XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Archives of disease in childhood. Fetal and neonatal edition

Bacterial meningitis in children.

Objective To assess the sex difference in the prevalence of COVID-19 confirmed cases. Design Systematic review and meta-analysis. Setting PubMed, Cochrane Library and Google Scholar were searched for related information. The authors developed a data extraction form on an Excel sheet and the following data from eligible studies were extracted: author, country, sample size, number of female patients and number of male patients. Using STATA V.14 for analysis, the authors pooled the overall prevalence of men and/or women using a random-effect meta-analysis model. The authors examined the heterogeneity in effect size using Q statistics and I2 statistics. Subgroup and sensitivity analyses were performed. Publication bias was also checked. Participants Studies on COVID-19 confirmed cases were included. Intervention Sex (male/female) of COVID-19 confirmed cases was considered. Primary and secondary outcome measures The primary outcome was prevalence of COVID-19 among men and women. Results A total of 57 studies with 221 195 participants were used in the analysis. The pooled prevalence of COVID-19 among men was found to be 55.00 (51.43–56.58, I2=99.5%, p Conclusions The prevalence of symptomatic COVID-19 was found to be higher in men than in women. The high prevalence of smoking and alcohol consumption contributed to the high prevalence of COVID-19 among men. Additional studies on the discrepancies in severity and mortality rate due to COVID-19 among men and women and the associated factors are recommended.

https://bmjopen.bmj.com/content/bmjopen/10/10/e040129.full.pdf

Sex difference in coronavirus disease (COVID-19): a systematic review and meta-analysis.

Background . Studies on the health benefits of breastfeeding in developed countries have shown conflicting results. These studies often fail to account for confounding, reverse causality, and dose-response effects. We addressed these issues in analyzing longitudinal data to determine if breastfeeding protects US infants from developing diarrhea and ear infections. Methods .  Mothers participating in a mail panel provided information on their infants at ages 2, 3, 4, 5, 6, and 7 months. Infants were classified as exclusively breastfed; high, middle, or low mixed breast- and formula-fed; or exclusively formula-fed. Diarrhea and ear infection diagnoses were based on mothers’ reports. Infant age and gender; other liquid and solid intake; maternal education, occupation, and smoking; household size; family income; and day care use were adjusted for in the full models. Results . The risk of developing either diarrhea or ear infection increased as the amount of breast milk an infant received decreased. In the full models, the risk for diarrhea remained significant only in infants who received no breast milk compared with those who received only breast milk (odds ratio = 1.8); the risk for ear infection remained significant in the low mixed feeding group (odds ratio = 1.6) and among infants receiving no breast milk compared with those who received only breast milk (odds ratio = 1.7). Conclusions . Breastfeeding protects US infants against the development of diarrhea and ear infection. Breastfeeding does not have to be exclusive to confer this benefit. In fact, protection is afforded in a dose-response manner. The more breast milk an infant receives in the first 6 months of life, the less likely that he or she will develop diarrhea or ear infection. longitudinal analysis, diarrhea, ear infection, breastfeeding.

A longitudinal analysis of infant morbidity and the extent of breastfeeding in the united states

Exclusive breastfeeding means babies are given only breast milk and nothing else: no other milk, food, drink, not even water for one day (24 hrs) before the survey was conducted. It prevents 13% of childhood mortality; i.e, at least 1.2 million children worldwide would be saved every year. The objective of this study was to assess the prevalence exclusive breastfeeding (EBF) practice and its associated factor among mothers who have infants less than six months of age in Motta town, East Gojjam, Amhara Regional State, Ethiopia. A community based quantitative cross-sectional study was conducted from April 7, 2015 to May 7, 2015. A simple random sampling technique was applied after taking all registered mothers who have infants less than six months old from local health extension workers of each kebele. A total of 423 mothers with infant less than six months old were included in this study. The data was collected using an interviewer administered questioaire. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with exclusive breastfeeding practice. Prevalence of exclusive breastfeeding was 50.1%. Mothers with young infants aged 0-1 month (Adjusted Odds Ratio [AOR] 3.86: (1.64, 9.07), unemployed mothers (AOR 3.01: 1.46, 6.20), low income mothers (AOR 3.61: 1.75, 7.45), mothers who received breastfeeding counseling in pregnancy (AOR 2.76: 1.52, 4.99), fed colostrum (AOR 3.50: 1.45, 8.45), didn't give prelacteal feeds (AOR 4.48: 1.82, 11.03) and were supported by their husband (AOR 2.67: 1.04, 6.95) were more likely to practice exclusive breastfeeding than their counterparts. Prevalence of exclusive breastfeeding practice in study area was lower than country recommended level. Age of the child, maternal occupation, income, breastfeeding counseling during antenatal care, husband support of breastfeeding and colostrum feeding were independent predictors of exclusive breastfeeding practice. Recommendations to increase exclusive breastfeeding practice are revising postpartum maternity leave, increasing health professional's habit of breastfeeding counseling through training, involving husbands during counseling, educating mothers and the community as a whole to avoid traditional practices that hinder exclusive breastfeeding up to six months.

/pdf/exclusive-breastfeeding-practice-and-associated-factors-3oe6539mvl.pdf

Exclusive breastfeeding practice and associated factors among mothers in Motta town, East Gojjam zone, Amhara Regional State, Ethiopia, 2015: a cross-sectional study.

Timely initiation of breastfeeding within one hour after birth and exclusive breastfeeding is recommended for the first six months of infant life along with continuation of breastfeeding up to two years. Timely initiation of breastfeeding has the potential to prevent 22 % of neonatal deaths. The objective of this study was to assess timely initiation of breastfeeding and associated factors among mothers who have infants less than six months of age in Motta town, East Gojjam, Amhara Regional State, Ethiopia. Community based quantitative cross-sectional study was conducted from April 7, 2015 to May 7, 2015. Simple random sampling technique was applied after taking all registered mothers who have infants less than 6 months old from local health extension workers of each kebele. A total of 423 mothers with infant less than six month old were included in this study. The data was collected from all four Kebeles using interviewer administered questionnaire. Descriptive and inferential statistics were used to present the data. Both bivariate and multivariate logistic regression analyses were used to identify factors associated with timely initiation breastfeeding. Prevalence of timely initiation of breastfeeding was78.8 % [95 % CL: 74.88 %, 82.72 %]. Mothers who gave birth to their infant in a health institution [AOR = 3.486(1.253, 9.700)], birthed vaginally [AOR = 5.722(3.134, 11.246)] and didn’t give prelacteal food [AOR = 4.627(2.095, 10.220)] were more likely to initiate breastfeeding early than their counterparts. Prevalence of timely initiation of breastfeeding in the study area was 78.8 %. Place of delivery, mode of delivery and prelactal feeding were the independent predictors of timely initiation of breastfeeding. Recommendations to increase timely initiation of breastfeeding were: encouraging mothers to deliver their child in a health institution, minimizing caesarean delivery as much as possible and educating mothers and community as a whole to avoid traditional prelactal feeding practice.

/pdf/timely-initiation-of-breastfeeding-and-associated-factors-36hocuzrne.pdf

Timely initiation of breastfeeding and associated factors among mothers in Motta town, East Gojjam zone, Amhara regional state, Ethiopia, 2015: a cross-sectional study.

Sepsis remains a major cause of morbidity and mortality among neonates. The risk factors and clinical outcomes of sepsis are poorly understood. Most cases of sepsis occurred mostly within the first week of newborns life related to perinatal risk factors. Late onset sepsis is related to hospital acquired infections which is seen after seven days of age. The purpose of this study was to assess clinical outcome and risk factors of neonatal sepsis in Felege Hiwot referral hospital Bahir Dar, North West Ethiopia. Among the total 225 neonatal charts reviewed; 164 (72.9%) were age less than or equal to 7 days, and 144 (64%) were males. About 29 (12.9%) neonates were with irregular respiratory signs and 40 (17.8%) had meconium aspiration syndrome. Regarding the clinical outcome of neonatal sepsis: 189 (84%) were improved after treatment, 9 (4%) were died and 13 (5.8%) referred to other organizations for further treatment. Respiratory distress syndrome [AOR = 0.258 (0.072–0.930)] and meconium aspiration syndrome [AOR = 0.1989 (0.059–0.664)] were the determinant factors for poor outcome of neonatal sepsis. The clinical outcome of neonatal sepsis in Felege Hiwot referral hospital was not satisfactory. The significant risk factors for poor outcome of neonatal sepsis were respiratory distress syndrome and meconium aspiration syndrome. Recommendations to improve neonatal outcome are: performing essential newborn care for all newborns and arranging appropriate follow up until the end of neonatal period, increasing antenatal care and early detection and management of neonatal infections or problems.

/pdf/clinical-outcome-and-risk-factors-of-neonatal-sepsis-among-4t6qtczrdy.pdf

Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review.

Neonatal sepsis is an invasive infection, usually bacterial, and often occurring during the neonatal period (0–28 days). Neonatal sepsis causes a high burden of morbidity and mortality in developing countries like Ethiopia. There are fragmented, inconsistency, and no review has been conducted to report the magnitude and associated factors of neonatal sepsis in Ethiopia. Thus, this study aimed to assess the pooled prevalence of neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia. Electronic media searches like PubMed, CINHAL, EMBASE, Google Scholar, Web of Science, Cochrane library databases and African health science library were used. All original peer-reviewed papers which reported the prevalence of neonatal sepsis in Ethiopia were included in this study. Two reviewers independently extracted the data using a standardized data extraction format for eligibility and appraised their quality. Data were analyzed using Stata version 14 software. The pooled prevalence of neonatal sepsis was estimated with the random-effect model. Heterogeneity between studies was assessed by I 2 statistics test. Subgroup and meta-regression analyses were done to assess the source of variation between the studies. Egger’s test followed by trim and fill analysis were used to determine publication bias. A sensitivity analysis was carried out. A total of 952 research papers reviewed, of which, eight studies were finally included in this systematic review and meta-analysis. The random effect pooled prevalence of neonatal sepsis in Ethiopia was 49.98% (CI: 36.06, 63.90). In subgroup analysis, the pooled estimated neonatal sepsis among cross-sectional studies was 53.15% while the cohort was 40.56%. Newborns with a birth weight of less than 2.5 kg were 1.42 times more likely to develop neonatal sepsis infection compared to normal babies. The odds ratios of preterm babies were 3.36 to develop neonatal sepsis compared to term infants. The pooled prevalence of neonatal sepsis in Ethiopia was high. Thus, health care providers should adhere to aseptic precautions while performing procedures, especially in preterm and low birth weight infants were recommended.

/pdf/neonatal-sepsis-and-its-association-with-birth-weight-and-572sxdr8m2.pdf

Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis

Monotonous low quality diets are the norm in resource-limited environments across the globe. Dietary diversity is a challenge for rural communities in developing countries. Their diets are based on starchy staples with inadequate animal products, fresh fruits and vegetables. A community based cross sectional study was conducted from August 22–30, 2015 at Finote Selam Town. Systematic random sampling technique was used to select 400 households. Data were collected using pretested and semi-structured questionnaire. Both bivariate and multivariate logistic regression analyses were carried out to identify factors associated with household dietary diversity. The prevalence of low, medium and high dietary diversity scores were 11.8, 67.2 and 21% respectively. Family head (Men headed) [AOR = 4.75 (2.22, 10.16)], frequency of eating [AOR = 6.06 (2.82, 13.06)] and shortage of water for cooking [AOR = 5.69 (1.39, 23.27)] were significantly associated with household dietary diversity. In this study the prevalence of adequate household diversity was 88.2%. Family head, frequency of eating and shortage of water for cooking were significant factors for household dietary diversity. Empowering women, increasing frequency of eating among family members and avoiding shortage of water for cooking were recommended to sustain and improve household dietary diversity.

/pdf/household-dietary-diversity-and-associated-factors-among-3u4wvgv0lq.pdf

Tilahun Tewabe

Papers

Exclusive breastfeeding practice and associated factors among mothers in Motta town, East Gojjam zone, Amhara Regional State, Ethiopia, 2015: a cross-sectional study.

Timely initiation of breastfeeding and associated factors among mothers in Motta town, East Gojjam zone, Amhara regional state, Ethiopia, 2015: a cross-sectional study.

Clinical outcome and risk factors of neonatal sepsis among neonates in Felege Hiwot referral Hospital, Bahir Dar, Amhara Regional State, North West Ethiopia 2016: a retrospective chart review.

Neonatal sepsis and its association with birth weight and gestational age among admitted neonates in Ethiopia: systematic review and meta-analysis

Household dietary diversity and associated factors among residents of finote selam town, north west Ethiopia: a cross sectional study