SUNScholar - Browsing by Author "Okwundu, Charles I."

Browsing by Author "Okwundu, Charles I."

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Brief school-based interventions and behavioural outcomes for substance-using adolescents
(Cochrane, 2016-01-20) Okwundu, Charles I.; Louw, Johann; Myers, Bronwyn J.; Carney, Tara
Background: Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use. Objectives: To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.
Citation classics in systematic reviews and meta-analyses : who wrote the top 100 most cited articles?
(Public Library of Science, 2013) Uthman, Olalekan A.; Okwundu, Charles I.; Young, Taryn; Wiysonge, Charles S.; Clarke, Aileen
Background Systematic reviews of the literature occupy the highest position in currently proposed hierarchies of evidence. The aims of this study were to assess whether citation classics exist in published systematic review and meta-analysis (SRM), examine the characteristics of the most frequently cited SRM articles, and evaluate the contribution of different world regions. Methods The 100 most cited SRM were identified in October 2012 using the Science Citation Index database of the Institute for Scientific Information. Data were extracted by one author. Spearman’s correlation was used to assess the association between years since publication, numbers of authors, article length, journal impact factor, and average citations per year. Results Among the 100 citation classics, published between 1977 and 2008, the most cited article received 7308 citations and the least-cited 675 citations. The average citations per year ranged from 27.8 to 401.6. First authors from the USA produced the highest number of citation classics (n=46), followed by the UK (n=28) and Canada (n=15). The 100 articles were published in 42 journals led by the Journal of the American Medical Association (n=18), followed by the British Medical Journal (n=14) and The Lancet (n=13). There was a statistically significant positive correlation between number of authors (Spearman’s rho=0.320, p=0.001), journal impact factor (rho=0.240, p=0.016) and average citations per year. There was a statistically significant negative correlation between average citations per year and year since publication (rho = -0.636, p=0.0001). The most cited papers identified seminal contributions and originators of landmark methodological aspects of SRM and reflect major advances in the management of and predisposing factors for chronic diseases. Conclusions Since the late 1970s, the USA, UK, and Canada have taken leadership in the production of citation classic papers. No first author from low or middle-income countries (LMIC) led one of the most cited 100 SRM.
Delivery arrangements for health systems in low-income countries : an overview of systematic reviews
(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Ciapponi, Agustin; Lewin, Simon; Herrera, Cristian A.; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S.; Bastias, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Marti, Sebastian Garcia; Glenton, Claire; Okwundu, Charles I.; Penaloza, Blanca; Suleman, Fatima; Oxman, Andrew D.
Background: Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. Objectives: To provide an overview of the available evidence from up‐to‐date systematic reviews about the effects of delivery arrangements for health systems in low‐income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. Methods: We searched Health Systems Evidence in November 2010 and PDQ‐Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well‐conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low‐income countries. Main results: We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate‐ or high‐certainty evidence and no moderate‐ or high‐certainty evidence of undesirable effects.
Factors that affect the uptake of community-based health insurance in low-income and middle-income countries : a systematic protocol
(BMJ Publishing Group, 2014) Adebayo, Esther F.; Ataguba, John E.; Uthman, Olalekan A.; Okwundu, Charles I.; Lamont, Kim T.; Wiysonge, Charles S.
ENGLISH SUMMARY : Introduction: Many people residing in low-income and middle-income countries (LMICs) are regularly exposed to catastrophic healthcare expenditure. It is therefore pertinent that LMICs should finance their health systems in ways that ensure that their citizens can use needed healthcare services and are protected from potential impoverishment arising from having to pay for services. Ways of financing health systems include government funding, health insurance schemes and out-of-pocket payment. A health insurance scheme refers to pooling of prepaid funds in a way that allows for risks to be shared. The health insurance scheme particularly suitable for the rural poor and the informal sector in LMICs is community-based health insurance (CBHI), that is, insurance schemes operated by organisations other than governments or private for-profit companies. We plan to search for and summarise currently available evidence on factors associated with the uptake of CBHI, as we are not aware of previous systematic reviews that have looked at this important topic. Methods: This is a protocol for a systematic review of the literature. We will include both quantitative and qualitative studies in this review. Eligible quantitative studies include intervention and observational studies. Qualitative studies to be included are focus group discussions, direct observations, interviews, case studies and ethnography. We will search EMBASE, PubMed, Scopus, ERIC, PsycInfo, Africa-Wide Information, Academic Search Premier, Business Source Premier, WHOLIS, CINAHL and the Cochrane Library for eligible studies available by 31 October 2013, regardless of publication status or language of publication. We will also check reference lists of included studies and proceedings of relevant conferences and contact researchers for eligible studies. Two authors will independently screen the search output, select studies and extract data, resolving discrepancies by consensus and discussion. Qualitative data will be extracted using standardised data extraction tools adapted from the Critical Appraisal Skills Program (CASP) qualitative appraisal checklist and put together in a thematic analysis where applicable. We will statistically pool data from quantitative studies in a meta-analysis; but if included quantitative studies differ significantly in study settings, design and/or outcome measures, we will present the findings in a narrative synthesis. This protocol has been registered with PROSPERO (ID=CRD42013006364). Dissemination: Recommendations will be made to health policy makers, managers and researchers in LMICs to help inform them on ways to strengthen and increase the uptake of CBHI.
Governance arrangements for health systems in low-income countries : an overview of systematic reviews
(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Herrera, Cristian A.; Lewin, Simon; Paulsen, Elizabeth; Ciapponi, Agustin; Opiyo, Newton; Pantoja, Tomas; Rada, Gabriel; Wiysonge, Charles S.; Bastias, Gabriel; Marti, Sebastian Garcia; Okwundu, Charles I.; Penaloza, Blanca; Oxman, Andrew D.
Background: Governance arrangements include changes in rules or processes that determine authority and accountability for health policies, organisations, commercial products and health professionals, as well as the involvement of stakeholders in decision‐making. Changes in governance arrangements can affect health and related goals in numerous ways, generally through changes in authority, accountability, openness, participation and coherence. A broad overview of the findings of systematic reviews can help policymakers, their technical support staff and other stakeholders to identify strategies for addressing problems and improving the governance of their health systems. Objectives: To provide an overview of the available evidence from up‐to‐date systematic reviews about the effects of governance arrangements for health systems in low‐income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on governance arrangements and informing refinements of the framework for governance arrangements outlined in the overview. Methods: We searched Health Systems Evidence in November 2010 and PDQ Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well‐conducted systematic reviews of studies that assessed the effects of governance arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use (health expenditures, healthcare provider costs, out‐of‐pocket payments, cost‐effectiveness), healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty, employment) and that were published after April 2005. We excluded reviews with limitations that were important enough to compromise the reliability of the findings of the review. Two overview authors independently screened reviews, extracted data and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence) and assessments of the relevance of findings to low‐income countries. Main results: We identified 7272 systematic reviews and included 21 of them in this overview (19 primary reviews and 2 supplementary reviews). We focus here on the results of the 19 primary reviews, one of which had important methodological limitations. The other 18 were reliable (with only minor limitations). We grouped the governance arrangements addressed in the reviews into five categories: authority and accountability for health policies (three reviews); authority and accountability for organisations (two reviews); authority and accountability for commercial products (three reviews); authority and accountability for health professionals (seven reviews); and stakeholder involvement (four reviews). Overall, we found desirable effects for the following interventions on at least one outcome, with moderate‐ or high‐certainty evidence and no moderate‐ or high‐certainty evidence of undesirable effects.
Interleukin-2 as an adjunct to antiretroviral therapy for HIV-positive adults
(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Onwumeh, Jennifer; Okwundu, Charles I.; Kredo, Tamara
Background: Human immunodeficiency virus (HIV) continues to be a leading cause of morbidity and mortality, particularly in sub‐Saharan Africa. Although antiretroviral drugs have helped to improve the quality of life and life expectancy of HIV‐positive individuals, there is still a need to explore other interventions that will help to further reduce the disease burden. One potential strategy is the use of interleukin‐2 (IL‐2) in combination with antiretroviral therapy (ART). IL‐2 is a cytokine that regulates the proliferation and differentiation of lymphocytes and may help to boost the immune system. Objectives: To assess the effects of interleukin‐2 (IL‐2) as an adjunct to antiretroviral therapy for HIV‐positive adults. Search methods: We searched the following sources up to 26 May 2016: the Cochrane Central Register of Controlled Trials (CENTRAL), published in the Cochrane Library; MEDLINE; Embase; the Web of Science; LILACS; the World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP); and ClinicalTrials.gov. We also checked conference abstracts, contacted experts and relevant organizations in the field, and checked the reference list of all studies identified by the above methods for any other potentially eligible studies. Selection criteria: Randomized controlled trials (RCTs) that evaluated the effects of IL‐2 as an adjunct to ART in reducing the morbidity and mortality in HIV‐positive adults. Data collection and analysis:Two review authors independently screened records and selected trials that met the inclusion criteria, extracted data, and assessed the risk of bias in the included trials. Where possible, we compared the effects of interventions using risk ratios (RR), and presented them with 95% confidence intervals (CI). We assessed the overall certainty of the evidence using the GRADE approach. Main results: Following a comprehensive literature search up to 26 May 2016, we identified 25 eligible trials. The interventions involved the use of IL‐2 in combination with ART compared with ART alone. There was no difference in mortality apparent between the IL‐2 group and the ART alone group (RR 0.97, 95% CI 0.80 to 1.17; 6 trials, 6565 participants, high certainty evidence). Seventeen of 21 trials reported an increase in the CD4 cell count with the use of IL‐2 compared to control using different measures (21 trials, 7600 participants). Overall, there was little or no difference in the proportion of participants with a viral load of less than 50 cells/mL or less than 500 cells/mL by the end of the trials (RR 0.97, 95% CI 0.81 to 1.15; 5 trials, 805 participants, high certainty evidence) and (RR 0.96, 95% CI 0.82 to 1.12; 4 trials, 5929 participants, high certainty evidence) respectively. Overall there may be little or no difference in the occurrence of opportunistic infections (RR 0.79, 95% CI 0.55 to 1.13; 7 trials, 6141 participants, low certainty evidence). There was probably an increase in grade 3 or 4 adverse events (RR 1.47, 95% CI 1.10 to 1.96; 6 trials, 6291 participants, moderate certainty evidence). None of the included trials reported adherence. Authors' conclusions: There is high certainty evidence that IL‐2 in combination with ART increases the CD4 cell count in HIV‐positive adults. However, IL‐2 does not confer any significant benefit in mortality, there is probably no difference in the incidence of opportunistic infections, and there is probably an increase in grade 3 or 4 adverse effects. Our findings do not support the use of IL‐2 as an adjunct to ART in HIV‐positive adults. Based on our findings, further trials are not justified.
Interventions for improving adults’ use of primary oral health care services
(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Harris, Rebecca; Raison, Heather; Christian, Bradley; Bakare, Lawal; Okwundu, Charles I.; Burnside, Girvan
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of interventions aimed at improving adults’ use of primary dental care services in order to improve their oral health and quality of life.
Male versus female condoms for contraception
(John Wiley & Sons, 2013-06-13) Motaze, Nkengafac V.; Okwundu, Charles I.; Temfack, Elvis; Mboudou, Emile
The main objective of this review is to compare the female condom to the male condom as a method of contraception.
Procalcitonin, C-reactive protein, and presepsin for the diagnosis of sepsis in adults and children
(John Wiley & Sons, Ltd. on behalf of The Cochrane Collaboration, 2017) Onyenekwu, Chinelo P.; Okwundu, Charles I.; Ochodo, Eleanor A.
This is a protocol for a Cochrane Review (Diagnostic test accuracy). The objectives are as follows: The objectives of this review are: - To assess the diagnostic accuracy of PCT, CRP and presepsin for sepsis in adults and children. - To investigate sources of heterogeneity in the estimates of diagnostic accuracy. - To compare the performance of the above tests.
Transcutaneous bilirubin screening for hyperbilirubinemia in African newborns
(Stellenbosch : Stellenbosch University, 2019-04) Okwundu, Charles I.; Wiysonge, Charles S.; Smith, Johan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Epidemiology and Biostatistics.
ENGLISH SUMMARY : Background: In many parts of the world, including African countries, apparently healthy newborns are usually discharged home early. Serum bilirubin levels usually peaks on postnatal days 3 to 5, by when many newborns have already been discharged home. Severe neonatal hyperbilirubinemia constitutes an important cause of neonatal mortality and morbidity in Africa. There is a need for ways of identifying newborns at risk of severe jaundice before hospital discharge especially in developing countries with poor health systems and inadequate follow-up procedures after discharge from hospital. Objectives: The objective of this combination of studies is to provide evidence for the use of transcutaneous bilirubin (TcB) screening in a population of indigenous African newborns. Methods: We summarized the available evidence on the accuracy and effectiveness of TcB screening in two Cochrane systematic reviews. In the first systematic review, we summarized the evidence on the effectiveness of TcB screening in newborns. The second review summarized the evidence on the accuracy of TcB measurement compared to total serum bilirubin (TsB) measurement. We also conducted research on the effects of TcB screening and on the accuracy of the TcB measurement in a population of South African newborns. Results: For our first systematic review, we did not identify any randomized controlled trial that assessed the effect of TcB screening on readmission for jaundice or on the incidence of severe hyperbilirubinemia in newborns. Findings from included observational studies from North America suggest that universal pre-discharge TcB screening in newborns reduces readmission for hyperbilirubinemia and also reduces the incidence of severe hyperbilirubinemia. We conducted a randomized controlled trial of TcB screening in an indigenous population of African newborns from South Africa. Findings from our trial confirmed that TcB screening reliably identified newborns at risk of severe hyperbilirubinemia and led to a 75% reduction in the readmission rate for hyperbilirubinemia and up to 73% decrease in the incidence of severe hyperbilirubinemia. However, the effect of TcB screening on kernicterus and bilirubin induced neurology dysfunction is not known. Findings from our second systematic review of accuracy of TcB measurement compared to TsB measurement in the laboratory, suggest a significant correlation coefficient of up to 0.98 between these two measurements. However, there are mixed findings from the included studies on the effect of various factors including: gestational age, race, postnatal age, TsB concentration, on the correlation. Also, there are limited studies in indigenous African newborns. Our cross-sectional study on the accuracy of the TcB measurement in a population of South African newborns showed a good correlation between TcB measurement and TsB measured in the laboratory. Conclusion: The TcB tool can be used to reliably estimate TsB in African newborns and can help identify newborns who need phototherapy before hospital discharge. We recommend that every newborn should be assessed for hyperbilirubinemia using objective means of measuring or estimating serum bilirubin measurement such as the TcB or TsB before discharge from hospital. This could go a long way in reducing hyperbilirubinemia related readmissions and incidence of severe hyperbilirubinemia. Pre-discharge TcB screening in newborns can therefore be used to identify newborns in need of phototherapy or those who are at risk of readmission for hyperbilirubinemia after discharge.
Zinc supplementation for the treatment of measles in children
(2015) Awotiwon, Ajibola; Oduwole, Olabisi; Sinha, Anju; Okwundu, Charles I.
Background: Measles is an important cause of childhoodmorbidity andmortality globally, despite increasing vaccine coverage. Zinc plays a significant role in the maintenance of normal immunological functions, therefore supplements given to zinc-deficient children will increase the availability of zinc and could reduce measles-related morbidity and mortality. This is an update of a review first published in 2015. Objectives: To assess the effects of zinc supplementation in reducing morbidity and mortality in children with measles.

Browsing by Author "Okwundu, Charles I."

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