Response of Late Season Maize/Soybean Intercropping to Nitrogen in the Humid Environment of South Southern Nigeria

Intensification of maize/legume production during early rains in the High Rainforest region of South Southern Nigeria is limited by heavy rainfall. Production of late season maize/legume by peasant farmers is gaining prominence though yields are low due to low soil fertility and improper crop arrangement. The objective of this research was to investigate the yield performance of late season maize/soybean intercropping in response to nitrogen fertilization and spatial arrangement of the intercrops. The trial was a split-plot design in randomized complete block with three replications. Treatments consisted of five rates of nitrogen (0, 25, 50, 75 and 100 kg ha-1) and five crop arrangements (sole maize at 53,333 plants ha-1, sole soybean at 266,666 plants ha-1 and maize: soybean additive mixture arrangements of 1:1, 2:2 and 1:2). Nitrogen fertilization increased yield in both maize and soybean at all the treatment levels, when grown sole or in mixtures. Application of 100 kg N ha-1 to maize increased number of ears per plant, 100-grain weight, cob yield and grain yield by 46, 35, 138 and 153 percents, respectively in 2007, and by 15, 48, 88 and 109 percents, respectively in 2008, over no nitrogen application. Similarly, application of 100 kg N ha-1 to soybean increased number of pods per plant, number of barren pods and 1000-seed weight by 53, 120 and 16 percents, respectively in 2007, and by 55, 99 and 14 percents, respectively in 2008, over no nitrogen application. Optimum seed yield in soybean was obtained at 50 kg N ha-1. The yield values of 1,352.8 and 1,158.2 kg ha-1 were higher than those obtained at 0 kg N ha-1 by 31 and 21 percent in 2007 and 2008. Increasing the nitrogen level further to 100 kg ha-1 depressed seed yield by 8 percent in 2007 over 0 kg ha-1. The nitrogen x crop arrangement interaction effects on grain yield and all other parameters were not significant (p< 0.05). Late season maize and soybean populations may be superimposed on each other and fertilized with 50 kg N ha-1 to take advantage of optimum soybean seed yield and 66-76 percent of the maize grain yield. Key words: maize, soybean, intercropping, additive mixtures, nitrogen fertilize

Quality of life of patients with kidney failure in sub-Saharan Africa: protocol for a systematic review of quantitative studies

Introduction: The burden of chronic kidney disease (CKD) is rising in sub-Saharan Africa. Access to kidney replacement therapy (KRT) remains limited and modelling suggests a significant hidden burden of kidney failure managed without KRT. Kidney failure is contributing to serious health-related suffering (SHS) at a global level. Despite this, access to palliative care remains extremely disparate. There is an urgent need for greater palliative care provision for patients with kidney failure in sub-Saharan Africa. To inform this, it is important to understand their current quality of life. This article outlines our review protocol, ensuring transparency of our planned methods and reporting. Methods and analysis: A comprehensive search will be conducted of MEDLINE (Ovid), EMBASE, CINAHL, African Index Medicus and Africa Journals Online. ProQuest Dissertations & Theses Global will be searched for grey literature. Eligible sources will be quantitative observational studies, conducted in sub-Saharan Africa, and published in English or French. The primary outcome measure will be quality of life of those with kidney failure, measured using a validated quality of life tool. Abstract screening, data extraction and risk of bias assessments will be conducted independently by two reviewers. Meta-analysis will be performed on study subgroups, if appropriate, based on heterogeneity of included studies; otherwise results will be summarised narratively. This protocol is structured according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidance. Ethics and dissemination: Ethical approval is not required because this review will synthesise published data. Findings will be disseminated in a peer-reviewed journal. PROSPERO registration ID: 27543

Nutrient Status and Ameliorating Effects of Poultry Droppings on Soil pH and Sustainable Production of Garden Egg

Sustainable production of crops on tropical soils requires soil amendment to remediate soil acidity status and raise fertility level. Industrial lime and inorganic fertilizers are either not available or too expensive to buy. This study was carried out with the objective of investigating the effects of poultry droppings on soil acidity amelioration and increased fertility for sustained production of garden egg (Solanum aethiopicum L.).The field trials were conducted at the Teaching and Research Farms of the University of Agriculture, Makurdi, and the Faculty of Agriculture, Cross River University of Technology, Obubra in 2009 and 2010. Two varieties of African garden egg (Gilo and Kumba) and three rates of poultry droppings (5, 10 and 15 t ha-1) were in factorial combinations. The experiment was laid out in a Randomized Complete Block Design with three replications.  The results obtained showed that all rates of the manure reduced the soil pH within 30 days after incorporation in both years and locations. At 60 days after application, and up to 140 days after incorporation, all manure rates increased the soil pH in both locations and years. The highest increase occurred with 15 t ha-1 poultry droppings at 140 days after incorporation. With no manure application, there was a steady decrease in pH up to the harvest time. All manure rates significantly (P<0.05) increased the yield of the garden egg varieties over when no manure was used. Poultry droppings at 15 t ha-1 produced the highest fruit yield in both years and locations. The crop yields were significantly (p<0.05) higher in Makurdi than Obubra in both years. Yield for 2010 was significantly higher than 2009 in both locations. Poultry dropping at the rate of 15 t ha-1 may be used to remediate soil pH and improve fertility for sustainable production of garden egg in the Guinea savanna or the Rainforest agro-ecologies

mHealth guideline training for non-communicable diseases in primary care facilities in Nigeria: a mixed methods pilot study

From BMJ via Jisc Publications RouterHistory: received 2021-12-19, accepted 2022-07-12, ppub 2022-08, epub 2022-08-26Publication status: PublishedFunder: UK National Institute for Health Research (NIHR) [NIHR Global Health Research programme /NIHR Research Unit on Health in Situations of Fragility].; Grant(s): 16/136/100Objective: To pilot the use of a scalable innovative mobile health (mHealth) non-communicable diseases (NCDs) training application for nurses at the primary care level. Design: Mixed methods pilot of mHealth training on NCD care for nurses at primary healthcare (PHC) facilities. We provide a descriptive analysis of mHealth training test scores, with trend analysis of blood pressure (BP) control using paired t-test for quantitative data and thematic analysis for qualitative data. Setting: PHC facilities in rural and urban communities in Cross River State, south eastern Nigeria. NCDs were not part of routine training previously. As in most low-and-middle-income settings, funding for scale-up using conventional classroom in-service training for NCDs is not available in Nigeria, and onsite supervision poses challenges. Participants: Twenty-four health workers in 19 PHC facilities. Intervention: A self-paced mHealth training module on an NCD desk guide was adapted to be applicable within the Nigerian context in collaboration with the Federal Ministry of Health. The training which focused on hypertension, diabetes and sickle cell disease was delivered via Android tablet devices, supplemented by quarterly onsite supervision and group support via WhatsApp. The training was evaluated with pre/post-course tests, structured observations and focus group discussions. This was an implementation pilot assessing the feasibility and potential effectiveness of mHealth training on NCD in primary care delivery. Results: Nurses who received mHealth training recorded a statistically significant difference (p<0.001) in average pretest and post-test training scores of 65.2 (±12.2) and 86.5 (±7.9), respectively. Recordings on treatment cards indicated appropriate diagnosis and follow-up of patients with hypertension with significant improvements in systolic BP (t=5.09, p<0.001) and diastolic BP (t=5.07, p<0.001). The mHealth nurse training and WhatsApp support groups were perceived as valuable experiences and obviated the need for face-to-face training. Increased workload, non-availability of medications, facility-level conflicts and poor task shifting were identified challenges. Conclusions: This initiative provides evidence of the feasibility of implementing an NCD care package supported by mHealth training for health workers in PHCs and the strong possibility of successful scale-up nationally

Implementing health worker training on sepsis in South Eastern Nigeria using innovative digital strategies: an interventional study

Background: Sepsis is a leading cause of morbidity and mortality especially in low- and middle-income countries such as Nigeria. Training of health workers using digital platforms may improve knowledge and lead to better patient outcomes. Objectives: To assess the effectiveness of a digital health educational module on sepsis in improving the knowledge of medical doctors in Cross River State Nigeria on the diagnosis and management of patients presenting with sepsis. Design: Quasi-experimental analytical study. Methods:: We developed and deployed a sepsis module through an innovative application (Sepsis tutorial app) to doctors in Calabar, Nigeria. We assessed quantitative pre- and post-intervention knowledge scores for those completing the tutorial on sepsis between both assessments. A user satisfaction survey evaluated the content of the tutorial and the usability of the app. Results:: One hundred and two doctors completed the course. There were more males than females (58.8% versus 41.2%). Over half (52%) were junior doctors, a minority were general practitioners and house officers (3% and 5%, respectively), and 72.6% had practiced for periods ranging from 1 to 15 years post-qualification. Gender and age appeared to have no significant association with pre- and post-test scores. The oldest age group (61–70) had the lowest mean pre- and post-test scores, while general practitioners had higher mean pre- and post-test scores than other cadres. The majority (95%) of participants recorded higher post-test than pre-test scores with a significant overall increase in mean scores (25.5 ± 14.7%, p < 0.0001). Participants were satisfied with the content and multimodal delivery of the material and found the app usable. Conclusion:: Digital training using context-responsive platforms is feasible and may be used to close the critical knowledge gap required to respond effectively to medical emergencies such as sepsis in low- to middle-income settings

Renal and bone adverse effects of a tenofovir-based regimen in the treatment of HIV-Infected children: a systematic review.

Introduction Tenofovir disoproxil fumarate (TDF)-containing regimens in the treatment of HIV-infected children have safety concerns with respect to renal and bone toxicity. Objective The aim of this study was to systematically review and critically appraise the literature relating to the reported renal and bone adverse effects of TDF-based regimens in the treatment of HIV-infected children from 2 to 19 years old. Methods Searches were performed using the Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Ovid SP, Science Direct and Web of Science databases and platforms. All primary studies involving tenofovir use in HIV-infected children were sought. Studies that involved the use of TDF for pre-and post-exposure prophylaxis, and treatment of chronic hepatitis B virus infection were excluded. Data on study characteristics, participant’s characteristics, therapeutic intervention and adverse effects were extracted using a piloted tool. In addition, pharmacovigilance data from the WHO Adverse Reaction database were included. Results We identified 19 studies that reported the presence of renal and bone adverse effects of TDF and these included a total of 1100 study participants. The reports were in distinctly heterogeneous participant groups. A total of 287 renal and bone adverse effects were reported (250 renal and 37 bone adverse effects). Approximately 238 (21.6 %) participants were affected by these adverse effects. Of these, 15 participants stopped their TDF-containing regimen due to these adverse effects. In addition, the pharmacovigilance data from the WHO Adverse Reaction database reported 101 renal and bone adverse effects for patients whose indication was HIV/AIDS. Conclusion This systematic review summarises the reports of renal and bone adverse effects of a TDF-containing regimen in the treatment of HIV-infected children. Our findings suggest that the benefits of using TDF in children need to be balanced against the potential risk of toxicity

Haemodialysis in an emerging centre in a developing country: a two year review and predictors of mortality

Abstract Background Haemodialysis is the most common form of renal replacement therapy in Nigeria. The high cost of haemodialysis has made optimal therapy of end-stage renal disease difficult in Nigeria. This paper is a review of data collected over two years of provision of dialysis services in a new tertiary hospital in Southern Nigeria. Methods This retrospective analysis is done on data obtained from the patient case files and dialysis records in the first two years of provision of dialysis services in our centre. A gender comparison of the patients' baseline sociodemographic, clinical and biochemical was performed and a logistic regression model used to assess the predictors of mortality. Results A total of 98 patients had 471 sessions in the two years under review. Males and females had similar characteristics at baseline except for a higher median serum urea in the males. The commonest causes of end-stage renal disease were chronic glomerulonephritis (34.5%), hypertension (32.1%) and diabetes mellitus (17.9%). The main predictor of mortality was under treatment with haemodialysis due to inability to pay for more than a few dialysis sessions. Conclusions This study has highlighted the unchanging demographics of our advanced kidney failure patients. Efforts should be aimed at subsidizing the cost of dialysis for our teeming population of dialysis dependent chronic kidney disease patients.</p

Demographics, cost, and sustainability of haemodialysis among end-stage kidney disease patients in Southern Nigeria: A single-center study

Context: Access to chronic hemodialysis for patients with end‑stage kidney disease has improved over the years. However, it is unclear if thisbhas resulted in lower cost and improved dialysis vintage. Aim: We aimed to assess the demographics, cost implication, and sustainability of maintenance hemodialysis in our cohort of end‑stage kidney disease (ESKD) patients. Methods: Retrospective descriptive study of ESKD patients on maintenance HD from 2014 to 2018 using hemodialysis records. Time‑to‑HD discontinuation and reasons for discontinuation were recorded. Using Kaplan–Meier graphs, the time‑to‑dialysis discontinuation experience of the cohort was shown. Log‑rank test was used to compare the experience between both genders. Univariable and multivariable Cox proportional hazard models were built to identify independent associations with time‑to‑dialysis discontinuation. Results: Over the 5‑year period, 702 individuals initiated HD, males were older than females, the complete cohort contributed 65,714 person‑days to the study and the median time‑to‑HD discontinuation was 10 days (interquartile range, 2–42). Females had a shorter time to HD discontinuation (8 days [1–32 days]) compared to males (11 days [2–48 days]). Only 28.5%, 15.3% and 8.3% of the patients had HD beyond 30, 90, and 180 days, respectively. About 128 (18.2%) had thrice‑weekly HD. Most sustained the treatment for the 1st week. Majority (98.4%) of the patients were presumed dead, while 4 (0.65%) were still alive and 6 (0.98%) had renal transplantation. All patients who discontinued dialysis did so for financial reasons. Multivariable Cox proportional hazards model showed that individuals who could afford dialysis more than once a week had reduced hazard of dialysis discontinuation. Conclusion: Most patients cannot sustain HD beyond a few weeks for financial reasons. Several cost containment strategies need to be deployed to bring down the cost of care

Priority setting for new systematic reviews : processes and lessons learned in three regions in Africa

CITATION: Effa, E. E., et al. 2019. Priority setting for new systematic reviews : processes and lessons learned in three regions in Africa. BMJ Global Health, 4(4):e001615, doi:10.1136/bmjgh-2019-001615.The original publication is available at https://gh.bmj.comPriority setting to identify topical and context relevant questions for systematic reviews involves an explicit, iterative and inclusive process. In resource-constrained settings of low-income and middle-income countries, priority setting for health related research activities ensures efficient use of resources. In this paper, we critically reflect on the approaches and specific processes adopted across three regions of Africa, present some of the outcomes and share the lessons learnt while carrying out these activities. Priority setting for new systematic reviews was conducted between 2016 and 2018 across three regions in Africa. Different approaches were used: Multimodal approach (Central Africa), Modified Delphi approach (West Africa) and Multilevel stakeholder discussion (Southern-Eastern Africa). Several questions that can feed into systematic reviews have emerged from these activities. We have learnt that collaborative subregional efforts using an integrative approach can effectively lead to the identification of region specific priorities. Systematic review workshops including discussion about the role and value of reviews to inform policy and research agendas were a useful part of the engagements. This may also enable relevant stakeholders to contribute towards the priority setting process in meaningful ways. However, certain shared challenges were identified, including that emerging priorities may be overlooked due to differences in burden of disease data and differences in language can hinder effective participation by stakeholders. We found that face-to-face contact is crucial for success and follow-up engagement with stakeholders is critical in driving acceptance of the findings and planning future progress.https://gh.bmj.com/content/4/4/e001615Publisher's versio

Chronic kidney disease in the global adult HIV-infected population: A systematic review and meta-analysis

<div><p>Introduction</p><p>The widespread use of antiretroviral therapies (ART) has increased life expectancy in HIV patients, predisposing them to chronic non-communicable diseases including Chronic Kidney Disease (CKD). We performed a systematic review and meta-analysis (PROSPERO registration number CRD42016036246) to determine the global and regional prevalence of CKD in HIV patients.</p><p>Methods</p><p>We searched PubMed, Web of Science, EBSCO and AJOL for articles published between January 1982 and May 2016. CKD was defined as estimated glomerular filtration rate (eGFR) <60ml/min using the MDRD, Cockcroft-Gault or CKD-EPI equations. Random effects model was used to combine prevalence estimates from across studies after variance stabilization via Freeman–Tukey transformation.</p><p>Result</p><p>Sixty-one eligible articles (n = 209,078 HIV patients) in 60 countries were selected. The overall CKD prevalence was 6.4% (95%CI 5.2–7.7%) with MDRD, 4.8% (95%CI 2.9–7.1%) with CKD-EPI and 12.3% (95%CI 8.4–16.7%) with Cockcroft–Gault; p = 0.003 for difference across estimators. Sub-group analysis identified differences in prevalence by WHO region with Africa having the highest MDRD-based prevalence at 7.9% (95%CI 5.2–11.1%). Within Africa, the pooled MDRD-based prevalence was highest in West Africa [14.6% (95%CI 9.9–20.0%)] and lowest in Southern Africa (3.2%, 95%CI 3.0–3.4%). The heterogeneity observed could be explained by WHO region, comorbid hypertension and diabetes mellitus, but not by gender, hepatitis B or C coinfection, CD4 count or antiretroviral status.</p><p>Conclusion</p><p>CKD is common in HIV-infected people, particularly in Africa. HIV treatment programs need to intensify screening for CKD with added need to introduce global guidelines for CKD identification and treatment in HIV positive patients.</p></div