Emmanuel E. Effa

University of Calabar | unical · Department of Internal Medicine

Objective: To identify and summarize the evidence about the extent of overuse of medications in low- and middle-income countries, its drivers, consequences and potential solutions. Methods: We conducted a scoping review by searching the databases PubMed®, Embase®, APA PsycINFO® and Global Index Medicus using a combination of MeSH terms and free...

Background Malaria is a major public health concern in The Gambia. There is limited data on the clinical manifestation and outcome of severe malaria in adult patients in The Gambia. The study therefore assessed the clinical manifestations and outcome of severe malaria in adult patients admitted at the Edward Francis Small Teaching Hospital. Method...

Probiotic-based multi-component preparations refer to a mixture of bioactive agents, containing probiotics or postbiotics as main functional ingredients, and prebiotics, protectants, stabilizers, encapsulating agents, and other compounds as additional constituents.

Objective To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. Design Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with...

Probiotics and related preparations, including synbiotics and postbiotics, are living and non-living microbial-based multi-components, which are now among the most popular bioactive agents. Such interests mainly arise from the wide range and numerous beneficial effects of their use for various hosts. The current minireview article attempts to provi...

Delivery of kidney care in Africa is significantly constrained by various factors. In this review, we used International Society of Nephrology–Global Kidney Health Atlas (ISN–GKHA) data for Africa to address sub-regional differences in care delivery in the continent with focus on infrastructure, workforce, and the economic aspects of kidney care. F...

Introduction Sepsis is a leading cause of morbidity and mortality worldwide. In low- to middle-income countries (LMICs) such as Nigeria, the disproportionately high mortality rate is linked to lack of awareness, poor recognition, and late implementation of sepsis care bundles among health workers. Training of health workers using digital platforms...

Background The burden of hepatitis B and hepatitis C virus (HBV, HCV) infection is exceptionally high in sub-Saharan Africa (SSA). Many countries in the SSA region are classified as hyperendemic for HBV by the World Health Organization (WHO), with West Africa being most affected. Data from the WHO suggest that Africans infected with hepatitis virus...

Sickle cell disorder (SCD) is a multisystem disease with heterogeneous phenotypes. Although all patients have the mutated hemoglobin (Hb) in the SS phenotype, the severity and frequency of complications are variable. When exposed to low oxygen tension, the Hb molecule becomes dense and forms tactoids, which lead to the peculiar sickled shapes of th...

Background Decisions on whether to screen for chronic kidney disease (CKD) or not remains contentious in nephrology. This study provides a global overview of early CKD identification efforts. Methods Guidelines for scoping reviews were followed and studies were identified by searching Medline, Embase, Cochrane Library, CINAHL, ISI Web of Science a...

The increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of worldwide urbanization, growth of megacities and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agricu...

Feasibility of personalized medical care for patients with sickle cell anaemia using a lab-on-chip microfluidic platform to mimic and unravel components of vaso-occlusive crisis. Abstract: Sickle cell disorder (SCD) is a multisystem disease with heterogeneous phenotypes. Although all patients have the mutated haemoglobin (Hb) in the SS phenotype, t...

The increasing global human population is projected to reach 9.7 billion people by 2050. This population growth is currently linked to the trends of worldwide urbanization, growth of megacities, and shifting dietary patterns. While humankind faces the daunting challenge of feeding and providing healthy lives for its teeming populations, urban agric...

Background: The Bacille Calmette-Guérin (BCG) vaccine, given as a single dose, offers variable protection against Tuberculosis (TB). It is plausible that repeat doses could improve the effectiveness of the BCG vaccine in settings where the population remain at risk of the disease. Objective: To assess the effectiveness of BCG revaccination as a bo...

Introduction Cochrane Africa ( https://africa.cochrane.org/ ) aims to increase Cochrane reviews addressing high priority questions in sub-Saharan Africa (SSA). Researchers residing in SSA, despite often drawing on Cochrane methods, training or resources, conduct and publish systematic reviews outside of Cochrane. Our objective was to investigate th...

Background: Health worker training is an essential component of epidemic control; rapid delivery of such training is possible in low-middle income countries with digital platforms. Methods: Based on prior experience with the Ebola outbreak, we developed and deployed a bespoke InStrat COVID-19 tutorial app, to deliver accurate and regularly updated...

Abstract Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specifc implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR a...

Urbanization, armed confict, and deforestation in African countries have increased the risk of zoonotic infections, which requires a One Health approach focused on the environment, animal health and human health. This approach facilitates the assessment of risks from the human-animal-environment interface. Only by fully implementing One Health appr...

Background: As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physi...

Background: Globally, one of the major problems facing health systems is an acute deficit of health workforce. To ensure equitable distribution and deployment of health workers, up-to-date and timely information on the health workforce is vital. Health workforce registries (HWRs) have the potential to generate data for evidence-based human resourc...

Background: Many low- and middle-income countries (LMICs) are facing a crisis of human resources for health (HRH) attributed to poor governance and leadership that characterizes the health sector in this setting. It is unclear which specific strategies are effective in ameliorating the crisis. Methods: Selected electronic databases were searched...

Mobile health (mhealth) tools delivered through wireless technology are emerging as effective strategies for delivering quality training, ensuring rapid clinical decision making, and monitoring implementation of simple and effective interventions in under-resourced settings. We share our early experience of developing and deploying the InStrat COVI...

Across Africa, there is some evidence of COVID-19 private sector activities to tackle COVID-19 which include the development of rapid diagnostic kits, deployment of e-health platforms for bespoke health workforce training, disease surveillance, reporting, auto-screening and advisories. Inequities in living and access to care by disadvantaged popula...

The practice of Nephrology in Nigeria dates back to the 1960s when the country gained independence from the UK. The University College Hospital (UCH) in Ibadan, as a college of the University of London, had the first recognised Nephrology unit. Several other units have been established over the years countrywide in federal, state and private instit...

Background As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physici...

Context: Access to chronic hemodialysis for patients with end-stage kidney disease has improved over the years. However, it is unclear if this has resulted in lower cost and improved dialysis vintage. Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end-stage kidney disea...

The coronavirus disease 2019 (COVID-19) is now a pandemic with devastating social and economic consequences. The extent of the spread of COVID-19 within populations is uncertain since diagnostic tests have not been carried out on all eligible persons and doing such diagnostic tests on everyone is much less feasible in developing countries such as N...

Rationale & Objective Recent studies in the human immunodeficiency virus (HIV)-infected population have suggested that there are genetic predispositions to the development of chronic kidney disease (CKD) in this context. We investigated the association of genetic polymorphisms of the genes encoding apolipoprotein L1 (APOL1), transforming growth fac...

Objectives The International Society of Nephrology (ISN) has called for zero deaths by 2025. This survey aimed to determine the preparedness of Southern African Development Community (SADC) countries and Nigeria to heed this call.SettingA questionnaire was emailed to facilities, where renal replacement therapy is available; to determine type of ser...

Priority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect...

Background: In 2011 the World Health Organization (WHO) recommended parenteral artesunate in preference to quinine as first-line treatment for people with severe malaria. Prior to this recommendation many countries, particularly in Africa, had begun to use artemether, an alternative artemisinin derivative. This Cochrane Review evaluates intramuscu...

Introduction: Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods:...

Background: The burden of the people living with human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) is largely borne by communities in Sub-Saharan Africa. The rate of kidney disease is increasing amongst HIV patients and occurs more often in patients with advanced stage of the disease with lower CD4 count...

Background: The Cochrane Africa Network (CAN) aims to conduct relevant reviews informing healthcare decisions in sub-Saharan Africa. In 2017 the Network’s Hubs engaged evidence users to conduct priority setting. From the topics identified, we scoped the literature identifying gaps for new review topics. Objectives: To describe CAN Hubs' methods f...

Background: To a large extent, Africa - especially sub-Saharan African countries - bears most of the global burden of both communicable and non-communicable diseases. Therefore, it is important to set priorities for systematic reviews of interventions for identified priority conditions, so that scarce and limited resources can be allocated where th...

Introduction The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalen...

PRISMA 2009 checklist. (DOCX)

Search strategy for Pubmed, web of science, EBSCO host and AJOL. (DOCX)

Assessment of methodological quality of included articles. (DOCX)

Forest plot showing the pooled prevalence of CKD in HIV populations for studies with at least two eGFR estimates using MDRD, CKD-EPI and CG equations. (TIF)

Scoring criteria for quality of studies. (DOCX)

Funnel plots for studies with two or more eGFR values. (TIF)

Summary statistics from meta-analyses of prevalence studies on CKD in people with HIV random effects model and arcsine transformations (subgroup analyses of gender, ARV status, CD4 count levels, Age groups, and co-morbid hypertension, diabetes mellitus, hepatitis B and C infection). (DOCX)

Forest plot showing pooled prevalence for studies with two or more MDRD-based eGFR estimates across the WHO regions. (TIF)

Cochrane Africa is a network of researchers and health stakeholders who aim to support the use of high quality Cochrane evidence to improve health outcomes in Africa. It comprises a coordinating centre in South Africa, a Francophone hub directed from Cameroon, a Southern and Eastern Africa Hub directed from South Africa and a West Africa Hub direct...

Widespread use of antiretroviral therapy (ART) in human immunodeficiency virus (HIV) patients has led to improved longevity with the attendant increase in noncommunicable disease prevalence including chronic kidney disease (CKD). This study documents the prevalence of CKD in a large HIV population in Southern Nigeria. This is a single center, 15-ye...

The International Diabetes Federation estimates that 1.6 million (1 in 53) Nigerian adults have diabetes mellitus while 60.7% (949,900) of Nigerian adults with diabetes are undiagnosed. In spite of these worrying projections, current nationwide data on diabetes prevalence to aid policy formulation in Nigeria is non-existent. This was a cross-sectio...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: This review aims to assess the benefits and harms of fenoldopam for the prevention or treatment of AKI in children and adults.

AIM: This paper examines the activities of mobile services units including ultrasound services in rural and urban communities in the Calabar region of South-South, Nigeria. MATERIALS AND METHODS: Consenting individuals were invited and attended five medical outreach activities in rural and urban areas of the Calabar region between January and June...

Background/Objective: Tigecycline belongs to the glycylcycline class of antibiotics with

Background: Acute interstitial nephritis (AIN) is a common cause of acute kidney injury that has not been adequately characterized in Sub-Saharan Africa (SSA) despite an increasing use of potentially inciting agents for the treatment of human immunodeficiency virus (HIV) and tuberculosis in the region. Methods: A retrospective audit of records o...

Background: Women and girls who have undergone type III female genital mutilation (FGM) may suffer urologic complications such as recurrent urinary tract infections, obstruction, stones, and incontinence. Objective: To assess the effectiveness of deinfibulation for preventing and treating urologic complications in women and girls living with FGM...

Background . Studies have indicated that diabetic tubulopathy may occur earlier than glomerulopathy, therefore providing a potential avenue for earlier diagnosis of diabetic nephropathy. Urinary beta-2-microglobulin ( β 2m) was investigated in this study as a potential biomarker in the detection of early nephropathy in type 2 diabetics. Methods . O...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To evaluate the effectiveness of these vaginal health interventions on; 1.Rates of HIV sero-conversion. 2. Incidence of vaginal infections namely bacterial vaginosis, trichomoniasis and vaginal candidiasis.

Chronic kidney disease is a major public health problem that continues to show an unrelenting global increase in prevalence. The prevalence of chronic kidney disease has been predicted to grow the fastest in low- to middle-income countries (LMICs). There is evidence that people living in LMICs have the highest need for renal replacement therapy (RR...

Background: A septic abortion refers to any abortion (spontaneous or induced) complicated by upper genital tract infection including endometritis or parametritis. The mainstay of treatment of septic abortion is antibiotic therapy alone or in combination with evacuation of retained products of conception. Regimens including broad-spectrum antibioti...

Introduction Tenofovir disoproxil fumarate (TDF)-containing regimens in the treatment of HIV-infected children have safety concerns with respect to renal and bone toxicity. Objective The aim of this study was to systematically review and critically appraise the literature relating to the reported renal and bone adverse effects of TDF-based regimens...