Background and Aims Immunosuppressant non-adherence is a leading cause of preventable renal allograft dysfunction, rejection and graft loss. The barriers to immunosuppressant adherence as well as associated risk factors of non-adherence vary across studies in different locations. This study aimed to investigate the prevalence of immunosuppressant non-adherence among adult kidney transplant recipients and identify barriers to adherence in a renal transplant cohort. Method A cross sectional survey was conducted using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS), the Immunosuppressant Therapy Barrier Scale and the Beliefs about Medicines Questionnaire. Adherence was defined according to the BAASIS, with barriers to adherence and beliefs about medicines compared between the two groups. Participants were recruited from the out-patient clinic at Zenith Medical and Kidney centre. An advert for the study was placed in consultation rooms and patients were approached to join the study when they attend appointments. IBM SPSS Statistics for Windows, Version 23 (Armonk, NY: IBM Corp) was used for data analysis. Results The rate of non-adherence was 50.7% out of 67 kidney transplant recipients attending outpatient clinic. There were statistically significant associations between non-adherence and occupation (P = 0.049). Participants who are on MMF were more adherent than those on sirolimus (97.0% vs 79.4% and 0.0% vs 8.8%) and this difference is statistically significant (P = .038). Also, participants who have had one or more post-transplant hospital admission are more non-adherent when compared with those that have never been admitted (P = .022) The only significant barrier to adherence was when patients travelled out of town (P < 0.005). Adherence was not associated with patients’ belief about their medicines. Conclusion Interventions aimed at ensuring constant access to immunosuppressant drugs and those based on habit forming may significantly improve adherence in this cohort.

Background: Soil-transmitted helminths (STHs) are among the most common human infections worldwide and a major cause of morbidity. They are caused by different species of parasitic worms and transmitted by eggs released in faeces. The main control strategy in endemic regions is periodic treatment with deworming medication. In the last 10 years, there has been a scale-up of prevention and control activities with a focus on community-based interventions (CBIs). This review aims to systematically analyse the impact of CBIs on the prevalence and infection of STH infection in sub-Saharan Africa. A systematic review was published on this topic in 2014, but there have subsequently been several new studies published which are included in this updated review.Method: Electronic database search of MEDLINE (Ovid), Global Health Online (Ovid), Cochrane Library, Embase (Ovid) and Web of Science was conducted. Titles, abstracts, and full texts were screened by two independent reviewers according to predefined eligibility criteria. Data were extracted and a meta-analysis of included studies was conducted.Results: A total of 2329 de-duplicated titles were screened, and 18 studies were included in the review. 13 focussed on community-wide treatment while seven studies investigated school-based interventions, and two studies investigating both. Results suggest that CBIs are effective in reducing the prevalence of Hookworm (Relative risk [RR]: 0.24, 95% CI: 0.17, 0.33, 0.29), Trichuris trichiura (RR: 0.72, 95% CI: 0.57, 0.93) and Ascaris lumbricoides (RR: 0.68, 95% CI 0.54, 0.86). School-based treatment and community-wide treatment, as well as annual and semi-annual deworming, all reduce STH prevalence significantly.Conclusions: Results suggest that CBIs are effective in reducing the prevalence and intensity of STH infections. While most studies delivered preventive chemotherapy (PC), few studies explored the impact of interventions such as water, sanitation, and hygiene (WASH) or health education, which may be essential in preventing reinfection after PC.

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Background: Schistosomiasis is a major cause of morbidity in sub-Saharan Africa where almost 90% of cases are found. In the last decade, prevention and control activities have scaled up, with a focus on interventions delivered in community settings. The aim of this review is to assess the impact of community-based interventions (CBIs) on the prevalence and infection intensity of schistosomiasis in sub-Saharan Africa. A systematic review was published on this topic in 2014, but there have subsequently been several new studies published which are included in this updated review. Method: Five electronic databases were searched for studies relating to schistosomiasis and CBIs published since 2013 to update the previous review published in 2014. Titles, abstracts, and full texts were screened according to predefined eligibility criteria by two independent reviewers. Data were extracted in duplicate and a meta-analysis of included studies was conducted.Results: A total of 2329 de-duplicated titles were screened by two independent reviewers, and 17 studies were included in the review, 14 of which are included in the meta-analysis. Findings from the meta-analysis suggest that CBIs reduce the prevalence of Schistosoma mansoni by 46% (RR: 0.54, 95% CI [0.44, 0.67]) and S. haematobium by 56% (RR: 0.44, 95% CI [0.25, 0.77]). Both school-based and community-wide treatment are effective platforms for achieving reductions in prevalence. Only three studies reported growth outcomes or anaemia and found mixed effects.Conclusions: Most interventions included in this review delivered drug treatment, and results suggest that these are effective in reducing prevalence. While drug treatment can have immediate beneficial health effects, reinfection is likely to continue if unsafe water contact continues. Therefore, interventions that both prevent infection and reduce prevalence and intensity of infection are required.