Background Tuberculosis remains a global threat and a public health problem that has eluded attempts to eradicate it. Low vitamin D levels have been identified as a risk factor for tuberculosis infection and disease. The human cathelicidin LL-37 has both antimicrobial and immunomodulatory properties and is dependent on vitamin D status. This systematic review attempts to compare vitamin D andLL-37 levels among adult pulmonary tuberculosis patients to non-pulmonary TB individuals between 16–75 years globally and to determine the association between vitamin D and cathelicidin and any contributing factor among the two study groups. Methods/Design We performed a search, through PubMed, HINARI, Google Scholar, EBSCOhost, and databases. A narrative synthesis through evaluation of vitamin D and LL-37 levels, the association of vitamin D and LL-37, and other variables in individual primary studies were performed. A random-effect model was performed and weighted means were pooled at a 95% confidence interval. This protocol is registered under the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42019127232. Results Of the 2507 articles selected12 studies were eligible for the systematic review and of these only nine were included in the meta-analysis for vitamin D levels and six for LL-37 levels. Eight studies were performed in Asia, three in Europe, and only one study in Africa. The mean age of the participants was 37.3±9.9 yrs. We found low vitamin D and high cathelicidin levels among the tuberculosis patients compared to non-tuberculosis individuals to non-tuberculosis. A significant difference was observed in both vitamin D and LL-37 levels among tuberculosis patients and non-tuberculosis individuals (p = < 0.001). Conclusion This study demonstrated that active pulmonary tuberculosis disease is associated with hypovitaminosis D and elevated circulatory cathelicidin levels with low local LL-37 expression. This confirms that vitamin D status has a protective role against tuberculosis disease.
Background The current global situation is such that 340,000 women still die annually of avoidable maternal health-related complications. Recent statistics in Uganda indicate that maternal deaths among women of age 15 – 49 years are 18% translating to a maternal mortality ratio of 336 deaths per 100,000 live births. Moreover, at least 26% of live deliveries are not attended to by professional practitioners, and 27% are not delivered at a health facility. Additionally, 40% of the last Uganda Demographic and health survey did not attend at least four antenatal care visits, a minimum formerly advocated for before the introduction of the eight contact visits. Methods The study used a cross-sectional research design with the dataset of the most recent UDHS of 2016. A sample of 9869 most recent births for which full information of delivery and ANC was attained, was used. The multilevel logistic regression model was fitted at both bivariate and multivariate levels, as well as a random intercept model to establish latent influence within the communities/clusters. Stata 16 was used for data analysis. Results The results showed that 28.2% Inter class correlation relates to the latent community influence on the health-seeking behavior of mothers on whether to deliver in health facilities or otherwise. Determinants positively associated with facility delivery included at least four ANC (OR=1.59, CI=1.28 – 1.85), professionally employed partner (OR = 1.38; CI =1.09 - 1.74) use of mobile phones (OR =1.23; CI). Those negatively associated include; no education (OR = 0.41; CI = 0.19 - 0.84), unwanted pregnancy (OR=0.98; CI = 0.87 - 1.13), and partner with primary education level (OR = 0.71; CI = 0.51 - 0.99). Conclusion There is a need to ensure sensitization about the 8 ANC visits which the bivariate stage of this study found positively associated with facility delivery, even with limited awareness. More so, advocacy through social marketing to positively influence the latent effect and encourage contraception use or abstinence to avoid unwanted pregnancies.
Background Preterm births affect households’ incomes through direct and indirect expenditures associated with low productivity and the actual loss of employment in many cases. We studied the determinants of preterm birth in Uganda as one of the major contributors to neonatal morbidity and mortality, leading to households’ economic losses. Methods We used a cross-sectional research design based on the most recent Uganda Demographic Health Survey of 2016. The sample contained 1,537 women aged 15-49 years. The variable selection process was guided by categorization of the variables into; socio-demographic, reproductive history, and gestational birth characteristics. The study adopted two means of analysis. The logistic regression model to determine variables of preterm birth between 22 – 36 weeks and normal delivery period. Then the multinomial logistic regression model to determine how two preterm birth categories (22 – 32 weeks and 33 – 36 weeks) relate with the normal delivery period. Results Belonging to the poorest quintile (AOR2.09, 95% CI (1.69-2.57)) and attending antenatal care less than four times (AOR1.41, 95% CI (1.20-1.66)) had the highest odds ratios for the logistic regression model. Whereas the multinomial logistic regression model; for the 22-32 weeks category, belonging to the poorest quintile (RRR2.43, 95% CI(1.45-4.08)), attending antenatal care less than four times (RRR2.44, 95% CI (1.63-3.64)), had the highest relative risk ratios. For the 33-36 weeks category; belonging to a poorest quintile (RRR2.03, 95% CI (1.62-2.53)), having had less than four antenatal visits (RRR1.29, 95% CI (1.09-1.54)), and unwanted pregnancy (RRR1.22, 95% CI (1.03-1.45)), had the highest relative risk ratios. Conclusion Attending antenatal care for less than four times and belonging to the poorest quintile are common risk factors related to preterm birth. We therefore recommend that these receive utmost attention from the policy makers and implementers.
Introduction Birth weight has three possible outcomes that include normal birth weight (NBW) (2500 – 3999grams), low birth weight (less than 2500 grams), and macrosomia (at least 4000 grams and beyond). Low birth weight (LBW) and macrosomia are considered adverse outcomes of newborn health. The prevalence of LBW globally ranges from 7 – 17 %, whereas, that of macrosomia ranges from 4 – 16%. However, the information established in Uganda during the five years preceding the 2016 Uganda Demographic Health Survey (UDHS), only 67% of mothers had their weights taken at birth, indicating a 33% shortfall. Methods A cross-sectional research design was used on the basis of the dataset of the most recent UDHS of 2016. A sample of 4687 singleton births for which full information of birth weight was attained was used. The multinomial logistic regression model was fitted at both bivariate and multivariate levels with consideration for LBW, NBW, and macrosomia for which NBW was used as the base category. STATA 16 was used for data analysis. Results The results showed that premature birth delivery increases the risk of LBW (RRR 3.5, CI (2.029,5.886)); facility delivery reduces LBW (RRR0.58, CI (0.401, 0.850)). Adequate ANC attendance reduces the risk of LBW (RRR0.38, CI (0.182, 0.794)) and also reduces the risk of macrosomia (RRR0.6, CI (0.340, 1.052)). A male fetus increases the risk of macrosomia comparison category (RRR1.3, CI (1.223, 1.498)), primary education attainment reduces the relative risk of macrosomia (RRR0.8, CI (0.664,0.963)), secondary education increases the relative risk of macrosomia (RRR1.29, CI (1.022,1.634). Conclusion We recommend ANC attendance and facility delivery, given their positive effect on normal birth weight. ANC will guide the feeding habits of expectant mothers as well as ensure nutritional interventions, maternal and fetal assessment for detection of danger and establish the risky gender, implement any preventive measures, intervene in case of common physiological symptoms, and recommend the health system interventions to improve utilization of the available facilities.
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