Seroprevalence Survey of Rubella Antibodies among Pregnant Women in Maiduguri, Borno State, Nigeria

Rubella is a vaccine- preventable viral infection. Its etiologic agent, rubella virus was identified as a human teratogencapable of causing spectrum of birth defects described as congenital rubella syndrome (CRS) if the pregnant mother isinfected within the first trimester of pregnancy. A total of 90 pregnant women attending a secondary health carefacility in Maiduguri were screened for IgM and IgG antibodies using enzyme linked immunosorbent assay (ELISA)kit (Cortez Diagnostics Inc. USA). Of these, 37.8% (34/90) and 83.3% (75/90) were seropositive for anti-rubella IgM (x2Cal 5.1; p=0.05) and IgG respectively. Chi-square analysis (x2 Cal 38.38, p=0.05// x2 tab 31.41, p=0.05) revealed anassociation between miscarriage and IgG antibody level in twenty-one subjects. Pregnant women within 20-24yearshad the highest prevalence of 40% (36/90)( x2 Cal 4.22, p=0.05) : 44.4% (16/36) of them were seropositive for IgM (x2 Cal4.31, p=0.05). A marked surge in IgG antibody level, which tantamount acute infection, was observed in 15.6% (14/90)(x2 Cal 19.85, p=0.05) of the pregnant women. Pregnant women in the first trimester seropositive for anti-rubella IgMwere 36.4% (4/11), inferring that the fetuses of these women are susceptible to sequelae of rubella. This resulthighlights the consequence of rubella infection and confirms continuous circulation of rubella virus in the study area.There is need for vaccination of vulnerable population in order to ensure the control /elimination of rubella virus inNigeria.Key words: Rubella virus, teratogen, antibodies, Maiduguri La rubéole est une infection virale évitable par la vaccination. Son agent étiologique, virus de la rubéole a été identifiécomme un tératogène humain capable de provoquer le spectre de malformation congénitale décrite comme lesyndrome de rubéole congénitale (SRC) si la femme enceinte est infectée au cours du premier trimestre de lagrossesse. Au total, 90 femmes enceintes fréquentant un établissement de soins de santé secondaires à Maiduguri ontété dépistées pour le dosage des anticorps IgM et IgG à l'aide de kit immunoenzymatique (ELISA) (CortezDiagnostics Inc. USA). Parmi elles, 37,8% (34/90) et 83,3% (75/90) étaient séropositives respectivement pour lesanticorps anti-IgM (X2 Cal. 5,1, p=0,05) et IgG de la rubéole. L’analyse Chi-carré (X2 Cal. 38,38, p=0,05 /X2Tab. 31,41,p=0,05) a révélé une relation entre la fausse couche et le niveau d'anticorps IgG dans vingt-et-un sujets. Les femmesenceintes de 20 à 24 ans ont eu la plus forte prévalence de 40% (36/90) (X2 Cal. 4,22, p=0,05): 44,4% (16/36) d'entre ellesétaient séropositives pour les IgM (X2 Cal. 4,31, p=0,05). Une augmentation remarquable de taux d'anticorps IgG, équivalent à l’infection aiguë, a été observée chez 15,6% (14/90) (X2 Cal. 19,85, p=0,05) de femmes enceintes.Les femmesenceintes au premier trimestre, séropositives aux IgM anti-rubéole, ont été de 36,4% (4/11), déduisant que les foetus deces femmes sont sensibles aux séquelles de la rubéole. Ce résultat souligne la conséquence de la rubéole et confirme lacirculation continue du virus de la rubéole dans la zone d'étude. Il est nécessaire de vacciner la population vulnérableafin d'assurer le contrôle et/ou l’élimination du virus de la rubéole au Nigeria.Mots clés: virus de la rubéole, tératogènes, anticorps, MaiduguriArticle in English

HIV sero-positive status among clients aged ≥ 50 years that presented for care in a tertiary health facility in northeastern Nigeria.

The introduction of highly active antiretroviral therapy (HAART) has transformed HIV infection from hopeless to manageable health condition comparable to non-infectious diseases such as asthma and diabetes mellitus. This modest achievement has reduced morbidity and mortality and increased longevity and quality of life among HIV infected persons. Although reports from developing countries such as Nigeria, shows that youth within the reproductive are most affected by the scourge of HIV/AIDS. Older patients with features that may be indicative of HIV infection are often overlooked in favour of other differential diagnosis. Objective: To document HIV positive sero-status among client aged 50 years and above that necessitated HIV test as part of their clinical evaluation after voluntary counseling and testing at a tertiary health facility. Method: Record of 1674 adults participants that presented for care between January 2009- December 2013, were retrieved for this study. Results: The HIV-seropositive status among the participants was 370 (22.1%). It showed a female preponderance of 136 (26.0%) than 234 (20.0%) in males. The peak annual prevalence was observed in the year 2010, steady decline was observed thereafter. Overall, older participants between 60-70 years had higher HIV-seropositivity status. This study shows one out four males and five females with index of suspicion either based on clinical presentation or risky sexual behavior are positive for HIV infection. Conclusion: This report underscores the need to explore other risk factors that may be peculiar to older segment of the society and introduce HIV intervention strategies for the older populations. Delivery of HIV intervention measures and services to this segment of the population is expedient. Measures and interventions should take into consideration the peculiarities, specific vulnerabilities and HIV-related challenges faced by this group of clients

Assessment of request pattern and utility of rheumatoid factor in a tertiary hospital in North east Nigeria

The diagnostic utility of Rheumatoid Factor (RF) test is not well documented. The question therefore is: - 'when is it appropriate to make this request'? When patients' own immunological defense mechanisms go awry and start attacking one's tissues, (autoimmune), there usually arises a problem. This usually affects the heart, musculo skeletal system and other organs giving rise to signs and symptoms that are seen in other ailments. The joints are the most common site of affectation and an early diagnosis may go a long way in managing the disease. Usually an antibody (Rheumatoid factor) is found in such patients. It is formed against the Fc portion of IgG, forming an IgG-Fc immune complex that normally leads to the disease process. It is this complex (usually an IgM) in the patient's serum that is exposed to a commercial antigen in the laboratory and the titer determined against a standard. The normal level is usually <14IU/ml. Levels higher are usually considered abnormally high, elevated or positive. A negative RF test however does not mean that the patient hasn't got the disease. Objective: To determine the frequency of positivity of rheumatoid factor and the context in which the requests are made by group of physicians and advise on when to make the request. Methods: A retrospective study of case notes of 354 patients requested to perform rheumatoid factor test at the immunology department over a period of 6 years were reviewed. The requesting departments, clinical and demographic characteristics of patients were reviewed and analyzed. Data analyzed using SPSS version 22. Results: Of the 354 requests made,265 (74.9%) were due to musculo skeletal symptoms and but20 (5.6%) were positive for RF. Of the 20, 19 (95%) had polyarthritis while 1 (5%) was asymptomatic. The mean age was 37.06±13.91 and 205 (57.9%) were females. Most (137 or 38.7%) of requests for RF were from the general out-patient department and 108 (30.5%) from medical out-patient department. The sensitivity and specificity for RF test in detecting MSK disease were 7.17% (95%CI, 4.37-10.97) and 98.88% (95%CI 93.90%, 99.97%). The positive likely hood ratio was 6.38% (95% CI 0.87, 40.99). The positive predictive value (PPV) and negative predictive value (NPV) were 95.0% (95%CI 77.02, 99.29%) and26.35% (95%CI 25.48, 35.30%). Test accuracy was 30.23% (95% CI25.48, 35.30%). Conclusion: We recommend that rheumatoid factor should be requested only in patients with fleeting arthritis,good clinical evaluation for signs and symptomsand looking for differentials

The Impact of Retail-Sector Delivery of Artemether–Lumefantrine on Malaria Treatment of Children under Five in Kenya: A Cluster Randomized Controlled Trial

In a cluster randomized trial, Beth Kangwana and colleagues find that provision of subsidized packs of the malaria therapy artemether-lumefantrine to shops more than doubled the proportion of children with fever who received drugs promptly

Barriers to prompt and effective malaria treatment among the poorest population in Kenya

<p>Abstract</p> <p>Background</p> <p>Prompt access to effective malaria treatment is central to the success of malaria control worldwide, but few fevers are treated with effective anti-malarials within 24 hours of symptoms onset. The last two decades saw an upsurge of initiatives to improve access to effective malaria treatment in many parts of sub-Saharan Africa. Evidence suggests that the poorest populations remain least likely to seek prompt and effective treatment, but the factors that prevent them from accessing interventions are not well understood. With plans under way to subsidize ACT heavily in Kenya and other parts of Africa, there is urgent need to identify policy actions to promote access among the poor. This paper explores access barriers to effective malaria treatment among the poorest population in four malaria endemic districts in Kenya.</p> <p>Methods</p> <p>The study was conducted in the poorest areas of four malaria endemic districts in Kenya. Multiple data collection methods were applied including: a cross-sectional survey (n = 708 households); 24 focus group discussions; semi-structured interviews with health workers (n = 34); and patient exit interviews (n = 359).</p> <p>Results</p> <p>Multiple factors related to affordability, acceptability and availability interact to influence access to prompt and effective treatment. Regarding affordability, about 40 percent of individuals who self-treated using shop-bought drugs and 42 percent who visited a formal health facility reported not having enough money to pay for treatment, and having to adopt coping strategies including borrowing money and getting treatment on credit in order to access care. Other factors influencing affordability were seasonality of illness and income sources, transport costs, and unofficial payments. Regarding acceptability, the major interrelated factors identified were provider patient relationship, patient expectations, beliefs on illness causation, perceived effectiveness of treatment, distrust in the quality of care and poor adherence to treatment regimes. Availability barriers identified were related to facility opening hours, organization of health care services, drug and staff shortages.</p> <p><b>Conclusions</b></p> <p>Ensuring that all individuals suffering from malaria have prompt access to effective treatment remains a challenge for resource constrained health systems. Policy actions to address the multiple barriers of access should be designed around access dimensions, and should include broad interventions to revitalize the public health care system. Unless additional efforts are directed towards addressing access barriers among the poor and vulnerable, malaria will remain a major cause of morbidity and mortality in sub-Saharan Africa.</p

Prevalence and burden of HBV co-infection among people living with HIV:A global systematic review and meta-analysis

Globally, in 2017 35 million people were living with HIV (PLHIV) and 257 million had chronic HBV infection (HBsAg positive). The extent of HIV-HBsAg co-infection is unknown. We undertook a systematic review to estimate the global burden of HBsAg co-infection in PLHIV. We searched MEDLINE, Embase and other databases for published studies (2002-2018) measuring prevalence of HBsAg among PLHIV. The review was registered with PROSPERO (#CRD42019123388). Populations were categorized by HIV-exposure category. The global burden of co-infection was estimated by applying regional co-infection prevalence estimates to UNAIDS estimates of PLHIV. We conducted a meta-analysis to estimate the odds of HBsAg among PLHIV compared to HIV-negative individuals. We identified 506 estimates (475 studies) of HIV-HBsAg co-infection prevalence from 80/195 (41.0%) countries. Globally, the prevalence of HIV-HBsAg co-infection is 7.6% (IQR 5.6%-12.1%) in PLHIV, or 2.7 million HIV-HBsAg co-infections (IQR 2.0-4.2). The greatest burden (69% of cases; 1.9 million) is in sub-Saharan Africa. Globally, there was little difference in prevalence of HIV-HBsAg co-infection by population group (approximately 6%-7%), but it was slightly higher among people who inject drugs (11.8% IQR 6.0%-16.9%). Odds of HBsAg infection were 1.4 times higher among PLHIV compared to HIV-negative individuals. There is therefore, a high global burden of HIV-HBsAg co-infection, especially in sub-Saharan Africa. Key prevention strategies include infant HBV vaccination, including a timely birth-dose. Findings also highlight the importance of targeting PLHIV, especially high-risk groups for testing, catch-up HBV vaccination and other preventative interventions. The global scale-up of antiretroviral therapy (ART) for PLHIV using a tenofovir-based ART regimen provides an opportunity to simultaneously treat those with HBV co-infection, and in pregnant women to also reduce mother-to-child transmission of HBV alongside HIV

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Prevalence and Predictors of Tuberculosis Coinfection among HIV-Seropositive Patients Attending the Aminu Kano Teaching Hospital, Northern Nigeria

Background: The HIV/AIDS epidemic has been accompanied by a severe epidemic of tuberculosis (TB), although the prevalence of coinfection is largely unknown, especially in developing countries, including Nigeria. The aim of this study was to determine the prevalence and predictors of TB coinfection among HIV-seropositive Nigerians. Methods: The case files of HIV/AIDS patients attending Aminu Kano Teaching Hospital, Nigeria from January to December 2006 were reviewed. Results: A total of 1320 HIV/AIDS patients had complete records and were reviewed, among which 138 (10.5%) were coinfected with TB (95% CI, 8.9% to 12.2%). Pulmonary TB was diagnosed in 103 (74.6%) patients, among whom only 18 (17.5%) were sputum-positive. Fifty (36.2%) coinfected patients had some type of extrapulmonary TB (EPTB); 15 had both pulmonary TB and EPTB. Among the 35 patients with EPTB only, 20 (57.1%) had abdominal TB, 5 (14.3%) had TB adenitis, 5 (14.3%) had spinal TB, 3 (8.6%) were being monitored for tuberculous meningitis, and 1 (2.9%) each had renal TB and tuberculous adrenalitis. The highest prevalence of TB, 13.7% (n = 28), was seen among patients aged 41–50 years. TB coinfection was significantly associated with marital status, WHO clinical stage, and CD4 count. Marital status (OR, 2.1; 95% CI, 1.28–3.59; P = 0.04), WHO clinical stage at presentation (4.81; 1.42–8.34; P = 0.001), and baseline CD4 count (2.71; 1.51–6.21; P = 0.02) remained significant predictors after adjustment for confounding. Conclusions: The moderately high prevalence of TB among HIV-seropositive patients underscores the urgent need for strategies that lead to rapid identification and treatment of coinfection with active or latent TB

Formulation studies on the seeds of Ricinus Communis Linn. fam. Euphorbiaceae

Ricinus communis Linn. Family- Euphorbiaceae (castor oil plant) has been used widely as a contraceptive herbal drug in Nigeria, Africa and some countries in the Middle East. The efficacy of the seeds as a contraceptive drug has been confirmed by many scientists working independently in different locations around the world. With adequate information on the efficacy of these seeds, it became necessary to conduct a formulation study in order to develop a suitable and stable dosage form for this drug. The physical and chemical properties of the seeds used locally in Nigeria were determined and did not differ significantly from the properties of R. communis L. described in the African Pharmacopoeia. A total ash of 3.1% and alcohol soluble extractive value of 52.4% were obtained for the seeds while phyto-chemical screening revealed that the seed extract contained steroids and alkaloids. For safety and efficacy, the LD50 was determined and was found to be 13.17g/kg. The formulation studies revealed that 10 %starch mucilage was the best binder for the formulation of the granules while lactose at aconcentration of 75% was the best diluent for the drug. Characterization of the dosage forms produced showed that increases in compression pressure resulted in correspondent increase in the hardness, tensile strength, packing fractions and disintegration time. Administration of the dosage forms to albino rats, showed significant contraceptive activity (80%)