Quality of life of people living with HIV and AIDS attending Irrua Specialist Teaching Hospital, Edo State, Nigeria

Background: With the use of highly active antiretroviral therapy (HAART), life expectancy of HIV-infected persons had increased and the disease is now managed as a chronic one, but the quality of life (QOL) of the patients is now a concern. Social support enhances QOL of patients with chronic illnesses. However, no study has been done to determine the QOL of people living with HIV and AIDS (PLWHA) in our environment. This study therefore assessed the QOL of PLWHA attending antiretroviral therapy (ART) clinic of Irrua Specialist Teaching Hospital (ISTH), Edo State of Nigeria Methodology: A descriptive cross-sectional study design was used. Two hundred and thirty PLWHA attending the ART clinic of ISTH, Irrua, Edo State, Nigeria, were systematically selected for the study. A structured questionnaire was interviewer-administered to collect data on sociodemographic and clinical profiles of selected participants, and the WHOQOL-HIV BREF questionnaire was used to collect data the QOL of each participant. Data were analyzed with IBM SPSS version 20.0. Results: The overall mean QOL score for the participants was 89.13±1.18 (95% CI=87.95-90.31). The scores in three of the six life domains in the WHOQOL-HIV BREF instrument were similar and high; spirituality/ religion/personal beliefs (16.33±0.36), physical health (15.83±0.28) and psychological health (15.07±0.24). Lower mean QOL scores were observed in the social relationships (13.49±0.28) and environment (13.45±0.20) domains. Clinical HIV stage, marital status, educational status and gender were significantly associated with mean QOL scores in bivariate analysis while only HIV stage 1 and 2 were significantly associated with good QOL in multivariate logistic regression analysis. Conclusion: It is pertinent that PLWHA are kept in early stages of HIV disease through combination of efforts such as prompt enrolment, commencement and monitoring compliance of HAART, and treatment of opportunistic infections, as well as public health measures including education, de-stigmatization, early diagnosis by extensive accessible screening/testing of at-risk population, social supports and economic empowerment, psychotherapy and social integration of affected individuals especially in a functional home

Numerical and experimental assessment of the modal curvature method for damage detection in plate structures

This paper is concerned with the use of numerically obtained modal curvatures for damage detection in both isotropic and composite laminated plates. Numerical simulations are carried out by using COMSOL Multiphysics as FEM solver of the governing equations, in which a Mindlin-Reissner plate model is assumed and defects are introduced as localized smoothed variations of the baseline (healthy) configuration. Experiments are also performed on steel and aluminum plates using scanning laser vibrometry. This study confirms that the central difference method greatly amplifies the measurement errors and its application leads to ineffective predictions for damage detection, even after denoising. As a consequence, different numerical techniques should be explored to allow the use of numerically obtained modal curvatures for structural health monitoring. Herein, the Savitzky-Golay filter (or least-square smoothing filter) is considered for the numerical differentiation of noisy data

Synthesis, characterization and antimicrobial activity of copper(II) Schiff base adducts of some p-substituted aniline Schiff bases

The synthesis, characterization and antimicrobial activity of Cu(II) complexes of some p-substituted aniline Schiff base ligands have been carried out. The Schiff bases were obtained from salicylaldehyde and o-vanillin. The Cu(II) complexes have been characterized by elemental analysis, conductivity measurement, infrared and electronic spectral data. The complexes were obtained either as metal chelates [Cu(L)2] or Schiff base adducts (CuCl2.2LH).xH2O. The metal chelates were non-electrolytes while the Schiff base adducts exhibited 1:1 or 2:1 electrolytes in methanol. The Cu(II) complexes exhibited slight antimicrobial activity against Escherichia coli ATCC® 8739™*, Staphylococcus aureus subsp. aureus ATCC® 6538™*, Bacillus subtilis subsp. spizizenii ATCC® 6633™* and Candida albicans ATCC® 2091™*. The complexes exhibited significant antifungal activity.                     KEY WORDS: Metal Chelates, Schiff bases, Adducts, Cu(II) complexes, Salicylaldimines   Bull. Chem. Soc. Ethiop. 2021, 35(1), 33-42. DOI: https://dx.doi.org/10.4314/bcse.v35i1.

Numerical and experimental assessment of the modal curvature method for damage detection in plate structures

Use of modal curvatures obtained from modal displacement data for damage detection in isotropic and composite laminated plates is addressed through numerical examples and experimental tests. Numerical simulations are carried out employing COMSOL Multiphysics as finite element solver of the equations governing the Mindlin-Reissner plate model. Damages are introduced as localized non-smooth variations of the bending stiffness of the baseline (healthy) configuration. Experiments are also performed on steel and aluminum plates using scanning laser vibrometry. The obtained results confirm that use of the central difference method to compute modal curvatures greatly amplifies the measurement errors and its application leads to unreliable predictions for damage detection, even after denoising. Therefore, specialized ad hoc numerical techniques must be suitably implemented to enable structural health monitoring via modal curvature changes. In this study, the Savitzky-Golay filter (also referred to as least-square smoothing filter) is considered for the numerical differentiation of noisy data. Numerical and experimental results show that this filter is effective for the reliable computation of modal curvature changes in plate structures due to defects and/or damages

Land tenure and property rights, and household food security among rice farmers in Northern Nigeria

There are growing campaigns to promote land titling to secure Land Tenure and Property Rights (LTPRs) in African agriculture. Theoretically, deed registration should reduce land disputes, facilitate land use as collateral for loans, and stimulate investment in land improvement for increased productivity, income and food security. Empirical evidence in these regards, however, remains anecdotal, and sometimes conflicting. This paper reports a study that examined LTPRs' among smallholder rice farmers in Northern Nigeria and the influence on household food security (HFS). It used cross-section data obtained from 549 rice farmers, selected by multistage sampling across 84 rice-growing communities, seven (7) States and the three (3) geopolitical zones in northern Nigeria. Data collection was by personal interviews of adult members of the farmers' households, focusing on the households' socio-economics, livelihoods, and LTPRs on farmland cultivated during the 2016/17 farming season. HFS was assessed within the framework of the United States Department of Agriculture’ HFS Survey Module. LTPRs assessment was in terms of the type (source) and registration of titles to farmlands. HFS modelling was within the framework of Poisson, Instrumental Variable Poisson (IVP) and Zero-inflated Poisson (ZIP) regression methods, with endogeneity concerns and choice of specification addressed within Hausman specification tests. The results show that land titling is not endogenous in the estimated models; and that HFS is significantly (p < 0.01) enhanced with an increase in shares of freehold and leasehold in the households’ farmlands, as against reliance on communal holdings. Holding de jure secure title to farmlands, however, had no significant influence on HFS. The evidence supports the need to develop land markets to enhance the ease of land transfer, as part of measures to enhance HFS in northern Nigeri

Survey data on land tenure and food security among farming households in northern Nigeria

This dataset presents data collected from the households’ survey in Northern Nigeria to examine land tenure and prop�erty rights among smallholder rice farmers and the influence it has on household food security. Data collection was by personal interviews of adult members of the farmers’ house�holds, focusing on the households’ socio-economics, United States Department of Agriculture’- 18 Household Food Secu�rity questions for households with children, land titling sta�tus and land tenure type on farmland cultivated during the 2016/17 farming season. The data were collected from 475 rice farmers selected by multistage sampling across 84 rice�growing communities, seven States and the three geopoliti�cal zones in northern Nigeria. Household food security was assessed within the framework of the United States Depart�ment of Agriculture’ HFS Survey Module. Land Tenure and Property Rights (LTPRs) assessment was in terms of the type (source) and registration of titles to farmlands. The hypothe�sis that guided the cross-sectional survey conducted to gen�erate these data is that insecure land tenure and property rights are important drivers of food insecurity

Assessment of Radionuclide Concentrations in Catfish and Tilapia fish from Asa-Dam Ilorin, North-central Nigeria

High concentration of naturally occurring radionuclides in food can have adverse effect on human health. Radioactivity measurement of radionuclides in Catfish and Tilapia fish samples from Asa-Dam Ilorin, Nigeria was carried out using gamma ray spectrometer technique. The results of the gamma ray spectrometry were utilized in the estimation of some radiological parameters in the bid to effectively determine the extent of the health implications as regards to radiation from the consumption of fishes in that area. The mean activity concentrations of 40K, 238U and 232Th for Catfish are 37.90±2.83, 8.08±2.71 and 11.73±2.51 Bqkg-1, respectively. Similarly, the mean activity concentrations of 40K, 238U and 232Th for Tilapia are 26.31±3.67, 6.16±2.47 and 8.89±2.19 Bqkg-1, respectively. The mean values of 40K, 232Th and 238U in Catfish were observed to be high when compared to Tilapia. The average absorbed dose rate for both Catfish and Tilapia samples were 12.40 and 9.31 nGyh-1.  The mean annual effective doses were 29.65, 276.81, 52.04, 41.10 and 35.00 μSvy-1; 22.41, 209.10, 38.99, 30.93 and 26.43 μSvy-1 for adult, fishermen, 5 years, 10 years and 15 years, respectively for cat and Tilapia fish. The estimated excess lifetime cancer risk for adult, fishermen, 5 years, 10 years and 15 years were 0.10, 0.97, 0.18, 0.14, and 0.12 and 0.09, 0.85, 0.16, 0.13 and 0.11 for both Catfish and Tilapia, respectively. The results of all the radiological parameters estimated showed trends that are generally low, hence, poses no significant radiological health burden

Ablative therapy for people with localised prostate cancer: a systematic review and economic evaluation

© Queen’s Printer and Controller of HMSO 2015.Background People diagnosed with cancer of the prostate, a sex gland in the pelvis, have a choice of treatment options depending on the severity of disease. For people whose cancer is at medium and low risk of spread, the main options are surgical removal of the prostate, radical prostatectomy (RP), use of external beam radiotherapy (EBRT) to destroy the cancer or delaying treatment until there are signs that the cancer is getting worse [active surveillance (AS)]. RP and radiotherapy are effective at curing the cancer but may also cause long-term urinary incontinence and sexual problems. AS, on the other hand, may be quite difficult for people to cope with as they know that the cancer is still present. Newer treatments aim to target the disease more precisely so that surrounding normal tissues can be preserved, reducing the risk of side effects but still effectively destroying the cancer. These more targeted ablative therapies include cryotherapy, high-intensity focused ultrasound (HIFU), brachytherapy, photodynamic therapy (PDT), radiofrequency interstitial tumour ablation (RITA) and laser therapy, among others. Aims This study aimed to develop clinical care pathways relevant to a UK NHS context review systematically the evidence of the clinical effectiveness and safety of each newer ablative therapy concerning primary and salvage treatment of localised prostate cancer• determine which therapies are most likely to be cost-effective for implementation in the UK NHS identify and prioritise future research needs. Methods Clinical effectiveness review We conducted two discrete systematic reviews: (a) primary ablative treatment of localised prostate cancer compared with AS, RP or EBRT (b) salvage ablative treatment for local prostate cancer relapse after primary EBRT compared with salvage RP. MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, EMBASE, Bioscience Information Service (BIOSIS), Science Citation Index, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE) and the Health Technology Assessment (HTA) databases were searched to the end of March 2013. Reference lists of all included studies were scanned and experts on our advisory panel were contacted for details of additional reports. Evidence came from randomised controlled trials (RCTs), non-randomised comparative studies (NRCSs) (if no RCT evidence was identified) and single-arm cohort studies (case series) with greater than 10 participants for the ablative procedures only. Conference abstracts or non-English-language reports were excluded. For the primary therapy systematic review, the ablative therapies considered were cryotherapy, HIFU, PDT, RITA, laser ablation and brachytherapy. The comparators were AS, RP and EBRT. For the salvage therapy systematic review, the ablative therapies considered were cryotherapy and HIFU. The comparator was RP. Outcomes were cancer related, adverse effects (functional and procedural) and quality of life. Two reviewers extracted data and carried out quality assessment. For meta-analysis, a Bayesian indirect mixed-treatment comparison was used. Cost-effectiveness The cost-effectiveness of the different treatments and their subsequent care pathways was assessed using a modified Markov individual simulation model, applied to a UK NHS setting. The perspective for the model was a health services perspective. Parameter estimates were derived from the systematic review of clinical effectiveness, a micro-costing exercise, other literature, the expert advisory group and other UK sources. The outputs of the model were costs and quality-adjusted life-years (QALYs) for each procedure, incremental costs and QALYs and incremental cost per QALY over the remaining lifetime. Both costs and QALYs were discounted at 3.5%. An elasticity analysis, together with probabilistic and deterministic sensitivity analyses, were performed to explore the uncertainty surrounding parameter estimates. Results Clinical effectiveness Cryotherapy Data from 3995 patients who received cryotherapy across 19 studies (1 RCT, 4 NRCSs and 14 case series) were included, with most studies considered to be at high risk of bias. In the short term, there was conflicting evidence relating to cancer-specific outcomes when cryotherapy was compared with either EBRT or surgery. The only finding that reached statistical significance was 1-year disease-free survival, which was worse for cryotherapy than for either EBRT or RP. However, none of the other cancer-specific outcomes, such as biochemical failure or overall survival, showed any significant differences between them. The findings in relation to cancer-specific outcomes are best regarded as inconclusive. There was evidence that the rate of urinary incontinence at 1 year was lower for people undergoing cryotherapy than for those undergoing RP [3% vs. 66%; odds ratio (OR) 0.02, 95% credible interval (CrI) < 0.01 to 0.34], but the size of the difference decreased with longer follow-up. There was a general trend for cryotherapy to have fewer procedural complications, apart from urinary retention. The only difference that reached statistical significance was for urethral stricture, which was less frequent after cryotherapy than after RP (1% vs. 8%; OR 0.24, 95% CrI 0.09 to 0.54). High-intensity focused ultrasound Data from 4000 patients who received HIFU across 21 studies (1 NRCS and 20 case series) were included, with all studies considered to be at high risk of bias. There was some evidence that biochemical failure rates were higher at 1 year when using HIFU than when using EBRT, and this was statistically significant. However, the difference was no longer statistically significant at 5 years. Similar findings were observed with regard to disease-free survival at 1 year, with worse outcomes for HIFU than for EBRT, which were statistically significant. The differences were no longer significant at 3 years. The biochemical result was in contrast to overall survival at 4 years, which was higher when using HIFU. There were insufficient data on any urinary incontinence, erectile dysfunction or bowel problems to draw any robust conclusions, although at 1 year HIFU had lower incontinence rates than RP (10% vs. 66%; OR 0.06, 95% CrI 0.01 to 0.48). The safety profile for HIFU was generally good, apart from a potential numerical increase in rates of urinary retention and dysuria. However, HIFU appeared to have a slightly higher incidence of urethral stricture than EBRT, and the difference was statistically significant (8% vs. 1%; OR 5.8, 95% CrI 1.2 to 24.5). Brachytherapy This review considered data from 26,129 patients who received brachytherapy across 40 studies (2 RCTs and 38 NRCSs), with most studies considered to be at high risk of bias. The data for brachytherapy were generally more robust than for other ablative therapies. In the short term, there was some evidence at 5-year follow-up that the rate of biochemical failure was lower for brachytherapy (7%) than for EBRT (13%; OR 0.46, 95% CrI 0.32 to 0.67) or RP (11%; OR 0.35, 95% CrI 0.21 to 0.56). There was also some evidence that disease-free survival was better for brachytherapy at 3-year follow-up. There was evidence that the rate of urinary incontinence up to 5 years after treatment was lower for people undergoing brachytherapy than for RP, but the size of the difference decreased with longer follow-up. There was also a trend towards lower erectile dysfunction rates for brachytherapy than for EBRT or RP and this reached statistical significance at 3 years after treatment (60% vs. 81% for EBRT and 88% for RP). There were insufficient data to draw any conclusions on bowel problems. The findings regarding procedural complications were mixed. Dysuria rates were higher for brachytherapy and this reached statistical significance when compared with RP. Urinary retention was also statistically significantly higher for brachytherapy than for EBRT. Stricture rates for brachytherapy were higher than those for EBRT, but lower than those for RP. The differences for stricture reached statistical significance when compared with RP. For rectal pain, there was evidence that rates were significantly lower for brachytherapy than for EBRT. Acute genitourinary toxicity, though rare, had statistically higher rates for brachytherapy than for EBRT, but acute gastrointestinal toxicity was lower for brachytherapy. Other ablative therapies Only two other ablative therapies were identified in the review: focal laser ablative therapy and PDT. Data were too scarce (a total of 35 participants for these two procedures) for any conclusions. Salvage therapy Data from 400 participants who were treated with salvage therapy following primary EBRT across nine case series were included. Six studies involved salvage RP, two involved salvage cryotherapy and one involved salvage HIFU. In six studies, data were not collected prospectively, and only short-term outcomes were reported. As such, all of the studies were considered as having a high risk of bias. There was no robust evidence that mortality or other cancer-specific outcomes differed between salvage cryotherapy and salvage RP in the short term. There were no data on cancer-specific outcomes for salvage HIFU. In regard to functional and quality of life outcomes, lack of data prevented any conclusions. In terms of adverse event outcomes, salvage cryotherapy had numerically fewer periprocedural complications (especially for bladder neck stenosis) than salvage HIFU or salvage RP, but there was a high level of uncertainty with this observation. Focal ablation Descriptive subgroup assessment within studies reporting the use of focal ablation was limited, but suggested that cancer-specific outcomes were at least comparable with those seen in full-gland therapy studies. Urinary incontinence rates may be lower following focal ablation, but the evidence is weak in light of the poor quality and quantity of the data. Active surveillance Lack of outcome data prevented comparison of the efficacy of ablative therapies with a programme of AS, apart from the rate of erectile dysfunction at 12 months, where there was no statistically significant difference. Cost-effectiveness Assuming equal recurrence in line with the lack of statistical differences from the effectiveness review, EBRT was the least costly (£19,363 per patient) and least effective (3.63 QALYs), whereas HIFU was more costly (£19,860 per patient) and more effective (3.86 QALYs). HIFU was more effective and less costly than the other newer ablative interventions. The lifetime incremental cost per QALY for HIFU compared with EBRT was £2915. There was a 75% chance that HIFU would be considered cost-effective at a £30,000-per-QALY threshold. In a plausible best-and-worst-case analysis, the probability that HIFU would be considered cost-effective varied between 60% and 70%. Strengths and limitations The main strength of the study was the systematic approach taken to review the literature and the inclusion of a relatively large quantity of studies, giving a high total number of participants. The main limitations were the low quantity and poor quality of the data available on cancer-related outcomes and long-term adverse events of urinary incontinence, sexual and bowel dysfunction, and the changing technology over the review period. Many published studies were poorly reported or lacked sufficient detail. Inconsistency in outcome definition, measurement and reporting was also a significant problem, and much of the information available was unsuitable for meta-analysis. Another major limitation resulted from the majority of comparisons being made using case series, with few head-to-head comparisons of ablative therapies against current practice. The estimates were therefore generated using indirect comparisons. Like all analyses, they require assumptions to be made that may or may not be reasonable. Accordingly, the results should be interpreted with a large degree of caution. Despite the considerable efforts to construct a model and seek the best data available, the lack of effectiveness data had implications for the economic evaluation. The limited data meant that there was insufficient evidence to assume that there was any difference between interventions for a number of parameters, a particular issue for biochemical recurrence, which was a key parameter in the evaluation. The impact of these assumptions was explored in sensitivity analyses. Conclusions Implications for health care For primary ablative therapy, neither cryotherapy nor HIFU had sufficiently robust data to enable any definitive conclusions to be made. The effectiveness data on brachytherapy were more robust and there was some evidence that cancer-specific outcomes in the short term were either better or equivalent to either EBRT or RP, with comparable adverse effect profiles apart from a possible increased risk of dysuria and urinary retention. The findings on focal ablative therapy were mostly derived from data on focal cryotherapy, which suggested that cancer-specific outcomes were at least comparable with those of full-gland cryotherapy, and there was a suggestion that the urinary incontinence outcome may be better following focal cryotherapy than whole-gland cryotherapy. The cost-effectiveness analysis confirmed the uncertainty from the clinical review and that there is no technology which appears superior, on the basis of current evidence, in terms of average cost-effectiveness. The probabilistic sensitivity analyses suggest that a number of ablative techniques are worthy of further research. For salvage ablative therapy following primary EBRT, a lack of reliable and robust data prevented any meaningful conclusions from being made, in comparison with salvage RP. The findings from the review indicate that there is insufficient evidence to help inform recommendations on the use of ablative therapies in the UK NHS. Need for further research The main gaps in the evidence base are the lack of direct comparative studies of ablative therapies; the consequent lack of robust data to inform calculations of cost-effectiveness and the role of focal ablative therapies; and the lack of longer-term data on cancer control, such as overall and cancer-specific mortality. The key research recommendations, in order of importance, are as follows: 1. HIFU and brachytherapy seem the most promising newer interventions but they lack high-quality evaluation. Such evaluation should ideally be by multicentre RCT with long-term follow-up, and would include predefined assessment of cancer-specific, dysfunction and health-related quality-of-life measures. Such studies should incorporate economic evaluations and also inform economic modelling

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

Methods for specifying the target difference in a randomised controlled trial : the Difference ELicitation in TriAls (DELTA) systematic review

Peer reviewedPublisher PD