Neglected Tropical Diseases in Sub-Saharan Africa: Review of Their Prevalence, Distribution, and Disease Burden

The neglected tropical diseases (NTDs) are the most common conditions affecting the poorest 500 million people living in sub-Saharan Africa (SSA), and together produce a burden of disease that may be equivalent to up to one-half of SSA's malaria disease burden and more than double that caused by tuberculosis. Approximately 85% of the NTD disease burden results from helminth infections. Hookworm infection occurs in almost half of SSA's poorest people, including 40–50 million school-aged children and 7 million pregnant women in whom it is a leading cause of anemia. Schistosomiasis is the second most prevalent NTD after hookworm (192 million cases), accounting for 93% of the world's number of cases and possibly associated with increased horizontal transmission of HIV/AIDS. Lymphatic filariasis (46–51 million cases) and onchocerciasis (37 million cases) are also widespread in SSA, each disease representing a significant cause of disability and reduction in the region's agricultural productivity. There is a dearth of information on Africa's non-helminth NTDs. The protozoan infections, human African trypanosomiasis and visceral leishmaniasis, affect almost 100,000 people, primarily in areas of conflict in SSA where they cause high mortality, and where trachoma is the most prevalent bacterial NTD (30 million cases). However, there are little or no data on some very important protozoan infections, e.g., amebiasis and toxoplasmosis; bacterial infections, e.g., typhoid fever and non-typhoidal salmonellosis, the tick-borne bacterial zoonoses, and non-tuberculosis mycobaterial infections; and arboviral infections. Thus, the overall burden of Africa's NTDs may be severely underestimated. A full assessment is an important step for disease control priorities, particularly in Nigeria and the Democratic Republic of Congo, where the greatest number of NTDs may occur

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

A Cross sectional Study of the Knowledge and Practice Patterns of Family Medicine Residents Regarding Chronic Kidney Disease Screening

Background: The postgraduate training in medicine is aimed at equipping the trainee with the necessary skills to practice as an expert. The family physician (FP) is usually the first contact between the patient and the health care system. As such, it becomes imperative to assess the FP trainees' knowledge and practice with regards to chronic kidney disease (CKD) Patients and Methods: Self-administered questionnaires were distributed to physicians attending a nationally organized continuing medical education workshop for resident doctors preparing for the part I and part II exit examinations of the National Postgraduate Medical College of Nigerian in the specialty of Family Medicine. Results: Seventy six (20 senior residents and 56 junior residents) of the 150 physicians surveyed returned completed questionnaires. Only nine (11.7%) correctly identified CKD as occurring in approximately one in every ten individuals. CKD risk factors correctly identified by the respondents included: hypertension (97.4%), diabetes mellitus (94.4%), human immunodeficiency virus infection (75%), autoimmune diseases (51.3%), cancer (34.2%), advanced age (26.3%) and lower socioeconomic status (22.4%). Urinalysis and estimation of the GFR using prediction equations were correctly recognized as screening modalities for CKD by 72 (94.7%) and 71 (93.4%) respondents respectively. The majority (54.7%) considered proteinuria as significant when it is 2+. Four (5.3%) physicians “Always” screen for CKD risk factors when consulting a patient; 10 (13.3%) “Most times”; 48 (64%) “Sometimes”; 12 (16%) “Occasionally” and one (1.3%) “Never”.Conclusion: The overall knowledge of CKD prevalence among Nigerian FP trainees attending a workshop is poor; however the knowledge regarding CKD screening is adequate. There exists a gap between CKD screening knowledge and the practice patterns of these physicians.Key words: Chronic kidney disease; Family medicine, Residents, Screenin