2015, Issue 12
No publications in this issue
2015, Issue 11
No publications in this issue
2015, Issue 10
One updated review is available in Issue 10, 2015 of the Cochrane Database of Systematic Reviews
- Interventions to improve water quality for preventing diarrhoea (Clasen TF, Alexander KT, Sinclair D, Boisson S, Peletz R, Chang HH, Majorin F, Cairncross S).
Thomas Clasen and his team have updated this review, which now includes 55 studies enrolling over 84,000 participants. Source-based water quality improvement include providing protected groundwater (springs, wells, and bore holes), or harvested rainwater, as an alternative to surface sources (rivers and lakes). Alternatively water may be treated at the point-of-use in people's homes by boiling, chlorination, flocculation, filtration, or solar disinfection. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies), with unimproved water sources (30 studies), and unimproved or unclear sanitation (34 studies). There is not enough evidence to know if source-based improvements in water supplies, such as protected wells and communal tap stands or treatment of communal supplies, consistently reduce diarrhoea in low-income settings; there are no trials evaluating reliable piped-in water supplies to people's homes. Distributing disinfection products for use in the home may reduce diarrhoea cases by one quarter to one third, depending on the product used; water filtration at home probably reduces diarrhoea by around a half. Distributing plastic bottles with instructions to leave filled bottles in direct sunlight for at least six hours before drinking probably reduces diarrhoea by around a third. Evidence also suggests that the more people use the various interventions for improving water quality, the larger the effects, so it is important to assess programmatic approaches to optimize coverage and long-term utilization of interventions to improve water quality.
2015, Issue 9
Two updated reviews are available in Issue 9, 2015 of the Cochrane Database of Systematic Reviews
- Incentives and enablers to improve adherence in tuberculosis (Lutge EE, Wiysonge CS, Knight SE, Sinclair D, Volmink J)
The latest update of this review has a slightly modified title and a larger authors’ team, led by Elizabeth Lutge. Interventions included any form of material incentive to return for TB test results, or adhere to, or complete anti-TB treatment. These may have been direct such as cash or vouchers for groceries, or indirect such as the provision of a service for which the patient would have had to pay, such as transport to and from the clinic. The review includes 12 trials: 10 from the USA (one in adolescents, 4 in injection drug or cocaine users, 3 in homeless adults, and 2 in prisoners). The remaining two trials, in general adult populations, were conducted in Timor-Leste and South Africa. Two trials assessed the effect of incentives on long-term adherence and completion of treatment for active TB, and did not demonstrate a clear benefit. Three trials assessed the effects of material incentives and enablers on completion of TB prophylaxis, with mixed results; however, in specific populations, such as recently released prisoners, drug users, and the homeless, trials show that material incentives probably do improve one-off clinic re-attendance for initiation or continuation of anti-TB prophylaxis. When comparing different types of incentives, an immediate cash incentive seemed more effective than delaying the incentive until completion of treatment; cash incentives appeared more effective than non-cash incentives; and higher cash incentives were more effective than lower cash incentives.
- Hand washing promotion for preventing diarrhoea (Ejemot-Nwadiaro R, Ehiri JE, Arikpo D, Meremikwu M M, Critchley JA)
This review, prepared by Regina Ejemot-Nwadiaro and colleagues, has replaced the original publication in 2008, with a new title that introduces the concept of promotion. This includes group or individual training on hygiene education, germ-health awareness, use of posters, leaflets, comic books, songs, and drama. The review includes 22 randomized controlled trials conducted in both high-income countries (HICs) and low- and middle-income countries (LMICs), enrolling 69,309 children and 148 adults. Hand washing promotion at child day-care facilities or schools in HICs prevents around 30% of diarrhoea episodes, and may prevent a similar proportion in schools in low and middle income countries (LMICs). Among communities in LMICs, hand washing promotion prevents around 28% of diarrhoea episodes. In the only hospital-based trial included in this review, hand washing promotion also had important reduction in the mean episodes of diarrhoea; the trial however had only few participants. None of the included trials assessed the effect of handwashing promotion on diarrhoeal-related deaths, all-cause under-five mortality, or the cost-effectiveness of hand washing promotions. Also, not much is known about how to help people maintain hand washing habits in the longer term.
2015, Issue 8
One new review and one new protocol are available in Issue 8, 2015 of the Cochrane Database of Systematic Reviews
- Vector and Reservoir control for preventing leishmaniasis (González U, Pinart M, Sinclair D, Firooz A, Enk C, Vélez ID, Esterhuizen TM, Tristan M, Alvar J)
Leishmaniasis is a tropical disease that potentially affects 350 million, often impoverished, people, across 98 countries. The disease is caused by Leishmania parasites, and has two distinct clinical syndromes: cutaneous leishmaniasis (CL), which affects the skin and mucous membranes, and visceral leishmaniasis (VL), which affects internal organs. Leishmaniasis could be prevented by reducing human contact with infected phlebotomine sandflies (the vector), or by reducing the number of infected animals (the reservoir). In this new Cochrane Review, Urbà González and his colleagues have analysed 14 trials of vector and reservoir control interventions, which were undertaken in different settings; most included trials were of low methodological quality. Using insecticides appeared to reduce CL incidence, but there is not enough evidence to know whether it is better to use insecticides to spray the internal walls of houses, or use insecticide-treated bednets, bedsheets, or curtains. Personal protection using insecticide-treated clothing was also evaluated in two trials in soldiers, but the trials were too small to know whether or not this was effective. For VL, insecticide-treated nets may not be effective at preventing disease, but this was only tested in a single trial from India and Nepal.
- Antimalarial drug combinations for treating uncomplicated malaria in pregnancy (Tagbor H, Mahama RP, Antwi G)
2015, Issue 7
One updated review is available in Issue 7, 2015 of the Cochrane Database of Systematic Reviews
- Deworming drugs for soil-transmitted intestinal worms in children: effects on nutritional indicators, haemoglobin and school performance (Taylor-Robinson DC, Maayan N, Soares-Weiser K, Donegan S, Garner P)
The World Health Organization (WHO) recommends treating all school children at regular intervals with deworming drugs in areas where helminth infection is common, with the assumption that this treatment will improve nutritional status, haemoglobin and cognition and consequently children’s health, intellect and school attendance. There is also a considerable investment in delivering this intervention and it is imperative to critically evaluate the evidence on its benefits. David Taylor-Robinson and colleagues have added 4 new studies to their 2012 edition of the review, for a total of 45 trials. One trial evaluating mortality included over one million children, and the remaining 44 trials included a total of 67,672 participants. In trials that treat only children known to be infected, deworming drugs may increase weight gain but we do not know if there is an effect on cognitive functioning or physical well-being. Deworming had little or no effect on average weight gain, haemoglobin, or cognition in trials treating all children living in an endemic area. There is good evidence that regular treatment probably has no effect on average height, formal tests of cognition, or exam performance, and do not know if there is an effect on school attendance. The authors conclude that large scale programmes to deworm all school children in low income countries do not lead to the acclaimed educational and economic benefits, and call for policy makers to look again at the evidence in a systematic way, in order to re-think current WHO recommendations.
2015, Issue 5
One updated review is available in Issue 5, 2015 of the Cochrane Database of Systematic Reviews
- Directly observed therapy for treating tuberculosis (Karumbi J, Garner P)
Jamlick Karumbi has replaced Jimmy Volmink as an author, together with Paul Garner, in the update of this review, last published in 2007. Directly Observed Therapy (DOT) is a specific strategy, endorsed by the World Health Organization, to improve adherence to anti-tuberculosis treatment, by requiring health workers, community volunteers or family members to observe and record patients taking each dose. This review includes 11 trials with 5662 participants comparing DOT with routine self-administration of treatment or prophylaxis in a variety of settings (clinic, the patient's home or the home of a community volunteer). Overall, cure and treatment completion in both self-treatment and DOT groups was low, and DOT did not substantially improve this. There were no differences when DOT was conducted at home or at the clinic, or by a community health worker or family member; also, DOT had little or no effect on treatment completion in injection drug users. The authors conclude that DOT does not provide a solution to poor adherence in TB treatment, and given the large resource and cost involved, policy makers might want to reconsider TB control strategies that depend on direct observation.
2015, Issue 4
Two new protocols and one new review are available in Issue 4, 2015 of the Cochrane Database of Systematic Reviews
- Tafenoquine for preventing relapse in people with Plasmodium vivax malaria (Rajapakse S, Rodrigo C, Fernando SD)
Tafenoquine is an 8-aminoquinoline and a synthetic analogue of primaquine, which is the only licensed drug capable of eliminating the Plasmodium vivax hypnozoites. Tafenoquine has been tested as an alternative to primaquine as it has potential to be useful in regimens for prophylaxis and radical cure of P. vivax malaria. Tafenoquine has shorter duration of therapy and this makes it an attractive option to improve adherence. A Sri Lankan author team led by Senaka Rajapakse, identified three RCTs conducted in Thailand, India, Peru and Brazil on adults with confirmed P. vivax malaria that randomized 453 participants, for inclusion in the review. All participants received chloroquine (to clear the parasites in the blood) and some groups received either tafenoquine, primaquine or no further treatment. All trials tested people for G6PD enzyme, and excluded patients who were deficient, as both primaquine and tafenoquine can cause haemolysis in these individuals. Patients receiving tafenoquine at doses greater than 300 mg had fewer relapses than adults who had no further treatment, and tafenoquine 600 mg may be better in relapse prevention than standard primaquine doses. The drug is still untested in pregnancy, children and in G6PD-deficient people.
- Mosquito repellents for malaria prevention (Maia MF, Kliner M, Richardson M, Lengeler C, Moore SJ)
- Interventions to control flies for preventing diarrhoea in children under five years of age (Das JK, Salam RA, Hoda M, Lassi ZS, Bhutta ZA)
2015, Issue 3
One new review is available in Issue 3, 2015 of the Cochrane Database of Systematic Reviews
- Circulating antigen tests and urine reagent strips for diagnosis of active schistosomiasis in endemic areas (Ochodo EA, Gopalakrishna G, Spek B, Reitsma JB, van Lieshout L, Polman K, Lamberton P, Bossuyt PMM, Leeflang MMG)
This new review prepared by Eleanor Ochodo and her team evaluates point-of-care (POC) tests for diagnosing schistosomiasis. POC tests include assays based on circulating antigen detection and urine reagent strip tests, which are quick and easier to use in the field, and, if they show sufficient diagnostic accuracy, they could replace conventional microscopy. This review evaluated urine reagent strip tests to detect active Schistosoma haematobium infection, with microscopy as the reference standard; and circulating antigen tests for detecting active Schistosoma infection in geographical regions endemic for Schistosoma mansoni or S. haematobium or both, with microscopy as the reference standard. 90 studies involving almost 200,000 people were included (88 from field settings in Africa). For detecting urinary schistosomiasis, urine strips for detecting blood were better than those detecting protein or white cells, and the parasite antigen test performance was worse than urine strips for detecting blood. For intestinal schistosomiasis, the circulating parasite antigen urine test detected many infections identified by microscopy, but wrongly labelled many uninfected people as positive. Studies were in general poorly reported.
2015, Issue 2
One new review, one updated review and two new protocols are available in Issue 2, 2015 of the Cochrane Database of Systematic Reviews
- Artemisinin-naphthoquine for treating uncomplicated Plasmodium falciparum malaria (Isba R, Zani B, Gathu M, Sinclair D)
The World Health Organization (WHO) recommends artemisinin-based combination therapy (ACT) for treating people with Plasmodium falciparum malaria. Five combinations are currently recommended, all administered over three days. Artemisinin-naphthoquine is a new combination developed in China, which is being marketed as a one-day treatment. This review prepared by Rachel Isba and colleagues compares the efficacy and safety of artemisinin-naphtoquine against established WHO-recommended ACTs regimes (3 days) , in adults and children suffering from P.falciparum malaria. Only 4 trials, all of low quality, enrolling 740 adults and children, met the inclusion criteria: 3 small trials compared artemisinin-naphthoquine to artemether-lumefantrine and one small trial compared it to dihydroartemisinin-piperaquine. Artemisinin-naphthoquine showed very low treatment failure in all trials; this is a promising result but it needs to be confirmed by larger multi-setting trials.
- Primaquine or other 8-aminoquinoline for reducing Plasmodium falciparum transmission (Graves PM, Gelband H, Garner P)
This review by Patricia Graves, Helen Gelband and Paul Garner has been updated with a new search but no added trials and no change to conclusions. Primaquine (PQ)is an antimalarial drug which does not cure malaria illness, but is known to kill the gametocyte stage of the malaria parasite which infects mosquitoes when they bite humans. The World Health Organization (WHO) in 2010 recommended adding a single dose of PQ to malaria treatment in order to reduce malaria transmission and to contribute to malaria elimination; in 2013 the recommended dose of PQ was reduced to 0.25 mg/kg due to concerns about safety, especially in people with G6PD deficiency. The review includes 17 RCT and one quasi-RCT and aims to assess whether PQ, or an alternative 8AQ, alongside treatment for P. falciparum malaria reduces malaria transmission, and to estimate the frequency of severe or haematological adverse events. The authors conclude that in individual patients, PQ added to malaria treatments reduces gametocyte prevalence when given in doses greater than 0.4 mg/kg. Two small studies reported a strong reduction in infectiousness, but no trials assessed whether this policy has an impact on community malaria transmission. Overall the safety of PQ given as a single dose was poorly evaluated across all studies.
- Intermittent preventive treatment for malaria in infants (Okafo O, Esu E, Oringanje C, Meremikwu MM)
- Smectite for acute infectious diarrhoea in children (Pérez-Gaxiola G, Cuello-García CA, Pérez-Pico V)
2015, Issue 1
One new review and one new protocol are available in Issue 1, 2015 of the Cochrane Database of Systematic Reviews
- Intermittent preventive antimalarial treatment for children with anaemia (Athuman M, Kabanywanyi AM, Rohwer AC)
Anaemia is a global problem, particularly in in children under five years in Africa and South-East Asia. Malaria is a common cause of anemia in these areas, and administering intermittent preventive antimalarial treatment (IPT) to children might reduce anaemia, as well as protect from new malaria infections, allow faster recovery from the illness, and help make the children less likely to succumb to other infections. Mwaka Athuman and her co-authors in this new review have included six randomised controlled trials which included 3847 participants; three trials were conducted in areas of low malaria endemicity and three in areas of high endemicity. In some trials, iron supplements were also given to children. In all trials there was a group that received IPT and a control group that were given a placebo. Although there were small benefits in haemoglobin levels when treating anaemic children with IPT, there was no effect on death or hospital admissions, irrespective of whether they received iron supplements. However, three of the six included trials were conducted in low endemicity areas where malaria transmission is low and thus any protective effect is likely to be modest.
- Mefloquine for preventing malaria in pregnant women (R González, Ragna S Boerma, ,David Sinclair, John J Aponte, Feiko O ter Kuile, Clara Menéndez)