SUNScholar - Browsing by Author "Schoonees, Anel"

Browsing by Author "Schoonees, Anel"

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Antiviral efficacy and safety of abacavir-containing combination antiretroviral therapy as first-line treatment of HIV-infected children and adolescents : a systematic review protocol
(BioMed Central, 2014-08) Adetokunboh, Olatunji O.; Schoonees, Anel; Wiysonge, Charles S.
Abstract Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy of abacavir might be low when compared to other NRTIs especially among children. There are also concerns that abacavir use may lead to serious adverse events such as hypersensitivity reactions and has potential predisposition to developing cardiovascular diseases. Methods: We plan to do a systematic review to evaluate the antiviral efficacy and safety of abacavir-containing combination antiretroviral therapy as first-line treatment of HIV-infected children aged between 3 months and 18 years, compared with other NRTIs. We will search Scopus, Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science databases for eligible studies regardless of language or publication status. We will check the reference lists of included studies, search relevant conference proceedings, email the authors of included studies and also look for unpublished and ongoing trials in prospective clinical trial registries. Two authors will independently screen search outputs, select studies, extract data and assess the risk of bias in included studies. All disagreements will be resolved by discussion and consensus. Where data allow, we will conduct meta-analysis for similar types of participants, study designs, interventions, and outcome measures. If the results are statistically homogeneous, we will use the fixed-effect model; otherwise, we will use the random-effects model and explore the reasons for heterogeneity using subgroup analyses. Heterogeneity will be assessed with the Chi-squared test and quantified with the I-squared statistic. Discussion: The findings will be useful to policy makers and programme managers to inform treatment and management of HIV in children and adolescents and to point out research gaps for future research. Trial registration: This review is registered with PROSPERO, registration number CRD42014009157.
Community-level interventions for improving access to food in low- and middle-income countries
(Cochrane, 2015-02-02) Schoonees, Anel; Durao, Solange; Ramokolo, Vundli; Oliveira, Julicristie Machado De; Kristjansson, Elizabeth
This is the protocol for a review and there is no abstract. The objectives are as follows: Primary objective : To determine the effects of community-level interventions that aim to improve access to nutritious food in LMICs, for both the whole community and for disadvantaged or at-risk individuals or groups within a community, such as infants and children, women, the elderly, the poor, the unemployed, or minority groups. Secondary objectives : To determine the features of community-level interventions that enable or impede the effective implementation of these interventions to improve access to food. To identify unintended consequences of interventions to improve access to food.
Efficacy and safety of abacavir-containing combination antiretroviral therapy as first-line treatment of HIV infected children and adolescents : a systematic review and meta-analysis
(BioMed Central, 2015-10) Adetokunboh, Olatunji O.; Schoonees, Anel; Balogun, Tolulope A.; Wiysonge, Charles S.
Background: Abacavir is one of the recommended nucleoside reverse transcriptase inhibitors (NRTIs) for the treatment of HIV infections among children and adolescents. However, there are concerns that the antiviral efficacy of abacavir might be low when compared to other NRTIs especially among children. There are also concerns that abacavir use may lead to serious adverse events such as hypersensitivity reactions and has potential predisposition to developing cardiovascular diseases Methods: We searched four electronic databases, four conference proceedings and two clinical trial registries in August 2014, without language restrictions. Experimental and observational studies with control groups that examined the efficacy and safety of abacavir-containing regimens in comparison with other NRTIs as first-line treatment for HIV-infected children and adolescents aged between one month and eighteen years were eligible. Two authors independently screened search results, extracted data and assessed the risk of bias of included studies using a pre-specified, standardised data extraction form and validated risk of bias tools. We also assessed the quality of evidence per outcome with the GRADE tool. Results: We included two randomised controlled trials (RCTs) and two analytical cohort studies with a total of 10,595 participants. Among the RCTs we detected no difference in virologic suppression after a mean duration of 48 weeks between abacavir- and stavudine-containing regimens (2 trials; n = 326: RR 1.28; 95 % CI 0.67–2.42) with significant heterogeneity (P = 0.02; I2 = 81 %). We also found no significant differences between the two groups for adverse events and death. After five years of follow-up, virologic suppression improved with abacavir (1 trial; n = 69: RR 1.96; 95 % CI 1.11–3.44). For cohort studies, we detected that the virologic suppression activity of abacavir was less effective than stavudine in both the lopinavir/ritonavir (1 study, n= 2165: RR 0.79, 95 % CI 0.67–0.92) and efavirenz sub-groups (1 study, n = 3204: RR 0.79, 95 % CI 0.67–0.92) respectively. The quality of evidence from RCTs was moderate for virologic suppression but low for death and adverse events, while that of cohort studies was low for all three these outcomes. Conclusions: Available evidence showed little or no difference between abacavir-containing regimen and other NRTIs regarding efficacy and safety when given to children and adolescents as a first-line antiretroviral therapy.
Evaluating evidence-based health care teaching and learning in the undergraduate human nutrition; occupational therapy; physiotherapy; and speech, language and hearing therapy programs at a sub-Saharan African academic institution
(Public Library of Science, 2017-02-16) Schoonees, Anel; Rohwer, A.; Young, Taryn; Interdisciplinary Health Sciences: Centre for Evidence-Based Health Care
Background: It is important that all undergraduate healthcare students are equipped with evidence-based health care (EBHC) knowledge and skills to encourage evidence-informed decision-making after graduation. We assessed EBHC teaching and learning in undergraduate human nutrition (HN); occupational therapy (OT); physiotherapy (PT); and speech, language and hearing therapy (SPLH) programs at a sub-Saharan African university. Methods: We used methodological triangulation to obtain a comprehensive understanding of EBHC teaching and learning: (1) through a document review of module guides, we identified learning outcomes related to pre-specified EBHC competencies; we conducted (2) focus group discussions and interviews of lecturers to obtain their perspectives on EBHC and on EBHC teaching and learning; and we (3) invited final year students (2013) and 2012 graduates to complete an online survey on EBHC attitudes, self-perceived EBHC competence, and their experience of EBHC teaching and learning. Results: We reviewed all module outlines (n = 89) from HN, PT and SLHT. The OT curriculum was being revised at that time and could not be included. Six lecturers each from HN and OT, and five lecturers each from PT and SLHT participated in the focus groups. Thirty percent (53/176) of invited students responded to the survey. EBHC competencies were addressed to varying degrees in the four programs, although EBHC teaching and learning mostly occurred implicitly. Learning outcomes referring to EBHC focused on enabling competencies (e.g., critical thinking, biostatistics, epidemiology) and were concentrated in theoretical modules. Key competencies (e.g., asking questions, searching databases, critical appraisal) were rarely addressed explicitly. Students felt that EBHC learning should be integrated throughout the four year study period to allow for repetition, consolidation and application of knowledge and skills. Lecturers highlighted several challenges to teaching and practising EBHC, including lack of evidence relevant to the African context and lack of time within curricula.
Low carbohydrate versus isoenergetic balanced diets for reducing weight and cardiovascular risk : a systematic review and meta-analysis
(Public Library of Science, 2014-07) Naude, Celeste E.; Schoonees, Anel; Senekal, Marjanne; Young, Taryn; Garner, Paul; Volmink, Jimmy
Abstract Background: Some popular weight loss diets restricting carbohydrates (CHO) claim to be more effective, and have additional health benefits in preventing cardiovascular disease compared to balanced weight loss diets. Methods and Findings: We compared the effects of low CHO and isoenergetic balanced weight loss diets in overweight and obese adults assessed in randomised controlled trials (minimum follow-up of 12 weeks), and summarised the effects on weight, as well as cardiovascular and diabetes risk. Dietary criteria were derived from existing macronutrient recommendations. We searched Medline, EMBASE and CENTRAL (19 March 2014). Analysis was stratified by outcomes at 3–6 months and 1–2 years, and participants with diabetes were analysed separately. We evaluated dietary adherence and used GRADE to assess the quality of evidence. We calculated mean differences (MD) and performed random-effects metaanalysis. Nineteen trials were included (n = 3209); 3 had adequate allocation concealment. In non-diabetic participants, our analysis showed little or no difference in mean weight loss in the two groups at 3–6 months (MD 0.74 kg, 95%CI 21.49 to 0.01 kg; I2 = 53%; n = 1745, 14 trials; moderate quality evidence) and 1–2 years (MD 0.48 kg, 95%CI 21.44 kg to 0.49 kg; I2 = 12%; n = 1025; 7 trials, moderate quality evidence). Furthermore, little or no difference was detected at 3–6 months and 1–2 years for blood pressure, LDL, HDL and total cholesterol, triglycerides and fasting blood glucose (.914 participants). In diabetic participants, findings showed a similar pattern. Conclusions: Trials show weight loss in the short-term irrespective of whether the diet is low CHO or balanced. There is probably little or no difference in weight loss and changes in cardiovascular risk factors up to two years of follow-up when overweight and obese adults, with or without type 2 diabetes, are randomised to low CHO diets and isoenergetic balanced weight loss diets.
Mapping oral cancer research in South Africa
(South African Dental Association, 2018) Botha, Paul J.; Schoonees, Anel; Pontes, Carla C.
The aim of the present study was to review the scope of oral squamous cell carcinoma (OSCC) research in South Africa, including its epidemiology, diagnosis, associated risk factors and management. All publications relating to OSCC on the South African population were sought. A total of 72 studies were included and classified into seven categories; most studies were case reports or case series. Risk factors and epidemiology were the most investigated categories while early detection and diagnosis was the least explored. All the main ethnic groups in South Africa were investigated. The highest incidence of OSCC in South Africa was reported for males of mixed ancestry; there was a male predominance in all ethnic groups except for Asians. There is a high prevalence of OSCC in younger individuals in comparison with the global average. Future research about early detection and diagnosis, risk factors, premalignant lesions, management and disease progression is suggested. Educational programmes are necessary and should include schools and tertiary education institutions to reach adolescents and young adults.
Methods used and lessons learnt in conducting document reviews of medical and allied health curricula : a key step in curriculum evaluation
(BioMed Central, 2014-11) Rohwer, Anke; Schoonees, Anel; Young, Taryn
Background: This paper describes the process, our experience and the lessons learnt in doing document reviews of health science curricula. Since we could not find relevant literature to guide us on how to approach these reviews, we feel that sharing our experience would benefit researchers embarking on similar projects. Methods: We followed a rigorous, transparent, pre-specified approach that included the preparation of a protocol, a pre-piloted data extraction form and coding schedule. Data were extracted, analysed and synthesised. Quality checks were included at all stages of the process. Results: The main lessons we learnt related to time and project management, continuous quality assurance, selecting the software that meets the needs of the project, involving experts as needed and disseminating the findings to relevant stakeholders. Conclusion: A complete curriculum evaluation comprises, apart from a document review, interviews with students and lecturers to assess the learnt and taught curricula respectively. Rigorous methods must be used to ensure an objective assessment.
Priority setting for new systematic reviews : processes and lessons learned in three regions in Africa
(BMJ Publishing Group, 2019) Effa, Emmanuel E.; Oduwole, Olabisi; Schoonees, Anel; Hohlfeld, Ameer; Durao, Solange; Kredo, Tamara; Mbuagbaw, Lawrence; Meremikwu, Martin; Ongolo-Zogo, Pierre; Wiysonge, Charles S.; Young, Taryn
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 on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effectively lead to the identification of region specific priorities. Systematic review workshops including discussion about the role and value of reviews to inform policy and research agendas were a useful part of the engagements. This may also enable relevant stakeholders to contribute towards the priority setting process in meaningful ways. However, certain shared challenges were identified, including that emerging priorities may be overlooked due to differences in burden of disease data and differences in language can hinder effective participation by stakeholders. We found that face-to-face contact is crucial for success and follow-up engagement with stakeholders is critical in driving acceptance of the findings and planning future progress.
Pycnogenol for the treatment of chronic disorders : a systematic review
(Stellenbosch : Stellenbosch University, 2011-03) Schoonees, Anel; Volmink, J.; Visser, J.; Musekiwa, A.; Stellenbosch University. Faculty of Health Sciences. Dept. of Interdisciplinary Health Sciences. Human Nutrition.
ENGLISH ABSTRACT: Background: Oxidative stress has been implicated in the development of a number of conditions including amongst others cancer, arthritic disorders and cardiovascular disease. Pycnogenol is a herbal dietary supplement derived from French maritime pine bark extract. Pycnogenol is standardised to contain 70 ± 5% procyanidin which is a powerful antioxidant. Pycnogenol is marketed as a supplement for preventing or treating a wide range of chronic conditions. Although several randomised controlled trials of Pycnogenol have been conducted to date, this evidence has not yet been systematically reviewed. Objectives: The aim was to carry out a systematic review in order to assess the efficacy and safety of Pycnogenol for the treatment of chronic disorders. Search methods The electronic databases CENTRAL (until 18 September 2010), MEDLINE (until 18 September 2010) and EMBASE (until 13 October 2010) were searched, as well as three trial registries. Furthermore the manufacturer of Pycnogenol was contacted and bibliographies of included studies were hand-searched. Selection criteria: Randomised controlled trials (RCTs) evaluating the effectiveness of Pycnogenol in adults or children with any chronic disorder were included. The primary outcomes were any clinical outcomes directly related to the disorder (stratified as participant- and investigator-reported) as well as all-cause mortality. Adverse events and biomarkers of oxidative stress were also assessed. Data collection and analysis: Two authors independently assessed trial eligibility, extracted all data and judged methodological quality. A third author additionally extracted information on outcomes and results. With two exceptions, results for outcomes across studies could not be pooled mainly due to poor quality reporting. Study authors were contacted for additional information. Results: This review includes 15 RCTs with a total of 791 participants that have evaluated Pycnogenol for the treatment of seven different chronic disorders. The disorders included asthma (2 studies; N = 86), attention deficit hyperactivity disorder (1 study; N = 61), chronic venous insufficiency (2 studies; N = 60), diabetes mellitus (4 studies; N = 201), erectile dysfunction (1 study; N = 21), hypertension (2 studies; N = 69) and osteoarthritis of the knee (3 studies; N = 293). Two of the studies were conducted exclusively in children; the others involved adults. Due to small sample size, limited numbers of trials per condition, variation in selected outcomes and outcomes measures and the risk of bias no definitive conclusions regarding the efficacy or safety of Pycnogenol are possible. Authors’ conclusions: Current evidence is insufficient to support Pycnogenol use for the treatment of any chronic disorder. Well designed, adequately powered trials are recommended to establish the value of this treatment.

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