Current Issue : October - December Volume : 2016 Issue Number : 4 Articles : 6 Articles
Background: In Tanzania elders are respected as repositories of inherited wisdom, experienced\nand principal decision makers in the community. However, evidence shows that such repositories\nare no longer considered important in most societies. As a result elders are neglected with some\nmistreatment in terms of provision of health and social services for instance; at times they get denied\nand ignored of their obvious rights, ignoring their retirement benefits and the rights onto\nfree social services as per the Tanzania National Ageing Policy of 2003. Elders are therefore faced\nwith physical, psychological and geriatric social suffering. It is on this basis that this study tries to\nexplore the common preventable health and social problems encountered by elderly in Shinyanga\nRegion in northern part of Tanzania. Methods: Across sectional community based study of 465\nsubjects randomly selected was done in three wards of Kahama District. The district was selected\nrandomly out of 8 districts of Shinyanga Region, structured questionnaires with both closed and\nopened endower used; the information was collected from house to house and other information\ncollected from health facilities within the wards as every ward had one public health facility; subjects\n(respondents) were obtained using purposive sampling technique aiming at elderly with 60\nyears of age and above. Results: Kahama district has a population of approximately 36,014 of\nwhich 1500 (4%) are in the elderly age group of 60 years and above. The study population was\n465 which is 30% (465/1500) of the geriatric population of Kahama. Among this group 5% were\nfemale while 41% were male and 53% (248/465) were married. 64% (297/465) were taking care of themselves, 32% (150/465) cared by relatives and 4% (18/465) cared by the community.\nAmong the respondents, 40% (185/465) were affected by HIV/AIDs in one way or another either\nliving with orphans whose parents died of HIV/AIDS or asking care of the infected patients within\nthe family. It was also found that 73% of the geriatrics were not exempted from medical treatment\nfees so they had to pay for their medical care. However, only 32% were aware of getting free\ntreatment and 61% of the study populations were not satisfied with the medical care provided at\nthe public health facilities. The common diseases affecting this age group are: Eye problem 59%\n(273/465); Arthritis 52% (241/465); Dental problems 27% (124/465); Hypertension 23%\n(107/465); Backache 22% (105/465); Malaria 28% (132/465); Hearing problems 26% (121/645);\nUrinary tract Infection 35% (165/465); Depression 8% (36/465). Dementia was also a problem\nthough we had no tools to confirm the diagnosis; some of the geriatrics had more than two diseases.\nConclusion: The majority of the elderly age group in Kahama District are not aware of their\nrights that they deserve free treatment according to Tanzania policy, furthermore for assessment\nand screening of health problems. A majority of the elderly die prematurely due to preventable\ndiseases and more than half of the diseases affecting geriatrics are preventable....
Background: To optimise care HIV patients need to be promptly initiated on antiretroviral therapy (ART) and subsequently\nretained on treatment. In this study we report on the interval between enrolment and treatment initiation,\nand investigate subsequent attrition and mortality of patients on ART at a rural clinic in Malawi.\nMethods: HIV-positive individuals were recruited to a cohort study between January 2008 and August 2011 at\nChilumba Rural Hospital (CRH). Outcomes were ascertained, up to 7 years after enrolment, through follow-up and\nby linkage to ART registers and the Karonga Health and Demographic Surveillance System (KHDSS). Kaplanââ?¬â??Meier\nmethods and Cox regression were used to examine ART initiation after enrolment, mortality after ART initiation, and\nattrition after ART initiation.\nResults: Of the 617 individuals recruited, 523 initiated ART between January 2008 and January 2015. Median time\nfrom HIV testing to commencement of ART was 59 days (IQR: 10ââ?¬â??330). By a year after enrolment 74.2 % (95 % CI\n70.6ââ?¬â??77.7 %) had initiated ART. Baseline clinical data at ART initiation and data on attrition was only available for the\n438 individuals who initiated ART during active follow-up, between January 2008 and August 2011. Of these individuals,\n6 were missing Ministry of Health numbers, leaving 432 included in analyses of attrition and mortality. At 4 years\nafter ART initiation 71.3 % (95 % CI 65.7ââ?¬â??76.2 %) of these patients were retained on treatment at the CRH and 17.2 %\n(95 % CI 13.8ââ?¬â??21.4 %) had died. Participants who had a lower CD4 count at enrolment (ââ?°Â¤350 cells/Ã?¼l), enrolled in\n2008, or tested for HIV at the CRH rather than through serosurveys, initiated treatment faster. Once on treatment,\nmortality rates were higher in patients who were HIV tested at the CRH, male, older (ââ?°Â¥35 years), missing a CD4 count,\nor underweight (BMI < 18.5) at ART initiation.\nConclusions: Through linkage to the KHDSS and ART registers it was possible to continue follow-up beyond the end\nof the initial cohort study. Annual mortality after ART initiation remained considerable over a period of 4 years. Greater\naccess to HIV and CD4 testing alongside initiation at higher CD4 counts, as planned in the test and treat strategy,\ncould reduce this mortality....
While substance use is one of the most consistent predictors of poor adherence to antiretroviral therapy (ART), few studies among\npeople living with HIV (PLH) have utilized mobile phone-based assessment of these health behaviors. PLH were recruited from\nprimary care clinics to report ART and substance use using a smartphone application (app) for 14 consecutive days. The app�s\nfeasibility as a data collection tool was evaluated quantitatively via surveys and qualitatively via in-depth interviews to assess daily\nreport completion, compliance, and study satisfaction. Overall, 26 participants (M = 49.5 years, 76% male) completed 95.3% of\ntime-based daily reports. Participants reported high satisfaction with the app and expressed future interest in using smartphones\nto report daily behaviors. High completion rates and participant acceptability suggest that smartphones are a feasible, acceptable\nmethod for collecting substance use and ART data among PLH. Potential areas of concern such as sufficient training and assistance\nfor those with limited smartphone experience should be considered for future app-based research studies among PLH....
Liver disease has emerged as the most common non-AIDS-related cause of death in HIV patients. However, there is limited data\nregarding this condition including our setting in Ethiopia. Hence, liver enzyme abnormalities among highly active antiretroviral\ntherapy (HAART) experienced and HAART naÃ?¨Ã?±ve patients were assessed in this study. A total of 164 HAART experienced and 164\nHAART naÃ?¨Ã?±ve patients were studied. Blood specimen was collected to determine alanine aminotransferase (ALT) and aspartate\naminotransferase (AST), CD4 count, and viral hepatitis. The prevalence of liver enzyme abnormality was 20.1% and 22.0% among\nHAART experienced and HAART naÃ?¨Ã?±ve patients, respectively. The HAART experienced patients had higher mean ALT than\nHAART naÃ?¨Ã?±ve patients (P = 0.002). Viral hepatitis (AOR = 6.02; 95% CI = 1.87ââ?¬â??19.39), opportunistic infections (AOR = 2.91;\n95% CI = 1.04ââ?¬â??8.19), current CD4 count <200 cells/mm3 (AOR = 2.16; 95% CI = 1.06ââ?¬â??4.39), and male sex (AOR = 1.83; 95% CI =\n1.001ââ?¬â??3.33) were associated with elevated ALT and/or AST. In conclusion, liver enzyme abnormalities were high in both HAART\nexperienced and HAART naÃ?¨Ã?±ve HIV-1 infected patients. Hence, monitoring and management of liver enzyme abnormalities in\nHIV-1 infected patients are important in our setting....
Background: Human immunodeficiency virus (HIV) and hepatitis B virus (HBV) coinfection has been associated with\nhigher morbidity and mortality and may impact significantly on healthcare resource utilization. However, in Ghana,\naccurate estimates of the prevalence of HIV/HBV coinfection needed to inform policy decisions and the design of\npublic health interventions are currently lacking. In this study, our aim was to determine the HIV/HBV coinfection\nprevalence rate in Ghana.\nMethods: Primary studies reporting prevalence of HIV/HBV coinfection in Ghana were retrieved through searches\nconducted in PubMed, science direct, Google scholar and Africa journals online (AJOL) databases. The websites of the\nMinistry of Health and Ghana Health Service were also searched for related reports or reviews. Additionally, the online\nrepository of two leading Ghanaian universities were searched to identify unpublished thesis related to the subject.\nAll online searches were conducted between 01/03/2016 and 12/03/2016. Further searches were conducted through\nreference screening of retrieved papers.\nResults: Twelve (12) studies published between 1999 and 2016 and conducted across seven (7) regions of Ghana\nwere included in this review. The three (3) regions with no studiesââ?¬â?¢ representation were Upper East, Upper West and\nCentral regions. The 12 included studies involved a total of 8162 HIV patients. The reported HIV/HBV coinfection\nprevalence rates ranged from 2.4 to 41.7 %. The pooled HIV/HBV coinfection prevalence rate was determined as\n13.6 % (95 % CI 10.2ââ?¬â??16.8 %; P < 0.001).\nConclusions: In Ghana, about one in seven HIV patients may be also be chronically infected with HBV. Preventive\ninterventions and strategic policy directions including systematic screening of all newly diagnosed HIV cases for\ncoinfection will be needed, so as to improve management strategies for HBV infection and antiretroviral therapy (ART)\nimplementation....
Over 3.2 million children worldwide are infected with HIV, but only 24% of these children receive antiretroviral therapy (ART).\nART adherence among children is a crucial part of managing human-immunodeficiency virus (HIV) infection and extending the\nlife and health of infected children. Important causes of poor adherence are formulation- and regimen-specific properties, including\npoor palatability, large pill burden, short dosing intervals, and the complex storage and transportation of drugs. This review aims\nto summarize the various regimen- and formulation-based barriers to ART adherence among children to support the need for\nnew and innovative pediatric formulations for antiretroviral therapy (ART). Detailing the arguments both for and against investing\nin the development of pediatric HIV medications, as well as highlighting recent advances in pediatric ART formulation research,\nprovides a synopsis of the current data related to pediatric ART formulations and adherence....
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