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A pinboard by
Emmanuel Benyeogor

Principal Investigator, University of Lagos

PINBOARD SUMMARY

A community based descriptive cross-sectional study was carried out among 125 mothers of under-fives

Introduction: Diarrhoea is the passage of unusually loose or watery stools, usually at least three times in a 24 hour period. Despite the declines in mortality, diarrhoea remains the second most common cause of death among under-fives globally. The home as first line management for diarrhoea and replacing of fluids, administered by a mother in recognition and practice of informed care seeking behaviour on bouts of diarrhoea has been targeted for enhancement in the Community Integrated Management of Childhood Illness (C-IMCI) strategy. The aim of this study was to assess the knowledge, determine the attitude and identify practices in the home management of diarrhoea in under-fives among mothers in Ijegun Egba Community, Amuwo LGA of Lagos Methodology: A community based descriptive cross-sectional study was carried out among 125 mothers of under-fives in Ijegun Egba community two weeks preceding the study. Respondents were selected from the community using multistage sampling technique. Data was collected using interviewer administered semi structured questionnaire and analyzed using Epi info 7.1.4.0. Chi square and Fisher’s exact were the test statistics. Level of significance was set at < 0.05. Results: The mean age of mothers was 31.5 ± 5.438 years and their under-fives 30.1 ± 13.205 months. Prevalence of diarrhoea in two weeks preceding the study was 47 (37.6 percent). A very few of the mothers 5 (4 percent) had no formal education, few of them 29 (23.2 percent) were either unemployed, a full time housewife or student and half of the mothers 62 (49.5 percent) earned less than 10,000 Naira per month. More of the mothers 77 (61.8 percent) had good level of knowledge on the home management of diarrhoea. More of the mothers 77 (61.6 percent) correctly identified “Bad water and contaminated food” as the causes of diarrhoea. More of the mothers 79 (68.8 percent) correctly identified “Immunization 2 (1.6 percent), Avoiding contaminated water 61 (48.8 percent), food and hand washing 16 (12.8 percent)” as prevention for diarrhoea. Most mothers 87 (75.6 percent) had correctly identified the recommended home treatment for diarrhoea “ORS (New/Old) 88 (70 percent) and SSS 7 (5.6 percent)” A few of the mothers 9 (7.2 percent) had negative attitude overall. Most mothers 119 (96.2 percent) attributed risk of dying to dehydration while half 62 (49.6 percent) of them were willing to give lots of fluid and food during a diarrhoea episode. More of the mothers 73

3 ITEMS PINNED

Multiplex tests to identify gastrointestinal bacteria, viruses and parasites in people with suspected infectious gastroenteritis: a systematic review and economic analysis.

Abstract: Gastroenteritis is a common, transient disorder usually caused by infection and characterised by the acute onset of diarrhoea. Multiplex gastrointestinal pathogen panel (GPP) tests simultaneously identify common bacterial, viral and parasitic pathogens using molecular testing. By providing test results more rapidly than conventional testing methods, GPP tests might positively influence the treatment and management of patients presenting in hospital or in the community.To systematically review the evidence for GPP tests [xTAG(®) (Luminex, Toronto, ON, Canada), FilmArray (BioFire Diagnostics, Salt Lake City, UT, USA) and Faecal Pathogens B (AusDiagnostics, Beaconsfield, NSW, Australia)] and to develop a de novo economic model to compare the cost-effectiveness of GPP tests with conventional testing in England and Wales.Multiple electronic databases including MEDLINE, EMBASE, Web of Science and the Cochrane Database were searched from inception to January 2016 (with supplementary searches of other online resources).Eligible studies included patients with acute diarrhoea; comparing GPP tests with standard microbiology techniques; and patient, management, test accuracy or cost-effectiveness outcomes. Quality assessment of eligible studies used tailored Quality Assessment of Diagnostic Accuracy Studies-2, Consolidated Health Economic Evaluation Reporting Standards and Philips checklists. The meta-analysis included positive and negative agreement estimated for each pathogen. A de novo decision tree model compared patients managed with GPP testing or comparable coverage with patients managed using conventional tests, within the Public Health England pathway. Economic models included hospital and community management of patients with suspected gastroenteritis. The model estimated costs (in 2014/15 prices) and quality-adjusted life-year losses from a NHS and Personal Social Services perspective.Twenty-three studies informed the review of clinical evidence (17 xTAG, four FilmArray, two xTAG and FilmArray, 0 Faecal Pathogens B). No study provided an adequate reference standard with which to compare the test accuracy of GPP with conventional tests. A meta-analysis (of 10 studies) found considerable heterogeneity; however, GPP testing produces a greater number of pathogen-positive findings than conventional testing. It is unclear whether or not these additional 'positives' are clinically important. The review identified no robust evidence to inform consequent clinical management of patients. There is considerable uncertainty about the cost-effectiveness of GPP panels used to test for suspected infectious gastroenteritis in hospital and community settings. Uncertainties in the model include length of stay, assumptions about false-positive findings and the costs of tests. Although there is potential for cost-effectiveness in both settings, key modelling assumptions need to be verified and model findings remain tentative.No test-treat trials were retrieved. The economic model reflects one pattern of care, which will vary across the NHS.The systematic review and cost-effectiveness model identify uncertainties about the adoption of GPP tests within the NHS. GPP testing will generally correctly identify pathogens identified by conventional testing; however, these tests also generate considerable additional positive results of uncertain clinical importance.An independent reference standard may not exist to evaluate alternative approaches to testing. A test-treat trial might ascertain whether or not additional GPP 'positives' are clinically important or result in overdiagnoses, whether or not earlier diagnosis leads to earlier discharge in patients and what the health consequences of earlier intervention are. Future work might also consider the public health impact of different testing treatments, as test results form the basis for public health surveillance.This study is registered as PROSPERO CRD2016033320.The National Institute for Health Research Health Technology Assessment programme.

Pub.: 18 Jun '17, Pinned: 20 Jun '17

A Nationwide Study of Severe and Protracted Diarrhoea in Patients with Primary Immunodeficiency Diseases.

Abstract: Diarrhoea lasting longer than 14 days and failing to respond to conventional management is defined as severe and protracted diarrhoea (SD). In this study, we investigated the prevalence, pathogens and prognosis of SD in primary immunodeficiency diseases (PIDs). Among 246 patients with predominantly paediatric-onset PIDs from 2003-2015, 21 [Btk (six), IL2RG (four), WASP, CD40L, gp91 (three each), gp47, RAG2 (one each)] and five [CVID (four), SCID (one)] without identified mutations had SD before prophylactic treatment. Detectable pathogens included pseudomonas, salmonella (six each), E. coli, cytomegalovirus, coxsackie virus and cryptosporidium (one each), all of whom improved after a mean 17 days of antibiotics and/or IVIG treatment. Seven (7/26; 27.0%) patients died [respiratory failure (four), lymphoma, sepsis and intracranial haemorrhage (one each)]. The patients with WAS, CGD and CD40L and SD had a higher mortality rate than those without. Another five males with mutant XIAP, STAT1, FOXP3 (one each) and STAT3 (two) had undetectable-pathogenic refractory diarrhoea (RD) that persisted >21 days despite aggressive antibiotic/steroid treatment and directly resulted in mortality. For the patients with RD without anti-inflammatory optimization, those with mutant XIAP and FOXP3 died of Crohn's-like colitis and electrolyte exhaustion in awaiting transplantation, while transplantation cured the STAT1 patient.

Pub.: 18 Jun '17, Pinned: 20 Jun '17

Effect of community health clubs on child diarrhoea in western Rwanda: cluster-randomised controlled trial.

Abstract: Community health clubs are multi-session village-level gatherings led by trained facilitators and designed to promote healthy behaviours mainly related to water, sanitation, and hygiene. They have been implemented in several African and Asian countries but have never been evaluated rigorously. We aimed to evaluate the effect of two versions of the community health club model on child health and nutrition outcomes.We did a cluster-randomised trial in Rusizi district, western Rwanda. We defined villages as clusters. We assessed villages for eligibility then randomly selected 150 for the study using a simple random sampling routine in Stata. We stratified villages by wealth index and by the proportion of children younger than 2 years with caregiver-reported diarrhoea within the past 7 days. We randomly allocated these villages to three study groups: no intervention (control; n=50), eight community health club sessions (Lite intervention; n=50), or 20 community health club sessions (Classic intervention; n=50). Households in these villages were enrolled in 2013 for a baseline survey, then re-enrolled in 2015 for an endline survey. The primary outcome was caregiver-reported diarrhoea within the previous 7 days in children younger than 5 years. Analysis was by intention to treat and per protocol. This trial is registered with ClinicalTrials.gov, number NCT01836731.At the baseline survey undertaken between May, 2013, and August, 2013, 8734 households with children younger than 5 years of age were enrolled. At the endline survey undertaken between Sept 21, 2015, and Dec 22, 2015, 7934 (91%) of the households were re-enrolled. Among children younger than 5 years, the prevalence of caregiver-reported diarrhoea in the previous 7 days was 514 (14%) of 3616 assigned the control, 453 (14%) of 3196 allocated the Lite intervention (prevalence ratio compared with control 0·97, 95% CI 0·81-1·16; p=0·74), and 495 (14%) of 3464 assigned the Classic intervention (prevalence ratio compared with control 0·99, 0·85-1·15; p=0·87).Community health clubs, in this setting in western Rwanda, had no effect on caregiver-reported diarrhoea among children younger than 5 years. Our results question the value of implementing this intervention at scale for the aim of achieving health gains.Bill & Melinda Gates Foundation.

Pub.: 18 Jun '17, Pinned: 20 Jun '17