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  • 1.
    Uthman, Muhammed Mubashir B.
    et al.
    Univ Ilorin, Fac Clin Sci, Dept Epidemiol & Community Hlth, Coll Hlth Sci, Ilorin, Nigeria.
    Uthman, Olalekan A.
    Univ Warwick, Warwick Med Sch, CAHRD, Warwick, England.
    Yahaya, Ismail
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Interventions for the prevention of mycobacterium avium complex in adults and children with HIV2013In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 4, p. Art. no. CD007191-Article, review/survey (Refereed)
    Abstract [en]

    Background Mycobacterium avium complex (MAC) infection is a common complication of advanced acquired immunodeficiency syndrome (AIDS) disease and is an independent predictor of mortality and shortened survival. Objectives To determine the effectiveness and safety of interventions aimed at preventing MAC infection in adults and children with HIV infection. Search methods We searched MEDLINE, EMBASE, and The Cochrane Library (search date December 2012). Selection criteria Randomised controlled trials comparing different strategies for preventing MAC infection in HIV-infected individuals. Data collection and analysis Two reviewers independently assessed trial eligibility and quality, and extracted data. Where data were incomplete or unclear, a third reviewer resolved conflicts and/or trial authors were contacted for further details. Development of MAC infection and survival were compared using risk ratios (RR) and 95% confidence intervals (CI). The quality of evidence has been assessed using the GRADE methodology. Main results Eight studies met the inclusion criteria. Placebo-controlled trials There was no statistically significant difference between clofazimine and no treatment groups in the number of patients that developed MAC infection (RR 1.01; 95% CI 0.37 to 2.80). Rifabutin (one study; RR 0.48; 95% CI 0.35 to 0.67), azithromycin (three studies; RR 0.37; 95% CI 0.19 to 0.74) and clarithromycin (one study; RR 0.35; 95% CI 0.21 to 0.58) were more effective than placebo in preventing the development of MAC infection. There was no statistically significant difference between those treated with clofazimine (one study; RR 0.98; 95% CI 0.41 to 2.32), rifabutin (one study RR 0.91; 95% CI 0.78 to 1.05), azithromycin (three studies, pooled RR 0.96; 95% CI 0.69 to 1.32) and placebo in number of reported deaths. One study found that the risk of death was reduced by 22% in patients treated with clarithromycin compared to those treated with placebo (RR 0.78; 95% CI 0.64 to 0.96). Monotherapy vs. monotherapy Patients treated with clarithromycin (RR 0.60; 95% CI 0.41 to 0.89) and azithromycin (RR 0.60; 95% CI 0.40 to 0.89) were 40% less likely to develop MAC infection than those treated with rifabutin. There was no statistically significant difference between those treated with clarithromycin (RR 0.98; 95% CI 0.83 to 1.15), azithromycin (RR 0.98; 95% CI 0.77 to 1.24) and rifabutin in the number of reported deaths Combination therapy versus monotherapy There was no statistically significant difference between patients treated with a combination of rifabutin and clarithromycin and those treated with clarithromycin alone (RR 0.74; 95% CI 0.46 to 1.20); and those treated with combination of rifabutin and azithromycin and those treated with azithromycin alone (RR 0.59; 95% CI 1.03). Patients treated with a combination of rifabutin plus clarithromycin were 56% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.44; 95% CI 0.29 to 0.69). Patients treated with a combination of rifabutin plus azithromycin were 65% less likely to develop MAC infection than those treated with rifabutin alone (RR 0.35; 95% CI 0.21 to 0.59). There was no statistically significant difference in the number of reported deaths in all the four different comparisons of prophylactic agents. Authors' conclusions Based on limited data, azithromycin or clarithromycin appeared to be a prophylactic agent of choice for MAC infection. Further studies are needed, especially direct comparison of clarithromycin and azithromycin. In additions, studies that will compare different doses and regimens are needed.

  • 2.
    Yahaya, Ismael
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. London Sch Hyg & Trop Med, London WC1, England.
    Uthman, O
    Univ Liverpool, Liverpool Sch Trop Med, Int Hlth Grp, Liverpool L3 5QA, Merseyside, England.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Inst, Dept Publ Hlth Fdn Sci, Div Social Med, Stockholm, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Inst, Dept Publ Hlth Fdn Sci, Div Social Med, Stockholm, Sweden.
    Social disorganization and history of child sexual abuse against girls in Sub-Saharan Africa: A multilevel analysis2013In: BMC International Health and Human Rights, ISSN 1472-698X, E-ISSN 1472-698X, Vol. 13, no 33Article in journal (Refereed)
    Abstract [en]

    Background

    Child sexual abuse (CSA) is a considerable public health problem. Less focus has been paid to the role of community level factors associated with CSA. The aim of this study was to examine the association between neighbourhood-level measures of social disorganization and child sexual abuse CSA.

    Methods

    We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351 adolescents from six countries in sub-Saharan Africa between 2006 and 2008.

    Results

    The percentage of adolescents that had experienced CSA ranged from 1.04% to 5.84%. There was a significant variation in the odds of reporting CSA across the communities, suggesting 18% of the variation in CSA could be attributed to community level factors. Respondents currently employed were more likely to have reported CSA than those who were unemployed (odds ratio [OR] = 2.05, 95% confidence interval [CI] 1.48 to 2.83). Respondents from communities with a high family disruption rate were 57% more likely to have reported CSA (OR=1.57, 95% CI 1.14 to 2.16).

    Conclusion

    We found that exposure to CSA was associated with high community level of family disruption, thus suggesting that neighbourhoods may indeed have significant important effects on exposure to CSA. Further studies are needed to explore pathways that connect the individual and neighbourhood levels, that is, means through which deleterious neighbourhood effects are transmitted to individuals.

  • 3.
    Yahaya, Ismail
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Childhood Sexual Abuse Against Girls in Sub-Saharan Africa: Individual and Contextual Risk Factors2014Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and objectives: Childhood sexual abuse (CSA) is a substantial public health and human rights problem, as well as a growing concern in sub-Saharan Africa (SSA). It has both short and long term effects on girls: physical and psychological, including negative sexual outcomes. Up to one-third of adolescent girls report their first sexual experience as being forced. Despite growing evidence supporting a link between contextual factors and violence, no studies have investigated the connection between CSA and contextual factors. It is therefore important to identify the extent of CSA and understand factors associated with it in SSA in order to develop interventions aimed to address the scale of the problem.

    Aim: The overall aim of this thesis is to assess the individual and contextual factors associated with CSA. In addition, the thesis aims to quantify the magnitude of CSA and describe the factors associated with CSA among women from SSA (Study I). This thesis also examines the independent contribution of individual and community socio-economic status on CSA (Study II). Moreover, it scrutinises the effect of social disorganisation on CSA (Study III) and explores the relationship between CSA and sexual risk behaviours as well as potential mediators (Study IV).

    Methods: This thesis used the Demographic and Health Survey (DHS) datasets conducted between 2006 and 2008 from six SSA countries. The thesis used multiple logistic regression models to describe and explore factors associated with CSA among 69,977 women (Study I).  It used multivariable multilevel logistic regression analysis to explore the effect of contextual level variables (neighbourhood socio-economic status) on CSA among 6,351 girls (Study II). Neighbourhood socio-economic status was operationalized with a principal component analysis using the proportion of respondents who were unemployed, illiterates, living below poverty level and rural residents. Study III applied multivariable multilevel logistic regression analysis on 6,351 girls and considered five measures of social disorganisation at the community level: neighbourhood poverty, female-headed households, residential mobility, place of residence, population density, and ethnic diversity. In study IV, 12,800 women from the Nigerian DHS were used. Structural equation modelling was applied using a two-step approach. The first step used a confirmatory factor analysis to develop an acceptable measurement model while the second step involved modifying the measurement model to represent the postulated causal model framework.

    Results: In study I, the reported prevalence of CSA ranged from 0.3% in Liberia to 4.3% in Zambia when the prevalence was based on all respondents aged between 15 and 49 years and who were present during the survey. None of the socio-economic factors were associated with CSA. In study II, where the data was restricted to permanent residents aged between 15 and 18 years, the prevalence ranged between 1.04% in Liberia to 5.8% in Zambia. At the individual level, there was no significant association between CSA and wealth status while at the community level, there was no significant association between CSA and socio-economic position. However, 22% of the variation in CSA was attributed to the community level factors. In study III, there was significant variation in the odds of reporting CSA across the communities, with community level factors accounting for 18% of the variation. In addition, respondents from communities with a high family disruption rate were 57% more likely to have reported sexual abuse in childhood. Study IV showed that there was a significant association between CSA and sexual risk behaviours and the association was mediated by alcohol and cigarette use.

    Conclusions: The study provides evidence that adolescents in the same community were subjected to common contextual influences. It also highlighted the significance of mediators in the relationship between CSA and sexual risk behaviours. It is therefore important that effective preventive strategies are developed and implemented that will cut across all socio-economic spheres in a context that both permits and encourages disclosure as well as identifying predisposing circumstances for recurrence.

  • 4.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    De Leon, Antonio Ponce
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    A comparative study of the socioeconomic factors associated with childhood sexual abuse in sub-Saharan Africa2012In: Pan African Medical Journal, ISSN 1937-8688, E-ISSN 1937-8688, Vol. 11, no 51, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background: Childhood sexual abuse (CSA) is a problem of considerable proportion in Africa where up to one-third of adolescent girls report their first sexual experience as being forced. The impact of child hood sexual abuse resonates in all areas of health. The aim of this study was to describe the prevalence of childhood sexual abuse and variations across socioeconomic status in six sub-Saharan countries. Methods: Datasets from Demographic and Health Surveys (DHS) in six sub-Saharan African countries conducted between 2003 and 2007 were used to access the relationship between CSA and socio economic status using multiple logistic regression models. Results: There was no association between CSA and education, wealth and area of settlement. However, there was contrasting association between CSA and working status of women. Conclusion: This study concurs with other western studies which indicate that CSA transcends across all socio economic group. It is therefore important that effective preventive strategies are developed and implemented that will cross across all socio-economic groups. © Ismail Yahaya et al.

  • 5.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Evidence-Based Global Health, Nigeria.
    Ponce de Leon, Antonio
    Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden..
    A. Uthman, Olalekan
    Warwick - Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, The University of Warwick, Coven try, CV4 7AL, United Kingdom.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institute, Sweden.
    Individual and community-level socioeconomic position and its association with adolescents experience of childhood sexual abuse: a multilevel analysis of sixcountries in Sub-Saharan Africa2013In: Journal of Injury and Violence Research, ISSN 2008-2053, E-ISSN 2008-4072, Vol. 6, no 1, p. 21-30Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Childhood sexual abuse (CSA) is a substantial global health and human rights problem and consequently a growing concern in sub-Saharan Africa. We examined the association between individual and community-level socioeconomic status (SES) and the likelihood of reporting CSA. METHODS: We applied multiple multilevel logistic regression analysis on Demographic and Health Survey data for 6,351female adolescents between the ages of 15 and 18 years from six countries in sub-Saharan Africa, between 2006 and 2008. RESULTS: About 70% of the reported cases of CSA were between 14 and 17 years. Zambia had the highest proportion of reported cases of CSA (5.8%). At the individual and community level, we found that there was no association between CSA and socioeconomic position. This study provides evidence that the likelihood of reporting CSA cut across all individual SES as well as all community socioeconomic strata. CONCLUSIONS: We found no evidence of socioeconomic differentials in adolescents’ experience of CSA, suggesting that adolescents from the six countries studied experienced CSA regardless of their individual- and community-level socioeconomic position. However, we found some evidence of geographical clustering, adolescents in the same community are subject to common contextual influences. Further studies are needed to explore possible effects of countries’ political, social, economic, legal, and cultural impact on Childhood sexual abuse.

  • 6.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Centre for Evidence-Based Global Health, Nigeria.
    Ponce de Leon, Antonio
    Karolinska Institutet, Stockholm, Sweden.
    Uthman, Olalekan
    Warwick Medical School, The University of Warwick, Coventry, UK.
    Soares, Joaquim
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Macassa, Gloria
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Childhood sexual abuse among girls and determinants of sexual risk behaviours in adultlife in sub-Saharan Africa2015In: Journal of Aggression, Conflict and Peace Research, ISSN 1759-6599, Vol. 7, no 2, p. 67-75Article in journal (Refereed)
    Abstract [en]

    Purpose – The purpose of this paper is to investigate the relationship between child sexual abuse and sexual risk behaviours as well as its potential mediators. Design/methodology/approach – This cross-sectional study used data from a cross-sectional study from 12,800 women between 15 and 49 years of age included in the 2008 Nigerian Demographic and Health Survey. Structural equation modelling (SEM) was applied to assess the association between childhood sexual abuse (CSA) and sexual risk behaviours. Findings – The authors found that CSA was directly associated with sexual risk behaviours. In addition, the association between CSA and sexual risk behaviour was also partially mediated by alcohol and cigarette use. Research limitations/implications – The results show that being abused in childhood is important for the subsequent development of sexual risk behaviours in adulthood and the association is mediated by alcohol and cigarette use. Practical implications – The results may be helpful for policy makers and health care planners in designing cultural sensitive public health intervention that will reduce the burden of CSA, its long-term effects (sexual risk behaviours) and intervening mediators that increase the risks. Social implications – These findings suggest that to reduce sexual risks, interventions to address sexual abuse needs to include other social problems (smoking, alcohol) that victims result to when faced with trauma. Originality/value – The current study is the only one so far in sub-Saharan Africa to have explored the relation between CSA and sexual risk behaviours using SEM.

  • 7.
    Yahaya, Ismail
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Uthman, Olalekan A.
    Save the Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
    Uthman, Muhammed Mubashir B.
    Save the Youth Initiative, PO Box 3951, Kaduna North, Kaduna, Nigeria.
    Interventions for HIV-associated nephropathy2013In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 1, p. Art. no. CD007183-Article, review/survey (Refereed)
    Abstract [en]

    Background Human immunodeficiency virus-associated nephropathy (HIVAN) is the most common cause of end stage kidney disease (ESKD) in human immunodeficiency virus-1 (HIV-1) serotype patients and it mostly affects patients of African descent. It rapidly progresses to ESKD if untreated. The goal of treatment is directed toward reducing HIV-1 replication and/or slowing the progression of chronic kidney disease. The following pharmacological agents have been used for the treatment of HIVAN: antiretroviral therapy, angiotensin-converting enzyme inhibitors (ACEi), steroids and recently cyclosporin. Despite this, the effect of each intervention is yet to be evaluated. Objectives To evaluate the benefits and harms of adjunctive therapies in the management of HIVAN and its effects on symptom severity and all-cause mortality. Search methods In January 2012 we searched the Cochrane Renal Group's Specialised Register, AIDS Education Global Information System (AEGIS database), ClinicalTrial.gov, the WHO International Clinical Trials Registry Portal, and reference lists of retrieved articles without language restrictions. In our original review we searched CENTRAL, MEDLINE, EMBASE, and AIDSearch, in addition to contacting individual researchers, research organisations and pharmaceutical companies. Selection criteria Randomised controlled trials (RCTs) and quasi-RCTs of any therapy used in the treatment of HIVAN. Data collection and analysis We independently screened the search outputs for relevant studies and to retrieve full articles when necessary. For dichotomous outcomes results were to be expressed as risk ratios with 95% confidence intervals, and for continuous scales of measurement the mean difference was to be used. Main results We identified four relevant ongoing studies: one is still ongoing; two have completed recruitment but are yet to be published; and the fourth study was suspended for unspecified reasons. No completed RCTs or quasi-RCTs were identified. We summarised and tabulated the data from the observational studies, however no formal analyses were performed. Authors' conclusions There is currently no RCT-based evidence upon which to base guidelines for the treatment of HIVAN, however three ongoing studies have been identified. Data from observational studies suggest steroids and angiotensin-converting enzyme inhibitors appear to improve kidney function in patients with HIVAN, however no formal analyses were performed in this review. This review highlights the need for good quality RCTs to address the effects of interventions for treating this group.

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