Maternal Mortality and the Role of Quality Education

Today, the issue of high maternal mortality is a topical problem in developing countries, in particular, Nigeria. The African Population and Health Research Centre put the incidence of maternal mortality in Nigeria at approximately 40,000 annually, accounting for roughly 20 per cent of the global maternal mortality. With the present situation of a high maternal mortality rate amidst different initiative or programme interventions in Nigeria, how vital is the role of quality education? The leading objective of this research is to pursue to a logical conclusion the policy feasibility of improved quality education towards maternal mortality reduction in Nigeria. Adopting the Autoregressive Distributed Lag method of estimation, the study, among others, suggested enormous evidence of a percentage increment in quality education leading to a maternal mortality rate reduction of up to 0.31 per cent in the short run and 1.45 per cent in the long run per annum

Antibodies against Lagos Bat Virus in Megachiroptera from West Africa

To investigate the presence of Lagos bat virus (LBV)–specific antibodies in megachiroptera from West Africa, we conducted fluorescent antibody virus neutralization tests. Neutralizing antibodies were detected in Eidolon helvum (37%), Epomophorus gambianus (3%), and Epomops buettikoferi (33%, 2/6) from Ghana. These findings confirm the presence of LBV in West Africa

Effective vaccination against rabies in puppies in rabies endemic regions.

In rabies endemic regions, a proportionally higher incidence of rabies is often reported in dogs younger than 12 months of age, which includes puppies less than 3 months of age; this presents a serious risk to public health. The higher incidence of rabies in young dogs may be the effect of low vaccination coverage in this age class, partly as a result of the perception that immature immune systems and maternal antibodies inhibit seroconversion to rabies vaccine in puppies less than three months of age. Therefore, to test this perception, the authors report the virus neutralising antibody titres from 27 dogs that were vaccinated with high quality, inactivated rabies vaccine aged three months of age and under as part of larger serological studies undertaken in Gauteng Province, South Africa, and the Serengeti District, Tanzania. All of these dogs seroconverted to a single dose of vaccine with no adverse reactions reported and with postvaccinal peak titres ranging from 2.0 IU/ml to 90.5 IU/ml. In light of these results, and the risk of human beings contracting rabies from close contact with puppies, the authors recommend that all dogs in rabies endemic regions, including those less than three months of age, are vaccinated with high quality, inactivated vaccine.Funding for the study in Zenzele was provided by the International Fund for Animal Welfare (IFAW) and World Animal Protection (WAP). Funding for the study in Tanzania was provided by the RCVS Small Grant Programme and the University of Edinburgh Small Grant Scholarship Program. Dog vaccines for the Serengeti study were donated by MSD Animal Health. Partial funding for the APHA was provided by the UK Department for Environment and Rural Affairs (Project SV3500). JW receives support from the Alborada Trust and the Research and Policy for Infectious Disease Dynamics Program of the Science and Technology Directorate, Department of Homeland Security, Fogarty International Centre, National Institute of Health.This is the author accepted manuscript. The final version is available from BMJ Group via http://dx.doi.org/10.1136/vr.10297

Intravenous Inoculation of a Bat-Associated Rabies Virus Causes Lethal Encephalopathy in Mice through Invasion of the Brain via Neurosecretory Hypothalamic Fibers

The majority of rabies virus (RV) infections are caused by bites or scratches from rabid carnivores or bats. Usually, RV utilizes the retrograde transport within the neuronal network to spread from the infection site to the central nervous system (CNS) where it replicates in neuronal somata and infects other neurons via trans-synaptic spread. We speculate that in addition to the neuronal transport of the virus, hematogenous spread from the site of infection directly to the brain after accidental spill over into the vascular system might represent an alternative way for RV to invade the CNS. So far, it is unknown whether hematogenous spread has any relevance in RV pathogenesis. To determine whether certain RV variants might have the capacity to invade the CNS from the periphery via hematogenous spread, we infected mice either intramuscularly (i.m.) or intravenously (i.v.) with the dog-associated RV DOG4 or the silver-haired bat-associated RV SB. In addition to monitoring the progression of clinical signs of rabies we used immunohistochemistry and quantitative reverse transcription polymerase chain reaction (qRT-PCR) to follow the spread of the virus from the infection site to the brain. In contrast to i.m. infection where both variants caused a lethal encephalopathy, only i.v. infection with SB resulted in the development of a lethal infection. While qRT-PCR did not reveal major differences in virus loads in spinal cord or brain at different times after i.m. or i.v. infection of SB, immunohistochemical analysis showed that only i.v. administered SB directly infected the forebrain. The earliest affected regions were those hypothalamic nuclei, which are connected by neurosecretory fibers to the circumventricular organs neurohypophysis and median eminence. Our data suggest that hematogenous spread of SB can lead to a fatal encephalopathy through direct retrograde invasion of the CNS at the neurovascular interface of the hypothalamus-hypophysis system. This alternative mode of virus spread has implications for the post exposure prophylaxis of rabies, particularly with silver-haired bat-associated RV

To conserve African tropical forests, invest in the protection of its most endangered group of monkeys, red colobus

Forest loss and overhunting are eroding African tropical biodiversity and threatening local human food security, livelihoods, and health. Emblematic of this ecological crisis is Africa's most endangered group of monkeys, the red colobus (genus Piliocolobus). All 17 species, found in forests from Senegal in the west to the Zanzibar archipelago in the east, are threatened with extinction. Red colobus are among the most vulnerable mammals to gun hunting, typically disappearing from heavily hunted forests before most other large-bodied animals. Despite their conservation status, they are rarely a focus of conservation attention and continue to be understudied. However, red colobus can act as critical barometers of forest health and serve as flagships for catalyzing broader African tropical forest conservation efforts. We offer a plan for conservation of red colobus and their habitats and discuss conservation and policy implications.Additional authors: Deo Kujirakwinja, Barney Long, W. Scott McGraw, Russell A. Mittermeier, Thomas T. Struhsake

Barriers of attendance to dog rabies static point vaccination clinics in Blantyre, Malawi

<div><p>Rabies is a devastating yet preventable disease that causes around 59,000 human deaths annually. Almost all human rabies cases are caused by bites from rabies-infected dogs. A large proportion of these cases occur in Sub Saharan Africa (SSA). Annual vaccination of at least 70% of the dog population is recommended by the World Health Organisation in order to eliminate rabies. However, achieving such high vaccination coverage has proven challenging, especially in low resource settings. Despite being logistically and economically more feasible than door-to-door approaches, static point (SP) vaccination campaigns often suffer from low attendance and therefore result in low vaccination coverage. Here, we investigated the barriers to attendance at SP offering free rabies vaccinations for dogs in Blantyre, Malawi. We analysed data for 22,924 dogs from a city-wide vaccination campaign in combination with GIS and household questionnaire data using multivariable logistic regression and distance estimation techniques. We found that distance plays a crucial role in SP attendance (i.e. for every km closer the odds of attending a SP point are 3.3 times higher) and that very few people are willing to travel more than 1.5 km to bring their dog for vaccination. Additionally, we found that dogs from areas with higher proportions of people living in poverty are more likely to be presented for vaccination (ORs 1.58-2.22). Furthermore, puppies (OR 0.26), pregnant or lactating female dogs (OR 0.60) are less likely to be presented for vaccination. Owners also reported that they did not attend an SP because they were not aware of the campaign (27%) or they could not handle their dog (19%). Our findings will inform the design of future rabies vaccination programmes in SSA which may lead to improved vaccination coverage achieved by SP alone.</p></div

Adherence to International Guidelines in the Management of Hypertension in a Tertiary Hospital in Nigeria

Purpose: The role of physicians in the overall management of hypertension and their adherence to the JNC VII, WHO/ISH and ESH guidelines were examined in this study. Method: Case notes of hypertensive patients diagnosed between 1 January 2004 and 30 September 2005, in the Cardiology Clinic of University of Benin Teaching Hospital were retrieved for evaluation. They were assessed for adherence to the JNC VII, WHO/ISH and ESH guidelines, in the management of hypertension. Result: Five hundred and one case notes were used in the study. Prevalence of hypertension was highest in the Grade 2 category (36%). More women (60%) than men (40%) were affected, with a diagnostic mean systolic blood pressure (SBP); male (164.0mmHg ± 21.9), female (163.7 mmHg ± 18.8) and mean diastolic blood pressure (DBP); male (100.1 mmHg ± 13.2), female (97.3 mmHg ± 13.1). After commencing treatment, mean SBP and DBP for male and female were (131.8 mmHg ± 11.6; 84.3 mmHg ± 7.5), and (132.3 mmHg ± 11.5 83.2 mmHg ± 7.6), respectively. The commonest co-morbidity was diabetes mellitus (18%). Co-morbidity was commonest in Grade 2 (34%) and Grade 3 hypertension (34%). Almost half of the subjects (49%) were on a two-drug combination while 14% were on monotherapy. Calcium channel blockers were the most commonly prescribed anti-hypertensive drug (31%) followed by diuretics (30%). In combination drug regimen, diuretics were the commonest (74%). There was no evidence of body weight management in hypertension. Conclusion: Physicians in this hospital fairly complied with the stated guidelines, but do not appear to have recommended lifestyle modifications to their hypertensive patients