Dataset Information

Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

ABSTRACT: Background:Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined. Methods:Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and Google) were explored. 20 out of 818 studies were included in this study. The IDRs and predictors of neonatal mortality were computed from studies conducted in survival analysis. Fixed and random effect models were used to compute pooled estimates. Subgroup and sensitivity analyses were performed. Results:Neonates were followed for a total of 1,095,611 neonate-days; 67142 neonate-days for neonates treated in neonatal intensive care units and 1,028,469 neonate-days for community-based studies. The IDRs of neonatal mortalities in neonatal intensive care units and in the community were 24.53 and 1.21 per 1000 person-days, respectively. The IDRs of early and late neonatal mortalities neonatal intensive care units were 22.51 and 5.09 per 1000 neonate-days, respectively. Likewise, the IDRs of early and late neonatal mortalities in the community were 0.85 and 0.31, respectively. Not initiating breastfeeding within one hour, multiple births, rural residence, maternal illness, low Apgar score, being preterm, sepsis, asphyxia, and respiratory distress syndrome were independent predictors of time to neonatal mortality in neonatal intensive care units and male gender, perceived small size, multiple births, and ANC were predictors of neonatal mortality in the community. Conclusion:The incidence density rate of neonatal mortality in Sub-Saharan Africa is significantly high. Multiple factors (neonatal and maternal) were found to be independent predictors. Strategies must be designed to address these predictors, and prospective studies could reveal other possible factors of neonatal mortalities.

SUBMITTER: Bitew ZW

PROVIDER: S-EPMC7586147 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Bitew Zebenay Workneh ZW Alemu Ayinalem A Ayele Ermias Getaneh EG Jember Desalegn Abebaw DA Haile Michael Tamene MT Worku Teshager T

International journal of pediatrics 20201015

<h4>Background</h4>Neonatal mortality in Sub-Saharan countries is remarkably high. Though there are inconsistent studies about the incidence density rate of neonatal mortalities (IDR) and predictors in Sub-Saharan Africa, they are inconclusive to policymakers and program planners. In this study, the IDR of neonatal mortalities and predictors was determined.<h4>Methods</h4>Electronic databases (Web of Science, PubMed, EMBASE (Elsevier), Scopus, CINAHL (EBSCOhost), World Cat, Google Scholar, and G ...[more]

PMID: 33123204

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Project description:BackgroundDrug resistance remains from among the most feared public health threats that commonly challenges tuberculosis treatment success. Since 2010, there have been rapid evolution and advances to second-line anti-tuberculosis treatments (SLD). However, evidence on impacts of these advances on incidence of mortality are scarce and conflicting. Estimating the number of people died from any cause during the follow-up period of SLD as the incidence proportion of all-cause mortality is the most informative way of appraising the drug-resistant tuberculosis treatment outcome. We thus aimed to estimate the pooled incidence of mortality and its predictors among persons receiving the SLD in sub-Saharan Africa.MethodsWe systematically identified relevant studies published between January, 2010 and March, 2020, by searching PubMed/MEDLINE, EMBASE, SCOPUS, Cochrane library, Google scholar, and Health Technology Assessment. Eligible English-language publications reported on death and/or its predictors among persons receiving SLD, but those publications that reported death among persons treated for extensively drug-resistant tuberculosis were excluded. Study features, patients' clinical characteristics, and incidence and/or predictors of mortality were extracted and pooled for effect sizes employing a random-effects model. The pooled incidence of mortality was estimated as percentage rate while risks of the individual predictors were appraised based on their independent associations with the mortality outcome.ResultsA total of 43 studies were reviewed that revealed 31,525 patients and 4,976 deaths. The pooled incidence of mortality was 17% (95% CI: 15%-18%; I2 = 91.40; P = 0.00). The studies used varied models in identifying predictors of mortality. They found diagnoses of clinical conditions (RR: 2.36; 95% CI: 1.82-3.05); excessive substance use (RR: 2.56; 95% CI: 1.78-3.67); HIV and other comorbidities (RR: 1.96; 95% CI: 1.65-2.32); resistance to SLD (RR: 1.75; 95% CI: 1.37-2.23); and male sex (RR: 1.82; 95% CI: 1.35-2.44) as consistent predictors of the mortality. Few individual studies also reported an increased incidence of mortality among persons initiated with the SLD after a month delay (RR: 1.59; 95% CI: 0.98-2.60) and those persons with history of tuberculosis (RR: 1.21; 95% CI: 1.12-1.32).ConclusionsWe found about one in six persons who received SLD in sub-Saharan Africa had died in the last decade. This incidence of mortality among the drug-resistant tuberculosis patients in the sub-Saharan Africa mirrors the global average. Nevertheless, it was considerably high among the patients who had comorbidities; who were diagnosed with other clinical conditions; who had resistance to SLD; who were males and substance users. Therefore, modified measures involving shorter SLD regimens fortified with newer or repurposed drugs, differentiated care approaches, and support of substance use rehabilitation programs can help improve the treatment outcome of persons with the drug-resistant tuberculosis.Trial registration numberCRD42020160473; PROSPERO.

Project description:Sub-Saharan Africa represents 69% of the total number of individuals living with HIV infection worldwide and 72% of AIDS deaths globally. Pulmonary infection is a common and frequently fatal complication, though little is known regarding the lower airway microbiome composition of this population. Our objectives were to characterize the lower airway microbiome of Ugandan HIV-infected patients with pneumonia, to determine relationships with demographic, clinical, immunological, and microbiological variables and to compare the composition and predicted metagenome of these communities to a comparable cohort of patients in the US (San Francisco). Bronchoalveolar lavage samples from a cohort of 60 Ugandan HIV-infected patients with acute pneumonia were collected. Amplified 16S ribosomal RNA was profiled and aforementioned relationships examined. Ugandan airway microbiome composition and predicted metagenomic function were compared to US HIV-infected pneumonia patients. Among the most common bacterial pulmonary pathogens, Pseudomonas aeruginosa was most prevalent in the Ugandan cohort. Patients with a richer and more diverse airway microbiome exhibited lower bacterial burden, enrichment of members of the Lachnospiraceae and sulfur-reducing bacteria and reduced expression of TNF-alpha and matrix metalloproteinase-9. Compared to San Franciscan patients, Ugandan airway microbiome were significantly richer, and compositionally distinct with predicted metagenomes that encoded a multitude of distinct pathogenic pathways e.g secretion systems. Ugandan pneumonia-associated airway microbiome is compositionally and functionally distinct from those detected in comparable patients in developed countries, a feature which may contribute to adverse outcomes in this population. Please note that the data from the comparable cohort of patients in the USUS data was published as supplemental material of PMID: 22760045 but not submitted to GEO The 'patient_info.txt' contains 12 clinical, 7 immunological and 3 microbiological variables for each patient.

Project description:BackgroundTuberculosis, along with HIV, is the leading cause of mortality and morbidity globally. Despite the fact that several primary studies have been conducted on the incidence rate of tuberculosis in HIV-infected people in Sub-Saharan Africa, the regional-level tuberculosis incidence rate remains unknown. The objective of this study is to determine the tuberculosis incidence rate and its associated factors in HIV-infected people in Sub-Saharan Africa.MethodsA systematic review and meta-analysis were conducted by searching four databases for studies published in English between January 1, 2000, and November 25, 2022. The study was carried out using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. To assess the quality of the studies, the Joanna Briggs Institute critical appraisal checklist was used. A random-effects model meta-analysis was used to determine the pooled incidence of tuberculosis using STATA version 15. The I2 heterogeneity test was used to assess heterogeneity. Subgroup and sensitivity analyses were performed. Funnel plots and Egger's regression tests were used to investigate publication bias. The pooled estimate predictors of tuberculosis incidence rate with a 95% confidence interval were also determined using the hazard ratio of each factor (HR).ResultsOut of a total of 3339 studies, 43 were included in the analysis. The overall pooled incidence rate of tuberculosis in HIV-infected people was 3.49 per 100 person-years (95% CI: 2.88-4.17). In the subgroup analysis, the pooled incidence rate of tuberculosis in HIV-infected children was 3.42 per 100 person-years (95% CI: 1.78, 5.57), and it was 3.79 per 100 person-years (95% CI: 2.63, 5.15) in adults. A meta-analysis revealed that underweight (AHR = 1.79, 95% CI: 1.61-1.96), low CD4 count (AHR = 1.23, 95% CI: 1.13-1.35), male gender (AHR = 1.43, 95% CI: 1.22-1.64), advanced WHO clinical stages (AHR = 2.29, 95% CI: 1.34-3.23), anemia (AHR = 1.73, 95% CI: 1.34-2.13), bedridden or ambulatory (AHR = 1.87, 95%), lack of isoniazid preventive therapy (AHR = 3.32, 95% CI: 1.08-2.28), and lack of cotrimoxazole (AHR = 1.68, 95% CI: 1.08-2.28) were risk factors for tuberculosis incidence. HIV patients who received antiretroviral therapy had a 0.53 times higher risk of acquiring tuberculosis than HIV patients who did not receive antiretroviral therapy (AHR = 0.53; 95% CI: 0.3-0.77).ConclusionIn this systematic review and meta-analysis study, the incidence rate of tuberculosis among HIV-positive people was higher than the WHO 2022 Africa regional estimated report. To reduce the incidence of tuberculosis among HIV patients, HIV patients should take isoniazid prevention therapy (IPT), cotrimoxazole prophylaxis, and antiretroviral therapy (ART) without interruption, as well as increase the frequency and diversity of their nutritional intake. Active tuberculosis screening should be increased among HIV-infected people.

Dataset Information

Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

Publications

Incidence Density Rate of Neonatal Mortality and Predictors in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.

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