithromycin appeared to be a prophylactic agent of choice for MAC infection. Further studies are needed, especially direct comparison of clarithromycin and azithromycin. In additions, studies that will compare different doses and regimens are needed.
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| 2. |
- Yahaya, Ismail, et al.
(författare)
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Interventions for HIV-associated nephropathy
- 2013
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Ingår i: Cochrane Database of Systematic Reviews. - 1469-493X .- 1469-493X. ; :1, s. Art. no. CD007183-
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Forskningsöversikt (refereegranskat)abstract
- Background Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretroviral therapy, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. Objectives To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. Search methods In January 2012 we searched the Cochrane Renal Group's Specialised Register, AIDS Education Global Information System (AEGIS database), ClinicalTrial.gov, the WHO International Clinical Trials Registry Portal, and reference lists of retrieved articles without language restrictions. In our original review we searched CENTRAL, MEDLINE, EMBASE, and AIDSearch, in addition to contacting individual researchers, research organisations and pharmaceutical companies. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. Data collection and analysis We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. For dichotomous outcomes results were to be expressed as risk ratios with 95% confidence intervals, and for continuous scales of measurement the mean difference was to be used. Main results We identified four relevant ongoing studies: one is still ongoing; two have completed recruitment but are yet to be published; and the fourth study was suspended for unspecified reasons. No completed RCTs or quasi-RCTs were identified. We summarised and tabulated the data from the observational studies, however no formal analyses were performed. Authors' conclusions There is currently no RCT-based evidence upon which to base guidelines for the treatment of HIVAN, however three ongoing studies have been identified. Data from observational studies suggest steroids and angiotensin-converting enzyme inhibitors appear to improve kidney function in patients with HIVAN, however no formal analyses were performed in this review. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.
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| 3. |
- Uthman, Abdulrahman Olalekan
(författare)
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Attitudes towards and exposure to intimate partner violence against women in sub-Saharan Africa : contextual effects, neighbourhood variations and individual risk factors
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims: We described and compared attitudes toward intimate partner violence and associated socio-demographic, structural, and attitudinal factors among men and women from subSaharan Africa (SSA) (Study I) and explored plausible gender differences to examine societal level factors associated with it (Study II). We also examined if there are any evidence for area- and societal-level social inequalities on women’ attitudes toward IPVAW to further understand the pathway by which the broader social environment could influence the individual attitude (Study III). We further studied the association between gender inequality and exposure to IPVAW (Study IV) and examined whether men’s and women's attitudes (i.e. believing that IPVAW is justified) are directly linked to exposure and perpetuation of violence (Study V). Methods: We utilised data from 17 Demographic and Health Surveys (DHS) conducted between 2003 and 2007 among 165,983 women and 68,501 men nested within 7465 communities from 17 countries in SSA. We used multiple logistic regression models estimated by likelihood ratio test to explore factors associated with attitudes towards IPVAW (Study I). In Study II, we used meta-analytic methods to examine relationship between societal-level measures of socioeconomic position (SEP) and gender differences in attitude towards IPVAW. In Study III & IV, We applied multivariable multilevel logistic regression analysis. In study V, we used multilevel structural equation modelling. Results: We found that IPVAW was widely accepted under certain circumstances by men and women in all the countries studied (Study I). Women were more likely to justify IPVAW than men (Studies I, II & III). “Neglecting the children” was the most common reason agreed to by both women and men for justifying IPVAW followed by “going out without informing husband” and “arguing back with the husband” (Study I). Increasing wealth status, education attainment, urbanization, access to media, and joint decision making were associated with decreased odds of justifying IPVAW in most countries (Study I). The magnitude in gender disparity in attitudes towards IPVAW increased with increasing percentage of men practicing polygamy in each country (Study II). Men and women living in disadvantaged communities had higher rates of justifying IPVAW compared with their counterparts residing in the most advantaged communities after adjustment for individual SEP (Study III). In addition, women whose husband had higher education and women whose husband had more than one wife were more likely to accept IPVAW than other women (Study IV). Women who with positive attitudes towards IPVAW and those that had witnessed IPVAW were more likely to have reported spousal abuse (Study V). Conclusions: This large comparative analysis has provided evidence that IPVAW was widely acceptable under certain circumstances and more such among women, younger people, less educated, poorest, those living in rural areas, those with less access to media and single decision makers. We found that individual, community and societal context in which people live is associated with attitudes towards IPVAW. Given the societal factors that shape the behaviour of communities and individuals, we believe that structural interventions hold great promise for significant achievements in the prevention of IPVAW.
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| 4. |
- Yahaya, Ismail, et al.
(författare)
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Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse : a multilevel analysis of sixcountries in Sub-Saharan Africa
- 2013
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Ingår i: Journal of Injury and Violence Research. - : Journal of Injury and Violence Research. - 2008-2053 .- 2008-4072. ; 6:1, s. 21-30
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008. RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata. CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents’ experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries’ political, social, economic, legal, and cultural impact on Childhood sexual abuse.
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