Lassa Fever: Another Infectious Menace

Nigeria is presently suffering from another Lassa fever epidemic. This was confirmed in the statement of the Minister of Health of the Federation in which he said, “There has been an upsurge in the reported cases of Lassa fever since the beginning of this year, especially in the Federal Capital Territory and its environs. Within two weeks, 12 cases with five deaths due to the disease were recorded. 25 contacts are confirmed by laboratoryinvestigations to have been infected, including 4 health staff working in the National Hospital, Abuja.”1 Lassa fever is an acute viral haemorrhagic fever first described in 1969 in the town of Lassa in Borno state, Nigeria.2 It isendemic in West African countries, and causes 300,000 cases annually with 5000 deaths.3 Lassa fever epidemics occur in Nigeria, Liberia, Sierra Leone, Guinea and the Central African Republic.4 Lassa virus, the agent of the disease is a member of the Arenaviridae family. The virus is pleomorphic with single-stranded and bisegmented RNA genome.3 Its primary host is Natal Multimammate Mouse (Mastomys natalensis). Transmission to man occurs via exposure to the rat excrement through respiratory or gastrointestinal tracts5, exposure of broken skin or mucus membrane to infected material, direct contact, sexually and transplacentally. The prevalence of antibodies to the virus is 8-22%9 in Sierra Leone, 4-55% in Guinea,12 and 21% in Nigeria.13 Thedisease is mild or asymptomatic in 80% of infected people, but 20% have a severe multisystemic disease. Clinical features are difficult to differentiate from that of other viral haemorrhagic fevers  and common febrile illness such as Malaria, Typhoid fever and so on. Definitive diagnosis is by viral isolation, Antigen and Antibody detection and ReverseTranscriptase PCR. Treatment is with Ribavirin, an antiviral agent. No vaccine is currently available. Prevention is by keeping rats away from homes

Rural-urban differences on the rates and factors associated with early initiation of breastfeeding in Nigeria: further analysis of the Nigeria demographic and health survey, 2013

Background This study investigates and compares the rates and factors associated with early initiation of breastfeeding (EIBF) within one hour of birth in rural and urban Nigeria. Methods Data from the 2013 Nigeria Demographic and Health Survey (NDHS) were analyzed. The rates of EIBF were reported using frequency tabulation. Associated factors were examined using Chi-Square test and further assessed on multivariable logistic regression analysis. Results The rates of EIBF were 30.8% (95% confidence interval [CI] 29.0, 32.6) and 41.9% (95% CI 39.6, 44.3) in rural and urban residences, respectively (p < 0.001). The North-Central region had the highest EIBF rates both in rural (43.5%) and urban (63.5%) residences. Greater odds of EIBF in rural residence were significantly associated with higher birth order (Adjusted Odds Ratio [AOR] 1.29, 95% CI 1.10, 1.60), large birth size (AOR 1.33, 95% CI 1.10, 1.60), and health facility delivery (AOR 1.46, 95% CI 1.23, 1.72). Rural mothers in the rich wealth index, not working and whose husbands obtained at least a secondary school education had significantly higher odds of early initiation of breastfeeding. Regardless of residence, greater odds of EIBF were significantly associated with non-cesarean delivery (Rural AOR 3.50, 95% CI 1.84, 6.62; Urban AOR 2.48, 95% CI 1.60, 3.80) and living in North-Central (Rural AOR 1.84, 95% CI 1.34, 2.52; Urban AOR 4.40, 95% CI 3.15, 6.15) region. Also, higher odds of EIBF were significantly associated with living in North-East (Rural AOR 1.48, 95% CI 1.05, 2.08; Urban AOR 3.50, 95% CI 2.55, 4.83), South-South (Rural AOR 1.51, 95% CI 1.11, 2.10; Urban AOR 2.84, 95% CI 2.03, 3.97) and North-West (Urban residence only AOR 2.08, 95% CI 1.54, 2.80) regions. Conclusions Rural-urban differences in the rates and factors associated with EIBF exist in Nigeria with rural residence having significantly lower rates. Intervention efforts which address the risk factors identified in this study may contribute to improved EIBF rates. Efforts need to prioritize rural mothers generally, (particularly, those in rural North-West region) as well as mothers in urban South-West region of Nigeria

Patient's needs and preferences in routine follow-up after treatment for breast cancer

The purpose of the study was to analyse the needs of women who participated in a routine follow-up programme after treatment for primary breast cancer. A cross-sectional survey was conducted using a postal questionnaire among women without any sign of relapse during the routine follow-up period. The questionnaire was sent 2-4 years after primary surgical treatment. Most important to patients was information on long-term effects of treatment and prognosis, discussion of prevention of breast cancer and hereditary factors and changes in the untreated breast. Patients preferred additional investigations (such as X-ray and blood tests) to be part of routine follow-up visits. Less satisfaction with interpersonal aspects and higher scores on the Hospital Anxiety and Depression Scale (HADS) scale were related to stronger preferences for additional investigation. Receiving adjuvant hormonal or radiotherapy was related to a preference for a more intensive follow-up schedule. There were no significant differences between patients treated with mastectomy compared to treated with breast-conserving therapy. During routine follow-up after a diagnosis of breast cancer, not all patients needed all types of information. When introducing alternative follow-up schedules, individual patients' information needs and preferences should be identified early and incorporated into the follow-up routine care, to target resources and maximise the likelihood that positive patient outcomes will result